Transcript PCCYFS CHILDREN’S SERVICES POLICY DAY Behavioral Health

PCCYFS CHILDREN’S SERVICES
POLICY DAY
Behavioral Health and Child Welfare
Services
December 8, 2011
Discussion with Office of Mental
Health and Substance Abuse
Services Staff
Proposed Agenda
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Vision for OMHSAS, top priorities, projections for the future
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Cross-systems activities
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Status of the Department of Drug & Alcohol Services
Initiatives/Collaborations with other Departments (Health, Education, etc.)
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Future of BHRS
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Data on utilization of services
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Update on PRTF draft bulletin
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Outpatient services – experiences, rates, etc.
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Potential of offering trauma-informed services to military families
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Update on OMHSAS Children’s Bureau initiatives & efforts
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Money Follows the Person in children’s services
System of Care
Hi-Fidelity Wraparound / Youth & Family Training Institute
Youth Suicide Prevention – new Garrett Lee Smith grant
Priorities
• DPW Goals include Cost Containment and Self
reliance;
• OMHSAS Children’s Bureau goals include
youth and family empowerment, High Fidelity
Wraparound, and Systems of Care.
• Additional goals include Suicide Prevention,
and expansion of Evidence Based Practices.
BHRS Totals
06–07 07–08 08–09 09–10
Dollars $575M $581M $617M $617M
Users 53,700 54,394 57,436 60,824
Goals
1. Realign BHRS to become a more clinically
appropriate, high quality service.
2. Promote use of evidence based practices and the full
array of clinic and community-based services for
children.
3. Assure more cost effective delivery of BHRS.
4. Streamline the paperwork process (reduce the need
for packets).
Residential Treatment Facilities
• There has been a dramatic change in the
RTF system over the past 4 years;
• There has been reduced use due to
development of evidence based practices
such as Multi-Systemic Therapy and
efforts in Child Welfare and Juvenile
Justice;
Residential Treatment Facilities
• 7/13/09 we had 2,807 Accredited and 1,281
non-accredited
• 4,088 beds total beds in 2009
• 3/1/11 we have 1,960 Accredited and 501
non-accredited,
• a decrease of 1,627 beds in two years
• a total of 2,461 beds in 2011
Accredited RTFs
06–07 07–08 08–09 09–10
Dollars $239M $232M $218M $187M
Users
5,058
4,632
4,213
3,691
Non-Accredited RTFs
06–07 07–08 08–09 09–10
Dollars
$48M
$41M
$43M
$37M
Users
1,593
1,320
1,301
1,098
Family Based
Mental Health Services
Family-Based Mental Services
06–07 07–08 08–09 09–10
Dollars $62M
Users
$76M $88M $97M
6,572 8,079 9,048 9,803
The Context
 Ongoing reassessment of FBMHS program with the
goal of consistency, effectiveness, and quality
improvement
 Collaborations between the Children’s Bureau,
representatives from the regional offices, BH-MCOs,
consumer families, FBMHS program
directors/supervisors, and the three training centers
 Collaborations between the three training centers to
create greater uniformity in the practice model and
the training
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Concerns
• Inconsistency in implementation of the FBMHS
clinical model both within and across programs
• Wide variations in how programs define the role
of clinical supervisor and what is given focus in
supervision
• Need for cost effective approach to training and
program implementation
• Recognition that adult education theory
emphasizes coaching and supervision as well as
training
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The Solution Involves …
 Adoption of a uniform Family Based Treatment Adherence
measure that can be used by the training centers and
FBMHS programs across the state
 Expansion and clarification of the role of clinical
supervisors in FBMHS
 Establishment of best practice standards for FBMHS
supervision
 Implementation of a formal curriculum for FBMHS
supervisors by the training centers
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Rolling Implementation
• Gradual reallocation of resources and expectations.
• New training for supervisors and also for new FB staff, with
some training being done on-line and reduction in the
standard of hours of staff training.
• Further conceptual strengthening of the model.
• Use of FB fidelity instruments to maintain accountability to
the model.
• Use of a range of outcome measurements, with baseline
established at initiation of service, to maintain clinical
accountability.
• Gradual implementation of changes, with modification based
on mutual learning.
• Overall goal: For changes to be efficient and cost-neutral.
Fetal Alcohol Spectrum Disorder
• Report has been released
• Action is being planned
Evidence Based Practices
• Report from the EPIS Center
MST Outcomes
• 13 providers reporting
• 2,397 youth served in 2010
– 43% referred by CYS, 46% by JPO
– 67% would have been placed out-of-home otherwise
• 1,822 youth discharged in 2010
– Average length of stay for successful discharges = 3.6 months
– 11% were placed out-of-home
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MST Outcomes cont.
“Success” was defined as discharge by mutual agreement of
caregivers and MST team, and youth was living at home,
attending school, and had no new arrests at discharge.
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FFT Outcomes
• 12 providers reporting
• 1,661 youth served in 2010
– 28% referred by CYS, 53% by JPO
– 11% would have been placed out of home otherwise
• Of 1,175 youth discharged in 2010
– Average length of stay for successful discharges = 3.7
months
– 5% were placed out-of-home
FFT Outcomes cont.
“Success” was defined as completing all phases of the FFT
treatment model and positive ratings on Therapist and Client
Outcome Measures, indicating a reduction in risk factors and
increase in protective factors.
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Cost Savings
2010 Pennsylvania savings related to
reduced placement costs = $4.5 Million
 Conservative estimate of
savings, based on 3,031
youth discharged from EBIs in 2010
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Youth Suicide Prevention
• There is Youth Suicide Prevention plan which
is being updated
• There is a special grant which began in 3
counties
• And has been renewed to allow us to expand
to additional counites.
Garrett Lee Smith Memorial Act
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Passed by Congress in
2004
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Named after Senator
Gordon Smith’s (OR) son
who died by suicide at
age 21
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Provides funding for
community based
suicide prevention
The Need in Pennsylvania
Over half the counties in Pennsylvania have
suicide rates higher than the national average’
# Youth Suicides (15 to 24 years old),
by Pennsylvania County, 1990-2005
Targeted Counties: Lackawanna, Luzerne, Schuylkill
Central Aims
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Objective 1: Create a task force of a broad range of stakeholders
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Objective 2: Provide a youth suicide “gatekeeper” training program
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Objective 3: Provide medical practitioners in the 3 counties free access to
a web-based self report suicide screening tool
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Objective 4: Increase the integration of behavioral health services with
medical services
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Objective 5: Enhancing clinical services for suicidal youth
High Fidelity Wraparound
• There are 10 counties involved in High Fidelity
Wraparound, the 5 System of Care Counties:
and 6 others: Allegheny, Bucks, Delaware,
Fayette, and Northumberland.
• Over 500 youth and their families have been
served since the initiation of HFW in 2008.
• We are working with counties/BHMCOs to
expand the availability of HFW to more
counties.
• Philadelphia will be the next county!
System of Care Update
• We continue work with building the
infrastructure in the first 5 counties: Erie,
Chester, Lehigh, Montgomery, and York.
• We received funding for a planning grant from
SAMHSA to expand Systems of Care
throughout the Commonwealth.
Pennsylvania System of Care Expansion Proposal
SLT
Planning
Consultants
Tri-West
YLST
RPG
VBH
Counties
RPG
CBH
Philadelphia
County
Project
Director
FLST
RPG
CBHNP
RPG
MBH
RPG I
CCBHO
RPG II
CCBHO
Counties
Counties
Counties
Counties