Integration of Schools and System of Care

IL Children’s Mental Health Partnership Conference

June 26 – 27, 2012

Brief History – Systems of Care

1969 – Joint Commission on Mental Health of Children – very few youth were receiving mental health services

1982 – Jane Knitzer’s Unclaimed Children - youth were receiving services in overly restrictive settings

1984 – Child and Adolescent Service System Program (CASSP) Model – first system of care

1986 – System of Care approach & framework put forth by Stroul & Friedman

1992 – Congress passed legislation for CCMHS – System of Care Grants

System of Care Communities of the Comprehensive Community Mental Health Services for Children and

Their Families Program

Funded Communities

Date Number1993–1994 221997–1998 231999–2000 222002–2004 292005–2006 302008 182009–2010 29

System of Care-Definition “Spectrum of effective, community-based

services and supports For children and youth with or at risk for mental

health or other challenges and their families Organized into a coordinated network Builds meaningful partnerships with families and

youth Addresses cultural and linguistic needs Function better at home, in school, in the

community and throughout life.” (SMHSA 2010)

Core Values

Family Driven and Youth Guided

The strengths and needs of the child and family determine the types and mix of services

Families have primary decision-making role in ALL aspects concerning the care of their children

Community BasedServices and supports are provided

within child and family’s community

Traditional as well as non-traditional

Informal service providers and supports are utilized

Culturally and Linguistically CompetentOrganizations and programs reflect the

cultural, racial, ethnic and linguistic differences of the populations they serve

Facilitates access to and utilization of services and supports

Eliminates disparities in care

Champaign County SOC

Juli Kartel & Jill Mathews-Johnson

Champaign County SOCACCESS Initiative

Mission Build a trauma and justice informed

SOC

Designed to create a healed community

Works to ensure that youth and their families are resilient, resourceful, responsible and restored

Target Population Youth 10-18 with social, emotional

and behavioral challenges

Who are disproportionately represented in the juvenile justice and child welfare systems

and/or by negative academic and health outcomes

SPARCSStructured Psychotherapy for Adolescents

Responding to Chronic Stress Evidenced informed intervention 16-one hour groups Adolescents 12-21 History of trauma (broadly defined) Living with ongoing stressors Exhibit functional impairment

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) National Child Traumatic Stress Network

www.NCTSN.org

Why SPARCS? Was chosen by a committee of parents,

youth and agency stakeholders Had demonstrated positive outcomes for

youth in foster care in Illinois Broad definition of trauma fit for our

community’s experiences Flexible model allowed for youth input Non-Master’s clinician can co-lead

Mental Health – School Collaboration

Multiple Pre-planning Meetings

Introduce SPARCS to administrative team Identification of appropriate studentsReferral processConsents/communication with parentsProtocols for student getting to/from groupProcedures for meeting w/ students

individually

Identifying Students with Needs

Data-based Decision Rules for Entrance At Centennial High School: students were

freshman or freshman status andThrough two tier two interventions and

have not respondedTransitioning back from Regional

Alternative SchoolHad multiple SASS contactsMet criteria for trauma experience per

TESI-SR (Traumatic Events Screening Inventory-Self Report)

Continued MeetingsMental health provider and PBIS T.A.

Coordinator

Strengthen integration into PBIS Framework Communication between school and

community provider Identification of school and mental health

outcomes Future planning for further tiered integration

(skills only group)

Outcome MeasuresSchool (need to include data that we have)

ODRs ISS/OSS Grades/Credits Attendance

Mental Health YOQ parent and youth Youth group survey results

SOC Evaluation TRAC Noms CANS TESI

Organizational StructuresFunding

SAMHSA SOC Cooperative Agreement

United Way of Champaign County

Medicaid billing (future)

Probation/Court Services (future)

Feedback from StaffMH Staff:Positives

Being part of Tier II team helpful

Having school staff facilitate arrival/departures from group very helpful

Having one dedicated administrator is essential to coordination

Improvements

ImprovementsProtocols for communicating with

mental health staff when crisis or disciplinary events occur

More time prior to group to get to know student and parent

Establish formal Collaborative Agreement

Feedback - Students

Student Survey Results1=strongly agree 2=disagree 3= don’t know 4=agree

5=strongly agree

Skills were helpful to me:a) Mindfulness: 3.8b) Self-sooth/distract: 4.4c) LET ‘M GO: 4.0d) MAKE A LINK: 4.2

Have used skills outsideof group 4.4

Best Part of Group

“It helped me to make better choices and not get into trouble”

“That you can talk about stress level and feelings”

“It allowed me to share”“It helped me to identify my sources of

anger”“I liked that it had structure, that we had a

lesson plan that we followed and I liked the handbook”

“Food”

Outcomes School Data – Office Discipline Referrals

Outcomes School Data In-School and Out-of-

School Suspension

Outcomes School Data – Tardiness and Absences

Outcomes School Data - Grades

Future Goals Identify incoming freshman – service Summer 2012 Potential for multiple groups next year at

Centennial; feeder middle school is also beginning 2012-2012SY

Refine data decisions for appropriate ID of students Provide further teacher/staff training in SPARCS skills

and develop plan for further integration of skills Utilize students to co-lead group Build stronger parent engagement Build sustainability plan Professional development plan for all staff

Systems Work Stakeholders

Collaborative Efforts Schedule meetings with stakeholders

Bi-monthly “Secondary Systems” meetings Monthly/Quarterly administrative meetings

Allows all stakeholders to have voice Keeps communication lines open

Establish procedures and protocols Create true partnerships

Stakeholders need to be seen as viable members in both settings (team membership, professional development)

Make interventions sustainable Funding Part of system of support

System of Care Framework, Philosophy

and OutcomesPresented by: Angie Hampton, CEO

In 2009, EHD received the SAMHSA Children’s Mental Health Initiative grant for 6 years to transform our local children’s mental health system of care.

Project Connect

System of Care

PROJECT CONNECT

Comprehensive services Broad array of services Individualized to each child and family Provided in the least restrictive

environment Coordinated at both the system and

service delivery levels Organized to include families and youth as

full partners Designed to emphasize early identification

and intervention

SOC Guiding Principles

The System of Care approach can provide both a conceptual framework and specific strategies for implementation of the ACA in ways that ensure that the behavioral health needs of children, adolescents, young adults, and their families will be effectively.

The System of Care approach has been the major framework for improving delivery systems, services, and outcomes for children with mental health needs for the past 25 years, shaping system reforms in many states.

SYSTEM OF CARE

Extensive research and evaluation have documented the effectiveness of this approach for improving the organization and delivery of children’s mental health services, and for improving clinical and functional outcomes for children and their families.

SYSTEM OF CARE

EHD is integrating services with a local FQHC. A Care Coordinator is being hired by EHD but

located in the FQHC. (co-location) Illinois DocAssist contract (behavioral health

consultation to primary care providers in Region V)

A Family Nurse Practitioner is on staff to provide Medical Home services to complex cases as well as provide behavioral health consultation services to primary care providers

Integrated Care

The health home concept is closely aligned with the system of care approach, sharing many of the same values and operational principles.

The major goal of the health home model is to provide more comprehensive, coordinated, and cost-effective care for individuals with disabilities than is generally provided when services are fragmented across multiple health providers and organizations. Designed to operate under a “whole-person approach”

Health Homes

System of Care approach can serve as a model for implementation of health homes- not only for children with behavioral health disorders, but for other health care populations as well.

Health Homes

Systems of care and health reform are both designed to: Increase access to health care services Increase the array of available services

and supports Improve the coordination of care Improve the quality and outcomes of care Improve the cost-effectiveness of services,

and Better invest resources.

System of Care=Health Reform

1. Systems of care have demonstrated that the availability of a broad range of treatment and support services for children’s behavioral health is effective in preventing more serious problems and mitigating overall health care system costs.

2. An individualized, wraparound approach to service planning and delivery has proven effective and ensures that children and their families receive optimal, appropriate, and cost-effective care.

Systems of Care=Health Reform

3. Care coordination and management at the individual and system levels have reduced fragmentation and resulted in better use of resources.

4. Systems of care have demonstrated that there are cost-reducing and cost-effective alternatives to serving children in hospitals, residential treatment centers, and other institutional settings.

Systems of Care=Health Reform

Youth in Transition to Adulthood Presented by:Liz Doyle, Clinical Director and Sharon Slover, Director of Education & Careers,McHenry County Family CARE System of Care Grant 2006 - 2012

U. S.: 3,000,000 transition youth have serious emotional disorders - APA Fact Sheet (2000)

Prevalence is greatest among 18 – 25 year olds (12%) of population

60% of TY with SED do not complete high school, 3 Xs greater risk for JJ involvement, & higher risk for substance abuse

Statement of the Problem

1,617,703 (age 16 – 24) (2010 census) 12 % with serious emotional dx =

194,124

ISBE Stats (2010): 58,544 with IEPs (age 16+);

101, 079 with IEPs (age 14+)

Transitional Youth in State of IL

10/2005 – Received SAMHSA System of Care cooperative agreement for 6 years

TY - one of 4 populations of focus McHenry County (2010): 33,779 TY (age

16 – 24); estimated 4,053 (12%) with SED Youth in Special Ed: 3,621 (age 12 –

21) Youth receiving MH services: 1,200

(age 16 – 24)

Identification of Transitional Youth in McHenry County

through Family CARE

TYWG and Youth Council

Development of Youth Voice

Choosing an EBP: Identification of Transition to Independence Process (TIP) Model by Youth and Parents

Using System Of Care Principles to Identify and

Meet Needs of TY

1. Engage young people

2. Tailor services and supports

3. Develop personal choice

4. Ensure a safety net of support

5. Enhance young persons’ competencies  

6. Maintain an outcome focus

7. Involve young people, parents, and other community partners

TIP Process

Youth Needs: Life Skills and Education Training Needs in EBP

Adolescent & Adult; School and MH Shared training – use of same language

Lack of Coordination Lack of Specialized Programming

Needs of Transitional Youth

Youth-Guided Process Home-Based Case Management Program Strengths-based and futures planning Fidelity to the TIP Process Specialized Programming for TY Development of Formal and Informal

Supports

Transition to Adulthood Program (TAP)

Implemented 1/2012 First provider: SEDOM (Special Education

District of McHenry County) via school contract with MHB

TAP Clinical Panel meets every 2 weeks to review referrals, provide case consultation, and ensure data collection for CQI

Referral Process

Family Care Transitions to TAP

Current Census: 11 clients 4 females; 7 males Age range: 1 (16-17); 10 (18 and older) Ethnicity: 9 White, 1 African American, 1

Bi-racial Referred by: 5 - Schools; 4 - Mental Health

1 - JJ; 1 – Self Referrals Living Arrangement: 2 - Independent

Youth 6 - Two Parent Family 3 - Single Parent Family

TAP Program

Concerns Clarifications

Questions

Angie Hampton: CEO – Egyptian Public and Mental Health Department - ahampton@egyptian.org

Jill Mathews-Johnson: MSW, Technical Assistance Coordinator – PBIS Network

Juli Kartel: LCPC, Director of Youth and Family Services - Community Elements - jkartel@communityelemnts.org

Liz Doyle: LCPC, Clinical Director -McHenry County Mental Health Board, ldoyle@mc708.org

Sharon Slover, Director of Education & Careers, Special Education District of McHenry County (SEDOM), sslover@sedom.org

McHenry County Family CARE: 815-788-4360 Liz Doyle, Clinical Director, ldoyle@mc708.org Sharon Slover, Director of Education & Careers, Special Education District of McHenry

County (SEDOM

Contact Information