Department of Mental Health Child, Adolescent and Family Mental - PowerPoint PPT Presentation

Department of Mental Health Child, Adolescent and Family Mental Health and System of Care Melissa Bailey, Commissioner

The most vivid truth of this new age is that no single profession can take the full burden for resolving the complex problems facing children and no single profession can deal with these problems alone--they are interlocked. ~National Commission on Leadership in Interprofessional Education, April 15, 2004 Meeting in Washington, DC

3 • Child-Centered, Family-Focused • Collaboration Between and Among Families, Agencies and Community • Individualized Values for • Family-Driven Vermont’s System • Strength-Based of Care • Culturally Competent • Community-Based

Even though we seek to function as a holistic system of care for children, youth and families, each agency/department has its own mandates, rules and regulations System of Care in that have to be followed; and that is often the Real World where challenges arise. 4

Passed in 1988 and mandates that mental health, education and child welfare work together on behalf of children and adolescents through individual plans for youth in need, as well as interagency Act 264 - planning, budgeting and service development. Coordinated Act 264 created:  An interagency definition of severe emotional disturbance. Service  A coordinated services plan. Planning a –  One Local Interagency Team (LIT) in each of the State's twelve and the Agency of Human Services' districts. Interagency  Created a State Interagency Team (SIT).  Created a governor appointed advisory board. Agreement  Maximizes parent involvement.

6 What is Act 264? Act 264 was 1.Created an interagency definition of severe emotional disturbance. established 2.Created a Coordinated Services Plan. 3.Created one Local Interagency Team (LIT) in each of the State's twelve in 1988 and Agency of Human Services' districts. did the 4.Created a State Interagency Team (SIT). 5.Created a governor appointed advisory board. following: 6.Prioritized parent involvement.

7 • Decision making and service delivery is more coordinated and involves parent voice at all levels • Increased federal, state, and foundation funds for services, coordination, and training • More children, youth and families have been identified and served Progress made since Act 264 • Greater variety and flexibility of supports and services went into effect available • Increased interagency collaboration within System of Care at local and state levels Created ability to think and act like a system: common purpose, reasons to act together as allies; develop strategies for continuous quality improvement

 Collaboration between AHS and AOE to expand the Act 264 process to all children with a disability under IDEA AOE/AHS Interagency  Also expanded expectation to move to prevention and early Agreement intervention with use of the Coordinated Service Plan (June 2005)  Delineates the provision and funding of services required by federal or state law or assigned by state policy  Agreement covers coordination of services, agency financial responsibility, conditions and terms of reimbursement, and resolution of interagency disputes

 Students who are eligible for both special education and services provided by AHS or its contracted providers are eligible for coordination of services  Ensures all required services are coordinated and provided to AOE/AHS students with disabilities, in accordance with applicable state and Interagency federal laws and policies Agreement (June 2005)  It is intended that the agreement will provide guidance to human services staff and school personnel in the coordination and provision of services for students with disabilities

"There is no health without mental health." 10

Overall Operations supported by ~65 positions  Administrative Support Unit  Financial Services Unit  Legal Services Unit  Research & Statistics Unit Central Office  Clinical Care Management Unit Organization  Operations, Policy, & Planning Unit  Quality Management Unit  Children, Adolescent and Family Unit (CAFU)  Adult Mental Health Services Unit "There is no health without mental health."

 Budget $230 M  Oversees 10 Designated Agencies and 2 Specialized Service Agencies through quality review, designation and collaboration  35,000+ people served through the DA/SSA system with even more served by Emergency Services and Crisis Teams Overview of  Vermont Psychiatric Care Hospital and Middlesex Therapeutic Care Department Residence (25 and 7 beds)  600 Behavioral Interventionist and 200 School Based Clinicians in and partnership with local schools Responsibilities  265 staff, 200 at the facilities, 65 at Central Office  Several contracts such as with forensic psychiatrist, psychiatric consultation with primary care, child and adolescent psychiatric fellowship at UVM  Partners with sister departments, hospitals, other community providers, One Care, police departments, courts etc …

Specialized Services Agencies Designated Agencies (DAs) (SSAs)  A distinctive approach to service delivery and coordination or services to meet distinctive individual needs  Required to provide services DAs and SSAs to specified populations in an  Services are not available assigned geographic location from a DA in the manner required by a Dept.  Required to meet the full requirements of the  Can be local, regional, or administrative rule statewide  Certain requirements can be waived

NCSS 2 NKHS LCC 6 4 HC 3 WCMH 10 CSAC CMC 1 7 RMHS 8 HCRS UCS 5 9

 Number Served and by age breakdown  10,661 (81% Medicaid; 14% other insurance) Department Ages Served by % Of Mental 45% 40% Health-Child, 40% 36% 35% Adolescent 30% and Family 25% Services – 20% 20% FY16 15% 10% 5% 3% 0% 0 y.o - 6 y.o 7 y.o -12 y.o 13 y.o - 19 y.o 20 y.o - 34 y.o

Early Childhood and Family Mental Health Services 0-8 from 1999-2017 3500 3400 3400 3230 3300 3214 3185 3200 3079 3100 2931 3000 2899 Early 2839 2900 2734 2800 2575 2593 2644 2700 Childhood and 2600 2496 2500 2409 2400 Family Mental 2300 2206 2200 2100 1917 1958 2007 Health 2000 1900 1800 1708 1700 1600 1500 1400 1300 1200 1100 1000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Why DoACE S Matter?  If early childhood experiences are a link to health outcomes in adulthood, then shifting our focus to Adverse Family Experiences (AFEs) of children gives us the opportunity to intervene early, before poor health outcomes play out 1 type of experience = 1 ACE or AFE 17

33 % of Vermonters 25 18-44 with 19 0-4+ Adverse Childhood 13 11 Experiences 0 ACEs 1 ACE 2 ACEs 3 ACEs 4+ ACEs

53 % of Vermonters Younger than 18 with 0-4+ Adverse 24 Family Experiences 10 8 5 0 AFEs 1 AFE 2 AFEs 3 AFEs 4+ AFEs

% of the 4 25 24 Most Common AFEs (plus 15 residential 12 11 mobility) Among VT Children Family Income Divorced / Alcohol / Drug Severe Residential Hardship Separated Problems Depression / Mobility Parents Mental Illness / Suicide

"There is no health without mental health." 21

Intensive  Brattleboro Retreat Inpatient – 30 Beds Interventions Children and Adolescent Inpatient 450 400 388 381 350 342 333 300 300 271 281 250 200 150 100 50 49 60 47 54 49 44 33 0 FY11 FY12 FY13 FY14 FY15 FY16 FY17 Invol Vol Analysis is based on the youth inpatient tracking spreadsheet maintained by the Department of Vermont Health Access (DVHA). DVHA only tracks admissions with primary Medicaid. Includes youth who had an involuntary or voluntary legal status at admission

Number of Youth Waiting for Placement for Emergency Examination and Voluntary 25 FY2017 20 Number of Youth Waiting Emergency 15 Department 10 Wait Times 5 0 Jul 16 Aug 16 Sep 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 EE Total N Voluntary Total N

 NFI - 12 Hospital Diversion Beds (6 north/6 south)  Howard Center – 6 Crisis Stabilization Beds Medicaid Paid Voluntary Number of Admissions per 1,000 Age-Specific Population 10 9 Northern Southern Intensive 8 7 Interventions 6 Rate 5 4 3 2 1 0 2011 2012 2013 2014 2015 2016 2017 Fiscal Year Analysis is based on the youth inpatient tracking spreadsheet maintained by the Department of Vermont Health Access (DVHA). DVHA only tracks admissions with primary Medicaid. Includes youth who had a voluntary legal status at admission. The designated agency represents the home agency of the child, not necessarily the screening agency. The Northern Region includes: CSAC, HC, LCMH, NCSS, NKHS, and WCMH. The Southern Region includes: CMC, HCRS, RMHS, and UCS.

100 Intensive DMH PNMI Placements In-State and Out-of-State 90 89 Interventions 6/30/16 80 75 75 70 68 66 66 64 63 62 62 61 60 60 59 59 59  Residential 56 54 54 52 52 50 49 41 40 Total # Placements 30 30 23 21 20 14 Total # In-State 10 Placements 7 6 6 5 4 4 4 0 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 Total # Out-of-State Placements

"There is no health without mental health." 26