Transcript North Carolina Youth Accountability Planning Task Force

North Carolina Youth
Accountability Planning
Task Force
Doreen Cavanaugh, Ph.D.
Health Policy Institute
Georgetown University
April 22, 2010
Acknowledgments
Catherine Kelley, M.P.P. Candidate
 Amanda Lechner, M.P.P. Candidate
 Randolph Muck, M. Ed.

State Adolescent Substance Abuse
Treatment Coordination Grants
Small infrastructure grant ($400,000/3 yrs)
Coaching
Technical assistance
Required States to create change in five overarching areas:
1.
2.
3.
4.
–
–
–
–
–
Interagency collaboration
Finance/Organization
Workforce development
Dissemination of evidence based practices
Family involvement
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Overview

Overview
 National
Perspective
 System Design
 System Infrastructure
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Substance Use

Over 1.9 million (7.7 percent) adolescents aged 12 to 17
were dependent on or abused illicit drugs or alcohol in
2007 (NSDUH, OAS 2008).

Sixty-six percent of adolescents in the 2007 CSAT
national dataset (15,254 youth aged 12–17) presented at
substance abuse treatment with a co-occurring
psychiatric disorder.

Across a range of studies 54 - 95 percent of youth in
alcohol/drug treatment also have conduct or oppositional
defiant disorder; mood disorders are evident in
approximately half of these teens and 15 to 42 percent
exhibit anxiety disorders (Brown, n.d.).
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Substance Dependence or Abuse in the
Past Year, Numbers in Thousands, 2007
Age
Illicit Drugs
(2007)
Alcohol
(2007)
Illicit Drugs
or Alcohol
(2007)
12
26
38
131
243
308
346
381
21
47
120
323
352
502
596
43
70
205
431
539
652
780
13
14
15
16
17
18
Source: SAMHSA, Office of Applied Studies, NSDUH, 2007
© Doreen A. Cavanaugh, Ph.D.,
4/22/10
Substance Dependence or Abuse in the
Past Year, Percentages, 2007
Age
Illicit Drugs
(2007)
Alcohol
(2007)
Illicit Drugs
or Alcohol
(2007)
12
0.7
0.9
3.2
5.5
6.9
8.4
8.0
0.5
1.1
2.9
7.4
7.9
12.1
12.5
1.1
1.7
5.0
9.8
12.1
15.8
16.4
13
14
15
16
17
18
Source: SAMHSA, Office of Applied Studies, NSDUH, 2007
© Doreen A. Cavanaugh, Ph.D.,
4/22/10
Substance Use Disorders Among Adolescents
Involved with the Juvenile Justice System

Adolescents involved with the juvenile justice system
experience higher rates of substance use disorders.
 In a study of 401 youth aged 13-18 entering the
Illinois juvenile correctional system in 2000, 68.1%
were identified as needing substance abuse
treatment.*
 In
a study of adolescents aged 13-18 across five
child-serving systems, 36.9% of adolescents (n=419)
entering the juvenile justice system were diagnosed
with a past year substance use disorder.**
* Johnson, T.P., et al. (2004). Treatment need and utilization among youth entering the juvenile corrections
system. Journal of Substance Abuse Treatment. 26, 117-128.
** Aarons, G.A. (2001). Prevalence of Adolescent Substance Use Disorders Across Five Sectors of
Care. Journal of the American Academy of Child and Adolescent Psychiatry. 40, 4.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Substance Use Disorders Among Adolescents
Involved with the Juvenile Justice System

Adolescents involved with the juvenile justice system
experience higher rates of substance use disorders.
 In a multi State study analyzing over 1,400 youth across
three juvenile justice settings (community-based, detention
centers and secure residential facilities), Shufelt and
Cocozza found that 46.2% of sampled youth met criteria
for a substance use disorder.*
 In an analysis 1,066 individuals participating in 14 CSAT
Young Offender Reentry Program (YORP) sites from
2004-2006, 90% self-reported criteria for substance
disorders and 40% were classified with past year
dependence.**
* Shufelt, J.L. and Cocozza, J.J. (2006). Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study. National Center for
Mental Health and Juvenile Justice.
** Dennis, M.L. (2006). Part 2: Institution-Based Treatment for Adolescents with Substance Use/Co-Occurring Disorders. A Presentation
made to the SAMHSA/OJJDP Expert Panel on Juvenile Justice and Substance Abuse Treatment, December 6, 2006.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Mental Health Disorders Among Adolescents
Involved with the Juvenile Justice System

Any Disorder: Male (66.8%); Female (81.0%)

Disruptive Disorder: Male (44.9%); Female (51.3%)

Anxiety Disorder: Male (26.4%); Female (56.0%)

Mood Disorder: Male (14.3%); Female (29.2%)
Source: NCMHJJ Research and Program Brief; June 2006;
http://www.ncmhjj.com/pdfs/publications/PrevalenceRPB.pdf
© Doreen A. Cavanaugh, Ph.D. April 22, 2010
Youth Mental Health/Co-occurring
Disorders

One study of mental health service use among youth revealed
that nearly 43 percent of youth receiving mental health
services in the United States have been diagnosed with a cooccurring substance use disorder (CMHS, 2001).

“Co-morbidity is so common that dual diagnosis should be
expected rather than considered an exception. Consequently,
the application of best practices cannot be restricted to small
subpopulations but rather must be extended to the
development of models that apply to the entire system of care
and that require integrated system planning involving both
mental health and substance abuse treatment agencies”
(Minkoff, 2001, p. 597).
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Overview

Overview
 National Perspective
 System Design
 System
Infrastructure
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System
System Infrastructure
Community Resources
Recovery Services
Clinical Core
Recovery Supports
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System Design
•
Values and principles
– Being family focused;
– Employing a broad definition of family;
– Being age appropriate;
– Reflecting the developmental stages of youth;
– Acknowledging the nonlinear nature of recovery;
– Promoting resilience;
– Being strengths based;
– Supporting youth empowerment; and,
– Identifying recovery capital.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System Design

Services and supports
 therapeutic/clinical
interventions.
 ongoing family involvement;
 linkage to services;
 range of services and supports addressing multiple
domains in a young person’s life;
 services that foster social connectedness; and,
 specialized recovery supports.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System Design

Infrastructure elements
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Policy change at the Federal, State, and provider levels;
Family involvement at the design/policy level;
Collaborative financing;
Collaboration and integration across all youth-serving systems;
Workforce development;
Leadership; and,
Accountability.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System Design

Outcomes

Youth
 Social connectedness;
 Reciprocity: increased capacity of youth to give back to the
community;
 Increased self-sufficiency; and,
 Increased number of developmentally appropriate assets.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System
System Infrastructure
Community Resources
Recovery Services
Clinical Core
Recovery Supports
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Elements Within Clinical Core
Single point of entry
 Screening
 Comprehensive Assessment
 Collaborative Youth/Family Recovery Plan
 Treatment
 Aftercare
 Continuing Care

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Evidence-based Practices
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Adolescent Portable Therapy (APT)
Family Integrated Transitions (FIT)
Brief Strategic Family Therapy
Adolescent Community Reinforcement Approach (A-CRA)
Chestnut Health Systems – Bloomington Adolescent Outpatient
(OP) and Intensive Outpatient (IOP) Treatment Model
Family Behavior Therapy
Family Support Network (FSN)
Integrated Co-Occurring Treatment Program (ICT)
Multidimensional Family Therapy (MDFT)
Multisystemic Therapy (MST) for Juvenile Offenders
The Seven Challenges
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Clinical Core

Providing therapeutic and clinical Interventions
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Crisis management stabilization
Emotion/anger management
Behavioral aides
Residential treatment
Inpatient treatment
Therapeutic foster care
Therapeutic group homes
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Most treatment programs are actually
a mix of components
Average of 5.6 components distinguishable
in program descriptions from research
reports
Community service
Tutoring
Individual counseling
Group counseling
Family counseling
Parent counseling
Recreation/sports
Interpersonal skills
Source: Adapted from Lipsey, 1997, 2005
Anger management
Mentoring
Cognitive behavioral
Behavior modification
Employment training
Vocational counseling
Life skills
Provider training
Casework
Multimodal/individual
Mediation
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Major Predictors of Bigger Effects

Chose a strong intervention protocol based on prior
evidence

Use quality assurance to ensure protocol

Assure adherence to project implementation
protocols

Used proactive case supervision of individuals

Used triage to focus on the highest severity
subgroups
Source: Adapted from Lipsey,
1997,2005
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Implementation

Implementation Matters
 The
best effects are from a strong program
implemented well.
 Pick the strongest intervention that can be
implemented well across the State.
 The effect of a weak program implemented
well is as big as a strong program
implemented poorly.
Source: Adapted from Lipsey, 1997,2005
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Environmental Factors
Environmental factors predict relapse
 The effects of adolescent treatment are
mediated by the extent to which they lead
to actual changes in the recovery
environment or peer group

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System
System Infrastructure
Community Resources
Recovery Services
Clinical Core
Recovery Supports
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports

Ensuring ongoing family involvement
 Family/parent
support
 Family/parent counseling
 Family team
 Family preservation
 Sibling services
 Family/marriage education
 Parent aides
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports

Providing linkage to services
 Continuing
care with contacts
 Case management; link to services/supports
 Multiagency teams
 Certified family navigator advocacy/support
groups
 Post-treatment monitoring
 Post-treatment support
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports
•Assuring that the range and supports address
multiple domains in a young person’s life
 Life skills training
 Vocational training and assistance
 Recreational opportunities
 Transitions planning
 Social support
 Housing assistance and services
 Leadership development
 Recovery high school/college
 Afterschool services
 Professionally supervised recovery dorm
 Funding for basic needs
 Comprehensive student assistance programs
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports
•Assuring that the range and supports address
multiple domains in a young person’s life (Cont’d.)

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Art-related activities and public arenas to highlight
Faith-based community support groups
Education and training
Skill Development
Substance Abuse Education
Supported Community Living
Independent living
Specialized educational services
Community service activities
Vocational training/career development/employment support
Jobs
Household management
Tutors
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports

Fostering Social Connectedness
 Mentors
 Aftercare groups
 Self-help support groups
 Opportunities for community
service Integration
 Secular organizations for sobriety
 Women in sobriety
 Service projects
 Living with others in recovery
 Volunteers
 Local recovery celebration events
 Mutual aid support groups
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports

Providing specialized recovery supports
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Internet-based support tools
Recovery coach/consultant
Recovery groups
Recovery checkups
Outreach
Recovery home
Telephone contact
Interactive voice response systems
Voucher-based incentives
Peer leader, guide, escort
Recovery support specialists
Sponsors
Job coach
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Recovery Services and Supports

Providing ancillary supports
 Legal
advocacy
 Transportation
 Childcare
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Reclaiming Futures

The model combines system reforms, treatment
improvement and community engagement.

In 2006 the 10 communities that piloted this model all
reported significant improvements in the quality of
juvenile justice and substance abuse treatment services,
(Urban Institute/University of Chicago’s Chapin Hall
Center for Children).
Source: Source: Model Policies for Juvenile Justice and Substance Abuse Treatment:
A Report by Reclaiming Futures; RWJ Foundation: July 2008;
http://www.rwjf.org/files/research/3426.33714.reclaimingfutures1.pdf
© Doreen A. Cavanaugh, Ph.D. April 22, 2010
Reclaiming Futures


A Six-Part Model:
1. Initial Screening
 Use of a validated screening tool

2. Initial Assessment
 The youth is fully assessed using a reputable, validated tool that
measures the degree to which the youth is negatively affected by
alcohol and other drugs.

3. Service Coordination
 Intervention plans for youth substance abuse problems are designed
and coordinated as a system of care, using community treatment teams
that are family driven, span agency boundaries, and draw upon
community-based resources. The service coordinator role is sanctioned
and supported by each agency partner and by all service providers
involved in the youth’s care.
Source: Model Policies for Juvenile Justice and Substance Abuse Treatment:
A Report by Reclaiming Futures; RWJ Foundation: July 2008;
http://www.rwjf.org/files/research/3426.33714.reclaimingfutures1.pdf
© Doreen A. Cavanaugh, Ph.D. April 22, 2010
Reclaiming Futures



4. Service Initiation
 Using the Washington Circle treatment standards as a guide, initiation in
the Reclaiming Futures model is defined as at least one service contact
within 14 days of a youth’s assessment.
5. Service Engagement
 Three successful service contacts within 30 days of a youth’s full
assessment. Engagement can be measured for each service
component or for all elements of the service plan taken as a whole.
6. Service Completion
 One of the principal goals of the Reclaiming Futures model is to
implement performance management practices that allow communities
to connect youth with appropriate resources and to monitor their
interactions through to completion.
Source: Model Policies for Juvenile Justice and Substance Abuse Treatment:
A Report by Reclaiming Futures; RWJ Foundation: July 2008;
http://www.rwjf.org/files/research/3426.33714.reclaimingfutures1.pdf
© Doreen A. Cavanaugh, Ph.D. April 22, 2010
Overview

Overview
 National
Perspective
 System Design
 System Infrastructure
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Youth Recovery System
System Infrastructure
Community Resources
Recovery Services
Clinical Core
Recovery Supports
© Doreen A. Cavanaugh, Ph.D.
4/22/10
System Infrastructure
Collaboration
 Workforce Development
 Dissemination of Evidence-based
Practices
 Family Involvement
 Financing

Financing a Recovery-oriented System
Maximizing Efficiency and Resources
Through Collaboration
Financing
Goal
 Resources
 What do we have to work with? Financial
mapping
 Funding an efficient and effective system
 Examples

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Goal

Developing efficient, effective continuum
of treatment and recovery supports for
youth with substance use / mental health
and co-occurring (SU/MH/CO) disorders
© Doreen A. Cavanaugh, Ph.D.
4/22/10
What needs to be done?

Link and coordinate with other service systems
(juvenile justice, substance use disorders,
mental health, Medicaid, child welfare,
education, housing, labor and health).

Promote comprehensive, integrated services for
youth with substance use/mental health and/or
co-occurring disorders.
Source: SAC NOFA
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Why are we doing this?

For adolescents and families:
 To
increase access to treatment for new
group of youth
 To expand capacity of existing services
 To develop new services that:
fill holes in the continuum of services
 augment/extend/wrap-around treatment

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Why are we doing this?

For providers:
 To
simplify the contracting process
 To improve budgeting/reporting
 To reduce paperwork/administrative staff time
 To increase focus
 To streamline accountability
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Why are we doing this?

For the State:
 To
improve the contracting/purchasing process
 To create efficiencies
 To maximize resources
 To reduce cost shifting and duplication or gaps in
services.
 To increase accountability
 To promote common outcomes
© Doreen A. Cavanaugh, Ph.D.
4/22/10
How do we do this?

Conduct a comprehensive scan of existing
resources and untapped and/or underutilized sources of funding for services.

Identify current spending and utilization
patterns across agencies.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
What will you gain?

Information that:

may be used to develop a clearly
articulated coordinated statewide plan for
financing treatment for adolescents with
SU/COD
 may inform the development or
improvement of a data system for
ongoing tracking of utilization and
expenditures for these services
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Federal Policy Domains
Child Welfare
Juvenile Justice
Medicaid
CHIP
MHBG
SABG
Education
Labor
Housing
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Resources

Insurance
 Private
 Public
Medicaid
 CHIP


Non-Insurance based public funding
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Types of Non-Insurance Based Federal
Funding Sources
Entitlements
 Block grants
 Categorical funding
 Discretionary grants
 Demonstration grants
 Research

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Medicaid Program

Provides medical care and substance
abuse / mental health care for eligible
individuals
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$319.6 B in FY 07
Source: Kaiser Family Foundation, Statehealthfacts.org
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Selected Medicaid
Mandatory and Optional Benefits

Mandatory
 Early
and Periodic Screening, Diagnosis and
Treatment

Optional
 The
Psych Under 21 Benefit
 Rehabilitation Option
 Targeted Case Management
 Prescription Drugs
 Other providers
 TEFRA Option
 Chafee Option
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Inmate of a Public Institution


Public institution is “an institution that is the responsibility
of a Governmental unit or over which a governmental
unit exercises administrative control.”
Inmate of a public institution is not a person living in:



Public educational or vocational training institution, or
Public institution for a temporary period pending other
arrangements appropriate to his needs.
A public institution is not:

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

A medical institution;
An intermediate care facility;
A publicly operated community residence that serves no more
than 16 residents; or
A child-care institution housing children receiving Title IV-E
foster care benefits.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Health
Medicaid: ($319.6 billion in FY 07)
 CHIP ($10.6 billion in FY 09)
 Substance Abuse Prevention and
Treatment Performance Partnership Block
Grant: ($1.8 billion in FY 09)
 Community Mental Health Services
Performance Partnership Block Grant:
($400 million in FY 09)

© Doreen A. Cavanaugh, Ph.D.
April 22, 2010
Substance Abuse / Mental Health

Custody Relinquishment Issues1
- Parents place child in CW/JJ to get needed substance abuse /
mental health services for several reasons:
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Health insurance limitations
Inadequate supply of services
Limited resources of mental health/substance abuse/education
Externalizing disorders issue
Different eligibility requirements across agencies
Avoid Dual Substance Abuse / Mental Health
Systems

In Health and Juvenile Justice
1
GAO “Federal Agencies Could Help Play a Stronger Role in Helping States Reduce
the Number of Children Placed Solely to Obtain Mental Health Services” GAO-03397
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Juvenile Justice
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Juvenile Accountability Block Grant: ($55 million in FY 10)
Edward Byrne Memorial Justice Assistance Formula Grant: ($546 million in
FY 09)
Edward Byrne Memorial Justice Assistance Grant: ($2 billion in FY 09)
Edward Byrne Discretionary Grant Program: ($178.5 million in FY 09)
Edward Byrne Competitive Grant Program: ($225 million in FY 09)
Title II (Part B) JJDP Formula Grants Program: ($75 million in FY 09)
OJJDP/CSAT Juvenile Drug Courts: (Anticipated funding: $8.8 million in FY
10)
Justice and Mental Health Collaboration Program: ($12 million in FY 10)
Operation Weed and Seed: ($20 million in FY 10)
Residential Substance Abuse Treatment for State Prisoners Program: ($30
million in FY 10)
Second Chance Act Youth Offender Reentry Initiative: ($15 million in FY
10*)
* Note: This sum includes funds appropriated for both adult and youth offender reentry ©initiatives.
Doreen A. Cavanaugh, Ph.D.
April 22, 2010
Child Welfare
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Title IV-B Subpart 1: Child Welfare Services ($281 Million in FY 09)
Title IV-B Subpart 2: Promoting Safe and Stable Families ($408
Million in FY 09)
Title IV-E: Foster Care and Adoption Assistance (Approximately
$6.68 Billion in FY 09)
Title IV-E: Foster Care and Adoption Assistance Additional funds
authorized by the 2009 American Recovery and Reinvestment Act
($187 Million in FY 09)
John H. Chafee Foster Care Independence Program ($140 Million in
FY 09)
Child Abuse Prevention and Treatment Act as amended by the
Keeping Children and Families Safe Act of 2003 (State Grants $26.5
Million in FY09)
Runaway and Homeless Youth Basic Center Program ($53.4 Million
in FY 09)
Title XX: Social Services Block Grant (Approximately $1.7 Billion in
FY 09)
Source: FY 09 Appropriations Bill, P.L. 111-8
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Socioeconomic Status

Temporary Assistance to Needy Families ($16.5
Billion in FY 09)

Temporary Assistance to Needy Families
Additional funds authorized by the 2009 American
Recovery and Reinvestment Act ($5 Billion
provision for 2009-2010)
Source: FY 09 Appropriations Bill, P.L. 111-8
http://www.acf.hhs.gov/opa/fact_sheets/tanf_factsheet.html
42 U.S.C. 604(d)(2)
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Education

Vocational Rehabilitation Grants to States ($2.9
Billion in FY 09)

Individuals with Disabilities Education Act ($12.3
Billion for State grants in FY 09)
Source: FY 09 Appropriations Bill, P.L. 111-8
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Housing

Community Development Block Grant ($3.64
Billion in FY 09)
Source: FY 09 Appropriations Bill, P.L. 111-8
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Labor

Workforce Investment Act Youth Activities ($924
Million in FY 09)

Job Corps ($1.6 Billion in FY 09)
Source: FY 09 Appropriations Bill, P.L. 111-8
Workforce Investment Act, P.L. 105-220
© Doreen A. Cavanaugh, Ph.D.
4/22/10
State Resources

State should identify all State resources that
are used for:

Federal match
 Support for SU/MH/CO services
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Financial Mapping

Identification of current spending and utilization patterns
across agencies

Realignment of funding streams and structures

Financing of appropriate services and supports

The results provide an x-ray of the system. Findings can
inform the development of a comprehensive financial
plan that will coordinate funds in the most efficient and
effective ways to assure the provision of a statewide
array of treatment and recovery supports.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
How is Financial Mapping done?

Define the population of interest



Best to include entire population of interest
May do for subset but may be difficult
Identify the Fiscal Year under study


State should select the most recent fiscal year for
which full, reconciled data are available.
The financial map may be updated to demonstrate
changes in funding arrangements.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
How is Financial Mapping done?

Identify potential funding sources




Treatment for adolescents with SU/MH/CO disorders may be
supported by a number of Federal, State and, in some cases,
County funding sources.
State should address core funding sources (Medicaid, CHIP,
SAPTPPBG and the CMHPPBG) first. If the use of these funds
differ by eligibility groups that should be noted.
State should then move on to examine funding sources that
may be used to provide treatment. Funding sources are
grouped by policy domain (health, juvenile justice, child
welfare, education, socio-economic status).
Funding sources that may be affected by changes should also
be included (adult corrections and adult treatment system)
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Adolescent* Substance Abuse Treatment Financial Mapping Guide
Health: Core Funding Sources
Adolescent Substance Abuse Treatment –
Federal FY 2006 (October 1, 2005 – September 30, 2006)
Substance Abuse Detox, Treatment Services and Supports Covered by Core Funding Sources (Please list all
amounts in $100,000’s)
Medicaid
SCHIP
SAPTPPBG
CMHSPPBG
Total Amount
Expended
By Service Type
Screening
Assessment and
diagnostic evaluation
Outpatient treatment
Intensive outpatient
treatment
Medication
Management
Home-based
services
Crisis services
Mobile crisis
response and
stabilization services
Therapeutic foster
care
© Doreen A. Cavanaugh, Ph.D.
4/22/10
How is Financial Mapping done?

Identify total expenditures by funding
source and service type


Identify the total amount of funds expended for
treatment and recovery supports of adolescents
with SU/MH/CO disorders by funding source.
For Medicaid and CHIP determine expenditures
using variables for diagnosis, service type and age
group in the Medicaid/CHIP claims data bases.

State may wish to break-out Medicaid
expenditures by mandatory/optional eligibility
categories and/or benefits.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
How is Financial Mapping done?
 For
other funding sources identifying
expenditures may be more challenging.
Some federal funding sources require reporting by
service and by age group. In those cases,
expenditures will be readily available.
 In cases where reporting this is not required State
may need to rely on back-up data or in some
cases approximate the amount spent for the
adolescent population.

© Doreen A. Cavanaugh, Ph.D.
4/22/10
How is Financial Mapping done?

Identify expenditures for workforce
development/training


Several funding sources allow funds to be used for improving
the SU/MH/CO treatment workforce.
Identify State/County funding sources



State must complete similar tables for State funding resources
and may map County funding.
This is essential to provide the complete picture of public
resources supporting the adolescent treatment system.
It is only when all major public funding sources are displayed
that the State will have a good idea of the extent of resources
directed to services.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Developing a Comprehensive Financial
Plan

Completing the financial map is not an end in itself but rather a
means to provide information to the development of a statewide
comprehensive plan for financing a broad array of treatment and
recovery supports for adolescents with substance abuse/mental
health and co-occurring disorders.

Completing the map will identify service gaps, inefficiencies,
overlaps, and opportunities for collaboration with Federal, State and
County partners.

State officials may identify underutilized Federal funds.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Developing a Comprehensive Financial
Plan

The Map may assist planners in identifying which
Federal, State and/or County funding resources might be
combined in coordinated, braided or blended funding
arrangements.

This information can then help State interagency
planners design a comprehensive continuum of
treatment services and recovery supports that will not
only address adolescent substance abuse and mental
health conditions separately but program for the
adolescents who have co-occurring substance
use/mental health disorders.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Financing Options
Coordinate
$
$
$
Braid
$
$
Blend
$
$
$
$
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Illinois Key Challenges







Differences in state department/legacy systems
Changes in state contracting methodology
Differences in data collection systems
Differences in payment/expenditure accounting systems
Competing priorities, SAPT priority populations,
categorical appropriation funding, planning initiatives
Implementation of outcome and evidence based
contracts
Key system changes for expenditures
Source: Illinois Financial Mapping presentation
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Source: Illinois Financial Mapping presentation
© Doreen A. Cavanaugh, Ph.D.
7/09
Source: Illinois Financial Mapping Presentation
© Doreen A. Cavanaugh, Ph. D.
7/09
Treatment/Support
SFY06 Expenditures
by Service Type
Toxicology
0.01%
Detoxification
0.19%
Psychiatric Evaluations
0.48%
Case Management
2.15%
Interface Case
Management
1.35%
Re-entry Case
Management
0.22%
Early Intervention
4.12%
Substance Exposed
Behavioral Health
Assessments
0.45%
Res Rehab-Young
Adult(18-21) Tagged as
Youth services
4.10%
Recovery Home
1.37%
Residential RehabYouth
70.47%
Halfway House
0.02%
Community Intervention
0.88%
Childcare Residential
0.39%
Outpatient
10.93%
Intensive Outpatient
1.54%
Source: Illinois Financial Mapping presentation
© Doreen
4/22/10
Criminal Justice
Ind/Group
A. Cavanaugh,
Ph.D.
1.33%
Coordinate Existing Resources

Issues
 Different (and sometimes conflicting):
 Laws
 Regulations
 Reporting requirements
 Mandated performance measures (CFSR, NOMS)
 Timeframes
 Criteria (ASAM, Medicaid, Risk etc.)

Change from “why” driven funding
 Algorithm
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Models
Wraparound Milwaukee
 Dawn Project

© Doreen A. Cavanaugh, Ph.D.
4/22/10
Wraparound Milwaukee

Wraparound Milwaukee
 Public
managed care entity.
 Primary focus is to serve children and
adolescents who have serious emotional
disorders and
 who are identified by the Child Welfare or
Juvenile Justice System as being at
immediate risk of residential or correctional
placement or psychiatric hospitalization.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Wraparound Milwaukee

Funding
- combination of several state and county agencies,
including:
 the Bureau of Milwaukee Child Welfare,
 the County's Delinquency and Court Services,
 Behavioral Health Division, and;
 the State Division of Heath Care Financing
(Medicaid)

Funds from the four agencies are pooled to create
maximum flexibility and a sufficient funding source to
meet the comprehensive needs of the families
served.
© Doreen
A. Cavanaugh, Ph.D.
4/22/10
Dawn Project

Dawn Project
 Developed
a state-level consortium of
agencies including education, child welfare,
juvenile justice and mental health and
substance abuse services to pool mental
health treatment dollars to serve seriously
emotionally disturbed children and
adolescents through a capitated care
management entity.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Dawn Project

Dawn Project: Key Results
 The
project was piloted in Marion County, Indiana
home to the state capital of Indianapolis.
 Assisted Dawn Project payers in avoiding more than
$2 million in placement costs.
 Documented decreases in length of stay in residential
care compared to the client's previous year.
 Moved clients to less restrictive levels of care without
compromising their care.
 Documented a reduction by 50 percent in the cost of
residential care.
© Doreen A. Cavanaugh, Ph.D.
4/22/10
Lessons Learned
Build up the entire recovery system for
youth with substance use/mental health
disorders.
 Do not develop separate but equal
systems.
 Do not allow the JJ system to become the
default recovery system.
