PHSS - Multisystemic Therapy (MST)

Transcription

1 PHSS - Multisystemic Therapy (MST) Program Description: An evidence-based mental health program that provides 24/7, intensive home, school, and community-based services for youth ages years (and their families) experiencing challenges with juvenile justice, mental health, family conflict, and education. Treatment focuses on engaging the family to address the environmental/social issues impacting the youth s behaviors and functioning. Program Goals: 1. Decrease rates of antisocial behaviors 2. Decrease clinical symptoms/problems 3. Improve functioning (e.g., family relations, school performance) 4. Reduce out-of-home placements (incarceration, hospitalization, etc) Other: TST funds approximately 40% of total program cost. Thurston Mason Regional Support Network (a division of Thurston County Public Health and Social Services) funds the remainder with Medicaid and WISe case rates. Without the flexibility of TST dollars, it would be difficult to sustain this program. 1

2 Strategy Map Connection and Program Results Public Safety and Justice Strategy Map: People are safe where they live, work and play in Thurston County STRATEGIES OR OBJECTIVES MST INFORMATION/ACTIVITIES RESULTS Pre-arrest prevention, treatment, intervention options: mental health and substance abuse Post-arrest diversion options: mental health System interconnectedness: referral network of offender services, regional correctional services, in-school programs All MST clients exhibit behaviors associated with justice risk/involvement MST treatment plan and interventions target these behaviors Social marketing and collaboration with juvenile detention and courts Clients are diverted from deeper involvement with justice; have access to 24/7 intensive MST services MST focuses on cross-system issues Works closely with allied systems/providers Decreased physical violence; 39.5% Decreased property damage; 64.3% Decreased theft; 26.5% Decreased arrests; 32.0% Decreased problems relating to substance use; 23.1% Decreased conduct problems (SDQ); significant 30.0% referrals directly from probation department, court-related services, and parole department 57.9% youth served have justice involvement Remainder exhibit risk behaviors Referral sources include: juvenile justice, mental health, chemical dependency, child welfare, education, parent network, families, and youth Advisory (Core) Team members include representative from all referral sources Treatment involves coordination with other involved systems/agencies 2

3 Strategy Map Connection & Program Results - Continued Child and Youth Resilience Strategy Map: We live in a community where all children of all cultures are healthy, safe, valued and successful STRATEGIES OR OBJECTIVES MST INFORMATION/ACTIVITIES RESULTS Provide opportunities and access for families Parents and youth on Advisory (Core) Team Parents & youth have direct access through selfreferrals Shape policy and practice Served 58 youth/families in self referrals Q Build skills and competencies in parents/caregivers and youth Further the social and emotional development of children Treatment heavily focused on skill development with parents/caregivers parenting skills and strategies Interventions targeting youth skills/competencies Treatment plan addresses social/emotional development Improved school success; significant Decreased suspensions; 38.3% Increased school enrollment; 4.1% Decreased emotional symptoms; significant Decreased peer problems; significant Improved prosocial skills; significant Decreased suicide attempts; 50% Decreased suicide thoughts/gestures; 62.5% Decreased anxiety; 35.9% 3

4 Strategy Map Connection & Program Results - Continued Clinical Care Strategy Map: More people live longer, healthier lives because they take care of themselves and receive the right care at the right place at the right time STRATEGIES OR OBJECTIVES MST INFORMATION/ACTIVITIES RESULTS Educate consumers on appropriate health care settings Proactive care planning to decrease crises Intensive care planning and services to support staying in home and community 24/7 crisis services when needed decreases outof-home placements 80% completion rate indicates youth remained in home and met majority of treatment goals without more restrictive care Decreased running away; 64.0% Decrease use of jails as our primary mental health treatment center Improve access to mental health services especially for low and moderate income persons Increase use of evidence-based services MST specifically developed to decrease behaviors associated with juvenile justice involvement Services closely coordinated with detention/court staff Access to intensive, evidence-based services, for deep-end, vulnerable population Majority of services target low and moderate income families Adherent MST services; compliant with all MST Inc. requirements Increased enrollment in mental health services by 36.8% Decreased physical violence; 39.5% Decreased property damage; 64.3% Decreased theft; 26.5% Decreased arrests; 32.0% Decreased problems relating to substance use; 23.1% Decreased conduct problems (SDQ); significant Provides 6 MST-trained, MA-level therapists in community Additional provider - family/client choice Primarily serves Medicaid population with 4 non-medicaid slots 27.9% minority clients SAMHSA Model Program License in good standing Fidelity Score.66, which indicates full 4 adherence

5 Key Partners University of Washington, EBPI, Dr. Eric Bruns technical assistance, program evaluation, statistical analysis, reporting Donna Obermeyer WISe Coordinator Community Youth Services MST provider Core Team (Steering Committee) parents, youth, crosssystem partners, UW, TMRSN Referral Sources Allied systems/providers; Tribes; Parent Network (FAMH); Self referrals TMRSN and DBHR funding sources, monitoring/oversight 5

6 Current Problem or Opportunity Challenge No major challenges. Because MST has been approved as a WISe enhancement, it has required some process changes, e.g., use of CANS tool at screening and additional data requirements. Opportunity Able to leverage WISe case rates and sustain the MST program If increased capacity is needed in the future, likely able to leverage additional WISe funding This program has helped TMRSN/County meet contract deliverables including performance measures and appropriate access to EBPs MST positions us well to leverage other funding, e.g., Roads to Community Living, System of Care Grant, future State-funded pilot programs 6

7 Future Focus: Proposed Change and Expected Results CYS, TMRSN and the MST Core Team will continue to monitor MST outcomes and fidelity to identify quality improvement activities, as needed. We will also monitor capacity needs and expand, if indicated Result - ensures a quality program and appropriate access to MST services in Thurston County, which meets the needs of the eligible population 7

8 MST and Wraparound/WISe Program Comparison Descriptor MST Wraparound/WISe Target Population Family and Support Involvement Treatment Duration years of age Anti-social behaviors Multiple systems Justice risk/involvement Significant exclusionary criteria Client must be living with parent(s)/caregiver(s) Parent(s)/caregiver(s) must agree to participate 3-5 months months Caseload Size 4-6 families families Treatment Approaches Expected Outcomes Service-centered model Intensive Therapy especially focused on parenting skills Family therapy very little individual therapy with youth Interventions primarily from motivational interviewing, cognitive behavioral therapy, and family systems Service plan driven by treatment process mental health treatment plan System coordination Home/community-based at convenient times and locations Intensive weekly supervision and consultation 24/7 response Reduced justice involvement Reduced antisocial behaviors Reduced substance use Improved parenting skills Keeping youth at home Improved school/vocational performance Improved prosocial behaviors 5-20 years of age Complex emotional/behavioral health needs Multiple systems Justice risk/involvement Minimal exclusionary criteria Evidence SAMSHA Model Program; WSIPP EBP Research-based; WSIPP list Prefer that parent(s)/caregiver(s) participate Not required to living with parent(s)/caregiver(s) Involves other family members, extended family, friends of family, and agencies/systems serving child Intensive care planning with adjunctive therapy Family and natural supports center piece of model Facilitator, Family Partner, and Therapist assigned to each family team Treatment interventions prioritized by the team, therapist uses Managing and Adapting Practices (MAP) software to id strategies with most evidence Child and Family Team drives the treatment plan System involvement on team- cross-system care plan Home/community-based at convenient times and locations 24/7 response Reduced social/emotional symptoms Reduced risk for justice involvement Improved school functioning Increased safety and reduced need for emergency services Increased hope and confidence Blended network of natural supports and services to maintain wellness Both models are intensive 24/7 and community-based, but there are differences in ages served, inclusionary/exclusionary criteria, duration, caseload sizes, treatment philosophies/approaches, provider personnel, system involvement, and family roles in the service. 8