AR System of Care
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Transcript AR System of Care
AR System of Care
The Problems
Not meeting the needs of the child, youth and family
Increasing number of children being removed from
their homes and schools.
Increased numbers entering into acute in-patient
programs
Inefficient
Lacking localized services
Escalating costs
Inflexible
Lacking cross agency communication and
coordination
No identified outcomes
Services developed in response to funding
not need in response to the needs of the
child/youth/family
Not meeting the needs of the schools serving
our children
Many population disparities
Act 2209
Act 2209 in 2005 Mandated the
establishment of a “system of care”.
It required in-state stakeholders to develop
and implement the strategies that are present
in System of Care.
Provided the basis for the State assessment
and a System of Care Framework by Cliff
Davis of the Human Collaborative Project..
Recent Events Timeline
Cliff Davis Assessment (6/06)
Stakeholders Planning Committee (7/06 – 8/07)
Act 1593 (3/07)
First Lady’s Listening Tour (5/07)
System of Care 101 (6/07)
Children’s Behavioral Health Care Commission
(First meeting 8/30/07 - present)
What did Cliff Davis say?
Arkansas needs to improve children’s
behavioral health by FIRST:
Building family support.
Expanding local capacity to collaboratively
meet children’s needs.
Improving the quality of care
Establishing accountability in the system.
Act 1593 of 2007
Expanded and established the principles of a System
of Care for behavioral health care services for
children and youth as the “Public Policy of the
State”.
Act 1593
Requires DHS, under Commission advisement, to:
Ensure that children, youth and their families
are full partners in all aspects of the system of
care;
Revise Medicaid rules and regulations to
increase quality, accountability and
appropriateness of Medicaid reimbursed
behavioral health care services;
And further required that the State:
Define a standardized screening and
assessment process designed to provide
early identification of conditions that require
behavioral health care services; and
Develop an outcomes-based data system to
support an improved system of tracking,
accountability and decision-making.
Established: Children’s Behavioral
Health Care Commission
Twenty (20) representatives of youth, families,
advocates, providers, and other critical
stakeholders.
Commission received and approved
recommendations from the previous
Stakeholders group.
Continues to support an array of workgroups
and subcommittees, preparing additional
recommendations.
Commission:
Work Groups
Responsibility: To Make Recommendations to the
Commission
Family and Youth Support Network
Cultural Competence
Services, Supports and Standards
Outcomes/Assessment Tools
Local Infrastructure
Training and Workforce Development
Work groups
Meet monthly, weekly or biweekly
Are open to the public
Have telephone call in access
Post agendas, notes and related information
on the Commission web site
Moving towards a solution: A
System of Care
A coordinated network
held accountable
to provide a full array of mental health and
other services,
which meet the many needs of children with
serious emotional disturbances and their
families.
“System of Care” for Children
Not a new concept
First published definition actually appeared in
1986
“a comprehensive spectrum of mental health
and other necessary services which are
organized into a coordinated network to meet
the multiple and changing needs of children
and their families.” Stroul and Friedman
System of Care Framework
S.O.C. Foundation in Arkansas
To become: Family-driven, child centered,
youth guided with family participation at all
levels…. community- based… culturally
competent
Requires: Our system to provide cost effective
behavioral health services in the least restrictive
environment and collaborates across all systems.
SYSTEM OF CARE
Principles
Source: Stroul & Friedman
Individualized services based on needs
Comprehensive array of services
Least restrictive environment
Families and youth as full partners
And…
Care management
Early identification and intervention
Smooth transition to adult services
Advocacy
Culturally competent services
Where are we now?
Work is taking place at the State level and in local
communities.
About Arkansas DHS
Ten divisions, four offices
Approximately 7000 employees
83 local DHS offices
Serve over 1 million Arkansans
Child protection, foster care, juvenile justice,
Medicaid, behavioral health and substance abuse,
child care, state preschool, after-school,
developmental disabilities services, Food stamps,
energy assistance, eligibility determination for public
programs, aging/adult services, etc.
Why is this important?
Affects most, if not all, divisions
No. 1 priority for DHS
Many implications for public policy changes
across child-serving systems (e.g. standards
for mental health services)
Hard for one Division to “own”
Must connect with other State Departments
(e.g. Dept of Education, Dept. of Health)
AR DHS
Has hired a Director
Hiring additional staff
Seeking federal and private resources to
support State and local efforts
Reviewing lessons learned from an AR
pilot/evaluation project
Action for Kids
A collaboration with Mid South Health System, Inc
(CMHC), the State and the families/youth and
communities in Craighead, Mississippi, Lee and
Philips Counties
Funded by Substance Abuse and Mental Health
Administration and supported by local community and
State match
Serving children with severe emotional disorders
Provides:
An array of evidence
based practices to
children and their families
in their homes, schools
and community settings.
Provides extensive
training and programs to
school personnel and
other providers.
Has included Positive
Interventions and
Supports in the schools.
Work currently focused on those most
in need:
Under 18 years of age (unless in treatment when turning 18)
with a diagnosed mental, behavioral or emotional disorder of a
long-term nature
At risk of removal from their natural settings
Who have a multi-agency needs
Whose emotional problems are disabling upon social functioning
criteria
…with one or more of the following characteristics:
Responses so intense or frequent that the
consequences lead to severe measures of control:
seclusion, restraint, hospitalization or chemical
dependency.
Behaviors judged to be extreme or inappropriate for the
age.
Behaviors that lead to exclusion from school, home,
therapeutic or recreations settings.
Intense enough to be considered seriously detrimental to
the child’s growth, development, welfare or the safety or
welfare of others.
Problems: Lack of Services
Needs consistently identified:
Flexible dollars to meet the
needs of families
Intermediate levels of care
Respite
Mentors
Family support/education
Substance abuse services
Transportation
Non-school hour activities
Rural services
Issues around dual
diagnosis
And certainly not…
Not truly driven by the family and youth
With systems, agencies and individuals who
always work together
What does this mean in at home?
Learning to creatively work together:
Families, schools and public and private
providers.
Regional CASSP teams are developing
comprehensive plans.
Contact your representative to be involved.
Local Service Teams
CASSP & Together We Can are moving
towards becoming:
Wrap
Around Teams
•
Family - Driven
Youth - Guided
•
Child - Centered
•
The Wraparound
Process is an intensive,
individualized care
management process
for youths, children
and families with
serious and or complex
needs.
Evolution: MAPs
Family Wrap Around Plans
Multi Agency Plans of
Service to Family Wrap
Around Plans.
Shift the focus from
the agencies to the
families
CASSP teams will still
use MAPs for some
service delivery
Wrap Around Plans
Identify:
Provide:
Formal and informal
Plans for
Service planning and supports
Utilize resources: both
Strengths and needs
Immediate and long term needs
Designates
Responsibilities
Meetings must:
Include
Parent and youth
2 providers besides the local community
mental health center
Maintain confidentiality
Be flexible
Teams are striving to ensure that
services are:
Family driven, child
centered, youth guided
Community-based
Multi-system
Culturally competent
In the least
restrictive/least intrusive
environment
Wrap around teams
Participation and team composition
Driven by the family.
Families can exclude a party’s participation
Flexible meeting times
Teams can include:
Both formal and informal supports.
(immediate and extended family, pastors,
youth providers, family supporters)
This direction will require changes.
Discussion:
Familiarity with Together We Can & CASSP
teams? Experiences and Impressions?
What have you heard about System of Care?
Concerns….apprehensions?
Come and see what is going on …
Children’s Behavioral Health Commission
website:
http://ardhs.sharepointsite.net/ARSOC/default.
aspx
Contact information:
Elisabeth Wright-Burak –Director of Policy and
Planning - [email protected]
Carol Amundson Lee –
[email protected]
System of Care, Director