Annual Report to the Community September 2008

The community System of Care embraces, serves, and supports children with serious emotional disturbance and their families so children are safe and successful with their families and in their community.

www.impactsystemofcare.org

Painting the Story of Impact

Art can be a powerful medium – for expression, for insight, for advocacy, for healing. Twenty young people from Ingham County’s Impact System of Care communicated their emotions on canvas, telling the story of their mental health challenges. The paintings were displayed in the Lansing City Hall lobby May 5–9 and in the atrium at Community Mental Health Authority on East Jolly Road in July.

It was a compelling and courageous display. The art is represented throughout this Report to the Community.

Some of these young artists and their families joined the System of Care community at a public reception on May 8, National Children’s Mental Health Awareness Day. More than 100 stakeholders, including city and state officials, attended.

“We have allowed the stigma of mental illness to enter our lives and put up barriers between people,” Stephanie Johns, an Impact youth representative, told the attendees. “It’s time to take these barriers down. This day and this event is an opportunity for all communities to support and promote positive youth development and to stop the stigma of mental illnesses.”

1

“Impact helped me gain the skills I needed to work through my situations and improve them. It helped me and my family set goals.” – Brittney Jeter, Youth

2

Begun in 2006, the Impact initiative is one of 57 projects in the nation funded by the federal Center for Mental Health Services to create a System of Care for children and youth with serious emotional and behavioral needs. During the six-year project, the Impact partnership of child- and family-serving agencies are working with families and youth to strengthen home- and community-based services and supports for youth with serious emotional disturbance (SED).

Impact is a partnership of everyone who cares for families.

What Is Serious Emotional Disturbance (SED)?

These are the signs to look for in a child:

•Has a hard time learning

•Has a hard time making and keeping friends

•Is angry a lot

•Often seems sad or hopeless

• Has lost interest in things he or she used to enjoy

• Avoids friends or family and wants to be alone all the time

• Often hurts others, destroys things, or breaks the law

•Refuses to follow directions and often makes poor choices

Any child can have these signs for a short time, but over a longer time such signs can indicate a mental health concern such as SED. Impact can help determine whether your child has serious emotional disturbance.

Why Create a System of Care?

Studies show that children and youth with SED make big improvements at home, at school, and in their community when they are served by a System of Care that provides coordinated, community-based services and supports.

Celebrating Two Years of Impact Services

“I’m an advocate because it’s done so much for our family. Brittney wouldn’t be where she is without Impact. We have to bring the village back to raise our kids.” – Emily Small, Brittney’s mother

Impact has set ambitious goals and put in motion key strategies to achieve these goals.

Impact’s goals are to assure that:

•Families will receive individualized supports that meet their needs, and respect the diversity of youth and families.

•To the degree possible, every child will live in the community with his/her family.

•All children with serious emotional disturbance (SED) and their families receive high-quality, coordinated services.

•All families with children with SED have access to services that support them in meeting their needs.

•The community supports the System of Care’s philosophy and values.

Key strategies for reaching these goals are:

•Involving families and youth as partners

•Ensuring that services meet the needs of families and youth

•Supporting staff to work effectively with families

•Assuring that families and youth are partners with service agencies

•Continuous service improvement

•Using the assets of community to support families and youth

•Educating our community about needs and strengths of families and youth

Impact Values

• Family-Driven

• Youth-Guided

• Accessible and High-Quality Services

• Culturally and Linguistically Competent Services

• Individualized Care

• Coordinated Care

• Collaborative Care

Impact Goals and Strategies

3

4

Data on youth recently discharged from Impact System of Care shows that Impact youth fare better than others in the state on an assessment tool that measures how well they function in eight areas of their lives.

The average Child and Adolescent Functional Assessment Scale (CAFAS)® score for the youths when they entered Impact was 107. The average exit score was 66, a 41-point improvement on average. The majority of youths (72%) had improvements of 20 points or more.

“That’s clinically meaningful; more than just transitory change,” said Kay Hodges, author of the CAFAS. “They [Impact] are taking kids because of multiple agency kinds of needs, so they are more difficult kinds of cases.”

Youths in community mental health treatment statewide saw an average of 21-point improvements in their CAFAS scores during fiscal year 2007. The proportion of youths statewide who showed a clinically meaningful improvement in CAFAS scores was 53%.

Nearly half of Impact’s youths (41%) were discharged with CAFAS scores of 40 or less, meaning they no longer had serious emotional disturbance (SED). The proportion of Michigan youths who completed care with CAFAS scores of 40 or less was 23%.

“These are really exceptional results [for Impact],” said Hodges, who serves on Impact’s Scientific Advisory Team.

The eight domains that the CAFAS measures are school, home, community, behavior toward others, moods/emotions, self-harmful behavior, substance use, and thinking. Scores range from 0 to 240, with scores of 50 and above indicating SED. Youths with scores of 80 and above meet the criteria for Impact, meaning they have SED with a risk of out-of-home placement.

CAFAS data suggests that youth referred by the court have better results when service providers work together in teams. Their average length of stay in mental health services was 321 days. Thirty-nine youths were discharged from Impact from October 1, 2007, through April 30, 2008.

Impact Youth Improving at Home, School, and in the Community

The Impact System of Care has provided services to 262 Ingham County youths with SED since the project began coordinating and delivering services and supports in October 2006.

This past year we have established a set of key outcome measures and assembled initial baseline data. The data is a combination of local data and data collected from Impact families taking part in a national Systems of Care Longitudinal Outcomes Study (LOS).*

OutCOme 1

Maximized functioning of children with SED and their familiesIndicator is level of functioning and behavioral and emotional problems reduced / strengths improved:

72% of Impact youth who completed the program showed a significant level of improvement in behavioral and emotional function. The youths’ Child and Adolescent Functional Assessment Scale (CAFAS) scores improved 20 points or more, a reliable and clinically meaningful amount of change.

of Impact youth who completed the program no longer were identified41% as having serious emotional disturbance (SED).

56% of youth and 52% of caregivers say the youths are better at handling daily life as a result of the services the youth and family received.

The Ingham County Board of Commissioners authorized the Family Division of Ingham County Circuit Court to establish Samuel D. Ingham Academy, an alternative high school for adjudicated students. The Academy provides educational and behavioral support to youth who have intense educational needs and have not been successful in their home district.

OutCOme 2

Reduced need for out-of-home placementsWhile more data is being compiled, we know that Impact provides a greatcommunity-based alternative for youth who might otherwise have beenconsidered for residential placement. Also, Impact allows youth who are sentto residential care to be returned to the community sooner, meaning fewerdays in residential care.

5

“Prior to Impact, we spent $75,000-$80,000 a year to have a youth treated out of state. If it’s going to cost that much, why not keep them in their homes, in their communities, and in their schools and treat them right here. It just makes so much sense to me. That’s why I’m an Impact fan.” – Debra Nolan, Ingham County Commissioner

Summary of Key Outcomes Data

Sum

mar

y o

f Key

Out

com

es D

ata

(con

t.)

6

OutCOme 3

Efficient use of resourcesMeasures are being developed to determine the increase in the proportion of funding for home and community-based service and the decrease in the cost of residential placement.

OutCOme 4

Increased participation of families and youth in the development of the System of CareThere has been a historic level of parent involvement never before seen in Ingham County.

•Impact parents served as members of the Stakeholders Group, work groups, Parents Council, and the Power of We. Parents also participated in event planning and were co-presenters at local meetings and events, and state and national System of Care conferences.

•Impact youth served as members of the Stakeholders Group, work groups, and Speak Your Mind Youth Council. Youth participated in event planning and created paintings for the Children’s Mental Health Awareness Day art show. They also started a speakers’ bureau, assisted in grant writing, made presentations to Lansing City Council and the Ingham County Board of Commissioners, and attended a national System of Care conference.

OutCOme 5

A unified, family-driven, youth-guided, and culturally and linguistically competent System of Care for children with SED and their families

OutCOme 6

Increased community knowledge of the System of Care and decreased stigma•NumerouspresentationsweremadebyImpactparentsandyouththroughoutthe community, including Lansing City Council, Ingham County Board of Commissioners, and The Power of We.

•Community awareness of Impact was raised with a Children’s Mental Health Awareness Day art show at Lansing City Hall and a statewide System of Care conference held in Lansing.

•ImpactWebsiteupgradesledtoincreasedusage.Alongwithdetailedinformationabout Impact and SED, the site now includes a testimonial video, photo gallery, an archive of newsletters and other publications, monthly calendar, and staff training materials.

* The LOS data is based on responses from caregivers and youth at six months after intake. The sample size is very small for this report; the number of responses ranges from 19 to 25 for the survey questions.

St

rong

ly D

isagr

ee

Agre

e St

rong

ly

Disa

gree

Ag

ree •Themajorityofcaregivers(64percent)agreeorstrongly agreethattheyhelpedtochoose

theirchild’sservices

•Abouthalfofyouth(48percent)agreeorstrongly agreethattheyhelpedtochoosetheirservices

•Themajorityofyouth(67percent)andcaregivers(56percent)agreeorstrongly agreethatthey aresatisfiedwithservicesreceived

•56percentofcaregiversagreeorstrongly agreethattheygotthehelptheywantedfortheirchild

•Themajorityofyouth(56percent)agreeorstrongly agreethattheygotasmuchhelpasthey neededandgotthehelpthattheywanted

•Themajorityofcaregivers(84percent)andyouth(73percent)agreeorstrongly agreethat providersrespecttheirbeliefsandtraditions

7

“Impact’s System of Care has been one of the programs that have made the difference in whether I place a youth out of home or allow him or her to remain at home. Impact has been a tremendous benefit to many of the youth and families that come before me in Court.”

– Judge Janelle A. Lawless, Presiding Judge, Ingham County Circuit Court Family Division

In addition to the continuing participation of Impact families and youth in the Longitudinal Outcomes Study, discussion groups are being piloted to explore issues that are important to families. The evaluation will continue to monitor the key outcomes sought by Impact:

•MaximizedfunctioningofchildrenwithSEDandtheirfamilies •Reducedneedforout-of-homeplacements •Efficientuseofresources •Increasedparticipationoffamiliesandyouthinthedevelopment of the System of Care •Aunified,family-driven,youth-guided,andculturallyandlinguistically competent System of Care for children with SED and their families •IncreasedcommunityknowledgeoftheSystemofCareanddecreased stigma

Moving Forward

Characteristics of youth being supported by Impact: • 51% Male

• 49% Female

Most are between the ages of 13 and 18 years (82%); the rest are between the ages of 4 and 12.

• 147 White

• 76 African-American

• 5 American Indian or Alaskan

• 1 Asian

• 33 Other or unknown

“A second year of working with families and ongoing training has made us all more comfortable in our roles. Our ability to better navigate the systems will allow us to support even more families.” – Shawn Cook-Garmyn, Family Advocate

8

What has the Ingham County Board of Commissioners’ investment in Impact meant to the county?

Ingham County’s investment in Impact has given us the opportunity to put real focus on serving troubled youth who have mental health issues. Without Impact, many of these children would find themselves in trouble with their family, peers, or the law, and would have no options other than the judicial system.

Impact allows these children, and their families, to get the services they need to address their specific issues. By involving their families, Community Mental Health, the courts, the Department of Human Services, and many community partners in the decision of what type of treatment is best for the child, we get holistic solutions to problems. I can’t stress enough the importance of having all these partners around the same table at the same time.

Families are strengthened as Impact gets directly involved. This means the solutions are agreed upon, discussed, and implemented in a way that doesn’t alienate either the child or the family. This wrap-around care helps to eliminate future problems and saves Ingham County money. But more importantly it gives these children access to programs and services that help them deal with their issues and stay out of the juvenile justice system in the future.

What decisions have you or the Ingham County Board of Commissioners made in the last year that are evidence of your support of children’s mental health care?

The Board of Commissioners has allocated $878,550 out of Ingham County’s Juvenile Justice Millage to help support Impact programming. This money is matched by the state’s Child Care Fund. The general fund is also providing $50,000 in support in 2008 to Project Impact through the Department of Human Services budget. With more funding, we can reach more children and their families.

Commissioner Debra Nolan and I also attended the 2008 Training Institutes conference in Nashville in July that was sponsored by Substance Abuse and Mental Health Services Administration (SAMHSA), which provided a six-year grant to Impact. The decision to take a week away from our families and work to learn more about the various programming taking place in other communities has opened the door for some innovative new programming in Ingham County.

Q&A with Ingham County Commissioner Rebecca Bahar-Cook

9

Q.

A.

Q.

A.

For more information, go to:www.impactsystemofcare.org

Impact Stakeholders

YouthandFamiliesfromInghamCounty

AssociationforChildren’sMentalHealth

Boys&GirlsClubofLansing

ChildandFamilyServices–CapitalArea

CommunityMentalHealthAuthority,C-E-I

CristoReyCommunityCenter

Highfields,Inc.

InghamCountyCircuitCourt–FamilyDivision

InghamCountyDepartmentofHumanServices

InghamIntermediateSchoolDistrict

LansingPoliceDepartment

LansingSchoolDistrict

LutheranSocialServices

St.VincentCatholicCharities