VISION Every youth and family in Pennsylvania will be able to access - PowerPoint PPT Presentation

VISION Every youth and family in Pennsylvania will be able to access and navigate a unified network of effective services and supports that are structured in adherence to System of Care Values and Principles. MISSION The youth, family, and system leaders of Pennsylvania will work as equal and trusted partners for the purpose of creating sustainable change which will empower youth, families, and all youth serving systems to be responsible and accountable for outcomes that lead to the fulfillment of hopes and dreams. 2

 The current systems have a long tradition of serving youth, and are constantly trying to improve  They serve many youth and recipients of service generally rate them as being effective 3

 Each of the child serving systems struggle with youth who have complex problems and their families  The systems really experience problems when they have to work together 4

Detention/ RTF APS AAA Partial Probation Detox Mentor Court Services Truancy Psych Residential Special Ed Supports Counseling Referral Intake Referral Referral Therapist. Psychiatrist Eligibility Intake Ed. Sys JJ Case Mgmt. Sys t h D&A Sys Residential Case Mgmt. Referral TSS/BSC MH Sys MR Sys Intake Case Intake TSS/BSC Work CW Sys Partial Services MCO Sys Intake Inpatient Health Sys Mobile T Supports Foster Referral Referral Case Mgmt.. Care Intake Special Ed ER Hospital. Primary Care Care Mgmt. Intake 5

 3,500 in Residential Treatment Facilities  47,000 served by the Juvenile Justice system  40,000 in the Child Welfare system  28,000 in Foster Care  30,000 in Alternative Education  180,000 receiving Behavioral Health Services 6

 In 2009 – 2010, there were over 17,000 children in substitute care through the child welfare or juvenile justice systems, who received behavioral health services  Their behavioral health costs were more than double that of youth involved only in behavioral health services 7

$46,000 Average Annual Cost $9000 8

$15,000 Average Annual Cost $7000 9

 Pennsylvania is a Commonwealth of 67 counties  Understanding, accessing and obtaining services is difficult and confusing  Current services are based on diagnoses and problems rather than building on strengths and needs  Services are fragmented  Limited youth & family participation in many areas  All systems struggle to serve youth with complex behavioral health needs, multi-system involvement and their families 10

History of systems change initiatives:  CASSP principles (Mental Health)  High Fidelity Wraparound (Multi-system)  Family Group Decision Making (Child Welfare)  MacArthur Foundation (Juvenile Justice)  Positive Behavioral Supports (Education) 11

From To Fragmented service delivery Coordinated service delivery Categorical programs/funding Multidisciplinary Teams Reactive to crises Crisis prevention planning Focus on high use/restrictive Least restrictive settings Youth out-of-home Youth in families & communities Creation of “dependency” Empowerment/active participation Needs/deficits assessments Strength-based assessments Youth & Families as partners Youth & Families as problems Cultural/linguistic competence Cultural blindness Coordinated w/informal & natural supports Highly professionalized Individualized approach Youth/family must fit services Adapted from Pires, S. (2010). Building systems of care: A primer. 2nd Edition. Washington, D.C.: Human Service Collaborative 12

In 20 In 2007 07, , Of Office of fice of Menta Mental He l Health alth an and Substa d Substanc nce e Abuse Abuse S Ser ervices vices (OMHSAS) and the Children’s Adviso Advisory y Committe Committee e Kne Knew i w it t was as Ti Time f me for a T or a Tran ansf sfor orma mation. tion.  They selected the High Fidelity Wraparound model and created the Youth and Family Training Institute  We operationalize the System of Care philosophy at the individual family level using the High Fidelity Wraparound (HFW) process 13

Outcomes of High Fidelity Wraparound: (nine controlled, published studies to date; Bruns & Suter, 2010)  Better functioning and mental health outcomes for wraparound groups (NV, MD, NYS, elsewhere)  Reduced recidivism and better juvenile justice outcomes (Clark Co., Washington)  Higher rates and more rapid achievement of permanency when implemented in child welfare (Oklahoma)  Reduction in costs associated with residential placements (Milwaukee, LA County, Washington State, Kansas, many other jurisdictions) Source: Eric J. Bruns, Ph.D. presentation titled: Outcomes Based is the First Principle! What you need to know about research, outcomes, and wraparound 14

 The process is guided by 10 principles, follows four phases & their activities are based on the four components of the Theory of Change 15

 The Theory of Change suggests that if we focus on the youth and family priorities, integrate our efforts, and develop natural supports, it will improve self-efficacy  When youth and families begin to believe in themselves, and systems support their efforts, everyone works harder towards accomplishing their goals 16

For every 50 youth/families:  Four High Fidelity Wraparound Facilitators  Two Family Support Partners  Two Youth Support Partners  One Coach/Supervisor The Role of the Youth and Family Training Institute: To train, coach, and credential the High Fidelity Wraparound workforce as well as monitor fidelity and family outcomes related to the process model 17

System of Care is a philosophy made up of parameters and standards that provides an organizing framework for systems reform in partnership with youth and families. Adapted from Stroul, B. 2005. Georgetown University. Washington, D.C How do we bring this to life? 18

 Leadership/Governance  Family Driven  Youth Driven  System Integration  High Fidelity Wraparound for youth with complex mental health issues, multi-system involvement, and their families  Natural and community supports  Cultural and Linguistic Competence  Evaluation and CQI 19

 Establishment of a governance or leadership team composed of equal youth, family and system partners  Utilizing a single plan of care, systems communicate and coordinate service needs determined by youth and family led teams  Systems work to integrate their efforts using evidence based practices to reduce costs and eliminate ineffective and redundant services 20

 Challenges and barriers identified at the individual family level lead to policy and practice changes focused on improving long term outcomes  The leadership team and community enact processes, philosophies and programs that reflect the SOC principles in particular for the target population 21

 Systems of Care have been proven effective for youth with complex behavioral health challenges, multi- system involvement and their families  Youth experience improved outcomes in mental health symptoms and school performance, reduced involvement in child welfare and juvenile justice, and positive family functioning  And there are cost savings – with real, long term benefit as youth and families become more self-reliant 22

 Fewer days in inpatient care: $2,777 savings per child  Decreased utilization of inpatient care: 54% reduction in utilization  Mental health improvements sustained: 90% of children still stable after 18 months  Fewer suicide-related behaviors: 32% reduction in suicide-behavior 23

 Improved school achievement: 49 out of 113 sample had improved grades  Reduced Juvenile Justice Involvement: of 38 youth in Juvenile Justice, only two re-offended  Reduced Child Welfare Involvement: 50% of the 113 HFW graduates had Child Welfare involvement Of these: ~54% were discharged from CW by HFW graduation ~48% of discharges were considered successful 24

 More natural supports identified  Improved family relationships reported  Fewer paid services needed 25

 It is a huge challenge to change the cycle of failure and dependency for youth who have complex behavioral health challenges, multi- system involvement and their families  Working together in equal partnership will enable us to do what none of us could do alone – that’s why we need Systems of Care! 26

“The slowness of change is always respectable in the eyes of those who are in charge. It is a different story for those who are in pain.” Jonathan Kozol (1967), Death at an Early Age Rider, F. (2008), Involving Families, Inspiring Hope 27

 Subject matter experts: what really works?  Good business: strategic partnership  Youth and families as cultural guides  “In it for the long haul” - Continuous commitment to system improvement  Youth and families “keep it real” 28

 Established strong family voices to advocate, support & be involved in expanding SOCs  Established strong youth leaders/youth organizations Study on State Strategies for Expanding Systems of Care, Beth Stroul and Robert Friedman, March 2011 29