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Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth Through Systems of Care. Introductory Remarks Simon Gonsoulin Director, NDTAC. About NDTAC. Neglected-Delinquent TA Center (NDTAC) - PowerPoint PPT Presentation
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Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth
Through Systems of Care
Introductory Remarks Simon GonsoulinDirector, NDTAC
3
About NDTAC
Neglected-Delinquent TA Center (NDTAC)
Contract between U.S. Department of Education and the American Institutes for Research John McLaughlin,
Federal Coordinator, Title I, Part D Neglected, Delinquent, or At Risk Program
NDTAC’s Mission: Develop a uniform evaluation model
Provide technical assistance
Serve as a facilitator between different organizations, agencies, and interest groups
4
Agenda and Presenters
I. Sharon Hunt, Deputy Director of Operations, Technical Assistance Partnership for Child and Family Mental Health
II. Liz Doyle, Clinical Director, McHenry County Mental Health Board
III. Sharon Hunt
IV. Question and Answer Session
Addressing the Mental Health and Substance Abuse Needs of Juvenile
Justice Involved Youth Through Systems of Care
Sharon Hunt Deputy Director of
Operations, Technical Assistance Partnership for Child and Family Mental
Health
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life.
Gary Blau, Child, Adolescent and Family Branch, CMHS, SAMHSA
• An estimated 4.5 to 6.3 million children and youth in the US face mental health challenges.
• National survey findings show that 11.5% of youth aged 12-17 received mental health services in an educational setting.
• National survey findings show that 5.4 percent of adolescents had past year dependence on or abuse of alcohol and 4.3 percent past year dependence on or abuse of illicit drugs.
SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.
SAMHSA (2007) National Survey on Drug Use and Health.
• Family driven and youth guided • Home and community based• Strength based and individualized • Culturally and linguistically competent• Integrated across systems• Connected to natural helping networks• Data driven, outcomes oriented
Adapted from Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. Reprinted by permission.
Families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation.
• Choosing supports, services, and providers
• Setting goals
• Designing and implementing programs
• Monitoring outcomes
• Determining the effectiveness of all efforts to promote the mental health and well being of children and youth
Youth guided means that young people have the right to be empowered, educated, and given a decision-making role in the care of their own lives as well as the policies and procedures governing care for all youth in the community, state, and nation. This includes giving young people a sustainable voice and the focus should be towards creating a safe environment enabling a young person to gain self sustainability in accordance to the cultures and beliefs they
abide by. Further, through the eyes of a youth-guided approach we are aware that there is a continuum of power and choice that young people should havebased on their understanding and maturity in this strength based change process. Youth guided alsomeans that this process should be fun and worthwhile.
• Reduce disparities and enhance cultural and linguistic competence among policy makers, administrators and service providers.
• Enhance organizational capacity for cultural and linguistic competence.
• Increase awareness and knowledge of factors that contribute to disparities.
• Develop specific approaches that contribute to the goal of eliminating disparities.
FROM TOFragmented service delivery Coordinated service delivery
Categorical programs/funding Blended resources
Limited services Comprehensive service array
Reactive, crisis-oriented Focus on prevention/early intervention
Focus on “deep end,” restrictive Least restrictive settings
Children/youth out-of-home Children/youth within families
Centralized authority Community-based ownership
Creation of “dependency Creation of “self-help”
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
• Sixty to eighty percent of youth entering substance abuse treatment have co-occurring disorders (substance abuse and mental health)
• Untreated mental health and/or substance abuse issues may create the following problems for youth:o Increase in criminal behavioro Decrease in school attendanceo Increase in mental health and substance abuse symptoms
50%
42%
35%
24%
14%
63%
45%
31%
22%
9%
66%
0%
10
%
20
%
30
%
40
%
50
%
60
%
70
%
80
%
90
%
10
0%
Any Co- occurring Psychiatric
Conduct Disorder
Attention Deficit/ Hyperactivity Disorder
Major Depressive Disorder
Traumatic Stress Disorder
General Anxiety Disorder
Ever Physical, Sexual or Emotional Victimization
High severity victimization (GVS>3)
Ever Homeless or Runaway
Any homicidal/ suicidal thoughts past year
Any Self Mutilation
17 Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)
Age 12-17
Source: NSDUH 2006
37% Sustained Problems
5% Sustained Recovery
19% Intermittent, currently in
recovery
39% Intermittent, currently not in
recovery
The Majority of Adolescents Cycle in and out of Recovery
Source: Dennis et al, forthcoming
29%
52%
61%
17%
67%
79%
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Reg
ular
alc
ohol
use In home
among work/school peers
among social peers
Reg
ular
dru
g us
e In home
among work/school peers
among social peers
Source: CSAT AT Common GAIN Data set
An Integrated Co-occurring Treatment Model in a System of Care
Liz DoyleMcHenry County Family CARENDTAC Webinar December 14, 2009
History of Family Child and Adolescent Recovery Experience (CARE) Integrated Co-occurring Treatment (ICT) Program
Substance Abuse and Mental Health Services Administration (SAMHSA) System of Care grant awarded in October 2005
Targeted population: Youth with co-occurring mental health & substance abuse disorders (one of four populations targeted by Family CARE)
Family and youth involvement - exposed to Integrated Co-Occurring Treatment (ICT) Model at SAMHSA Conferences
SAMHSA planning grant awarded in October 2007 Established a collaborative community group Partners: Court Services, Law Enforcement, Psychiatric Inpatient, Mental Health
Agencies, Crisis Program, Special Education Reviewed different models of treatment
ICT Model Selected – June, 2008 Training started - July 2008 Goals for ICT Program:
Specialized treatment for mental health & substance abuse Treatment option for youth being served by Screening, Assessment and
Support Services Program Prevent youth from entering the juvenile justice system; reduce arrests Reduce hospitalizations and at-risk behaviors
Definition of ICT Integrated Co-occurring Treatment (ICT)
Program is an Evidence-Informed home-based 24/7 treatment model developed to address the specific issues of youth with both mental health and substance abuse issues.
Major Goals: Prevent JJ contacts, decrease
substance abuse, and increase positive school, home and community interactions.
Components of Family CARE ICT Program
Development of ICT Screening Committee Subset of the Planning Committee Members –
Weekly meetings to review admissions and discharges and program challenges; responsible for evaluation.
Screening Committee meetings began in September, 2008
ICT Team 3 ICT Therapists; 2 (.25) ICT Supervisors (1 Mental
Health and 1 Substance Abuse)
Participants September 2008 to March 2009 18 youth were enrolled Gender:
56% Male 44% Female
Ages: 11% were 12 years old 44% were 15 years old 44% were 16 years old
Ethnicity: 72% White 28% Hispanic
Discharge Data
Average length of participation in program: 185 days
Number of discharges in first year: 18 15 (83%) successful discharges 3 (17%) unsuccessful discharges
Positive Outcomes
End of First Year: 67% decreased their substance use from
intake to discharge 67% had more positive interactions in their
home/family 28% had more positive interactions in the
community 17% made positive changes in peers 55% had more positive interactions in school
Lessons Learned
Older youth with more chronic substance abuse
Youth involved with gangs Engagement of Schools
Did not understand the Reduction Theory of the ICT Model – wanted total abstinence
Buy-in of psychiatrists
Future Directions
Treating 45 - 60 adolescents in the ICT program per year
Sustaining 4 full-time therapists Recruiting a Spanish speaking ICT
therapist Soliciting more community referrals Collecting data and evaluating
outcomes
On the Horizon Further developing:
Family Resource Developers IFF (Illinois Federation of Families) Parent
Group Peer Leadership Support Group Peer to Peer Mentoring
Financing/Sustainability Plan
Blended Funding State Authorized Funding for SASS
Program participants Medicaid Clients/IL Rule 132 Private Insurance (if available) Non Medicaid Billable Services (IL
Department of Human Services) Local Tax Dollars
Contact Information
Liz Doyle, LCPCClinical DirectorMcHenry County Family CARECrystal Lake, IL (45 miles northwest of Chicago)Telephone: 815-788-4360Email: [email protected]
Systems of Care
Recovery
Transformation
Resilience
What is involved?• Rethinking traditional
approaches
• Strengths-based
• Family driven & youth guided
• Embracing culture
Who is involved?• Youth
• Adults
• Families
• Providers
• Communities
Fulfilling Potential
• Only 8% of youth in SOC for 12 months had repeated a grade, compared to 15% in the general public
• Youth receiving passing grades (C or better) increased from 55% upon entry into services to 66% after 12 months of services
• Within one year of entering SOC services, the percentage of youth attending school regularly increased from 75% to 81%
SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.
After receiving SOC services for 12 months:• There was a 22% reduction in the percentage of youth who changed
schools due to emotional and behavioral reasons• Expulsions from school decreased by 2/3 (from 15% at intake to
5%)• Sixteen percent of youth reported significant lower levels of
depression and 21% reported significant lower levels of anxiety than when they entered services
• Five percent of youth had reported suicide attempts (62% reduction after starting services)
US Department of Health and Human Services (www.samhsa.gov)
SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.
System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their
Families ProgramCurrently Funded Communities
Funded Communities
2004 292005–2006 302008 182009 20
Date Number
Albany County,
NY
New London County, CT
Northern Kentucky
Montana &
Crow Nation
Los Angeles County, CA
Butte County, CAPlacer County,
CA
Blackfeet Tribe, MT
Wyoming
(statewide)
Minnesota(4
counties)
Kalamazoo County,
MI
InghamCounty,
MI
Beaver County, PA
Allegheny County 2, PA
Monroe County, NY
Mississippi
River Delta
area, AR
HarrisCounty,
TX
Honolulu, HI
MauryCounty,
TN
Mecklenburg County, NC
SarasotaCounty,
FL
Rhode Island 3 (statewide)
Worcester County, MA
Maine (3 counties)
Erie County, NY
Seven Generations System
of Care, CA
Pascua Yaqui
Tribe, AZ
St. Joseph, MO
Minnesota(6
counties)
Yankton Sioux
Tribe, SDMcHenry
County, IL
Iowa(10
counties)
Mississippi(3 counties)
Multnomah County, OR
Northwest Georgia
Delaware 2 (statewide)
Nassau County, NY
OrangeCounty,
NY
ShelbyCounty,
TN
Texas(11
counties) Texas(5
counties)
Northwest Portland Area Indian Health
Board
Yakima County, WA
Alamance County,
NC
Southeastern
Indiana
Oklahoma
(statewide)
Baltimore City, MD
Chautauqua
County, NY
Lummi Nation
Creek Nation
Kentucky(statewid
e)
Vermont 3 (statewide)
Hawaiʽi (3 communities)
Alabama(3
counties)
Knox County, TN
Illinois(3
counties)
Champaign County,
IL
KentCounty,
MI
Alameda County, CA
Madison County, ID
Orange County, FL
Miami-Dade
County, FL
Maryland (9 counties)
New Mexico (3 areas)
Onondaga County, NY
Pennsylvania (15
counties)
San Francisco, CA
Guam
Mississippi
(statewide)
Boston, MA
Clermont County, OH
Hamilton County, OH
System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their
Families ProgramGraduated Communities
Funded Communities
1993–1994 221997–1998 231999–2000 222002–2003 25
Date Number
East Baltimore, MD
Passamaquoddy Tribe, ME
Delaware 1 (statewide)
Worcester, MA
Westchester County, NY
Bismarck, Fargo, &
Minot, ND
Northern Arapaho
Tribe, WY
Wisconsin(6
counties)
Sacred Child Project, ND
Willmar, MN
Nebraska(22
counties)
Birmingham,AL
Hillsborough
County, FL West Palm
Beach, FL
ClarkCounty,
NVNavajo Nation
Las Cruces, NM
King County, WA
Clark County, WA
Clackamas County, OR
Lane County, OR
Wai'anae &
Leeward, HI
Napa & Sonoma Counties, CA
California 5 (Riverside, San Mateo,
Santa Cruz, Solano, & Ventura Counties)
Santa Barbara County, CA
Sedgwick
County, KS
Southeastern Kansas
San Diego County, CA
Eastern Kentucky
St. CharlesCounty,
MO
RuralFrontier,
UT
TravisCounty,
TX
Sault Ste. Marie Tribe,
MI
Detroit,MI
Allegheny County 1, PA
Southern Consortium
& Stark County, OH
Pima County, AZ
Yukon Kuskokwim
Delta Region, AK
Contra Costa County, CA
United Indian Health Service, CA
Denver area, CO
Gwinnett &
Rockdale Counties,
GA
Lake County, IN
Nashville, TN
Guam
Puerto Rico
Fairbanks Native
Association, AK
ChoctawNation,
OK
Southwest
Missouri
Southeastern
Louisiana
Colorado (4 counties)
El Paso County, TX
Oklahoma(5
counties)
Ft. Worth, TX
San Francisco, CA
Sacramento County, CA
Glenn County, CA
Idaho
Urban Trails,
Oakland, CAMonterey,
CA
Mid-ColumbiaRegion
(4 counties), OR
Broward County, FL
Lyons, Riverside,
& Proviso, IL
Chicago, IL
Cuyahoga
County, OH
Charleston, WV
Greenwood, SC
North Carolina (11 counties)
Burlington County, NJ
New Hampshire (3 regions)
Montgomery County, MD
Vermont 2 (statewide)
Rhode Island 2 (statewide)
North Carolina (11 counties)
Maine (4 counties)Vermont 1
(statewide)
Edgecombe, Nash, & Pitt Counties, NC
Alexandria,VA
Rhode Island 1 (statewide)
Charleston, SC
South Philadelphia, PA
Mott Haven, NY
South Carolina (3 counties & Catawba Nation)
Washington, DC
Bridgeport, CT
New York, NY
Lancaster
County, NE St.
Louis,MO
MarionCounty,
IN
OglallaSiouxTribe,
SD Milwaukee, WI
HindsCounty,
MS
• Go to TA Partnership website (www.tapartnership.org) or SAMHSA’s website to see list of SOC grantees (http://mentalhealth.samhsa.gov/cmhs/childrenscampaign/grantcomm.asp)
• Contact your state children’s mental health director to get contact for the SOC.
• Contact the project director at the SOC to discuss ways to collaborate.
• Bring your resources to the table.
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Youth Involvement in Systems of Care http://www.tapartnership.org/docs/Youth_Involvement.pdf
Technical Assistance Partnership for Child and Family Mental Health website: www.tapartnership.org