An Integrated Approach to Working with Youth with Both Permanency and Behavioral Health Concerns

1. An Integrated Approach to Working with Youth with Both Permanency and Behavioral Health Concerns HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.

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3. DCF / DYFS Case Practice Improvement Overview HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.

4. 1st Focus on the Fundamentals Create the conditions that are pre-requisites to… 2nd Implementing Change in the Culture of Practice Move from a case management service delivery model to a strength-based, family centered, child focused model. Then, DYFS can… 3rd Deliver Results With improved outcomes for children and families. ** READ HEADER OUR REFORM HAS BEEN EVOLVING. THERE ARE THREE Phases… (Use pointer) Phase 1 is to FOCUS ON THE FUNDAMENTALS…THIS MEANS THE TOOLS WE NEED TO EFFECTIVELY IDENTIFY AND ADDRESS SAFETY, PERMANANCY AND WELL-BEING OF CHILDREN AND FAMILIES….FOR EXAMPLE ENOUGH STAFF AND TRAINED STAFF. OUR SECOND Phase IS TO IMPLEMENT THE CHANGE WITHIN OUR INTERNAL PROCESS. >>>>>>>>> READ SECOND POINT ............. THIRD PHASE IS TO DELIVER RESULTS …… IMPROVED OUTCOMES FOR CHILDREN AND FAMILIES ** READ HEADER OUR REFORM HAS BEEN EVOLVING. THERE ARE THREE Phases… (Use pointer) Phase 1 is to FOCUS ON THE FUNDAMENTALS…THIS MEANS THE TOOLS WE NEED TO EFFECTIVELY IDENTIFY AND ADDRESS SAFETY, PERMANANCY AND WELL-BEING OF CHILDREN AND FAMILIES….FOR EXAMPLE ENOUGH STAFF AND TRAINED STAFF. OUR SECOND Phase IS TO IMPLEMENT THE CHANGE WITHIN OUR INTERNAL PROCESS. >>>>>>>>> READ SECOND POINT ............. THIRD PHASE IS TO DELIVER RESULTS …… IMPROVED OUTCOMES FOR CHILDREN AND FAMILIES

5. LEADERSHIP MEETING ~~ CAME TO 413 YEARS!!! GAPS IN WORKFORCE DUE TO HISTORICAL FACTORS .…SO AS WE BEGAN in 2006 MUCH OF OUR CASEWORK STAFF WAS NEW. NEW STAFF …………..WELCOME……..IT HAS MEANT THAT THE RATIOS… REMAINED HIGH A LITTLE LONGER >>>>>>> READ SLIDE….. TRAINEES ……….EXTENSIVE PERIOD OF CLASSROOM AND FIELD EXPERIENCES UNDER THE SUPERVISION OF TRAINING SUPERVISORS LEARN PRACTICAL AND CRITICAL SKILLS BEFORE ASSUMING RESPONSIBILITY FOR THEIR OWN FAMILIES. NOW because we have better trained staff and manageable caseloads, WE CAN MOVE FORWARD AND INCREASE OUR EXPECTATIONS FOR QUALITY, FAMILY FOCUSED CASE PRACTICE.LEADERSHIP MEETING ~~ CAME TO 413 YEARS!!! GAPS IN WORKFORCE DUE TO HISTORICAL FACTORS .…SO AS WE BEGAN in 2006 MUCH OF OUR CASEWORK STAFF WAS NEW. NEW STAFF …………..WELCOME……..IT HAS MEANT THAT THE RATIOS… REMAINED HIGH A LITTLE LONGER >>>>>>> READ SLIDE….. TRAINEES ……….EXTENSIVE PERIOD OF CLASSROOM AND FIELD EXPERIENCES UNDER THE SUPERVISION OF TRAINING SUPERVISORS LEARN PRACTICAL AND CRITICAL SKILLS BEFORE ASSUMING RESPONSIBILITY FOR THEIR OWN FAMILIES. NOW because we have better trained staff and manageable caseloads, WE CAN MOVE FORWARD AND INCREASE OUR EXPECTATIONS FOR QUALITY, FAMILY FOCUSED CASE PRACTICE.

6. Average DYFS Caseload Size Statewide as of June 2010

7. Total Resource Homes Licensed

8. Finalized Adoptions FY 2006-2010

9. Children in DYFS Out of Home Placement FY 2005 - FY 2010

10. NOW THAT SOME OF THE FUNDAMENTALS ARE IN PLACE………..WE CAN START PHASE TWO ……….. IMPLEMENTING CHANGE IN THE CULTURE OF OUR PRACTICE. WE ARE NOT SIMPLY THE BROKERS OF SERVICES…. WE HAVE AN AMBITIOUS SCHEDULE OF TRAINING FOCUSED ON RECOGNIZING THAT FAMILIES HAVE THEIR OWN EXPERTS WITHIN THEIR MIDST……. THIS IS WHERE OUR PARTNERSHIP WITH CWPPG & RUTGER’S HAS BEEN TO HELPFUL …….NOW, TOGETHER WITH THE FAMILY, WE ARE LEARNING HOW TO TAP INTO THAT EXPERTISE SO THAT FAMILIES CAN WALK AWAY FROM THEIR EXPERIENCE WITH OUR AGENCY FEELING STRONGER, FEELING SUPPORTED AND HEALTHIER THAN WHEN WE WERE FIRST CALLED TO THEIR FRONT DOOR. NOW THAT SOME OF THE FUNDAMENTALS ARE IN PLACE………..WE CAN START PHASE TWO ……….. IMPLEMENTING CHANGE IN THE CULTURE OF OUR PRACTICE. WE ARE NOT SIMPLY THE BROKERS OF SERVICES…. WE HAVE AN AMBITIOUS SCHEDULE OF TRAINING FOCUSED ON RECOGNIZING THAT FAMILIES HAVE THEIR OWN EXPERTS WITHIN THEIR MIDST……. THIS IS WHERE OUR PARTNERSHIP WITH CWPPG & RUTGER’S HAS BEEN TO HELPFUL …….NOW, TOGETHER WITH THE FAMILY, WE ARE LEARNING HOW TO TAP INTO THAT EXPERTISE SO THAT FAMILIES CAN WALK AWAY FROM THEIR EXPERIENCE WITH OUR AGENCY FEELING STRONGER, FEELING SUPPORTED AND HEALTHIER THAN WHEN WE WERE FIRST CALLED TO THEIR FRONT DOOR.

11. Who is Part of a Family Team? A family team is made up of everyone important in the life of the child, including interested family members, foster/adoptive parents, neighbors, friends, clergy, as well as representatives from the child’s formal support system, such as school staff, therapists, service providers, CASA, the court service and legal systems. THERE IS A SAYING THAT IT TAKES A VILLAGE TO RAISE A CHILD… THIS IS WHERE YOU CAN COME IN… IF YOU HAVE BEEN INVOLVED IN OR ATTENDED A FAMILY TEAM MEETING, PLEASE RAISE YOU HAND. That is great. Hopefully many others will be identified by family members to become supportive members of their team as we move forward. ,,,,,,,,READ - SUMMARIZE THE POINTS>>>>>> IT IS NOT ALWAYS EASY FOR A PARENT OR FAMILY TO ASK FOR HELP. YOU CAN MAKE THAT EASIER BY OFFERING SUPPORT, EXPERIENCE AND EXPERT KNOWLEDGE WHEN ASKED TO ATTEND A MEETING. THERE IS A SAYING THAT IT TAKES A VILLAGE TO RAISE A CHILD… THIS IS WHERE YOU CAN COME IN… IF YOU HAVE BEEN INVOLVED IN OR ATTENDED A FAMILY TEAM MEETING, PLEASE RAISE YOU HAND. That is great. Hopefully many others will be identified by family members to become supportive members of their team as we move forward. ,,,,,,,,READ - SUMMARIZE THE POINTS>>>>>> IT IS NOT ALWAYS EASY FOR A PARENT OR FAMILY TO ASK FOR HELP. YOU CAN MAKE THAT EASIER BY OFFERING SUPPORT, EXPERIENCE AND EXPERT KNOWLEDGE WHEN ASKED TO ATTEND A MEETING.

16. Children’s System of Care Info: At any given time there are: 2,562 youth enrolled in MRSS 3,558 youth enrolled in YCM 2,400 youth enrolled in CMO 2,015 youth enrolled in UCM 1,868 youth currently in out of home care 39,779 youth who are open to the CSA

17. PerformCare, LLC Welcome To New Jersey Children’s System of Care PerformCare is the statewide Contracted System Administrator (CSA) for the Division of Child Behavioral Health Services (DCBHS).  As the CSA, PerformCare is committed to getting children, youth, young adults and their family/caregivers the services that they need at the right time, and in the right place.  Hours of Operation:24 Hours a Day 7 Days a Week For Assistance Please Contact Us at: 1-877-652-7624 

18. Mobil Response and Stabilization Services (MRSS) Initial Response (within 1 hour) Initial Response can last up to 72 hours Intervention and de-escalation Assessment – Crisis Assessment Tool (CAT) Safety/Crisis Planning Individualized Crisis Plan (ICP) Discharge/Transition Planning Stabilization Services (up to 8 weeks) Provide additional resources to ensure stabilization Linkage to community resources Individual and Family In-Home Counseling/Behavioral Assistance

19. Care Management Organizations –CMO/UCM No eject no reject. Referrals are assessed for CMO level of care through the CSA and assigned to the appropriate CMO/UCM CMO has 24 hours to make contact and 72 hours for the first visit. We are generally accompanied by the Family Support Organization. Commitment to Community Resource Development. Care is coordinated through a Child Family Team Process for which all things are coordinated.

20. How Does Care Management Work ? The CFT is tasked with looking at all life domains, identifying functional strengths of the youth, family and team and prioritizing the needs and developing thoughtful strategies to meet these needs. The average length of stay is 12 to 18 months. In a CMO/UCM the youth and family have 24 hour access to Care Management Staff.

21. Family Support Organizations - FSO … Educate families on their rights and responsibilities within the NJ System of Care Advocate to assure families get what they need Enhance the service system Encourage families to recognize and appreciate their strengths Help families articulate their needs Support families in providing feedback to their service providers, their Care/Case Managers Empower families to become their child’s best advocate Insure the family voice is heard

22. How do Family Support Organizations fulfill their missions? Strategic Partnerships Engender FSO/CMO/UCM Strategic Partnership Engage in Community Development Provide Peer to Peer Support for Families with Children at the highest levels of Care Management Educate Families about the System and their Child’s Challenges Educate Families to Advocate in their Child’s and Family’s best interest Monitor the System of Care for Family Involvement, Family “Friendliness” and Family Focus Advocate for System Change when Necessary. (NJ Division of Child Behavioral Health)

23. Peer to Peer Family Support Provided to Families who have Children enrolled in Care Management Organizations Give intense support services to these families when most needed Educate families to understand the NJ System of Care

24. Youth Partnership The Youth experiencing the System know it from the inside out. They bring a unique perspective to the System of Care Family Support Organizations empower Young People become advocates for themselves and their own services Youth Partnership activities are provided through the Family Support Organizations

25. Family Team and Child Family Team Similiarities Family Team Meeting - FTM Safety The family selects the team Strengths and needs focused Prioritize 3 to 4 needs Child Family Team - CFT Safety Family and youth select the team Strength and needs driven Prioritize 3 or 4 life domains

26. FTM and CFT Differences Family Team Meeting Underlying needs are quickly identified and addressed The focus is on the whole family Very quick time frames Child Family Team Underlying needs are identified and addressed over time The CFT focuses on the youth with a behavioral health concern The CFT focuses on all life domains over the Care manager’s involvement over12 to 18 months

27. Treatment Options Community Based Outpatient – individual, group and family Partial Care Partial Hospitalization Behavioral Assistance Intensive In Home – IIC Out of Home Treatment Treatment Home Group Home Residential Treatment Psych Community Residence Intensive Residential Treatment Services CCIS

28. Treatment Considerations Medical Necessity Safety Expectations Guardian Involvement Clinical Considerations Transition planning at admission Community Planning

30. Integrating Child Behavioral Health and Foster CareMorris and Sussex Recommendations CMO to provide crisis intervention training to all local DYFS staff. CMO to provide crisis intervention training to resource parents. CMO to develop a brochure targeted at resource parents. DYFS staff will present MRSS to resource parents as a normative transition service rather than a crisis-oriented program. Team Leader to speak directly with resource parents who have questions about or need assistance accessing DCBHS programs (especially MRSS and FSO)

31. Morris and Sussex Recommendations Continued: CMO staff can submit a timely addendum to resource home requests so that the child can be comprehensively presented from multiple perspectives. This will include strategies that are successful in comforting the youth. DYFS staff who have youth approaching discharge from out of home treatment will give early notice to the resource unit so that they can begin locating a potential step-down placement. Resource Family Workers will be invited to internal reviews to incorporate the needs of the resource parent. DYFS and CMO case/care manager will make a joint visit to resource homes requesting a youth’s removal to offer enhanced services to preserve the placement.

32. Permanency Project Joint venture by DYFS Team Leader, CMO Clinical Liaison, DYFS Concurrent Planner. Inspired by anecdotal evidence regarding children who require permanent living arrangements after completing treatment. 11 such cases were identified in Morris/Sussex area; sample of 5 was reviewed.

33. Permanency Project (cont.) Resulted in recommendations in the areas of family involvement; DYFS & DCBHS case management; and SOC refinement. Concrete efforts include: Adolescent FTM’s Adolescent Life Books Educational Sessions for Supervisors Development of Adolescent Permanency Training

34. Next Steps Monitor the data Youth who are placed in resource homes rather than treatment facilities. Youth who are returned to the community in a resource home. Youth removed from resource homes and moved to out of home treatment.

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