Multi-System Approaches for Multi-System Children

1. Multi-System Approaches for Multi-System Children Judge John J. Specia, Jr., Senior District Judge Partner – Plunkett & Gibson, Inc.

2. Texas Child Protection System, 2006 6.3 million children in Texas 1.5 million children living in poverty Over 821,000 calls to DFPS Intake Almost 348,000 children in CPS investigations Close to 68,000 confirmed victims of abuse or neglect 17,536 children removed from home

3. Juveniles Served by Probation Departments Are Often Clients of State Human Service Agencies Served by Child Protective Services in Same Year 17% Juveniles Referred and/or Supervised in Texas Juvenile Probation System 2005 99,173 Received Medicaid or CHIP Service in Same Year 46% Received state MH or Substance Abuse Service in Same Year 7% Source: DSHS Policy Workgroup, State Agency Matching 2006

4. MULTI-AGENCY DATA-MATCHING PROJECTfor The Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders Texas Department of Family and Protective Services (DFPS) Texas Department of State Health Services (DSHS) Texas Education Agency (TEA) Texas Health and Human Services Commission (HHSC) Texas Youth Commission (TYC) The University of Texas Addiction Research Institute Center for Social Work Research

5. Greater Percentage of Victims of Child Abuse/Neglect (as confirmed by Department of Family and Protective Services in FY2003) with Juvenile Justice Contact Had Criminal History in their Family, Had a Behavior Problem, and/or Had a Substance Abuse Issue > > > Source: DFPS Child Protective Services and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX.

6. But Less Than Half Received Behavioral Health Services Funded by the State Source: DFPS Child Protective Services, DSHS Mental Health and Substance Abuse, HHSC Child Medicaid, and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX.

7. A Greater Percentage of Victims of Child Abuse/Neglect (as confirmed by DFPS in FY2003) with a Behavior Problem Had an Earlier Disciplinary Problem Identified by TEA — Mostly Student Misconduct Source: FY2003 DFPS-TEA Data-Match, TEA, October 2006.

8. A Vicious Cycle? Parental Involvement with Criminal Justice System May Become a Parent TEA Earlier Discipline Problem (Student Misconduct) Youth Behavior Problem DFPS Youth Juvenile Justice Contact Youth Substance Abuse Issue

9. Policy Implications • Identify and target interventions for youth at a younger age (no later than 10). • Quality screening and early intervention have been found to sharply improve outcomes for children with serious emotional disturbances. • Screening and early interventions are less expensive and can be implemented on a larger scale. • Target more interventions/services toward youth with a behavior/discipline problem, substance abuse issue, and/or a family member with criminal justice involvement.

10. Data-Sharing Implications • Children with serious emotional disturbances (including co-occurring) have the highest rate of school failure, and are at extreme risk for injury, death, employment and housing problems, criminal justice involvement, and increased state costs due to poorer treatment outcomes (Pennell et al., 2003). • Therefore, it is imperative that State agencies create data systems that integrate child data to better understand child outcomes and to identify intervention points.  • Through the use of a data warehouse, State agencies can provide child data to be matched using tested algorithms to produce the greatest likelihood of integration between datasets.  • Once matched, de-identified data sets can be created to answer questions that unmatched data sets cannot address.

11. Bexar County Children’s Diversion Initiative ….Protecting the Future by diverting Children to essential Care today!

12. Implementation of the Initiative • Unlike adults, children are routinely in contact with a wide range of institutions • The GAINS Center model that suggests identifying intercept points to promote needed access to mental health services is used to organize the effort • The full stakeholder group is attended by all and meets quarterly to review progress • Three subcommittees were formed to begin working on intercept points and interventions

13. Gaps in Intervention • 18,500 alleged abuse and neglect victims not provided coordinated services • 5,900 juveniles not provided coordinated services • 77,376 students violate school code of conduct - no coordinated intervention

14. Research suggests that many behavioral health problems crises could be prevented or ameliorated with prevention, early detection and intervention. Early intervention efforts can improve school readiness, health status, academic achievement, reduce the need for grade retention, special education services, juvenile justice services, welfare dependency. Gaps in Intervention (cont’d)

15. Shared Populations • 26% of victims of abuse become involved in juvenile justice system • 80% of juvenile families have history of CPS involvement

16. Children in Need • Juvenile Probation FY 2005 • 11,000 referrals • 6,500 juveniles • Similar risk factors • 30%-50% present with mental health issues • 60-80% present with substance use difficulties • 35-45% learning disabled

17. Identifying Target Population • Emphasis on 1st Time Offenders • Family assault cases frequently detained • Suspected high rates of mental health needs • Complexity of behavior results in extended detention • 10-13 years of age • Severity and duration of behavior results in extended detention and involvement in justice system

18. Gaps in Screening & Early Identification • Child Protective Services • Does not conduct formal behavioral screenings on all alleged victims • Assessments conducted on confirmed victims who receive services • Juvenile Probation • Does not conduct formal behavioral screenings on all children referred to the department • Biopsychosocial assessments conducted on those requiring residential treatment • Schools * Does not conduct formal behavioral screenings on youth considered for District Alternative Education Placements (DAEP) or other school code of conduct violations.

19. Goals • To create an effective system of care to include early identification and early prevention of mental health and substance abuse crises for children involved in child-serving systems. • To create an improved crisis response system that moves children and families to best practice supports and services based on level of need. • To increase community capacity through a Crisis Care Model that recognizes earlymental health and substance abuse needs for children.

20. Children’s Crisis Outreach • Target population: • School children: In FY 2005-2006 77,346 students received either an expulsion to a JJAEP, placement to a DAEP, in school or out of school suspension for a Code of Conduct violation. • Foster family children: For FY 2007 through the month of April 3,090 children were in foster care, of these, 832 have identified emotional characteristics and 332 have drug/alcohol characteristics.

21. Treatment Foster Care • Target population: • Children whose mental health symptoms have contributed to a juvenile detention admission and juveniles with a potential admission to a RTC or TYC. On average 6,600 youth are detained a year, there are 300 + RTC placements and 248 TYC placements. Data indicates anywhere from 55% to 70% of juveniles have a mental health or co-occurring diagnosis. • Children in crisis who are NOT involved with the juvenile justice system, however, their mental health symptoms continue to escalate despite traditional outpatient services and two or more hospitalizations within an 18 month period.

22. C O L L A B O R A T E

23. Collaboration… ItsPromise: The Key Framework for Systemic Reform “The progress we have been able to make through collaboration is amazing…we function as a cohesive core committed to the same mission instead of various groups working independently…there’s a lot of power to effect lasting change in that.” - Stakeholder, Alexandria Project Site Source: Dobbin, S.A., Gatowski, S.I., and Maxwell, D.M. (2004) “Building a Better Collaboration: Facilitating Change in the Court and Child Welfare System,” p2, The Technical Assistance Bulletin, Vol. 8(2). National Council of Juvenile and Family Court Judges. Reno, Nevada.

24. Collaboration… Its Danger:The Thief of Time “…We have a million committees. A committee gets started for everything. We have duplicate committees, committees that have collapsed, some that are conflicting in recommendations, and no overall hierarchy…” -Stakeholder, Charlotte Project Site Source: Dobbin, S.A., Gatowski, S.I., and Maxwell, D.M. (2004) “Building a Better Collaboration: Facilitating Change in the Court and Child Welfare System,” p42, The Technical Assistance Bulletin, Vol. 8(2). National Council of Juvenile and Family Court Judges. Reno, Nevada.

25. Collaboration… “Don’t underestimate it [the collaborative process]. It reflects an important consensus building that has a lot of unanticipated consequences that can be positive or negative. Develop efficiency and partnerships. The broader the consensus, the broader the vision.” - San Jose Source: Dobbin, S.A., Gatowski, S.I., and Maxwell, D.M. (2004) “Building a Better Collaboration: Facilitating Change in the Court and Child Welfare System,” p127, The Technical Assistance Bulletin, Vol. 8(2). National Council of Juvenile and Family Court Judges. Reno, Nevada. The Reality: A Critical Tool for System Change

26. Differentiating Coordination, Cooperation and Collaboration PRECONDITIONS FOR SUCCESS (MUST HAVES) • COORDINATION: Shared objectives, need for more than one person to be involved; Understanding of who needs to do what by when • COOPERATION: Shared objectives; Need for more than one person to be involved; mutual trust and respect; Acknowledgement of mutual benefit of working together • COLLABORATION: Shared objectives; sense of urgency and commitment; Dynamic process; Sense of belonging; open communication; mutual trust and respect; Complimentary, diverse skills and knowledge; Intellectual agility *** All of the above from Wikipedia

27. COURTS MENTAL HEALTH DSS SCHOOLS TYC JUVENILE PROBATION SILOSTIC AGE

28. UTOPIANEPOCH DSS Mental Health Kids and Families Juvenile Probation TYC Courts Schools

29. Leading Change: The Eight Stage Process of Creating Major Change • Establish a Sense of Urgency • Develop a Vision and Create a Guiding Coalition • Strategy • Communicate the Change Vision • Empower Broad-Based Action • Generate Short-term Wins • Consolidate Gains and Produce More Change • Anchor New Approaches in the Culture • Evaluate Both the Collaborative Process and the Changes Implemented

30. Permanent Judicial Commission on Children, Youth and Families • Conference of Chief Justices Summit 2005 • Foster Care Consultative Group Dec 2006 • Consultative Group Report March 1,2007 • Supreme Court Public Hearing on feasibility of Judicial Commission Sept 25,2007 • Order Establishing Commission

31. Statement of Principles • Texas courts shape the lives and life chances of children. • All children should be treated equally and deserve safer permanent homes. • Children and families should have a voice in decisions that affect their lives. • All parts of the system have joint accountability, responsibility and commitment to ongoing improvement

32. Statement of Principles (cont’d) • Sharing appropriate information enhances judicial efficiency and is in the best interest of the child. • Efforts to improve the foster care system must focus on improving safety, permanency, well-being and fairness outcomes for children. • Best practices should be data-driven, evidence-based, and outcome-focused. • Children should not just be protected but equipped for long-term success.

33. Statement of Principles (cont’d) • The needs of children in foster care extend into early adulthood. • Decisions and services should be mindful of the child’s clock • Each child should have a chance to develop at least one lasting relationship before leaving the system. • Collaboration among systems, participants and the state is essential for achieving the best possible outcomes for children and families.

34. Mission Statement The mission of the Permanent Judicial Commission for Children, Youth and Families is to develop and implement policy initiatives designed to strengthen courts for children, youth and families in the child-protection system and thereby improve the safety, permanency, and well-being of children.

35. Goals • Identify and assess current and future needs for the judiciary to be more effective in serving children, youth and families; • Improve court performance and accountability in achieving child-welfare outcomes of safety, permanency, well-being and fairness; • Promote best practices that are data-driven, evidence-based, and outcome-focused; • Improve collaboration and communications among the courts, child-welfare agencies, and community partners.

36. Goals (cont’d) • Increase awareness of the courts’ critical role in the foster care system and the need for enhanced resources; • Identify funding and resource options for child welfare services and the courts; and • Provide leadership for meeting the needs of children, youth and families in the foster care system.