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Because Minds Matter: Collaborating to Strengthen Management of Psychotropic Medication for Children and Youth in Foster CareWashington, D.C. August 27-28, 2012

Maximizing Opportunities to Improve Child and Family Well-Being through Innovative Funding:

Transforming Rhode Island System of Care for Children, Youth and

Families

Dr. Janice DeFrances, Ed.D.Director, RI Department of Children, Youth and Families

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Rhode Island’s Commitment to System of Care Transformation

1989, CASSP – Child and Adolescent Service System Program (Infrastructure) Grant , SAMHSA

1991-Present, Statewide Family Network Grant – Parent Support Network of RI

1992, Project REACH grant – Center for Mental Health Services (youth with serious emotional disorders and their families) SAMHSA

1997, Project HOPE grant – Center for Mental Health Services (youth adjudicated) SAMHSA

2003, Report of RI System of Care Task Force: Toward An Organized System of Care for RI’s Children, Youth and Families

2005, RI Positive Educational Partnership – Center for Mental Health Services (early childhood and positive behavior supports and interventions- infrastructure) SAMHSA

2009, RI Family Care Community Partnership Implemented

2011, Expansion Grant – Planning Year, Center for Mental Health Services, SAMHSA

2012, RI Networks of Care Implemented July 1st

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System of Care Planning in RI: Overview

1992 through 2003-Statewide Children’s Mental Health Advisory Board/ CASSP Board/ and 8 Local Coordinating Councils

2001-2003 Governor’s Task Force meets to produce report to guide planning

State Redesign planning: Focus groups and Public meetings to gain community, family and youth input with concept papers and then final RFPs

Ongoing bi-annual retreats with state agencies, current and potential providers, community, family, and youth involvement

Present: Statewide Family Community Advisory Board and four regional Boards

Rhode Island State Expansion Team: Strategic Plan and National Consultation

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System of Care Planning in RI: The Foundation

2001, the RI System of Care Task Force was established with joint Leadership

Key leadership from House, Senate and the Department of Administration

Stakeholders met over the course of 2 years to develop the final report

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System of Care Planning in RI: The Foundation

Result:

The Report of the RI System of Care Task Force, “Toward an Organized System of Care for RI’s Children, Youth and Families”, January 2003 was submitted to the incoming governor and legislative leadership which included these key statements:

“With this letter, we send to you the report of the Rhode Island System of Care Task Force and ask for your full support and your strong leadership in moving us closer to an organized system of care for Rhode Island’s children, youth and families.”

“The members of the System of Care Task Force unanimously endorsed the vision and principles of this report and acknowledged that considerable work needs to yet be accomplished.”

(page 7, The Report of the Rhode Island System of Care Task Force, January 2, 2003)

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The Report became a blueprint for the statewide development toward an organized system of care for Rhode Island

The work of this Task Force became the springboard for our current system of care transformation in RI

System of Care Planning in RI: The Foundation

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Until 2005, innovative programs remained separate and a statewide integrated system had not been achieved

The outcomes for children, youth and their families had not changed significantly.

In 2005, RI DCYF Senior Leadership committed to full system transformation based on system of care (SOC) principles

Transforming RI’s System of Care: Transition

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Transforming RI’s System of Care: Implementation

Phase I - Family Care Community Partnerships (FCCP)- Implemented January of 2009

- Designed for families not involved with the Department: Prevention and early intervention through family preservation and community-based behavioral health programs and family supports

Phase II - Networks of Care- to implemented July of 2012- For families and youth active with the

Department

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System of Care - Phase II Implementation Date: July 1, 2012

RI Family Care Networks: Ocean State Network and RI Care Management Network

Phase II is serving families who are open to the department and actively receiving services. The department established two Statewide Networks of Care that partner with the department and families to consolidate the management of services and supports for each child and family according to their unique strengths and needs.

Each Network of Care has a Network Lead that is responsible for building a collaborative, comprehensive array of accessible formal and informal services and supports, including residential and home-based services and support that will strengthen and support the home setting during and following out-of-home placement.

The Networks must integrate wraparound principles, trauma and evidenced-based practice into service delivery and include strong partnerships with education and other entities in order to improve educational stability and success.

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Governance in Rhode Island

EOHHS / DCYF

Medicaid/RIte Care, Behavioral Health and Child Welfare dollars

Global Consumer Choice Medicaid Wavier

Statewide Protocol & Implementation Team State Expansion Team

Community Networks

4 FCCPs2 Networks of Care

Statewide Family Community

Advisory Board

Contracted Care Management

Networks

Anderson, J., Conlan-Lewis, L., (2012. Primer Hands On, Orlando, FL: RI Department of Children Youth and Families)

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RI Outcomes:

Over the past five years, the Department of Children, Youth and Families has:

Reduced the number of youth placed out of state by over 77% from 2008 -2012

Lowered the number of children entering out of home care by 39%from 2007 – 2012

Developed and implemented Phase I of the System of Care (FCCP) as a front end diversionary program that has successfully reduced the

number of families becoming open to the department and reduced the number of children in our care

Launched Phase II of System of Care (Networks of Care)

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FY20071,202 FY2009

965 FY2011809

FY2012503

0

500

1,000

1,500

Residential Census

RI Outcomes: Reduction in Residential Placements

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RI Outcomes: Reduction in Out-of-State Residential Placements

•As of June 2012 – Reduced to 44 Out-of State

•Most are nearby

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Current RI System of Care Management Structure and Funding for Promoting Safety, Permanency, and Well-being

State AppropriationsTitle IVB & EMedicaid/RiteCareChildren’s Trust Fund

Department of Children, Youth,

and Families- behavioral health, child welfare, and

juvenile justice

Family Care Community Partnerships4 Lead Provider Agencies and

Regional NetworksAt risk child welfare Service Navigation

Partnerships

Community Providers, Family Support Organizations, and Natural Helping Networks

Anderson, J. , Conlan-Lewis, L., (2012. Primer Hands On . Orlando, FL.: RI Department of Children, Youth, and Families)

CMHS , SAMHSA System of Care Grants

Executive Office of Health and Human Services

Networks of Care 2 Lead Provider Agencies and

Statewide NetworksFormal involvement with child welfare

Intensive Care CoordinationPartnerships

WraparoundChild & Family

Teams

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Structuring the Array of Servicesand Supports in Rhode Island: Funding

DCYF utilized prevention and earliest intervention, community-based

dollars to support the preservation of families, early childhood and school-based programs:

The state established the foundations of an evolving infra-structure to support:

- The strengths of families;- Develop and connect families to effective, evidence

based practices;- Identify kinship and protective factors, ensuring

that families are connected to natural helping networks.

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Community agencies are working together in partnerships to reduce duplication and identify the appropriate resources for families

Prevention dollars are being utilized across the state for mental health awareness and prevent child abuse events to support families in healthy, fun and “normalized” activities

State inter-agency collaborative work is demonstrating fruitful results:

1. RI DCYF and RI Medicaid are working to ensure the best use of State and Federal Funds

2. The Activities of the Wraparound process are now billable through the Global Consumer Waiver, (1115 Demonstration), “Cost Not Otherwise Matchable” (CNOM)

Structuring the Array of Servicesand Supports in Rhode Island: Funding

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Evidence-Based and EffectivePractices in Rhode Island – Building the Base

Established a Continuous Recruitment Request for Qualifications (CR-9) in 2002 for Evidence-based And Promising Practices: Child And Family Intervention.

Result: current array of practices including Multi-Systemic Therapy, Strengthening Families, Functional Family Therapy, Parents as Teachers, Cognitive Behavioral Therapy (CBT) and Alternatives for Families-CBT, Parenting with Love and Limits (PLL), Incredible Years and other promising practices.

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Building the Base: Family and Youth Peer Support

PSN peer mentor program- Medicaid feasibility study with state mental health block grant

Family members hired as Family Support Partners within Family Care Community Partnership agencies

State Expansion Team working on definition Medicaid service definition that incorporates family and youth support partner service components

Exploring Family Support Partner role hired within family organization and/or Networks of Care

Family and Youth Support Partner wraparound certification

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DCYF collaborated with large community child welfare provider, received funding by the National Child Traumatic Stress Network to establish training in trauma specific treatments.

DCYF partnered with Department of Health for Infant and Early Childhood Evidence-Based Home Visiting practices development such as Nurse Family Partnership.

Cross-agency commitment among Health, Education and Children, Youth and Families to collaborate to establish integrated system to insure

coordinated assessment and referral/access to most appropriate evidenced-based treatments.

RI is an “Appointed State” in the Quality Improvement Collaborative on improving management of psychotropic medication for children and youth in foster care, managed by the Center for Health Care Strategies.

Evidence-Based and Effective Practices in RI: Additional Supports

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Currently collaborating with Annie E. Casey Evidence 2 Success initiative in Providence RI, to better match proven Evidence-Based Practices to specific populations of need.

Collaboration with contracted System of Care providers to shift practice to

those that demonstrate the best outcomes for child and family well-being.

  

Evidence-Based and Effective Practices in RI: Continuous Commitment

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Schools

Child/Family

Public Agencies

Community

RI’s Collaboration with Annie E. Casey, Evidence2Success in Providence, combines the best of what works to improve children’s health and development: Logic Model

Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

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Evidence2Success Strategies Complementing RI efforts

Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

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Shift focus to improving child well-being through evidence-based approaches

Build and enhance partnerships with school district(s), mental health, Medicaid, legal system, education, etc.

Assess the needs of all children (in the aggregate)

Utilizing National Resources to Enhance Service System Development (Evidence2Success)

Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

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Administer youth well-being survey Analyze survey data to determine priority

outcomes and areas of elevated risk and protection

Estimate the proportion of youth that may be better served in less restrictive placements

Compare to city and neighborhood data to understand populations at risk of entering child welfare

Utilizing National Resources to Enhance Service System Development (Evidence2Success)

Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

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Partner neighborhoods

DCYF involved youth

Providence

Well-being surveys of:

Youth in Providence public schools

Youth involved with public systems

Utilizing National Resources to Enhance Service System Development (Evidence2Success)

Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

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RI: Successes

Families staying together at an increasing rate Children are remaining safely at home and in their schools

Youth are Transitioning from the Youth Development Center (YDC) to home

Children with behavioral health challenges and their families are receiving supports to help ensure growing stability and wellness

Reduction in Caregiver Strain

Prevention and early intervention with early childhood and elementary school settings is occurring at an increasingly coordinated and integrated manner

The RI System is continuing to develop skilled Wraparound Facilitators and recognizes the significant need for a Family Leadership and Family Support Partners