System of Care Planning

1. System of Care Planning Waiver Conference September 9, 2009

2. Purpose of the Session The presentation will focus on the planning for the development of a system of care for children with developmental disabilities or with serious emotional disturbance and their families. 2

3. Program Policy Guidelines The PPGs require CMHSPs to plan with local stakeholders, parents and youth to develop a system of care for: • Children with developmental disabilities and their families. • Children with serious emotional disturbance and their families. 3

4. Why develop a System of Care? • We are not getting the outcomes that are needed for children/youth to succeed in life. • We need to consider the whole child/youth and their family and the systems with which children/youth and their families interact. • There is an interconnectedness of outcomes for health, social, emotional and educational development across systems (Child Welfare, Education, Health Care, etc.). 4

5. System of Care It is anticipated that by completing the system of care planning process, there will be: • improved access to an array of community based mental health services for children/youth with developmental disabilities and children/youth with serious emotional disturbance • a focus on Medicaid eligible children/youth in other systems that meet the criteria for CMHSP services. 5

6. DCH Role and Commitment… DCH’s continues to support communities building local systems of care… Children’s Mental Health Block Grant RFP application has required system of care planning for the last 3 years with emphasis on partnerships with other systems. Regular meetings with our state system partners to increase opportunities and address barriers on the local level. The Program Policy Guideline (PPG) requires system of care planning process to be initiated by CMHSP for children with a SED and children with DD and their families. Training and technical assistance is available. 6

7. What is a System of Care? A community system of care for children/youth and their families is the organization of public and private service components within the community into a comprehensive and interconnected network in order to accomplish better outcomes for children/youth. 7

8. System of Care System of care is guided by a philosophy and supported by an infrastructure Philosophy Infrastructure Services and Supports Child/Youth and Family 8

9. Services and Supports Substance Abuse Services Mental Health Services Other Service Health Care/Services Child/Youth And Family Child Welfare (Abuse/Neglect, Adoption Svs.) Legal System/ Juvenile Justice Education and/or Vocational Services Other Support Recreational Services 9

10. System of Care Planning…. • All System of Care planning is done ensuring that we embrace the family-driven, youth-guided philosophy. It guides the development of the system of care. • Parents and youth are required stakeholders. • Our core values are…. 10

11. System of Care Planning • The planning process always promotes the adoption of system of care values and principles for children/youth and their families. 11

12. Core Values [1] The mental health component of the system of care should be family – driven, youth-guided, with the needs of the child and family dictating the types and mix of services provided. The system should be community based, with the focus of services as well as management and decision-making responsibility resting at the community level. The system should be culturally competent, with agencies, programs, and services that are responsive to the cultural, racial, and ethnic differences of the populations they serve. 12

13. Guiding Principlesof a System of Care • All children should have access to a comprehensive array of services and supports that address the child’s physical, emotional, social, and educational needs. • Early identification of needs and intervention for children should be promoted to enhance the likelihood of positive outcomes. • The families of all children should be full participants in all aspects of the planning and delivery of services. 13

14. Guiding Principles • Children and families should be provided with services coordination or similar mechanisms to ensure that multiple services are delivered in a coordinated manner and can move through the system in accordance with their changing needs. • All children should receive services that are integrated, with linkages between agencies/ programs and mechanisms for planning, developing and coordinating services. 14

15. Guiding Principles • The rights of all children should be protected, and effective advocacy efforts for children should be promoted. • All children should receive services within the least restrictive, most normative environment. • Young children should be ensured smooth transitions to services as needed. 15

16. Guiding Principles • All children and families should receive services without regard to race, religion, national origin, sex, physical disability, or other characteristics, and services should be sensitive and responsive to cultural differences and special needs. • All children should receive individualized services in accordance with the unique needs and potentials of each child and guided by an individualized service plan. 16

17. System of Care Planning for Children with Serious Emotional Disturbance 17

18. Michigan’s System of Care In Michigan, our system of care efforts began in the early 1990’s with the Child and Adolescent Service System Program (Michigan Family Preservation Initiative). • Initiated Wraparound Services and Initiated Multi-systemic Therapy • Began Home-based Services in CMHSPs • Initiated financing of children’s mental health services and supports across multiple systems 18

19. System of Care Planning • The purpose of a system of care is to improve outcomes for children, ages birth to 18, and their families. • CMHSPs were requested to use a System of Care planning process in preparation for application for funding for the Children’s Mental Health Block Grant and/or implementing the 1915(C) SED Waiver. 19

20. System of Care Planning • MDCH is interested in increasing overall access to specialty mental health services and supports for Medicaid-eligible children with SED and specifically children in Child Welfare and Juvenile Justice. 20

21. System of Care Planning • The anticipated system level outcomes for children with serious emotional disturbance and their families include: • Development and maintenance of an array of services and supports • Improved access to mental health services • Services are provided in the home, community. • Blended resources increase the total dollars available for mental health services. 21

22. System of Care Planning • The anticipated child and family level outcomes for children with serious emotional disturbance and their families include: • Children improve in functioning and behavioral concerns are reduced. • Children improve in their school attendance and grade achievement. • Children have fewer contacts with law enforcement and have few subsequent contacts with juvenile justice system. • Parents of children report reduced strain associated with care for children with serious emotional disturbance and improvement in overall family functioning. 22

23. System of Care Planning To ensure achievement of the outcomes, CMHSPs are encouraged to select evidence based, promising practices as they develop their system. Use of innovative approaches is encouraged when it includes the evaluation of the innovative approach. 23

24. Evidence Based, Promising and Innovative Practices The development of the system of care includes review of current services provided in the community. It is recommended that the stakeholders, as they review the current mental health services, determine if the services delineated are an evidence-based, promising or an innovative practice. 24

25. Evidence Based Practice is… Consistent research (at least 2 Randomized Control Group Trials), a written manual for replication, research includes best clinical expertise as well as positive outcomes • Examples of evidence based practices include: • Parent Management Training-Oregon Model • Multi-Systemic Therapy, Functional Family Therapy • Multi-Dimensional Treatment Foster Care • Trauma Focused - Cognitive Behavioral Therapy • Cognitive Behavior Therapy for Depression 25

26. Promising Practices are… Clinical or administrative practices with considerable evidence or expert consensus, show promise in improving client outcomes, but not proven yet with the strongest scientific evidence. • Examples of promising practices include: • Wraparound • Child Care Expulsion Prevention (CCEP) • Infant Mental Health Services • Parent-Child Interaction Therapy 26

27. Innovative Practice is… Innovative practice is the use of a model that promotes the adoption of innovative ways to strengthen child, parent and family functioning. The practice needs to be family-centered; measures outcomes; community-based, promote collaboration and enhance the current mental health service array. 27

28. Innovative Practice Examples include: • Parent-to-Parent support and education services, • Working with local courts to address the need for early childhood mental health services for infants-toddlers who have been abused/neglected. 28

29. System of Care The planning of the System of Care for children with SED is designed to ensure improved outcomes of those we serve. 29

30. System of Care Planningfor Children with Developmental Disabilities 30

31. Before we begin…. • The definition of Developmental Disability as defined in the Mental Health Code follows…. 31

32. Developmental Disability Michigan Mental Health Code Definition of Developmental Disability Developmental disability means either of the following: (a) if applied to an individual older than 5 years, a severe, chronic condition that meets all of the following requirements: (i) If attributable to a mental or physical impairment or a combination of mental and physical impairments. (ii) Is manifested before the individual is 22 years old. (iii) Is likely to continue indefinitely. (iv) Results in substantial functional limitations in 3 or more of the following areas of major life activity: 32

33. Developmental Disability (A) Self-care (B) Receptive and expressive language (C) Learning (D) Mobility (E) Self-direction (F) Capacity for independent living (G) Economic self-sufficiency (v) Reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated. (b) If applied to a minor from birth to age 5, a substantial developmental delay or a specific congenital or acquired condition with a high probability of resulting in developmental disability as defined in subdivision (a) if services are not provided. 33

34. Michigan’s History… • Our State’s Mental Health System has developed: • From an institutional based system to a community based system. • From out-of-home placement to supporting children living with their family in their home and in their community. • Policies and funding have supported these changes. 34

35. Michigan’s History… Michigan children and families are supported in their community in various ways… • Array of Services and Supports provided by CMHSP • Children’s Waiver Program • Family Support Subsidy • Adoption Subsidy 35

36. System of Care Planning • To develop the optimal array of services and supports, we need to join with our community partners and parents/youth, since children with developmental disabilities live, develop relationships and thrive in communities. 36

37. System of Care Planning • There continues to be barriers to permanence in the family and community inclusion that include lack of… • early identification of infants and young children, coordination with Early On®. • services/supports to assist children with DD who have problem behaviors. • access to the intensity of services needed to sustain children in their home, community. • access to medically necessary services such as comprehensive assessments, habilitative services, family support services. 37

38. System of Care Planning • There continues to be barriers to inclusion due to lack of… • coordination between mental health, education, child welfare, juvenile justice and other services/support providers in the community. • stigma around children with developmental disabilities in our communities. • a large number of children with developmental disabilities in the juvenile justice system. 38

39. System of Care Planning • To build upon the shifts in policy and funding, to address the identified barriers, and to improve the outcomes for children with DD and their families, the development of a system of services and supports is required. 39

40. System of Care Planning • Outcomes for children with developmental disabilities, birth to 18 years of age, and their families are linked to their opportunity to grow, develop within a family, within a community. 40

41. System of Care Planning • Anticipated system level outcomes include: • Development and maintenance of a comprehensive array of mental health services and supports for children and their families. • Improved access to services that are responsive to the needs identified by children/youth and their parents. • Services are provided where children and their families live and in natural settings. • Blended resources among child-serving providers increase total dollars available for mental health services. 41

42. System of Care Planning • Anticipated child and family level outcomes include: • Children improve in their functioning and behavioral concerns are reduced. • Children improve in their school attendance. • Children have fewer contacts with law enforcement. • Children have permanency and there is reduction in the abuse and neglect of children. • Parents of children served in systems of care experience reduced strain associated with care for children, along with improvement in overall functioning. 42

43. System of Care Planning • After the convening of the stakeholders, CMHSP begins the planning process by: • Identifying services and supports provided by CMHSP, including…. • Home-based services • Case Management/Services Coordination • Wraparound Services • Respite Services • Other Services/Supports 43

44. System of Care Planning • Stakeholders identify services/supports in the community for children with DD and their families. • In addition, the stakeholders identify who is providing these services, the number provided as well as the cost. • The Stakeholders then discuss the access to the services/supports available as well as the effectiveness of the service array. 44

45. Evidence Based, Promising and Innovative Practices The development of the system of care includes review of current services provided in the community. It is recommended that the stakeholders, as they review the current mental health services, determine if the services delineated are an evidence-based, promising or an innovative practice. 45

46. Evidence Based Practice is… Consistent research (at least 2 Randomized Control Group Trials), a written manual for replication, research includes best clinical expertise as well as positive outcomes • Example of evidence based practice: • Early Intensive Behavioral Intervention (EIBI) for young children with Autism Spectrum Disorder 46

47. Promising Practices are… Clinical or administrative practices with considerable evidence or expert consensus, show promise in improving client outcomes, but not proven yet with the strongest scientific evidence. Example of promising practice: Wraparound Positive Behavior Support 47

48. Innovative Practice is… Innovative practice is the use of a model that promotes the adoption of innovative ways to strengthen child, parent and family functioning. The practice needs to be family-centered; measures outcomes; community-based, promote collaboration and enhance the current mental health service array. 48

49. Innovative Practice Examples include: • Parent-to-Parent support and education services • Parent Navigators • Parent Education 49

50. System of Care The steps in the planning process will be discussed next in the presentation. Overall, the system of care planning process is provided to ensure…. • There is access to an array of services and supports for children with DD and their families in the community. 50