Children’s Mental Health

1. Children’s Mental Health DCF/DJJ Crossover Workgroup 11/5/09 Laurie Blades Frank Platt, L.C.S.W. Chief, Children’s Mental Health Office of Family Safety Laurie_blades@dcf.state.fl.usfrank_platt@dcf.state.fl.us 850-921-4474 850-922-2860

2. DCF/DJJ Crossover Workgroup Overview • Who we serve • System of Care • Funding Sources • Access to Services • Services and Supports • Child Welfare and Children’s Mental Health Integration • 2008 Interagency Agreement • Cross-Over Youth Project

3. Children’s Mental Health Target Populations Target populations for children and adolescent mental health services funded through the department, per Ch. 394.493, F.S are children and youth who: • are experiencing an acute mental or emotional crisis; • have a serious emotional disturbance or mental illness; • have an emotional disturbance; • are at risk of emotional disturbance. Within the target populations above, the following children and youth are the focus of specific activities and initiatives: • Children zero to five years of age; • youth transitioning to adulthood; • children and youth in foster care.

4. Children’s Mental Health System of Care Funding Sources • Insurance • Private/Company • Florida Healthy Kids/Behavioral Health Network (BNet) • Medicaid (Agency for Health Care Administration) • Children’s Mental Health (Department of Children and Families) • Secondary Funding Sources • Child Welfare • Dept. of Education • Dept. of Juvenile Justice • Dept. of Health • Local governments are secondary funding sources for mental health services and supports.

5. The Children’s Mental Health System of Care Access to Services and Supports Medicaid Eligible Children and Youth • Medicaid eligible children and youth in need of community mental health services can access them directly from Medicaid community mental health providers. • The Medicaid Community Behavioral Health Services Coverage and Limitations Handbook describes the array of services available to Medicaid eligible youth, the eligibility criteria for these services and how recipients are certified to receive them and the qualifications of service providers.

6. The Children’s Mental Health System of Care Access to Services and Supports Non-Medicaid Eligible Children and Youth • Private insurance, private pay/sliding fee scales, BNet and state fund provide access to mental health treatment services for non-Medicaid eligible children/youth. • The children’s mental health district/region office manages their limited allocation of general revenue funds to assist non-Medicaid eligible children and youth in need of mental health services, often with the assistance of a Multidisciplinary (MDT) or Family Services Planning Team (FSPT). • When funding is available, CMH can assist the parents/caregivers of children/youth, within the CMH target population, to access community mental health and residential treatment services.

7. Children’s Mental Health System of CareServices

8. Children’s Mental Health System of Care Services Community-Based • Assessment • Case Management • Crisis Support/ Emergency Services • In-home and On-Site Services • therapy and behavioral services provided to children and youth in their home, community, school and work place. • Outpatient Treatment/Outpatient Medical • individual, group or family therapy by mental health professionals, including psychiatrists, psychologists, and mental health counselors. This may include medication administration and monitoring.

9. Children’s Mental Health System of Care Services Residential Mental Health Treatment Types • Psychiatric Residential Treatment Facility (PRFT) and Statewide Inpatient Psychiatric Program (SIPP)/Medicaid • Therapeutic Group Home and Therapeutic Group Care/Medicaid • Therapeutic Foster Home and Specialized Therapeutic Foster Care/Medicaid Note: Statewide Inpatient Psychiatric Program (SIPP) is a Medicaid Service, not a placement type

10. Children’s Mental Health System of Care Services Residential Mental Health TreatmentGuidelines for Child Welfare • Placement in therapeutic group homes and Psychiatric Residential Treatment Facilities are governed by s.39.407(4)(a), F.S. & Rules for Juvenile Procedure 8.350 • Suitability Assessment • 30 day continued stay reviews (by provider) • 90 day continued stay reviews (by court) • Residential mental health treatment is the most intensive and restrictive intervention in the continuum of care and should: • Be used as the least restrictive intervention to address identified mental health needs; • Be short term and target the issues that require that level of care; • Provide a smooth transition to less restrictive placements.

11. Statewide Inpatient Psychiatric Program (SIPP) Ten Broeck & Daniel Memorial University Behavioral Center (UBC) & Devereux Meridian/Lakeview Devereux Ten Broeck Ocala Sandy Pines Personal Enrichment Through Mental Health Services (PEMHS) Tampa Bay Academy (TBA) Manatee Palms Alternate Family Care (AFC) & Citrus (CATS) Jackson Memorial Hospital & Citrus (RTS)

12. Children’s Mental Health System of Care Services Other Residential Treatment Options • Medical Foster Care- • Homes = 286 • Children placed = 422 • APD Foster/Group Homes • 150 APD Foster Home placements (Approx.) • 78 APD Group Home Placements (Approx.)

13. Child Welfare and Children’s Mental Health Integration Historical Overview • 1997 - Prepaid Mental Health Plan Pilots in AHCA Areas 1 & 6. • 1999 – Comprehensive Behavioral Health Assessment to determine mental health needs. • 2000 – Behavioral Health Overlay Services. • 2002 – Specialized Inpatient Psychiatric Program. • 2002 – Single Point of Access to assist child welfare staff to with assessments and service referrals.

14. Child Welfare and Children’s Mental Health Integration Child Welfare Prepaid Mental Health Plan • Operational 2/1/2007 • Limited Partnership • CBC of Seminole • Magellan Behavioral Health of Florida, Inc • Serves all Medicaid enrolled children in all placement types: • In Home, Protective Services • Shelter Care • Relative/non-relative Care • Licensed Substitute Care

15. Child Welfare and Children’s Mental Health Integration Child Welfare Prepaid Mental Health Plan Covered services: • All services in the Medicaid Handbook must be covered. • Services include Comprehensive Behavioral Health Assessment, Therapeutic Foster Care, Therapeutic Group Care. • Pre-authorization for some services such as psychological testing is required. • Does not cover Statewide Inpatient Psychiatric Program (SIPP) or Behavioral Health Overlay Services (BHOS). • May do “downward substitution” of services if they meet the child’s needs.

16. Child Welfare and Children’s Mental Health Integration Child Welfare Prepaid Mental Health Plan Covers all areas of the state except AHCA Areas: • 1 (Escambia, Okaloosa, Santa Rose, Walton) • 6 (Hardee, Highlands, Manatee, Polk) • 10 (Broward) • These areas represent about 7% of children served by child welfare

17. Medicaid Prepaid Mental Health Plans Area 1 PMHP Escambia, Okaloosa Santa Rosa, Walton CWPMHP CWPMHP PMHP-Area 1 CWPMHP Creating local System of Care Broward Medicaid Reform area Area 6 PMHP Hardee, Highlands, Manatee, Polk Child Welfare Prepaid Mental Health Plan Statewide except Medicaid Areas 1, 6, 10 CWPMHP Hillsborough Co joined the CWPMHP February 2009.

18. Behavioral Health Services for Child Welfare Single Point of Access (SPOA)/Service Coordinator: • Person or entity designated by the district/region’s SAMH program office to assist Child Welfare Counselors in accessing mental health services and Comprehensive Behavioral Health Assessments for children/youth in foster care Psychotropic Medications • Medication Consultation • Medication Authorization Comprehensive Behavioral Health Assessments (Medicaid funded): • Every child placed into shelter care over 72 hours and Medicaid eligible must be referred. • Used to identify needed behavioral health services and recommendations are integrated into a child’s child welfare case plan.

19. Collaboration Across Agencies Interagency Agreement 2008 Jointly Served Youth • DCF/DJJ/APD/AHCA/DOH Establishes • Local System of Care Reviews • “Champion” for the child • Headquarters Rapid Response Team

20. Collaboration Across Agencies Interagency Agreement 2008 Local System of Care Review Teams • Each participating agency may send a designee, as appropriate. • Local Review Teams may draft local interagency agreements or modify any pre-existing local interagency meetings / forums between the agencies. • Local community based care agencies will also be encouraged to participate on behalf of children who are involved with the child welfare system.

21. Collaboration Across Agencies Interagency Agreement 2008 “Champion” for the Child When the needs of an individual child brought to the attention of a local team are of such a nature that a coordinated multi-agency integrated service team is necessary to meet the child’s needs, the child’s individual integrated service team will identify a “Champion” for the child.

22. Collaboration Across Agencies Interagency Agreement 2008 Headquarters Rapid Response Team (Tallahassee) • The purpose of the Rapid Response Team is to work collaboratively across the necessary state agencies from a headquarters and statewide perspective to provide additional assistance to the Local Review Teams when such assistance is needed. • The members will serve as the point of contact for local team members of their agency. • The Rapid Response Team shall: • receive referrals on child-specific issues from the Local Review Teams and will work collaboratively across the necessary agencies to resolve placement or service delivery issues; • will review and amend practices and policies that may impede the ability to meet the individual needs of the multi-agency children by the Local Review Teams.

23. Collaboration Across Agencies Cross- Over Youth Project “Cross over” youth are those youth that have been adjudicated both dependent and delinquent and placed in DJJ residential programs for posing a perceived or real threat to public safety for engaging in criminal activity.

24. Collaboration Across AgenciesJuvenile Justice and Family Safety Jointly Served 1/1/2008 - 3/31/2008

25. Collaboration Across Agencies Cross- Over Youth Project DCF and DJJ are working together to: • identify barriers, both bureaucratic and unintended; • brainstorm solutions; • test/pilot these solutions; and • move toward statewide joint implementation.

26. Collaboration Across Agencies Cross- Over Youth Project Goal: To develop a standardized case management system to serve dependent/delinquent that includes: • A long term viable plan for permanency; • Independent living for those youth who can not return home; • Employment skills; • Graduation or GED from High School; • Substance and mental health services, as needed.

27. Collaboration Across Agencies Cross- Over Youth Project Background: • Meetings began in 2007 to develop Interagency Agreement, • Determined need for guidance on cross over youth staffings Outcomes: • Staffing at Desoto and Milton DJJ Girls residential centers • Action Plan

28. Collaboration Across Agencies Cross- Over Youth Project Best Practices • CBC Lead agency must have primary case management authority for jointly served youth. • Contingency plans are made for youth entering detention at the time of admission that have multiple needs. The CBC’s and Mental Health Providers participate in the detention review staffings. • When a youth enters a DJJ residential center discharge planning begins at intake.