Transcript Document

National Juvenile Justice
Network Forum
July 28, 2011
4:00 to 5:30 PM
Jim Wotring, Director, National Technical
Assistance Center for Children’s Mental Health
Teresa King, Training and Technical Assistance
Family Resource Specialist, Federation of Families
Learning Objectives
• Participants will describe 2 core values of a system
of care.
• Participants will describe 2 primary fund sources
used when blending or braiding funding.
• Participants will describe 2 benefits of the
Affordable Care Act.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE:
Definition
The system of care model is an organizational
philosophy and framework that involves
collaboration across agencies, families, and
youths for the purpose of improving access
and expanding the array of coordinated
community-based, culturally and linguistically
competent services and supports for children
and youth with a serious emotional
disturbance and their families.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: Definition Cont .
Systems of care engage families and youth
in partnership with public and private
organizations to design mental health
services and supports that are effective,
that build on the strengths of individuals,
and that address each person's cultural
and linguistic needs. A system of care
helps children, youth, and families
function better at home, in school, in the
community, and throughout life.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE:
The Framework
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child
Development Center, National Technical Assistance Center for Children’s Mental Health. Reprinted by permission.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE CORE VALUES
•
•
•
The mental health component of the system of care
should be family – driven, youth-guided, with the
needs of the child and family dictating the types
and mix of services provided.
The system should be community based, with the
focus of services as well as management and
decision-making responsibility resting at the
community level.
The system should be cultural and linguistically
competent, with agencies, programs, and services
that are responsive to the cultural, racial, and ethnic
differences of the populations they serve.
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child
Development Center, National Technical Assistance Center for Children’s Mental Health. Reprinted by permission.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE:
Guiding Principles
• Family Centered (family-driven, youth- guided)
will guide system development, evaluation and
services delivery at the child and family level
• Services will be community-based, culturally and
linguistically relevant.
• Children/youth and their families have access to
comprehensive array of services that address
their physical, emotional, social and educational
needs.
• Children/youth are identified early, provided
comprehensive assessment and, if indicated
provided needed services.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE:
Guiding Principles
• Children/youth live in families and are served in the
community in which they live
• Care coordination ensures that services are delivered
in a coordinated manner with linkages between
service systems and agencies (planning, developing,
and coordinating services)
• Full participation of the child/youth and their family
ensures “voice”
• Transition to adult services is facilitated and actively
planned for the
individual shall be done no later
th
than their 16 birthday
• Rights are protected
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE:
As a Systems Reform Initiative
TO
FROM
Fragmented service delivery
Coordinated service delivery
Categorical programs/funding
Joint purchasing of services
Limited services
Comprehensive service array
Reactive, crisis-oriented
Focus on prevention/early
Focus on “deep end,”
restrictive setting(s)
intervention
Children out-of-home
Integrated community settings
Children within families
Centralized authority
Community-based ownership
Creation of “dependency”
Creation of “self-help”
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE
The difference for a family entering a System
of Care is that it has been designed to serve
multiple needs within a single family.
The system of care is for the family who has a
child at risk for or already involved with
multiple child-serving systems or services,
like Juvenile Court, the Department of Child
and Family Services, alcohol and other drug
counseling, and mental health.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE
When a family enters a System of Care, they have heard the
phrase “We can help” more times than they can count, and
they are frustrated.
The children or youth in the family feel that they have never
found a “fit” with the services offered to them, or that those
services were not enough.
The parents or caregivers in the family have been missing
work because of the behavioral problems of their child, and
they know that bad news is on the other end when someone
from their child’s school calls.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Goals of the System of Care
Initiative
1.
Increased capacity of the systems to work with
children, youth and their families;
2.
Increased access of systems to provide effective
services for children, youth and their families;
3.
Improved child and family outcomes such as
improvements in child wellbeing, increased stability
in living arrangements, and increased school
attendance;
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga Tapestry System of Care
•
Tapestry focuses on strengths – not just in
families, but within provider agencies and
neighborhood centers as well!
• This initiative brings together all the best
efforts of the settlement house tradition,
community-based care for families, and
established mental health, child welfare,
and juvenile justice provider agencies
with the schools and churches.
• It is a “whole life” approach to serving
families!
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga Tapestry System of Care
•Tapestry braids formal Medicaid
billable mental health services with
informal supports.
•This lets dollars follow the child,
instead of the old way of doing business
that meant communities paid for
potentially repetitive services.
•Tapestry gives families access to an
astonishingly thorough network of nocost or low-cost services.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga Tapestry System of Care
What does that mean for a family?
• Families aren’t forced to travel from
agency to agency for the diverse range of
services they need
• Families stay where they are comfortable,
in their home and in their neighborhood
• Families connect with a Parent Advocate,
who knows the system and their
neighborhood
• Families stay together!
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga Tapestry System of Care
•Current partners within the system of
care have long histories in Cuyahoga
County—and saw a need to integrate
their efforts to serve the families with the
most complicated needs.
•Tapestry married clinical expertise
with neighborhood know-how
•Families benefit because they can
receive the best services the county
offers within their homes and
neighborhoods—no trips downtown to
get what they need
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga Tapestry System of Care
Mental Health Court Outcomes
• Progress in Therapy/Self Awareness
• Medication Compliance
• Reduction/Elimination of Psychiatric
Hospitalizations
• School behavior and Attendance Improve
• Academic Performance Improves
• Family Functioning/Relationships Improve
• Peer Functioning/Relationships Improve
• No New Charges
• Case Plan Compliance
• Development of Informal Supports
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Cuyahoga County: Example of Redirection,
Early Intervention and Braided Funds
SOC Funders Group
Chaired by Deputy County Administrator
for Human Services
County ASO:
Management
Entity
Neighborhood
Collaboratives &
Lead Provider
Agency Care
Coordination
Partnerships
Child/family teams
Family & Children First $$ State Early Intervention
Family & System Team $$ & Family Preservation
Residential Treatment Center $$$$
Therapeutic Foster Care $$$
“Unruly”/shelter care $
Tapestry $$
System of care grants
Strengthening
Communities
for Youth $$
Care Coordination Bundled Rate :
$1602 per child per mo. - Medicaid
Community providers and natural helping networks
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 1
What are the 2 Core Values
of a System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Financing Systems of
Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
System Planning
• Broad participatory planning, create a common
vision/mission, develop a logic model?
• Develop a communication plan?
• Empower action and helping others lead with
you?
• Identify short term wins (20 case report)
• Don’t let up, change takes time
• Develop a plan for institutionalizing the behavior
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Financing Systems of Care
• Financing for whom - target population
• Financing for what – services
• What do the purchasers want to buy?
– Juvenile Justice
– Child Welfare
– Mental Health
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Where to Look for Money and Other
Types of Support
Government
Federal, State,
County, City
Income Generating
Activities
e.g., Wellness
programs
Taxes and Levies
State and County
Foundations
National, Regional,
Community, Family
Individuals
Contributions, User
Fees, Volunteers
Business
Corporate Giving
Programs or Small
Business
Behavioral Health
Organizations
3rd Party
Reimbursement
Faith-Based Orgs
Service Clubs
e.g., Kiwanis, Junior
League, Lions
Media
Unions
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Sources of Government Funding
Medicaid
• Medicaid Inpatient
• Medicaid Clinic
• Medicaid
Rehabilitation
Services Option
• Medicaid Early
Periodic Screening,
Diagnosis and
Treatment (EPSDT)
• Targeted Case
Management
• Medicaid Waivers
• TEFRA Option
Mental Health
• MH General Revenue
• MH Medicaid Match
• MH Block Grant
Child Welfare
• CW General Revenue
• CW Medicaid Match
• IV-E (Foster Care and
Adoption Assistance)
• IV-B (Child Welfare
Services)
• Family
Preservation/Family
Support
Substance Abuse
• SA General Revenue
• SA Medicaid Match
• SA Block Grant
Juvenile Justice
• JJ General Revenue
• JJ Medicaid Match
• JJ Federal Grants
Education
• ED General Revenue
• ED Medicaid Match
• Student Services
Other
• TANF
• Children’s Medical
Services/Title V–
Maternal and Child
Health
• Developmental
Disabilities
• Title XXI-State
Children’s Health
Insurance Program
(SCHIP)
• Vocational
Rehabilitation
• Supplemental Security
Income (SSI)
• Part C Early Interven.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Example of Redirection & Blended Funds
CHILD WELFARE
Funds thru Case Rate
(Budget for Institutional
Care for Children w/CHIPS)
JUVENILE JUSTICE
(Funds budgeted for
Residential Treatment for
Youth w/Delinquency)
11.0M
SCHOOLS
youth at risk for
alternative placements
Per Participant Case Rates from
CW, JJ and ED range from about
$2000 pcpm to $4300 pcpm
Care
Coordination
MEDICAID CAPITATION
($1557 per month
per enrollee)
11.5M
16.0M
Wraparound Milwaukee
County BHO
Care Management Organization
$47M
Child and Family Team
Mobile Response & Stabilization co-funded by
schools, child welfare, Medicaid & mental health
MENTAL HEALTH
•Crisis Billing
•Block Grant
•HMO Commercial Insurance
8.5M
Families United
$440,000
Provider Network
210 Providers
70 Services
Plan of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 2
Name 2 Fund Sources Used when
Blending or Braiding Funds.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Finance & the
Affordable
Care ActHealth Reform
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
What to Expect From the
Affordable Care Act
• Increased access to mental health and
addictions services for the one in four
Americans that live with a mental illness.
• Expanded public and private insurance
coverage for mental health and addiction
treatment.
• Expanded Medicaid and CHIP programs.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance
Exchanges
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
• Eligibility for Participation in Exchanges:
• Sec. 1312:
– U.S. citizens and legal immigrants & individuals not
incarcerated with incomes up to 400% of the Federal
Poverty Level
– Small businesses
– After 2017, large employers can
participate in Exchanges.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIP
Why Is This Expansion Important For State
Behavioral Health Agencies?
•
The expansion of Medicaid to 133% of poverty and
increased CHIP coverage to about 6.5 million additional
children is estimated to increase enrollment in the
programs by 33% by 2019.
•
This expansion will account for the largest reduction in
uninsured populations, followed by the Health Exchanges.
•
Large numbers of uninsured individuals, estimated at
around 20%, have mental health or substance use problems
(Kaiser Family Foundation, 2009).
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIP
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid
• Sec 2402: 1915(i) State Plan amendment. States can amend
their State Plans to offer HCBS as State Plan option benefits.
• Income eligibility is up to 150% of federal poverty level or
300% of the maximum SSI payment (2,200/ month).
• States can do one plan amendment with several target
populations.
• Cannot waive state-wideness, but can target a specific
population (using needs based criteria)
– Children with SED
– Children with SED of a particular age
– Children with 2 or more hospitalizations
Source: Bazelon Center: Medicaid Reforms in the Patient Protection and Affordable Care Act
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 3
Describe 2 benefits of the
Affordable Care Act
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Jim Wotring, Director National Technical
Assistance Center for Children’s Mental Health
[email protected]
202-687-5052
Teresa King, Training and Technical Assistance
Family and Resource Specialist
[email protected]
202-687-5016