child and adolescent task force report charlotte v. mcnulty, vice chair presentation to house...
TRANSCRIPT
Child and Adolescent Task Force Report
Charlotte V. McNulty, Vice ChairPresentation to House Health, Welfare
and InstitutionsGeneral Assembly Building
September 6, 2007
Background
• Three Committees – Access to services for all children
with serious emotional disorders– Access to services for children
involved with juvenile justice services
– Involuntary Commitment
C&A Access Issues
• Many of the access issues for adults are just as evident for children and adolescents
• Inconsistent level of community based services for children across the state
• Need a broader mandate of services to provide an adequate mental health system of care
Proposed Mandated Services – All
CaseManagement
Outpatient
Residential/Housing
In-Home
Respite
Family Supports
Emergency ServicesCrisis Stabilization
Consumer
C&A
Inpatient/Acute Care
Both
Adult
Core Values
• System of care should be– Family focused
•Needs of the child and family dictate the types and mixes of services
– Community based– Culturally competent
Comprehensive Services Act (CSA)
• CSA incorporates the core values• CSA raises additional access concerns
– CSA should be a conduit for access but implementation has been problematic
C&A Access Issues (cont.)
• JLARC study– 16,262 young people served in 2005– One quarter received residential care
• Cost: $194 million
– Some young people are placed in more restrictive settings due to lack of community alternatives
– Costs related to residential care can be reduced by addressing the gaps in access to and availability of community based services
– Effectiveness of residential care is questionable
Medicaid - Mental Health – Other Count %
Yes No N/A Yes No N/A
Does Child have a DSM IV Mental Health Diagnosis?
6223
9486
0 40%
60%
0
Reason for Service Primary
Secondary
Tertiary
Total
Special Education 2496 301 231 3028
Emotional Issues 1001 1084 486 2571
Behavioral Issues 2558 1753 610 4921
Mental Issues 312 284 191 787
Physical Aggression 195 338 244 777
Homicidal 5 8 5 18
Suicidal 55 49 45 149
Disordered Thinking 5 43 45 93
Self-Mutilation 15 32 46 93
CSA Child Data Set FY07 QTR3
Juvenile Justice Committee
• DJJ reports survey of young people in custody for delinquency revealed– 43% are diagnosed with mental and emotional
problems– 70% are diagnosed with a substance use disorder
• Exploration of “Sequential Intercept Model”– At each intersect between juvenile justice and
behavioral health there is a need for• Prompt assessment• Access to community based behavioral health services
• Juvenile justice is NOT the best place to serve children with mental health issues
Model of Intervention
• Capacity Components necessary to improve access to other private and public community based services should be the same as the it is for adults
Early Intervention and Treatment services
Crisis Response Services
Intensive Support Services
Access Options
1) Fund incentives through the Office of Comprehensive Services to limit the use of residential treatment and use the money saved to create more community-based services;
2) Mandate additional services through CSB statute beyond emergency services and case management including crisis stabilization, family support, respite, in-home, day-treatment and psychiatric care. Insure funding is available
Access Options, Cont.
3) Recommend that the Office of Comprehensive Services develop a policy for communities that are over-reliant on residential care that requires that prior to any non-emergency residential placement, FAPT shall:– Obtain care coordinator and mental health evaluation
from CSB;– Explore all possible community-based services;– Document that they are inadequate and cannot be
created;– Develop discharge plan;– Report rationale and seek approval of CPMT
Access Options, cont.
4) CPMT shall review every residential placement within 21 days of placement to determine if crisis stabilization has occurred. Any longer care must be justified.
5) CSBs have legal authority for being “front-door” for behavioral health in community and, therefore, should conduct intake and evaluations for all CSA children needing behavioral health treatment.
Access Options, Cont.
6) An aggressive, clinically knowledgeable case management and utilization management system must be built in, especially in regards to use of residential care.
7) It is recognized that there is a need to build collaborative relationships between communities and universities for development of best practice models and evaluations processes.
Questions?
Contact Info:Charlotte V. McNulty, Executive Director
Harrison-Rockingham CSB1241 North Main Street
Harrisonburg, Virginia [email protected]
Phone: (540) 434-1941