The Illinois Department of Children and Family Services: SI/Behavioral Health Team Presents -

1. The Illinois Department of Children and Family Services:SI/Behavioral Health Team Presents - The Development of the IDCFS Behavioral Health System - A Paradigm Shift to Focus on Trauma

2. Part I Setting the Stage for the “Harmonic Convergence”

3. Initial Formation of the Behavioral Health Team as part of the Division of Service Intervention • Organizational concept born out of concerns raised by Consent decrees and Federal Review process • Identification of child/youth mental health needs • Provision of appropriate services • BHT inception – June 1, 2004 • Core assessment of DCFS programs and services • Development of conceptual framework • Identification of priorities and implementation of action plans to achieve a “seamless” system of coordinated behavioral health care for wards

4. DCFS Programs Integrated Assessment Foster Care System of Care (SOC) Specialized Foster Care Screening, Assessment & Social Supports (SASS) Shelters Medically Complex Provider Programs Hospitals Residential LANs MST DCFS Organization Divisional Structure Information systems Contracts Grants Funding structures Service and contract monitoring “2x4” Assessment Plan

5. Other System Linkages Child Mental Health Partnership Schools Downstate issues DHS Developmental Disabilities Substance Abuse Mental Health Community Mental Health Providers Juvenile Justice Federal Links Courts and Consent Decrees Other Key Considerations PIP BH consent Decree Etc. “2x4” Assessment Plan

6. Divisions Placement/ Permanency Field Operations Monitoring/Quality Assurance Guardian & Advocacy Clinical Practices & Professional Development Service Intervention Budget & Finance Planning & Performance Management Communications Child Protection IDCFS Organizational Structure

8. BHT Findings from Core Assessment of Programs and Services • August 4, 2004 – Findings presented to Director Bryan Samuels; August 15, 2004 – presented to Deputy Directors • Findings and Recommendations • Endorsement of Director’s lifespan approach • Trauma-focused care • Utilization of Anticipatory Guidance Principle rather than waiting for acute symptom presentation to signal need • Establish baseline screening for wards’ strengths, impact of trauma and mental health needs

9. BHT Findings from Core Assessment of Programs and Services • Findings and Recommendations (continued) • Need for cross-divisional information “nervous system” (CANS) • Need for uniform methodology to determine impact of trauma/impact of services provided • Overall workforce training on trauma and systematic needs/strengths assessment • Trans-divisional approach to implementation to decrease duplication of efforts and to increase appropriate utilization of resources & expertise

10. Conceptual Framework: PARK • Core notions - • Promoting the • Abilities and • Resilience of • Kids • Framework for organizing efforts, programs, services & contracts • An approach to identifying service gaps, trends and emerging needs

11. PARK– A Public Health Approach to Mental Health – Prevention, Early Identification, Assessment and Treatment • Primary/Universal Level – Addresses the risk factors for all infants, children and youth at large • Secondary/Targeted – Addresses the specific needs and risk factors associated with DCFS wards • Tertiary/Intensive – Addresses the needs and risk factors of wards experiencing the impact of trauma and/or serious emotional disturbance

12. Northwestern U Web-based CANS training Illinois CANS website Service-Focused Provider Database Treatment Quality Monitoring Unit Evaluation of Training Curriculum and Statewide Training Initiative DVMHPI Curriculum and Training Capacity Development on Trauma U of Chicago Geo-mapping Project Development of the BHT Action Plan: FY05 Focus on Infrastructure Development and Workforce Training

13. Part II Focus on Trauma and Its Impact

14. The Adverse Childhood Experiences StudyThe Effects of Adverse Childhood Experiences on Adult Health and Well Being What are the Adverse Childhood Experiences (ACEs)? Growing up (prior to age 18) in a household with: • Recurrent physical abuse • Recurrent emotional abuse • Sexual abuse

15. ACEs continued • An alcohol or drug abuser • An incarcerated household member • Someone who is chronically depressed, suicidal, institutionalized or mentally ill • Mother being treated violently • One or no biological parents • Emotional or physical neglect

16. DCFS ACEs – • Removal from biological parent(s) • Unplanned placement moves • Three or more placements in an eighteen month period

17. Trauma: The Cornerstone of the DCFS Behavioral Health Approach • Exposure to Trauma Increases the Risk for: • Major Mental Illness • Substance Abuse • AIDS and Sexually Transmitted Diseases • Impaired Physical Health • Developmental Disabilities

18. Trauma & Mental Health • Trauma Increases the Odds for Major Depression nearly two-fold. • Trauma Increases the Odds for suicide • Trauma is associated with poor response to antidepressant medication and poor overall treatment outcomes.

19. Trauma & Substance Abuse • Trauma significantly increases the risk for alcohol and drug abuse in adolescents. • Trauma is the best predictor of drug and alcohol abuse in women. • Trauma is associated with poor treatment outcomes and increased treatment drop out.

20. Trauma & HIV/STD Risk • Childhood Trauma dramatically increases risks for HIV-risk behavior. • IV Drug Use • Promiscuity

21. Trauma & Physical Health • Adverse Childhood Experiences Study • Increased ACES Correlate w/ Smoking • Increased ACES Correlate w/ Adult Alcoholism • Increased ACES Underlie Chronic Depression • According to the World Health Organization, depression is becoming the 2nd most costly illness.

22. Trauma & Physical Health (cont.) • ACES correlate w/ Increased Sexual Partners • ACES Correlate w/ History of STD

23. Trauma & Physical Health (cont.) ACES Correlate w/ Increased Sexual Partners ACES Correlate w/ Sexual Abuse of Male Children and Their Likelihood of Impregnating a Teenage Girl. ACES Correlate w/ Unintended Pregnancy or Elective Abortion ACES Correlate w/ Rape

24. Trauma & Academics • Impact of trauma on school readiness • Impact of trauma on school performance • Impact of trauma on cognitive functioning that may result in behavioral difficulties • Increased likelihood of dropping out of high school

25. Brain develops over time (birth thru early-mid 20’s) Brain mediates all internal and external processes – body, thought, feeling & behavior Trauma affects brain development – need to address the developmental element of growth affected by trauma “Body” and psychological memory Physiologic properties of alarm – stress – trauma Initial exposure – fight or flight – biological basis With persistent/significant trauma, one is on constant alert Branching Response – Dissociation v Hyper-arousal; impact over time and on “character” Power differential – strength v vulnerability “People not Programs change People” Trauma & The Brain – Some Key Concepts from Bruce Perry, MD

26. Part III Implementation of PARK and the CANS-DCFS

27. Refinement of the CANS Comprehensive into the CANS-DCFS Promoting Internal Collaboration based on identifying and understanding each other’s information needs • Director’s “Big Picture” presentation • Presentation and updates to the Deputy Directors • Forming a “common table” with Clinical Services, Training, Information Technology, BHT • Internal Social Marketing

28. Development of a “Common Information Language” • Precursor work with DCFS System of Care (SOC) Program and Screening, Assessment & Social Supports (SASS) • Determining baseline information about impact of trauma, mental health needs & strengths – Integrated Assessment Project • Systematic review of responses to care, emergent needs and responsiveness to care – 6-month Administrative Case Review

29. Streamlining System Mechanisms • Reworking internal programmatic silos – the Child/Youth Investment Team model • Utilization of the CANS-DCFS across Residential and Purchase of Services Providers • Improving system responsiveness to wards’ mental health needs – geo-mapping and resource identification/quality assurance/continuous quality improvement

31. New Child/Youth Investment Team Model for Decision-Making

32. Next Stages of Implementation and Anticipated Findings “This time next year” • Expected implementation of the CANS-DCFS July 2005 (CYIT, IA, Residential Monitoring) • Expected web-based CANS-DCFS training in place by September 2005 with statewide training completed by July 2006 • Databases and web-based download of CANS-DCFS data in place by September 2005

33. ……by this time next year…. • Preliminary analysis of CANS-DCFS data by January 2006 • Linking CANS-DCFS mechanisms with geo-mapping project by March 2006 • Trauma curriculum developed and training conferences completed by November 2005 • FY07 Contracting informed by CANS data by January 2006 • FY06 BHT PIP Proposal re EBP Pilot Projects (through the SOC network)

34. IDCFS BHT Contact Information • Tim Gawron, MS, MSW, LCSW Statewide Administrator, Behavioral Health Services TGawron@idcfs.state.il.us Phone (312) 814-1573 • Jamie Germain, PhD Downstate Administrator, Behavioral Health Services JGermain@idcfs.state.il.us Phone (618) 583-2126 • Felicia Guest, BA PSA, Behavioral Health Team Fguest@idcfs.state.il.us Phone (312) 814-6851 • Ray Wilkerson, MD Psychiatrist, Behavioral Health Team Rwilkerson@idcfs.state.il.us Phone (312) 814-5991