The Florida Children s Mental Health System of Care. Statewide Expansion Project Teleconference #1 WELCOME!!!

Transcription

1 Rick Scott, Governor Esther Jacobo, Interim Secretary The Florida Children s Mental Health System of Care Statewide Expansion Project Teleconference #1 WELCOME!!! Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency.

2 Contents Introduction and Background Mental Health Costs System of Care Overview National Evaluation Results (2010) SAMHSA System of Care Expansion Grant Where We Are Now Contact Information 2

3 Introduction and Background

4 Why are we here? Because we are all part of the system that serves children with Serious Emotional Disturbances (SED) in Florida What is our job here? To use the Florida statewide strategic plan as our roadmap to integrate the core values and principles of system of care into the state s behavioral health service delivery for children with SED and their families Why is this important to us? 1. Better functional outcomes for children and families 2. Cost effectiveness 3. Increased trust & cooperation throughout the system 4

5 Prevalence of Children s Behavioral Health Issues 1 In 2011, 5.3% of children and adolescents aged 4-17 experienced definite or severe emotional and behavioral difficulties, while14.4% experienced minor difficulties. In 2010, 11% of children aged 8-11 and 12% of adolescents aged experienced past year serious emotional disturbance. 1 See, site accessed, November 1,

6 Florida Outcomes for SED Children Fiscal Year 2012/ % of SED children improved their level of functioning SED children spent an average of 344 days in the community (excluding those in juvenile justice facilities) SED children attended 92% of school days 1 See, Florida Department of Children and Families Performance Dashboard, dashboard.dcf.state.fl.us/index.cfm? page=menu_listmeasures&purpose=sit&office_id=mh%20%20%20%20%20%20&filter=office&fiscal=2013, site accessed October 25,

7 Impact of Mental Health Education¹ In , 51% of Florida students 14 and older with severe mental health conditions dropped out of high school (U.S. Department of Education, 2008) One in five youth with an emotional disturbance pursue postsecondary education, among the lowest rates of any disability category (U.S. Department of Education, 2005) Suicide In 2012, suicide was the second leading cause of death for persons ages and the eighth leading cause of death for all Floridians ² The majority of young people who die by suicide have experienced significant psychiatric problems or cooccurring disorders 3 1 See, site accessed, October 25, See, site accessed, October 25, See, preventsuicide.fmhi.usf.edu/docs/flsuicidepreventstrategy.pdf, site accessed, October 25,

8 Mental Health Costs

9 Florida and U.S. Averages for Access to Home and Community Based Services 1 Florida Rank* U.S. Average Participants Per 1, (2007) Expenditures Per $ $ Capita (2009) % of HCBS to Total LTC Participants (2007) % of HCBS to Total LTC Expenditures (2009) *Rank is out of 51 (all States and the District of Columbia) 46% 42 62% 36% 38 45% 1 See, site accessed, October 25,

10 Top Ten Utilized Cost Centers for Children s Mental Health FY Cost Center Units Percentage of Total Children s Mental Health Units Case Management 90, Outpatient - Individual 71, In-Home and On-Site Services Overlay 55, MH Comprehensive - Individual 46, Intervention 30, Crisis Stabilization 19, Crisis Support / Emergency 18, Respite Services 17, Incidental Expenses 15, Medical Services 14, Report was created using only valid DCF contracts and DCF fund sources. Cost center definitions can be found in DCF Pamphlet 155-2, Chapter 7, pages 7-19 through See,

11 Florida Expenditures for Children s Services 1 Annual Cost % of Children & Adolescents Served % of Mental Health Expenditures for Children & Adolescents $3, % 50% Between $3,001 and $20, % 33% Between $20,001 and $200,000* 0.4% 17% *This group consisted of 224 children and adolescents and accounted for $9.8 million in expenditures. 1 Hutchings, G. P., & Cobb, H. C. (2012). Examining the efficacy of Florida s publicly funded mental health services: The science, the research, the return on investment. Alexandria, VA: Behavioral Health Policy Collaborative, LLC. 11

12 System of Care Overview

13 WHAT IS A SYSTEM OF CARE? A System of Care (SOC) Is: A 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, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life. 1 1 Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children s Mental Health. 13

14 The System of Care Model JUVENILE JUSTICE SERVICES RECREATIONAL SERVICES MENTAL HEALTH SERVICES CHILD AND FAMILY SOCIAL SERVICES EDUCATIONAL SERVICES VOCATIONAL SERVICES SUBSTANCE ABUSE SERVICES HEALTH SERVICES 14

15 Core Values of SOC s 1 Systems of Care are: 1. Family Driven and Youth Guided With the strengths and needs of the child and family determining the types and mix of services and supports provided 2. Community Based With the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level 3. Culturally & Linguistically Competent With agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports 1 Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children s Mental Health. 15

16 Guiding Principles of SOC s 1. Broad, flexible array of effective, evidence-informed services and supports, including traditional and nontraditional services, informal and natural supports 2. Individualized services guided by a strengths-based, wraparound service planning process and an individualized service plan 3. Least restrictive, most normative environments that are clinically appropriate 4. Ensure that families, caregivers, and youth are full partners in services and policies/procedures at all levels 5. Cross-system collaboration, linkages across administrative and funding boundaries and mechanisms for system-level management, coordination, and integrated care management 16

17 Guiding Principles of SOC s (cont d) 6. Care management for coordination of services 7. Services and supports needed to meet the social-emotional needs of young children and their families 8. Services and supports needed to facilitate the transition of youth and young adults to adulthood 9. Incorporate or link with mental health promotion, prevention, and early identification and intervention 10. Rights protection and advocacy 11. Continuous accountability mechanisms at the system level, practice level, and child and family level 12. Nondiscrimination 17

18 What a System of Care Concept Is Not It is not a model or a manualized treatment It is not a program that provides a service It is not a treatment or clinical intervention It is not Wraparound 18

19 What a System of Care Concept Is It is a basis for paradigm shift, ideals and vision It is an organizational framework for system reform based on a shared, clear value base It is a guide with flexibility to fit a community based on their strengths and needs 19

20 Paradigm Shift From To Funding tied to programs Reactive, crisis-oriented approach Funding tied to families Focus on prevention Children out-of-home Children with families Centralized authority Community-based ownership Child as focus Family and school as focus 20

21 Building Systems of Care Multi-level process State level (policies, financing mechanisms, workforce development) Local and neighborhood level (plan, implement, manage, and evaluate the system) Service delivery level (access to a broad array of services, comprehensiveness, quality) Frontline practice (child and family teams, wraparound process) Family level The reward is effective services and supports for children and their families 21

22 Wraparound Wraparound is how the SOC philosophy is operationalized at the service level Per the National Wraparound Initiative, Wraparound has been most commonly conceived of as an intensive, individualized care planning and management process Wraparound is not a treatment per se, but a process that consists of: A team of people relevant to the life of the youth (e.g., family members, the family s social support network, service providers, and agency representatives) Collaboratively develop an individualized plan of care Implement this plan Monitor the efficacy of the plan Work towards success over time 22

23 National Evaluation Results (2010)

24 The Comprehensive Community Mental Health Services for Children and their Families Program Evaluation Findings 2010 Annual Report to Congress 1 Funded by SAMHSA Gathers and reports on critical information about the system of care approach in serving children with mental health challenges, its implementation and outcomes across the country and in your own community. Who was served: 62.7% of all children served were male. (n = 28,274). Children and youth receiving services were more likely to be under 16 than those of similar age nationally 57.2% of children and youth served were living in poverty 26.8% were in legal custody of both biological parents 1 See, store.samhsa.gov/shin/content//pep12-cmhi2010/pep12-cmhi2010.pdf, site accessed, October 28,

25 Youth Outcomes Clinical Levels of Behavioral and Emotional Problems Declined Suicidal Thoughts and Attempts Declined 90% 80% 80.60% 35% 30.40% 70% 60% 66.30% 61% 30% 25% 50% 40% 30% Intake 12 Months 24 Months 20% 15% 9.40% 13.80% Suicidal Thoughts (n=1,686) Suicidal Attempts (n=1,685) 20% 10% (n=1,630) p < % 5% 3% p<.001 0% Total Problem Score as Measured by the Child Behavior Checklist (CBCL) 0% Intake 24 Months 25

26 Youth Outcomes continued Education Juvenile Justice Regular Attendance Good Performance Suspended or Expelled School Functioning Improved 29.50% (n=1,062) 31.60% 24 Months 44.40% 12 Months Intake 75.70% 75.20% 63.40% 83% 90.10% 90.20% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (n=729) p<.001 (n=1,105) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Engagement in Delinquent Behaviors Declined 76.60% 54.40% 44.50% Engaged in Delinquent Behavior Intake 12 Months 24 Months n=824 p<

27 Caregiver Outcomes 60% 50% 40% 30% 20% 10% Change in Caregiver Global Strain* 36.2% 56.5% 44.8% 47.7% 7.3% 7.5% Strain Lessened Strain Remained Stable Strain Worsened Average Number of Caregiver Work Days Missed Due to Child s Behavioral or Emotional Problems* % Intake to 12 Months Intake to 24 Months Intake 12 Months 24 Months p <.001 (n = 1,594) *As measured by the Caregiver Strain Questionnaire *Average number of work days missed in the previous 6 months 27

28 System Outcomes Cost Savings Service Delivery Ratings $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 Estimated Gross Cost Savings per Child or Youth* $3,623 $1,930 $2,258 $1,313 6 Months Prior to Intake Months After Intake Average Infrastructure Ratings for Communities Funded in Beginning of Funding Middle of Funding n=30 $0 Inpatient Care (n=2,246) Juvenile Arrests (n=1,254) *From reduction in inpatient hospitalization and juvenile arrests 28

29 Wraparound Maine Summary: Mental Health Service Use and Cost Study 1 Wraparound Maine is a statewide, multi-site initiative that implements high fidelity Wraparound Target population includes children & youth, ages 5-18, with serious behavioral challenges who are in residential treatment or in a juvenile corrections facility or at risk of such placements Study included 148 children and youth who entered Wraparound Maine between 7/1/2007 6/30/2009 Pre-Post study period included: 1. Pre-Wraparound a 12-month time period before entry into service 2. Post-Wraparound Initiation a 12-month time period starting on the date the child enters Wraparound Maine 1 See, site accessed, October 28,

30 Pre-post Wraparound Average Per Child Per Year Mental Health Expenditures Service Type Pre-Wraparound Average Per Child Expenditures Post-Wraparound Initiation Average Per Child Expenditures Pre-Post Difference Percent Change Targeted Case Management (Wraparound Maine)¹ Emergency Room (MH) HCT Services Crisis Intervention & Resolution Residential (PNMI) Services² MH Outpatient Treatment (Sec 65) Medication Assessment & Tx Psychiatric Inpatient Tx Outpatient Psychiatric Tx Other MH Services Child ACT Day Treatment Day Habilitation Total Mental Health $3, $7, $3, Ç 99% $ $ $26.31 Ç 6% $7, $6, $ È 10% $2, $1, $ È 30% $60, $43, $17, È 29% $1, $1, $ Ç 31% $ $ $31.72 È 4% $55, $31, $23, È 43% $ $ $ Ç 26% $ $ $ Ç 23% $8, $6, $1, È 20% $9, $7, $1, È 17% $10, $14, $4, Ç 39% $58, $41, $16, % 30 ¹ Targeted Case Management expenditures pre-wraparound initiation reflect use of non-wrap TCM services. Wraparound Maine services are billed through section 13 Targeted Case Management. The increase in TCM expenditure pre to post reflect the initiation of Wraparound services. ² Residential Treatment Services includes all PNMI Child Care and Crisis Residential Facility expenditures.

31 SAMHSA System of Care Expansion Grant

32 Grant Overview This cooperative agreement with SAMHSA provides funding to the Department of Children & Families to implement the SOC strategic plan. Project Period: 9/30/12 9/29/16 Funding Amount: Year 1: $984,136 Year 2: $999,795 Year 3: $999,795 Year 4: $999,795 Population: Children up to age 21 with serious emotional disturbances 32

33 SAMHSA Goal: SOC Expansion Grant To build upon progress made in developing comprehensive strategic plans to expand and sustain the system of care values and principles to address children and youth with serious mental health conditions and their families. 33

34 SAMHSA Expectations That grants will Create comprehensive and sustainable actions that promote and provide services, supports and infrastructure; and Facilitate wide scale adoption and operation of the System of Care framework. 34

35 Required Activities of the Grant Establish a SOC expansion Core Advisory Team; Develop a financing and sustainability plan; Update the logic model; Implement culturally and linguistically competent approaches to expand SOC practices throughout the state; Implement social marketing approaches; Enhance family and youth involvement throughout the system; Increase utilization of evidence-based approaches; and Evaluate the implementation process and services utilizing the Wraparound approach. 35

36 Florida s Proposal To implement System of Care seed sites in 5 of the 6 Department of Children and Families regions; To fund a family run organization to coordinate all youth and family SOC involvement; To provide training in the Wraparound approach and other research supported practices; To link with Early Childhood Initiatives to promote screening, prevention, and early intervention for behavioral issues; To coordinate system collaboration to effect policy, financing, infrastructure and practice changes; and To implement social marketing strategies that will increase social inclusion and market the SOC approach. 36

37 Integration of Key Florida Initiatives Statewide Medicaid Managed Care Expansion of regional substance abuse and mental health service delivery into seven managing entities Trauma-informed care expansion Behavioral health and primary care integration 37

38 Core Strategies Adopted from Other Expansion States 1 1. Implementing policy, administrative and regulatory changes 2. Developing services and supports based on SOC philosophy 3. Creating financing mechanisms to support SOC implementation 4. Providing training and TA to communities 5. Generating support 1 Stroul, B.A., & Friedman, R.M. (2011). Effective strategies for expanding the system of care approach: A report on the study of strategies for expanding systems of care. Atlanta, GA: ICF Macro. 38

39 Florida Children s Mental Health System of Care Theory of Change Activities Inputs and Resources Youth and Families State and Local Providers Community Partners At each level partners are engaged in learning, planning and change practice. Joint Planning Statewide Planning Team Local Planning Teams Resource Alignment State and Local Agencies Shared Outcomes Healthier Lives, Reduced Costs Comprehensive state and local priorities, benchmarks and outcomes established Collaborative and effective use of resources increases capacity at local and state levels Culturally relevant evidence based programs and practices implemented Evaluation Monitoring Progress and Improving Process Be One Florida 39

40 Where We Are Now

41 Florida s Vision of a System of Care Florida s children with behavioral health challenges and their families are engaged as primary decision makers in a culturally relevant, coordinated healthcare setting that provides the highest quality services and supports and promotes their individual growth to reach their maximum potential. 41

42 Florida SOC Initiatives Current Families And Communities Empowered for Success (FACES) Miami Dade County Wraparound Orange Orange County Families and Communities Together (FACT) Seminole County The Jacksonville System of Care Initiative Jacksonville Past Tampa Hillsborough Integrated Network for Kids (THINK) Hillsborough County Family HOPE Palm Beach County One Community Partnership Broward County Sarasota County Early Childhood Mental Health Partnership Sarasota County 42

43 Florida Expansion 3 active expansion sites Pasco & Pinellas Counties (Suncoast Region) Bay & Washington Counties (Northwest Region) Leon & Gadsden Counties (Northwest Region) 2 emerging expansion sites Volusia County (Northeast Region) Belle Glade (Southeast Region) 43

44 Progress To Date Completion of the Statewide Strategic Plan for SOC Expansion Partnership with the Federation of Families of Florida, including initiation of a statewide consortium of youth and families Start of a Youth M.O.V.E Chapter in Pinellas County Linkages with Project LAUNCH and other Early Childhood Initiatives Wraparound and Process Improvement Trainings in the Suncoast and Northwest Regions Convening of the State Core Advisory Team with diverse membership including families, youth, service providers, and child-serving state agencies. Evaluation of the implementation process 44

45 Contact Information 45

46 Ute Gazioch Principal Investigator Children s Mental Health System of Care Expansion Project Ute_Gazioch@dcf.state.fl.us Dr. P. Qasimah Boston, MPH, CHES, CPS State Cultural & Linguistic Coordinator Children s Mental Health System of Care Expansion Project Qasimah_Boston@dcf.state.fl.us 46