New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Workgroup Participants:

New Jersey Department of Children and FamiliesDivision of Child Behavioral Health Services

Meeting Students’ Behavioral Health Needs

Workgroup Participants:Wyndee DavisAntoinette GurdenDeb KennedyDeborah MageeHarry MarmorsteinDr. Nadezhda Robinson

Presentation by Antoinette Gurden

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New Jersey Department of Children and Families ▪ Division of Child Behavioral Health Services


Department of Children and Families

Table of Organization

(Three Major Divisions)

DCF

Division of Child Behavioral

Health Services

Division of Youth and

Family Services

Division of Prevention and

Community Partnerships

DCBHS Overview

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At Home

In School

Out of Trouble

(with their families and not in out-of-home treatment settings)

(in district)

(not involved with the Juvenile Justice Systemand at risk of detention or incarceration)

System of Care Guiding Principles

DCBHS Overview

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Division of Child Behavioral Health Services

Contracted Entities

Contracted Systems

Administrator Training and

Technical Assistance

Care Management

Agency

Family Support

OrganizationMobile

Response & Stabilization

Services

Youth Case Management

DCBHS Overview

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New Jersey Division of Child Behavioral Health Report reflects data as of 9/22/08

Services (DCBHS) Summary Report Excerpts Quarterly Report

Statewide (See Report NJ0184.3):

•The total number of children enrolled is 38,731.

•The total number of children who are active in a CMO is 3,067.

•The total number of children who are active in a YCM is 4,177.

•The total number of children who are active in MRSS is 851.

•The average number of families actively receiving peer support from an FSO is 1,182.

•The largest age group served by the DCBHS is children ages 14 through 17.

This age group comprises 45% of all children served.

•There are 41% females, 59% males served by the DCBHS.

DCBHS Overview

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Utilization Management

AssessmentServices

Outpatient Services

IIC Services

MRSS Services

Case Management Services

Out of Home Treatment Services

Acute Care Services

Assessment Services

Outpatient and Addictions Treatment(Not yet integrated into the DCBHS System of Care)

Intensive In-Community & Behavioral Assistance Services

Mobile Response & Stabilization Services

Inpatient Treatment

Intensive Residential Treatment

Out of Home Treatment

Case Management Services

Access and Utilization Management (CSA)

DCBHS Overview

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Youth presents with behavior

Current System of Screening Students

Youth screened at Psychiatric Emergency Service (PES)

PES are not kid-friendly

Current screening laws designed for adults

Medical model is not useful for most youth

Designed to determine if youth meets admission standard rather than what services youth may need


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Benefits:

Drawbacks:



threats

danger to self

danger to others

Benefits:

Drawbacks:

Screened for safety

Referral to services

Long wait

Inappropriate environment

High cost

Intense reaction to situation

Screened for safety

Referral to services

Lost time in school

Screened long after event

Punishes youth for BH issues

Youth screened immediately at PES

Youth suspended until screened at

PES

Changes youth’s school experience

Undue burden on family Undue burden on family


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threats

danger to self

danger to others


mood change

change in functioning

There is currently no standard response for youth who exhibit:

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Proposed Model to Screen Youth in Schools


threat to self or others

mood change

change in functioning

Response determined by age and risk factors

Regardless of age, youth at high risk for

harming self or others referred to PES

Proposed Model to Screen Students

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Step 1

Identify Concern

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and

Scenario AYouth needs immediate attention

and/or

suggest that youth may be at risk of significant emotional distress or of causing harm to self or others

Youth’s behavior within the last 5 or fewer days

Youth’s disclosure of information

the disruption in youth’s behavior impedes youth’s ability to learn and affect youth’s relationships with peers and/or staff

Step 1: Identify Concern

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Risk factors are perceived within the context of the youth’s individual cognitive and

intellectual capacity


Youth has a viable plan to carry out

threat as indicated

Youth has immediate access

to the means to carry out threat as

indicated

Youth has a sincere intention

to do harm

There is a realistic concern for the safety of the youth or others

based on the youth’sindividual risk

factors


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Consider suicide risk factors when youth threatens to harm self:

Significant change in eating, sleeping habits

Frequent complaints about physical symptoms

Neglect of personal hygiene and friendships

Boredom or loss of interest in previously pleasurable activities

Giving hints of not being around for long, such as verbal statements or giving away possessions

Sudden cheerfulness after a period of depression


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Service Pathways Appropriate for Youth in Scenario A

PES Psychiatrist

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Scenario BYouth presents with threatening behavior

Response to behavior should be shaped by the youth’s ability to:

and his or her subsequent:de-escalate him/herself by venting

amenability toward negotiating an alternate plan


De-escalateAbide by negotiated plan Utilize existing resources

Youth who is able to

and ormay be appropriate for Scenario C

De-escalateAbide by negotiated plan Utilize existing resourcesand ormay be appropriate for services other than PES

Youth who is NOT able to

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Scenario B


Service Pathways Appropriate for Youth in Scenario B

Pediatrician Psychiatrist

Private BH

ProviderCSA MRSS

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Scenario CYouth needs services

and

and/or

suggest that youth may be at risk of significant emotional distress or of causing harm to self or others

Youth’s behavior within the last 3 months or less

Youth’s disclosure of information

The disruption in youth’s behavior has consistently interfered with


Youth’s ability to learn and has affected

Youth’s relationships with peers and/or staff

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Scenario C


Service Pathways Appropriate for Youth in Scenario C

Pediatrician

Private BH Provider

CSA

MRSS

Information and

Referral

Assessment

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Step 2

Discuss ConcernWith Family

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Step 2: Discuss Concern With Family

After a concern is identified at any level, the family and school personnel collaborate on an action plan

Many high school aged youth can participate in this discussion

1.Sit down with the family

2.Develop an action plan

3.Develop a plan for follow up

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Step 3

Family ChoosesResponse Option

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Step 3: Choose Response Option

Available Options

PES

Psychiatrist

CommunityAssessment

Pediatrician

Mobile Response & Stabilization

Services

CSA

Informationand

Referral

Private BH Provider

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Step 3: Choose Response Option

Service OptionResponse

Time Frame Outcome

PES

Psychiatrist

Pediatrician

CSA

Information and Referral

Community Assessment

Mobile Response and Stabilization Services

Same day

Same day

Same day

Immediate

7-10 days

1 hour

Determination of inpatient admissibility

Determination of current risk to self/others, diagnosis, referrals

Referrals to services covered by private insurance if appropriate

Information about services available locally

Comprehensive biopsychosocial assessment and referral for services

72 hour intense intervention and up to 8 weeks of stabilization services

Indicates confidence in the ability of this option to effect meaningful and lasting change for this youth and family and minimize disruption of school attendance and school relationships

Private Behavioral Health Provider

1-3 monthsAssessment, family/individual therapy, diagnosis

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Step 4

Follow Up

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Step 3: Follow Up

Follow Up Responsibilities

Ensure that family’s needs have been met through the requested service

Be available to work with providerat family’s request

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Benefits of New Screening Model

Reduces lost education timeReduces lost education time

Components Necessary for Successful Implementation

Working relationship between school and screening and service providersWorking relationship between school and screening and service providers

Ensures youth is linked to appropriate servicesEnsures youth is linked to appropriate services

Eliminates unintended effect of punishing youth for BH needsEliminates unintended effect of punishing youth for BH needs

Working relationship with familiesWorking relationship with families

Acceptance of new model to satisfy “zero tolerance” policiesAcceptance of new model to satisfy “zero tolerance” policies

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Please feel free to contact the

Division of Child Behavioral Health Services

Contact Person:

(609) 292-4741

E-mail Address:

Phone Number:

Dr. Nadezhda Robinson

[email protected]

We look forward to partnering with you to meet the

behavioral health needs of your students

Documents

New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Workgroup Participants: