Design to Implementation: Delivering the New Children & Family Treatment Support Services
Objectives ‣ To provide an overview of the multi-level change that accompanies implementation of new services ‣ To describe the different roles and functions of providers involved in the oversight and delivery of Children & Family Treatment & Support Services ‣ To delineate the barriers to implementation ‣ To identify and understand the critical factors for implementation
Children’s System Transformation and Draft Timelines Six new State Plan services to be phased in over time with 3 ‣ new services available Jan 2019 Transition to Health Homes begins Jan 2019 ‣ Transition six children’s waivers to Managed Care: April 2019 ‣ Provide an aligned Home and Community Based Service (HCBS) ‣ array and phase in the expansion of children eligible for HCBS Aligned HCBS service array available: April 2019 ‣ 3 year phase in of Level of Care: Begins July 2019 ‣ Transition behavioral health benefits to Managed Care: July 2019 ‣ Transition foster care population to Managed Care: July 2019 ‣
Children & Family Treatment & Support Services State Plan Service Effective Date draft dates pending CMS approval State Plan services will Other Licensed January 1, 2019 Practitioner become part of Psychosocial January 1, 2019 the Managed Care Rehabilitation benefit on their Community Psychiatric Treatment January 1, 2019 implementation and Supports date Family Peer Support July, 1, 2019 Youth Peer Support and Training January 1, 2020 Crisis Intervention January 1, 2020 State Plan
Vision The development of the six new services are intended to: Better meet children’s needs ‣ Expand access to clinical ‣ treatment services Provide a greater array of ‣ approaches for rehabilitative interventions
Key Points • These services can be accessed individually or in a coordinated comprehensive manner when identified in the treatment plan. • Services provided to children and youth must include communication and coordination with the family, caregiver and/or legal guardians. • Coordination with other child-serving systems should occur to achieve the treatment goals. • In order to be eligible to provide Children and Family Treatment and Support Services, an organization must become a designated provider by submitting an application. • These practitioners must operate within a designated agency.
Important to Know Each new Children and Family Treatment and Support Service will have very distinct: • Agency Qualifications • Individual Staff Qualifications • Supervisory Qualifications • Required Trainings • Billing Requirements • Medical Necessity • Limitations and Exclusions
Shift Requires multi-level change: • Organizational Level • How the organization supports the delivery of these services • Provider Level • Willingness to deliver these services in community based environments • Ability to be adaptable to the family’s needs • Provider Relationships • Ability to partner with a variety of traditional and non traditional service providers in the community • Participant • Willingness to be open to receive services
SYNC Serving Youth IN their Communities Astor: Bronx, NY
SYNC Services Astor’s Tilden Day Treatment Program closed in August 2015 ‣ Tilden was serving 48 children ages 5-8 ‣ A Pilot of the new kids’ Children & Family Treatment & Support ‣ services was developed to provide community-based services to support the children impacted
Goals Test-drive the new kids’ Children & Family Treatment & Support ‣ services. Keep children with serious emotional and behavioral difficulties in ‣ their communities and out of restrictive settings. Collect outcome measures to analyze the effectiveness of services ‣ Identify implementation challenges. ‣ Reflect on lessons learned to potentially inform the statewide ‣ delivery of these new services.
Preparing for Implementation
Children & Family Treatment & Support Services SYNC identified they could provide the following services: ‣ Other Licensed Practitioner (OLP) • Community Psychiatric Supports & Treatment (CPST) • Psychosocial Rehabilitation Services (PSR) • Family Peer Support Services (FPSS) •
Population Target Population: Approximately 40-50 children being ‣ discharged from our day treatment Elementary & Middle School aged • Originally High Needs/High Risk • Previously enrolled in Day Treatment • Almost all Medicaid Eligible •
Expanded Population Added other populations: ‣ School Referrals • High Risk Clinic • Day Treatment Diversion • And later : ‣ School Based Behavioral Health & Training Program ◦
Staffing Model Other Licensed Practitioner (LCSW, LMSW, LMHC, LMFT)-2 ‣ Program Director • Supervisor • Behavioral Health Specialist (BHS)- 4 ‣ CPST • PSR • Family Peer Advocates (FPA)-2 ‣ FPSS •
Training ‣ Staff were trained in the following: Child and Adolescent Needs and Strengths (CANS-NY) • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) • Client Access to Lethal Means (CALM) Treatment Planning • Therapeutic Crisis Intervention (TCI) • Motivational Interviewing • Safety in the Community • Total training time averaged 15 hours Team meetings held frequently to discuss service provision, review data, and identify participant needs
Staffing Recruitment/Retention ‣ Required a significant amount of coordination with Human Resources to • find and hire qualified staff ◦ Screened for staff who had previous community-based experience and experience working with SED population ◦ Transferred qualified staff from our Transitions Program ◦ Sought internal recommendations for Family Peer Advocates Approximately 3 – 6 months to get staff fully trained in service provision • Services were provided during the training period • New staff shadowed experienced personnel to provide community- • based services
Communication Strategies Schools ‣ NYC DOE Superintendent of District 75 Schools • ✓ Described new SPA services ✓ Pilot in schools to support the discharged children Superintendent and Principals of 3 Schools with most children impacted • by Tilden closure Met with School Personnel at the 3 schools initially targeted •
Communication Strategies Engaging Youth & Families ‣ Contacted and informed caregivers • SYNC services described • ◦ Access ◦ Type ◦ Frequency ◦ Duration Determination by caregivers to participate • Re-assessed current level of need •
Delivering Services
Delivering Services Requires Flexibility in Hours ‣ To provide services at convenient times for caregivers • To provide services to child after school hours • To provide services during school recess • To provide services in other community settings •
Collaboration ‣ Outpatient Treatment Providers Clinicians (Social Workers; Psychologists; Mental Health Counselors) • Nurse Practitioners • Psychiatrists • Schools ‣ Teachers/Guidance Counselors • Teacher Assistants/Paraprofessionals • Committee on Special Education • ‣ Care Managers (excluding Waiver Service Providers) In-Patient Hospital Providers ‣ Summer Camps ‣ Afterschool Programs ‣ ‣
Service Provision Children Receiving Each Service 140 Children receiving each service: 120 OLP* – 132 ‣ 100 CPST-109 ‣ 80 PSR-106 ‣ 60 FPSS-109 ‣ 40 20 *Includes assessments when completed 0 OLP CPST PSR FPSS
Where Services are Provided LOCATION OPC On Site Other Home School Home On Site Off Site 12% 30% Other School 80% OPC 7% 43% 8%
Where Services are Provided Service Type by Location 100% 10% 13% 17% 90% 25% 14% 38% 80% 30% 23% 70% 60% 30% PSR 47% OLP 50% 24% FPSS 32% 40% 43% CPST 7% 24% 30% 20% 31% 30% 25% 10% 21% 18% 0% Schools Home Tilden SYNC Astor OPC Other Place of Service
Documentation Assessments ‣ Child and Adolescent Needs and Strengths (CANS-NY) • IOWA Conners • Parent/Teacher Questionnaire • Family Inventory of Resources & Stressors (FIRST) • Treatment Plan ‣ Progress Notes ‣
Treatment Plans Goals/Objectives developed by the OLP in collaboration with ‣ child, caregiver, school, and referral source Identification of specific CFTS services, including: ‣ Type of Service • Provider • Method (e.g. individual, group, family) • Frequency (e.g. daily, weekly, bi-weekly) • Location (e.g. home, school, community) • Identification of Collaterals •
Progress Notes Had to refine the fields in our Electronic Health Record (EHR) to ‣ include: Type of Service • Location of Contact • Length of Contact • Travel Time • Collaterals Present • Client Present •
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