Transcript Updates

Pennsylvania Council of Children
Youth and Family Services
Children’s Behavioral Health Services
Policy Day
June 13, 2011
Discussion with Office of Mental
Health and Substance Abuse Services
Agenda
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Environmental Scan
Call for Change
BHRS
RTF
FBMHS
Evidence Based Practices
School Based Behavioral Health
Outpatient Services
System of Care
Tri-Care
DPW Principles
•Integrated, Coordinated and Seamless
Service System
•Focus on Consumer Needs: Quality,
Independence, Flexibility and Service
Coordination
•Provide value through Financial Integrity
and Consumer Appropriate Care
•Personal Responsibility
Call for Change
in Children’s Behavioral Health
• Develop the capacity for the system to be youth and family
driven.
• Ensure ready access to a cost-effective array of quality
services including assessment, treatment and support
services that help to sustain and nurture family and
community ties.
• Establish the infrastructure (financing, policies, training, etc.)
to implement a system of comprehensive, integrated, costeffective array of services.
• Develop a public health approach to social and emotional
wellness for children, youth and families.
• Develop increased capacity for service systems to meet the
needs of transition age youth and young adults through cross
systems collaborative relationships and initiatives.
BHRS
• Brief Overview
• Intersection of Policy and Finance
• Identification of Major Strategies
Therapeutic Support Services
06–07 07–08 08–09 09–10
Dollars $303M $284M $274M $244M
Users 26,266 26,153 25,197 24,394
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.
Realign BHRS
• Streamline the process for accessing BHRS;
• Allow Mobile Therapy (MT) to be delivered
independently, with appropriate
licenses/oversight;
• Develop focused modalities under existing BHRS,
rehabilitation, and clinic service definitions to
target specific populations and to conditions that
can be expected to benefit;
Realign BHRS Administrative
Requirements
• Simplify BHRS prescription process by replacing
requirements for updated prescriptions,
evaluations and treatment plans (packets) with a
data-driven process to identify case and provider
outliers;
• Restructure the ISPT process to allow an array of
interagency planning approaches including High
Fidelity Wraparound.
TSS in Schools
• Develop and expand school-based behavioral
health services as preferred alternatives to
individual TSS;
• Work with BHMCOs and provider agencies to
expand traditional outpatient and to
implement innovative approaches in schools.
• Encourage other best practice efforts such as
outpatient satellites, or Mobile Therapy in
schools.
Address needed changes in bulletins,
contracts
• Identify financial barriers or
disincentives and extend current rate
review by Mercer to all of BHRS;
• Eliminate regulatory requirements that
run counter to family and youth-driven
service needs;
Appendix T requires that less intensive services must first be
tried prior to a recommendation for FBMHS
• A psychiatrist, physician or licensed psychologist
determines that the child is eligible and
recommends the FBMHS program
AND
• Other less restrictive, less intrusive services have
been provided and continuation in this less
intensive level of care cannot offer either an
expectation of improvement or prevention of
deterioration of the child’s and the family’s
condition
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;
Changing Field
• July 2009 we had 2,807 Accredited and 1,281
non-accredited
• 4,088 beds total beds in 2009
• March 2011 we have 1,960 Accredited and
501 non-accredited,
• a total of 2,461 beds in 2011
• a decrease of 1,627 beds in two years
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
Budget Work Plan
• There are still counties where there are additional
opportunities for cost savings and that is
reflected in the 11/12 budget.
• We will work with these counties and their
Managed Care Organizations to support them in
making the necessary changes.
• The Money Follows the Person initiative may
provide an opportunity for counties to expand
community based alternatives for these counties.
Proposed Regulations for RTFs
1. Comments to the proposed RTF regulations
have identified many issues, most of which
we can easily address in the next draft.
2. In addition to the organizational change that
will be required, there are significant
financial implications.
3. We have to gather more information and do
some more work before are ready to discuss
a new draft with stakeholders.
FBMHS Discussion
• Current situation with FBMHS
• Proposed change to more supervision based
model
• Actions
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
Current Situation
• 3 Training centers
• One exam (only taken by Mental Health
Workers)
• New modalities (IICAP, ABFT)
• Intensity of need appears to have increased
Current Status of Change
• Children’s Bureau working with 3 training
directors collectively.
• Learning more about strengths and
opportunities to improve FBMHS.
• Partial implementation of the paradigm shift
by the three training centers has begun.
• Identification of continuing agenda with
training centers, to achieve improved overall
quality and core standards .
Moving FBMHS closer in implementation to other
Evidence Based family empowerment models
• Increasing responsibility of the clinical supervisors at FB
agencies, with increased training and support for
supervisors by the training centers.
• Increasing accountability at multiple levels:
– Training center faculty: increased accountability to FB
supervisors at various agencies, and to new FB staff.
– Agency supervisors: to their staff, and to families
served.
– Therapists: to each other as team members, to their
supervisor, and to families served.
Supervision based model, emphasizing the supervisor’s
role and accountability for therapists’ completion of
outcome measures and their competency in delivering
clinical treatment
– Increased role of supervisor, when their therapists
present to training center staff.
– Certification of supervisors.
– Continued expectation of continuing education
and professional development, by agency
supervisors and agency therapists alike.
– Use of fidelity and outcomes tools by therapists,
who are trained by center staff.
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.
• Testing 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.
School Based Services
Student Assistance Program
• In FY 09/10, 111,881 students state wide were
referred to school Student Assistance Program
teams for consultations.
• Of those students 26,681 students were referred
for drug and alcohol or mental health
assessments in the SAP program.
• 17% were determined to have a primary problem
of Drug and Alcohol issues; 70% were determined
to have a primary problem of Mental Health
issues.
School-Wide Positive Behavior
Support (SWPBS)
• Positive Behavior Interventions and Supports is
an evidence-based approach for establishing the
social culture needed for schools to be effective
learning environments for all students.
• Positive Behavior Interventions and Supports
helps schools teach students expected behaviors
and social skills, creates student behavioral
health and academic support systems,
and applies data-based decision-making to
discipline, academics, and social/emotional
learning.
Expanding in Pennsylvania
Data for the 10-11 school year indicate that
SWPBS is operating in141 schools buildings:
• Elementary 92;
• Middle 32;
• High Schools 17
Evidence Based Practices
.
MST
• A total of 2397 youth and 4222
parents/caregivers were served in 2010.
• A total of 1838 new youth were admitted to MST
programs in 2010, 1230 (67%) of whom would
have otherwise been placed out-of-home
according to the provider.
• The majority of referrals came from Children &
Youth Services (43%) and Juvenile Probation
(46%). A smaller number of referrals came from
schools (3%) and other sources (8%).
MST Completions
Of the 1709 youth that had the opportunity to
complete MST (i.e., were not administratively
discharged) in 2010:
– 1388 youth (81%) were successfully discharged. The
average length of stay for successful cases was 3.6
months which is consistent with the MST model.
– 321 youth (19%) were unsuccessfully discharged. Of
these youth, 202 (63%) were placed out of home. The
average length of stay for unsuccessful cases was 2.8
months.
Of the 455 youth discharged from MST
between October-December, 2010
• Over 80% had no new criminal offense during
treatment.
• 80% remained drug free, as evidenced by
negative drug screen(s) during their last three
months in MST.
• Nearly 80% improved school attendance and
nearly 80% improved school performance.
• 70% had families that improved family
functioning, defined as improved parenting skills
and/or improved family relationships.
FFT
• A total of 1661 youth and 2038
parents/caregivers were served in 2010.
• A total of 1462 youth were admitted to FFT in
2010, 158 (11%) of whom would have otherwise
been placed out-of-home according to the
provider.
• 28% of referrals came from Children Youth &
Services, 6% came from schools, 53% came from
Juvenile Probation, and 13% came from another
source.
A total of 1175 youth were discharged
from FFT in 2010.
Of the 1120 youth that that had the opportunity to
complete FFT (i.e., were not administratively
discharged) in 2010:
– 801 youth (72%) were successfully discharged. The
average length of stay for successful cases was 3.7
months, which is consistent with the FFT model.
– 319 youth (28%) were unsuccessfully discharged. Of
these youth, 63 (20%) were placed out of home. The
average length of stay for unsuccessful cases was 2.6
months.
Of the 330 youth discharged from FFT
Between October-December, 2010):
• 95% had no new criminal offense during
treatment
• Nearly 70% remained drug free, as evidenced
by negative drug screen(s) during their last
three months in FFT
• Over 60% improved their school attendance
and nearly 70% improved their school
performance.
MTFC
• A total of 54 youth and 96 parents/caregivers
were served in 2010.
• A total of 45 new youth were admitted to
MTFC in 2010, 34 (76%) of whom were at
imminent risk of being placed in a more
restrictive setting prior to treatment.
Of the 34 youth discharged from MTFC
across 2010
• 97% had no new criminal charges during
treatment
• 71% decreased their antisocial behavior
• 68% improved their overall behavior
• 100% remained drug free (as evidenced by
negative drug screen(s) during their last three
months in MTFC)
• 71% improved on school attendance and 73%
improved on school performance
Parent Child Interaction Therapy
• PCIT was developed for children between the ages of
2 and 7 years who have externalizing behavioral
problems. It has been used in families with histories
of physical abuse and children with developmental
disabilities.
• In PCIT, parents are taught specific skills to establish
or strengthen a nurturing and secure relationship
with their child while encouraging prosocial behavior
and discouraging negative behavior.
Parent Child Interaction Therapy is
expanding rapidly
• PCIT is in 12 counties and 21 agencies.
• Allegheny County began in 4 agencies with
foundation funds
• Through the Heinz Endowment, OMHSAS and
OCDEL have supported 8 agencies:
• Value Behavioral Health has expanded in several
of its counties in the western part of the state
• CCBHO is expanding in the 23 county state option
Pennsylvania Agencies Providing
Parent-Child Interaction Therapy
Last Updated - May 14, 2011
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;
• Successful Conference in May with the 5
counties, and with counties that are doing
High Fidelity Wraparound;
• Submission of a proposal to SAMHSA for a
planning grant to expand Systems of Care
throughout the Commonwealth.
Pennsylvania System of Care Expansion Proposal
SLT
Planning
Consultants
Tri-West
YLST
Project
Director
FLST
RPG
VBH
RPG
CBH
RPG
CBHNP
RPG
MBH
RPG I
CCBHO
RPG II
CCBHO
Counties
Counties
Counties
Counties
Counties
Counties
Military Families
• SAMHSA has identified eight Strategic Initiatives, with
Military Families being one of them, to help individuals
with mental and substance abuse disorders and their
families build strong and supportive communities,
prevent costly and painful behavioral health problems,
and promote better health for all Americans.
• The Military Families Initiative is intended to support
America's service men and women — Active Duty,
National Guard, Reserve, and Veterans — together
with their families by leading efforts to ensure that
needed behavioral health services are accessible and
that outcomes are positive.
Pennsylvania Facts
• There are approximately 31,000 military
children living in the Commonwealth of
Pennsylvania.
• Pennsylvania provides the nation’s highest
number of National Guard troops and the
third largest number of all personnel serving
in the military effort.
Informational Packet from SAMHSA
Contains information on the TRICARE
healthcare entitlement, the provider
categories that may be authorized, services
that may be reimbursed, and the forms
required in the certification application.
Hang in There