Sustaining Well-Being Of Children and Families in Foster Care Family and Youth Leadership Summit National Alliance on Mental Illness of Virginia

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1 Sustaining Well-Being Of Children and Families in Foster Care Family and Youth Leadership Summit National Alliance on Mental Illness of Virginia Carl E. Ayers, Director, Division of Family Services Virginia Department of Social Services May 2, 2015

2 Opportunity to: Achieve cross-agency work that was difficult to move forward. Involve high level officials across the three branches of government to achieve results. Increase visibility & importance of work within & across agencies/branches. 2

3 Engaging top leaders. Aligning outcomes & work across executive, legislative & judicial branches into one evolving work plan. Established common priorities, consolidated focus, & increased oversight. Leveraging resources across agencies on priorities. 3

4 Accessing national/state experts &timely resources: Broadening our vision & strategies. Allowing us to build upon best current knowledge, move faster, more efficiently & with high quality results. Strengthening partnership with Medicaid & legislators: Educating on needs & issues of children in foster care Increasing mutual respect & understanding of challenges Improving life outcomes for youth & families 4

5 Executive Branch Governor s Office/Secretary s Office VDSS Commissioner, Team Leader Comprehensive Services Act (CSA) Executive Director Medicaid & child serving agency officials Legislative Branch 2 Senators; 2 Delegates, Commission on Youth Executive Director Judicial Branch Director of Court Improvement Program, Office of Executive Secretary, Virginia Supreme Court Judge, Juvenile & Domestic Relations Court Child serving agencies representatives Virginia League of Social Services Executives Virginia Association of Community Services Boards Virginia Association of School Superintendents Virginia Coalition of Private Provider Associations 5

6 Improve well-being for children in foster care: Trauma needs - experiencing maltreatment and/or through exposure to violence. Health needs - developmental, physical, medical, & dental. Behavioral health needs - mental health & substance abuse. Educational needs. 6

7 Physically healthy All children receive primary health care services. All children receive dental services. Emotionally & behaviorally healthy All children are screened/assessed for behavioral health needs. All children have access to & receive appropriate behavioral health services. Children demonstrate fewer behavioral & emotional needs. All children receive psychotropic medications when appropriate. Successful in school All school-aged children attend school. All children remain in their same school, unless contrary to their best interests. All children succeed in school. 7

8 All children receive primary health & dental services 100% of youth have: Medical exams within 30 days of entering foster care.* Well-child visits, when in foster care, based on Virginia s EPSDT periodicity schedule.* Dental exams when in foster care every 6 months from last exam, beginning at age 6 months up to 18 years.* *New VDSS data; may verify with Medicaid/managed care data 8

9 All children/youth are screened & assessed Upon entry into foster care, 100% of youth assessed: Who have urgent health, mental health, or substance abuse needs by licensed professional within 72 hours*. Using Child & Adolescent Needs and Strengths Assessment (CANS) within 30 days. Who have trauma, mental health, or substance abuse needs by licensed mental health professional within 60 days*. 100% of youth assessed with CANS: Based on needs of youth/family & intensity of services provided. Annually Assessments Within 90 days prior to exiting foster care. *New VDSS data; OCS data 9

10 Children demonstrate fewer behavioral/emotional needs Decreased percentage of children, age 5 & older, who received foster care services & have moderate or severe behavioral/emotional needs on the CANS: 2012 baseline data: 70% had impulsivity/hyperactivity 69% anxiety 66% depression 60% anger control 59% oppositional 48% adjustment to trauma 46% conduct 12% psychosis *OCS CANS data 10

11 Youth receive appropriate psychotropic medications 100% of youth, prior to new psychotropic medication, receive: Pediatric medical examination. Comprehensive child and adolescent mental health evaluation by qualified professional * *New VDSS data 11

12 All children attend, remain in, & succeed in school 100% of school aged children & youth: Enrolled as full-time student or completed secondary school. * Attending school & have less than 6 unexcused absences. * Remain in same school during year, when jointly determined in their best interests by social services and schools. * Increased student academic performance, as measured by Standards of Learning. ** Increased percentage of youth complete school: Graduate from high school. * Complete two or four year colleges/universities. * Earn Board of Education-approved career and technical education certification. * *New VDSS data; DOE data **Evolving; DOE data 12

13 Use health, behavioral health, psychotropic medications, & educational performance outcome data to improve decision making on a regular basis. Define outcomes & analyses using existing data whenever possible across agencies. Institute mechanisms for sharing/protecting data. Analyze baseline data. Finalize core measures/quality indicators for ongoing tracking. Incorporate into agencies data reporting systems. Provide management reports to help state and local agencies make decisions and assess progress. 13

14 Analyzing child need, service funding, & outcomes to support better decision-making for children and families served through Comprehensive Services Act (CSA). Initial Proof of Concept project funded by Casey Family Programs. Building application, using state general funds, to evaluate child demographics, assessment scores, service expenditures, & outcome data across three agencies. Utilizing high-powered data analytics through SAS Institute. Identifying most effective services for youth & families. Increasing accountability. 14

15 Improve screening & assessment for children in foster care. Expand Medicaid Managed Care to improve access to care & monitoring of health & behavioral health outcomes. Increase access to trauma-informed, evidence-based, research informed behavioral health services/practices. Improve appropriate & effective use of psychotropic medications. Manage systems change (e.g., Learning Collaboratives). 15

16 Incorporated well-being activities into foster care guidance. Integrating many well-being outcomes into VDSS automated data system. Incorporating well-being outcomes & actions into five year plan safety, permanency & well-being sections. 87% of children (4,739) in foster care now in Medicaid Managed Care (phased implementation Sept 2013 to June 2014): Improved access to health care providers. Coordination of health care services. Case management. Targeted services for chronic conditions. 24 hour nurse advice line. Behavioral Health Administrator began managing community behavioral health services through new Medicaid contract in Dec

17 Strengthening CANS Assessment for youth in foster care. Received 186 responses from front line users on how to improve CANS for children, families, workers, & supervisors. Created new child welfare module & enhanced trauma module. Developing CANS reports to assess progress over time: Child report on safety, permanency & well-being Parent/guardian report on permanency & protective factors Adding CANS assessment screen in online data system; will automatically populate top strengths & needs of child & parents from CANS, integrating CANS into online service plan. Enhancing overall user functionality/reporting capabilities for all CANS users. 17

18 Prescription Rate Analysis Of the top 10 medications prescribed to foster children in Medicaid, the top 2 are psychotropic medications: ADHD and Mood Disorder medications. The top 2 medications prescribed to non-foster children in Medicaid are antihistamines and antibiotics. 18

19 Institute in Philadelphia in July 2013 Institute in Milwaukee in July 2014 Nadia Sexton - state examples of managed care and youth in foster care Sheila Pires customizing managed care, monitoring psychotropic medications, & effective behavioral health services for foster care youth. Dr. Christopher Bellonci monitoring psychotropic medications, effective screening tools. Illinois Department of Children & Family Services trauma, Child Welfare CANS tool, learning collaboratives. Attended Leadership Team meeting - CFP, NGA, NCSL 19

20 Collaborating with CFP Permanency Work in Virginia on safely reducing number of children in foster care Kristin Zagar & Kikora Dorsey - Institutionalizing learning collaboratives Sue Badeau Possible presentation to Three Branch Leadership Team; Permanency Values Training Permanency Round Tables 20

21 Developing & implementing learning collaboratives: Permanency outcomes & practice ideas Protective factors Child & family engagement Comprehensive assessments Permanency & concurrent planning Creative service planning Well being outcomes and practice ideas Trauma informed care Evidenced-based, research informed, behavioral health services and practices Psychotropic meds Succeeding in school 21

22 Content experts for learning collaboratives - to help design/present information across the state recorded in knowledge center. Chapin Hall Center Well-being outcomes using VDSS, CANS, & Medicaid data Assistance developing a trauma informed care system across agencies Assistance in tying Medicaid reimbursement rates to evidence-based interventions and/or trauma informed providers. Examples of state legislation allowing the sharing of child-specific data across state education and social services 22

23 Ambitious, flexible & evolving work plan to meet federal requirements, fundamentally improve practice, and take advantage of opportunities. Successful & effective partnership State driven approach Individually tailored technical assistance High quality experts and consultations Networking with other states Videoconferencing works well Joan Ohl has been insightful, timely, flexible, and strategic in supporting and helping us move forward On site visits by national partners beneficial 23