An Integrated Approach to Working with Youth with

Both Permanency and Behavioral Health

Concerns

Elizabeth McGovern, Area Office Director, Morris/Sussex and PassaicJeena Williams, DYFS Team Leader, Morris/Sussex and PassaicElizabeth Manley, CEO Caring Partners

Who We Are . . . The New Jersey Department of Children and Families

CHILD PROTECTION, WELFARE, PERMANENCY; CHILD BEHAVIORAL HEALTH; AND ABUSE PREVENTION

Department of Children and Families (DCF)

Division of Youth & Family Services (DYFS)

Child Protective ServicedPermanency

Division of Child Behavioral Health Services (DCBHS)

Child Behavioral Health Services

Division of Prevention & Community Partnership

Prevention of Child Abuse

& Neglect

Area Offices

Local Offices

Early Childhood Services

Domestic ViolenceServices

School Linked Services

Family Support Services

Services to County Welfare

Agencies

System of CareFor Children1-877-652-

7624

DCF / DYFS

Case Practice Improvement Overview

Allison Blake, Ph.D., LSW, Commissioner

Department of Children and FamiliesJean Marimon, Director

DCF, Division of Youth and Family Services

1st Focus on the FundamentalsCreate the conditions that are pre-

requisites to…

2nd Implementing Change in the Culture of Practice

Move from a case management service delivery model to a strength-based, family centered, child

focused model. Then, DYFS can…

3rd Deliver ResultsWith improved outcomes for children

and families.

The federal lawsuit recognizes that reform requires a focused and staged process to achieve results:

Average DYFS Caseload Size Statewide as of June 2010

1-10 Families 62%

11-20 Families 37%

21-30 Families 1%

No Families 0.2%

More than 30 Families0.04%

Total Resource Homes Licensed

1287

10781242

1014

424769

1004

959

0

500

1000

1500

2000

2500

FY 2007 Total 1711 FY 2008 Total 1847 FY 2009 Total 2246 FY 2010 Total 1973

Non-kin Kin

Finalized Adoptions FY 2006-2010

1275

1435

13841388 1389

1150

1200

1250

1300

1350

1400

1450

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010

Children in DYFS Out of Home Placement FY 2005 - FY 2010

DCF Case Practice: Focusing on Families

DCF/DYFS Case Practice model aims to see a family’s whole life picture; including it’s natural supports (such as community organizations, family members, neighbors) and any issues effecting the family’s success (such as unemployment, substance abuse, housing, education, domestic violence, physical and mental health, etc.).

Who is Part of a Family Team?A family team is made up of everyone important in the life

of the child, including interested family members, foster/adoptive parents, neighbors, friends, clergy, as well as representatives from the child’s formal support system, such as school staff, therapists, service providers, CASA, the court service and legal systems.

Parents, children and youth (when age appropriate) and team members do become active participants in making decisions about what services and supports are needed, how and who should deliver the services and how to identify success.

Strengthening case practice, Strengthening case practice, engaging families toengaging families to

see a child not just as he is…

But as strong as his family can become.

DCF CASE PRACTICE DCF CASE PRACTICE

FAMILYFAMILYFOCUSFOCUS

Division of Child Behavioral Health Services (DCBHS)

Contracted Systems

AdministratorClinical AssessmentTo determine the

appropriate level of care within the system and /or

access to services(877)652-7624

PerformCare, LLCCare ManagementOrganization

Caring Partners of Morris/Sussex

(973)770-5505

Helps families create Child & Family Teams

that develop individual resources and give access to supportive services1-2 year model

Youth Case Management

Newton Memorial Hospital

(973)579-8312

Face-to-face Case Management that gives access to

supportive services

90 day model

Mobile Response & Stabilization

Family Intervention Services

(877)652-7624

Keeping kids at home & stable with access to short-term services4 to 8 week model

Community Providers

Community Services

Services through the System of Care & Direct to families

Medicaid &

Fee-for -service

Family Support OrganizationFamily Support Organization of Morris/Sussex

Available to all families inside and outside the DCBHS System of Care For information on parent support groups call: 973-940-3194

Family Based Services Association of New Jersey

Out of Home Treatment Providers

Highest levels of care

2003Local Systems of Care are initiated in Hudson and Middlesex counties.

2006Local Systems of Care are initiated in the remaining two areas of the state: Sussex/Morris, and Hunterdon/ Somerset/Warren.

2005Local Systems of Care are initiated in three areas: Gloucester/ Cumberland/Salem, Ocean, and Passaic counties.

2002• Local Systems of Care are initiated in three

additional areas: Atlantic/Cape May, Bergen, and Mercer counties

• Acting Governor DiFrancesco endorses the project with two caveats:

1. The name must be changed to “the Partnership for Children”, and

2. The project must be expedited to initiate local Systems of Care in urban areas.

2004• Local Systems of Care are initiated in Camden

and Essex counties

• The Office of Children’s Service (OCS) is created in response to the lawsuit against the Division of Youth and Family Services

• The Partnership for Children becomes the Division of Child Behavioral Health Services under OCS.

2001Local Systems of Care are initiated in three areas (patterned on vicinages): Burlington, Monmouth and Union counties.

1999• New Jersey wins System of Care grant award from the

Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal Department of Health and Human Services (USDHHS)

• Governor Whitman endorses the project with two caveats:

1. It must be statewide,

2. It must be funded through Medicaid “Rehabilitative Services.”

NJ Division of Child Behavioral Health Services

DCBHS HistoryDCBHS History

Children’s System of Care Info:

• At any given time there are: 2,562 youth enrolled in MRSS 3,558 youth enrolled in YCM 2,400 youth enrolled in CMO 2,015 youth enrolled in UCM 1,868 youth currently in out of home care 39,779 youth who are open to the CSA

PerformCare, LLCWelcome To

New Jersey Children’s System of Care• PerformCare is the statewide Contracted System Administrator

(CSA) for the Division of Child Behavioral Health Services (DCBHS).  As the CSA, PerformCare is committed to getting children, youth, young adults and their family/caregivers the services that they need at the right time, and in the right place. 

Hours of Operation:24 Hours a Day 7 Days a Week For Assistance Please Contact Us at: 1-877-652-7624 

•

Mobil Response and Stabilization Services (MRSS)

Initial Response (within 1 hour)• Initial Response can last up to 72 hours• Intervention and de-escalation• Assessment – Crisis Assessment Tool (CAT)• Safety/Crisis Planning• Individualized Crisis Plan (ICP)• Discharge/Transition Planning

Stabilization Services (up to 8 weeks)• Provide additional resources to ensure stabilization• Linkage to community resources• Individual and Family In-Home Counseling/Behavioral

Assistance

Care Management Organizations –CMO/UCM

No eject no reject. Referrals are assessed for CMO level of care through the CSA and assigned to the appropriate CMO/UCM

CMO has 24 hours to make contact and 72 hours for the first visit. We are generally accompanied by the Family Support Organization.

Commitment to Community Resource Development.

Care is coordinated through a Child Family Team Process for which all things are coordinated.

How Does Care Management Work ?

• The CFT is tasked with looking at all life domains, identifying functional strengths of the youth, family and team and prioritizing the needs and developing thoughtful strategies to meet these needs.

• The average length of stay is 12 to 18 months.• In a CMO/UCM the youth and family have 24

hour access to Care Management Staff.

Family Support Organizations - FSO …

• Educate families on their rights and responsibilities within the NJ System of Care

• Advocate to assure families get what they need• Enhance the service system• Encourage families to recognize and appreciate

their strengths• Help families articulate their needs• Support families in providing feedback to their

service providers, their Care/Case Managers• Empower families to become their child’s best

advocate• Insure the family voice is heard

How do Family Support Organizations fulfill their missions?

Strategic PartnershipsEngender FSO/CMO/UCM Strategic PartnershipEngage in Community DevelopmentProvide Peer to Peer Support for Families with

Children at the highest levels of Care ManagementEducate Families about the System and their Child’s

ChallengesEducate Families to Advocate in their Child’s and

Family’s best interestMonitor the System of Care for Family Involvement,

Family “Friendliness” and Family FocusAdvocate for System Change when Necessary.

(NJ Division of Child Behavioral Health)

Peer to Peer Family Support

Provided to Families who have Children enrolled in Care Management Organizations

Give intense support services to these families when most needed

Educate families to understand the NJ System of Care

Youth Partnership

• The Youth experiencing the System know it from the inside out.

• They bring a unique perspective to the System of Care

• Family Support Organizations empower Young People become advocates for themselves and their own services

• Youth Partnership activities are provided through the Family Support Organizations

Family Team and Child Family Team Similiarities

Family Team Meeting - FTM

• Safety

• The family selects the team

• Strengths and needs focused

• Prioritize 3 to 4 needs

Child Family Team - CFT

• Safety

• Family and youth select the team

• Strength and needs driven

• Prioritize 3 or 4 life domains

FTM and CFT Differences

Family Team Meeting

• Underlying needs are quickly identified and addressed

• The focus is on the whole family

• Very quick time frames

Child Family Team• Underlying needs are

identified and addressed over time

• The CFT focuses on the youth with a behavioral health concern

• The CFT focuses on all life domains over the Care manager’s involvement over12 to 18 months

Treatment Options

Community Based

• Outpatient – individual, group and family

• Partial Care• Partial Hospitalization• Behavioral Assistance• Intensive In Home – IIC

Out of Home Treatment

• Treatment Home• Group Home• Residential Treatment• Psych Community

Residence• Intensive Residential

Treatment Services• CCIS

Treatment Considerations

• Medical Necessity

• Safety

• Expectations

• Guardian Involvement

• Clinical Considerations

• Transition planning at admission

• Community Planning

Integrating Child Behavioral Health and Foster CareMorris and Sussex Recommendations

CMO to provide crisis intervention training to all local DYFS staff.

CMO to provide crisis intervention training to resource parents.

CMO to develop a brochure targeted at resource parents. DYFS staff will present MRSS to resource parents as a

normative transition service rather than a crisis-oriented program.

Team Leader to speak directly with resource parents who have questions about or need assistance accessing DCBHS programs (especially MRSS and FSO)

Morris and Sussex Recommendations Continued:

CMO staff can submit a timely addendum to resource home requests so that the child can be comprehensively presented from multiple perspectives. This will include strategies that are successful in comforting the youth.

DYFS staff who have youth approaching discharge from out of home treatment will give early notice to the resource unit so that they can begin locating a potential step-down placement.

Resource Family Workers will be invited to internal reviews to incorporate the needs of the resource parent.

DYFS and CMO case/care manager will make a joint visit to resource homes requesting a youth’s removal to offer enhanced services to preserve the placement.

Permanency Project• Joint venture by DYFS Team Leader,

CMO Clinical Liaison, DYFS Concurrent Planner.

• Inspired by anecdotal evidence regarding children who require permanent living arrangements after completing treatment.

• 11 such cases were identified in Morris/Sussex area; sample of 5 was reviewed.

Permanency Project (cont.)

• Resulted in recommendations in the areas of family involvement; DYFS & DCBHS case management; and SOC refinement.

• Concrete efforts include:– Adolescent FTM’s– Adolescent Life Books– Educational Sessions

for Supervisors– Development of

Adolescent Permanency Training

Next StepsMonitor the data

Youth who are placed in resource homes rather than treatment facilities.

Youth who are returned to the community in a resource home.

Youth removed from resource homes and moved to out of home treatment.

Thank you for attending our workshop!