PCCYFS CHILDREN’S SERVICES POLICY DAY

Behavioral Health and Child Welfare Services

December 8, 2011

Discussion with Office of Mental Health and Substance Abuse

Services Staff

Proposed Agenda• Vision for OMHSAS, top priorities, projections for the future • Cross-systems activities

– Status of the Department of Drug & Alcohol Services– Initiatives/Collaborations with other Departments (Health, Education, etc.)

• Future of BHRS

• Data on utilization of services

• Update on PRTF draft bulletin

• Outpatient services – experiences, rates, etc.

• Potential of offering trauma-informed services to military families

• Update on OMHSAS Children’s Bureau initiatives & efforts– Money Follows the Person in children’s services– System of Care– Hi-Fidelity Wraparound / Youth & Family Training Institute– Youth Suicide Prevention – new Garrett Lee Smith grant

Priorities

• DPW Goals include Cost Containment and Self reliance;

• OMHSAS Children’s Bureau goals include youth and family empowerment, High Fidelity Wraparound, and Systems of Care.

• Additional goals include Suicide Prevention, and expansion of Evidence Based Practices.

BHRS Totals

06–07 07–08 08–09 09–10

Dollars

$575M

$581M

$617M

$617M

Users53,70

054,39

457,43

660,82

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GoalsGoals

1. Realign BHRS to become a more clinically Realign BHRS to become a more clinically appropriate, high quality service. appropriate, high quality service.

2. Promote use of evidence based practices and the full 2. Promote use of evidence based practices and the full array of clinic and community-based services for array of clinic and community-based services for childrenchildren..

3. Assure more cost effective delivery of BHRS.3. Assure more cost effective delivery of BHRS.

4. Streamline the paperwork process (reduce the need 4. Streamline the paperwork process (reduce the need for packets).for packets).

Residential Treatment Facilities

• There has been a dramatic change in the RTF system over the past 4 years;

• There has been reduced use due to development of evidence based practices such as Multi-Systemic Therapy and efforts in Child Welfare and Juvenile Justice;

• 7/13/09 we had 2,807 Accredited and 1,281 non-accredited

• 4,088 beds total beds in 2009 • 3/1/11 we have 1,960 Accredited and 501

non-accredited, • a decrease of 1,627 beds in two years• a total of 2,461 beds in 2011

Residential Treatment Facilities

Accredited RTFs

06–07 07–08 08–09 09–10

Dollars

$239M

$232M

$218M

$187M

Users 5,058 4,632 4,213 3,691

Non-Accredited RTFs

06–07 07–08 08–09 09–10

Dollars $48M $41M $43M $37M

Users 1,593 1,320 1,301 1,098

Family Based Mental Health Services

Family-Based Mental Services

06–07 07–08 08–09 09–10

Dollars $62M $76M $88M $97M

Users 6,572 8,079 9,048 9,803

The Context Ongoing reassessment of FBMHS program with the

goal of consistency, effectiveness, and quality improvement

Collaborations between the Children’s Bureau, representatives from the regional offices, BH-MCOs, consumer families, FBMHS program directors/supervisors, and the three training centers

Collaborations between the three training centers to create greater uniformity in the practice model and the training

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Concerns

• Inconsistency in implementation of the FBMHS clinical model both within and across programs

• Wide variations in how programs define the role of clinical supervisor and what is given focus in supervision

• Need for cost effective approach to training and program implementation

• Recognition that adult education theory emphasizes coaching and supervision as well as training

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The Solution Involves … Adoption of a uniform Family Based Treatment

Adherence measure that can be used by the training centers and FBMHS programs across the state

Expansion and clarification of the role of clinical supervisors in FBMHS

Establishment of best practice standards for FBMHS supervision

Implementation of a formal curriculum for FBMHS supervisors by the training centers

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Rolling Implementation• Gradual reallocation of resources and expectations.• New training for supervisors and also for new FB staff, with

some training being done on-line and reduction in the standard of hours of staff training.

• Further conceptual strengthening of the model.• Use of FB fidelity instruments to maintain accountability to

the model.• Use of a range of outcome measurements, with baseline

established at initiation of service, to maintain clinical accountability.

• Gradual implementation of changes, with modification based on mutual learning.

• Overall goal: For changes to be efficient and cost-neutral.

Fetal Alcohol Spectrum Disorder

• Report has been released• Action is being planned

Evidence Based Practices

• Report from the EPIS Center

• 13 providers reporting

• 2,397 youth served in 2010– 43% referred by CYS, 46% by JPO– 67% would have been placed out-of-home otherwise

• 1,822 youth discharged in 2010– Average length of stay for successful discharges = 3.6 months– 11% were placed out-of-home

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MST Outcomes

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MST Outcomes cont.

“Success” was defined as discharge by mutual agreement of caregivers and MST team, and youth was living at home,

attending school, and had no new arrests at discharge.

• 12 providers reporting

• 1,661 youth served in 2010– 28% referred by CYS, 53% by JPO– 11% would have been placed out of home otherwise

• Of 1,175 youth discharged in 2010– Average length of stay for successful discharges = 3.7

months– 5% were placed out-of-home

FFT Outcomes

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FFT Outcomes cont.

“Success” was defined as completing all phases of the FFT treatment model and positive ratings on Therapist and Client Outcome Measures, indicating a reduction in risk factors and

increase in protective factors.

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Cost Savings

2010 Pennsylvania savings related to

reduced placement costs = $4.5 Million

Conservative estimate of savings, based on 3,031 youth discharged from EBIs in 2010

Youth Suicide Prevention

• There is Youth Suicide Prevention plan which is being updated

• There is a special grant which began in 3 counties

• And has been renewed to allow us to expand to additional counites.

Garrett Lee Smith Memorial Act• Passed by Congress in

2004

• Named after Senator Gordon Smith’s (OR) son who died by suicide at age 21

• Provides funding for community based suicide prevention

The Need in Pennsylvania

Over half the counties in Pennsylvania have suicide rates higher than the national average’

# Youth Suicides (15 to 24 years old), by Pennsylvania County, 1990-2005

Targeted Counties: Lackawanna, Luzerne, Schuylkill

Central Aims

• Objective 1: Create a task force of a broad range of stakeholders

• Objective 2: Provide a youth suicide “gatekeeper” training program

• Objective 3: Provide medical practitioners in the 3 counties free access to a web-based self report suicide screening tool

• Objective 4: Increase the integration of behavioral health services with medical services

• Objective 5: Enhancing clinical services for suicidal youth

High Fidelity Wraparound• There are 10 counties involved in High Fidelity

Wraparound, the 5 System of Care Counties: and 6 others: Allegheny, Bucks, Delaware, Fayette, and Northumberland.

• Over 500 youth and their families have been served since the initiation of HFW in 2008.

• We are working with counties/BHMCOs to expand the availability of HFW to more counties.

• Philadelphia will be the next county!

System of Care Update

• We continue work with building the infrastructure in the first 5 counties: Erie, Chester, Lehigh, Montgomery, and York.

• We received funding for a planning grant from SAMHSA to expand Systems of Care throughout the Commonwealth.

Pennsylvania System of Care Expansion Proposal

SLT

PlanningConsultants

Tri-West

ProjectDirector FLST

RPGCBH

Philadel-phia

County

RPGCBHNPCounties

RPGMBH

Counties

YLST

RPG IICCBH

OCounties

RPGVBH

Counties

RPG ICCBH

OCounties