Arkansas Children’s Behavioral Health Care Commission

1. Arkansas Children’s Behavioral Health Care Commission 2011 Annual Report to the Governor

2. Contents

3. Contents

4. Wraparound Sites Expanding Services to Reach More Families The purpose of the Arkansas System of Care (AR SOC) Wraparound sites is to facilitate the development of local systems of care and to provide funding for fourteen Department of Human Services (DHS) behavioral health service areas. In 2011, the Wraparound sites focused on reaching additional families. Referrals for Wraparounds or Multi-Agency Plans of Service (MAPS) are received from families, behavioral health care providers, schools, the Department of Human Services (DHS) Divisions of Children and Family Services (DCFS), DHS Division of Youth Services (DYS), courts, and community members. • 145 330 • New Wraparound Plans Developed • in 2011 • New Multi Agency Plans of Service Developed in 2011 • All Child and Adolescent Service System Program (CASSP) and Wraparound Project sites throughout the state provide numerous non-traditional services and supports based on the needs of the families. Every site is now able to offer one or more services. On average, 32% of services provided are subsistence, 22% mentoring, 14% respite care, 8% tutoring, and 24% other non-traditional services and supports, such as transportation and recreation. Sites partner with businesses in their communities to offer activities or classes on taekwondo, dance, guitar, photography, therapeutic horseback riding, boys and girls club memberships, and many more services that can make a big difference in a child or youth’s life. • Family support infrastructure development began in May 2011 statewide. Family support activities are implemented with the goal of encouraging support among families with children with behavioral health problems and to boost family and youth involvement in the Care Coordinating Councils (CCCs). These activities benefit children receiving services under the following three levels: • Severe to moderate behavioral health care needs; • Early identification and intervention placement prevention; or • Community level prevention services.

5. Wraparound Sites • Regional Child and Adolescent Service System Program (CASSP) Teams and Care Coordinating Councils (CCC) are the governance and financial structures for the sites of Arkansas System of Care (AR SOC) Wraparound Sites and are tasked with building the infrastructures in local communities to increase access to non-traditional supports and services for families and youth. During 2011, the Department of Human Services’ (DHS) System of Care’s (SOC) three technical assistants attend each site’s monthly council meetings to provide direction on infrastructure development. A two and a half day retreat allotted structured time for Community Care Directors (CCDs) to collaborate on ways to develop and monitor services and supports in their communities. Monthly CCD meetings offer trainings and in-services to increase the quality and fidelity of Wraparound services. Yearly site audits also closely monitor the development, growth, and sustainability of the site’s CCC with an emphasis on family and youth voice representation on the CCCs. • Wraparound Plans and Multi-agency Plans of Service (MAPS)are family-driven, youth guided approaches that wrap services and supports around families whose child or youth is at risk of removal from their home, school, or community due to moderate to severe behavioral health issues. Wraparound and MAPS forms have been revised, updated, and are now web-based. Wraparound Plans and MAPS are closely monitored to improve quality and ensure fidelity to the National Wraparound Initiative Model through the implementation ofchart reviews, site audits, parent interviews, and technical assistance. • Flexible funds are used in local communities for non-traditional services and supports that are identified on the Wraparound Plan or MAPS. Funds are linked to individualized and measured goals on the Plan. These funds are the funding source of last resort and cannot supplant any other funding or resources, such as natural community support. CCDs manage these funds with oversight from their CCCs. Flexible funds are closely monitored through an invoice system. The DHS Division of Behavioral Health (DBHS) staff monitor these funds on a monthly basis to ensure they are being spent in accordance with the fidelity to the wraparound model. Technical assistance is also provided to assist in the use of these funds to the families in Arkansas. Quality Assurance Over the last year, Wraparound sites focused heavily on quality assurance to ensure the delivered services and supports continue to build meaningful partnerships with families and youth. These quality assurance efforts have primarily focused on the three following areas:

6. Family Support Activities Family support activities implemented throughout the Arkansas System of Care (AR SOC) have been a success. Although the activities vary, the purpose of this prevention level initiative is to provide youth and families support, education, and leadership skills. These events allow caregivers and youth with minimal opportunities for socialization to interact with one another to provide support and encouragement. These events not only provide numerous opportunities for family growth, but also serve as opportunities to identify stumbling blocks to recovery. These activities are generally held monthly or bi-monthly and present a regular opportunity for caregivers to learn valuable skills to strengthen their families. As an example, providers have led workshops on teaching effective communication skills and implementing positive discipline. The leadership skills developed by caregivers and youth also assist in accurately directing Care Coordinating Council (CCC) activities. Family support funds were allocated to each Wraparound site to target the CCC and family support infrastructure. During the second quarter of State Fiscal Year 2012, Wraparound sites reported the number of family and youth events increased across the state and the number of family members in attendance also increased. In 2011, one provider held 49 different family support activities that included family fun events, parent and caregiver educational events, youth specific events, and community service projects.

7. Family Support Activities From July through December 2011, 72 family support activities were implemented across the state. While these activities vary in content, the Arkansas System of Care (AR SOC) funding for family support activities must be utilized by providers to implement activities within the areas of education, support, and governance. The following chart depicts the number of activities implemented within these categories. 21 22 29 • Data is collected on the number of family and youth involved, along with information regarding transportation, food, and program expenses. During the first half of the 2012 State Fiscal Year, 12,933 dollars were spent to facilitate these 72 activities. Below is a depiction of the distribution of funds utilized for family support activities. 21% 35% 10% 25%

8. Care Coordinating Councils Arkansas System of Care (AR SOC) providers report it is a great endeavor to successfully engage, maintain engagement, and provide opportunities for family and youth participation and governance functions in the Care Coordinating Councils (CCC). Several strategies have been employed to best identify and engage both advisory and steering members. Efforts are continuously made to ensure members feel confident and prepared to participate in CCC meetings. Meeting agendas and minutes are prepared for work group meetings to help record and orient members to the action steps and progression of the group. Department of Human Services (DHS) SOC staff members also help troubleshoot childcare needs if children are not in school. Transportation or gas stipends are provided if this is an identified stumbling block for family participation. Additionally, AR SOC or Child and Adolescent Service System Program (CASSP) staff members provide information regarding the CCC activities and functions, including upcoming event and meeting dates, locations, and topics and themes of the scheduled meetings or events. The Community Care Director (CCD), Wraparound Specialists, and the Family Support Partners (FSP) personally invite family members looking for opportunities to use their experiences to participate. At right, families joined the community to demonstrate that acts of kindness are repeated and grow by writing acts of kindness on pieces of paper to create a paper chain. The paper chain encircled the football field twice.

9. Family and Youth Assistance Network The mission of the Family and Youth Assistance Network (FYAN) is to facilitate family and youth driven education, support, and advocacy for children, youth, and their families living with emotional, behavioral, or mental health needs. The FYAN continues to make progress towards achieving this mission. As FYAN moves forward in implementing its strategic plan, the FYAN Steering Committee will evaluate current activities for effectiveness, build community partnerships, and identify advocacy needs of families served within the Arkansas children’s behavioral health system. The FYAN Resource Center continues to serve as a web-based platform for sharing resources with families, youth, and Arkansas communities.  Through a week long strategic planning session, the FYAN Steering Committee finalized the network’s infrastructure and has developed plans for expanding family and youth voices throughout the state.  In addition to the five family organizations currently represented as part of the governing body of the Steering Committee, members will include two Youth Representatives and five Regional Family Liaisons from Southeast, Southwest, Northeast, Northwest, and Central Arkansas. FYAN’s primary focus areas for 2012, include: FYAN is working collaboratively with the Department of Human Services (DHS) Fellows for Public Service Program and University of Arkansas for Medical Science (UAMS) Partners for Inclusive Communities to develop the needs of and provide advocacy training for families at a local level. The training will first be offered in areas with peer support services. In addition, FYAN will continue participation in the statewide Arkansas Wraparound Training Academies.  This collaboration with the DHS has been a valuable resource for families and professionals. The FYAN hosted two leadership conferences in 2011. The Building on Family Strengths Conference was highly praised by the 52 family members in attendance. Speakers, chosen for their work in family support or advocacy, shared information about the FYAN Resource Center, family support, and other elements of the mental health system. The FYAN’s annual fall conference, the Collaborative Problem Solving Approach, featuredDr. Ross Greene, from Harvard University. Dr. Greene returned to provide parents and caregivers with strategies for working together with youth and forming a mutually agreeable process to resolve problems, issues, and concerns. The next FYAN fall conference is scheduled for November 2012 and will focus on family empowerment.

10. Intensive Family Services The Department of Human Services (DHS) Division of Children and Family Services (DCFS) Intensive Family Services (IFS) program includes time limited counseling, skill building, support services, and referrals to resources that target the needs of families. Three hundred and fifty-five families received services and supports through IFS in State Fiscal Year 2011. IFS is primarily intended for families whose children are in imminent risk of an out of home placement, but may include families who have already experienced an out of home placement and reunification is planned.  Services are aimed at ensuring the safety of all family members, while helping the family learn how to stay together successfully. The goal is to safely keep children, when possible, with their families by providing services aimed at restoring family units in crisis to acceptable levels of functioning. Services are accessible and delivered in the family’s home or a natural environment and unless otherwise indicated, services are to be rendered for four to six weeks. DHS DCFS submitted a statewide Request for Proposals in February 2011. Seven contracts were awarded to provide IFS beginning on July 1, 2011. The National Family Preservation Network (NFPN), a national organization that provides research-based tools, training resources, and technical assistance to public and private child- and family service agencies, conducted trainings again this year for providers, and DCFS conducted several teleconferences with providers throughout the state to improve services and supports to families. The North Carolina Family Assessment Scale for General Services and Reunification (NCFAS) was developed by the NFPN and is used to identify strengths and areas of need for families. DCFS adopted the NCFAS as the instrument to be used by all contracted IFS providers. The purpose of the NCFAS is to gain insight into the progress of families who have received IFS.

11. Intensive Family Services • A total of 222 families received North Carolina Family Assessment Scale for General Services and Reunification (NCFAS)ratings at intake and closure of services. Considering the percentage of families “At or Above Baseline” at intake and closure, NCFAS ratings show that Arkansas families experienced a positive change in each domain. • The highest percentage of family improvement occurred in the area of Child Well-Being with an increase of 33%. • The lowest percentage of family improvement occurred in Caregiver/Child Ambivalence with an increase of 4%. • Note: “At or Above Baseline” is the threshold measure whereby there is no legal, moral, or ethical reason for public intervention. However, a family with ratings “At of Above Baseline” at intake does not prohibit the offer or acceptance of services. Caregiver/Child Ambivalence

12. ACTION for Kids ACTION for Kids (AFK) is a cooperative agreement site from the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide comprehensive mental health services for children, youth, and families. The population of focus is children and youth under the age of 21 at risk of entering or returning to an out-of-home placement in Craighead, Lee, Mississippi, and Phillips counties. Thus far, 268 youth participated in wraparound services through AFK. This Arkansas System of Care (AR SOC) program is currently completing the sixth and final year of this grant. During this extension year, AFK has focused on sustainability of the family-based organizations, Youth M.O.V.E. (Motivating Others through Voices of Experience) and Positive Behavior Interventions and Supports (PBIS), a school-based social and academic success program. Three family run non-profit organizations that support families of children and youth with mental, emotional, and behavioral disorders have been established. Their mission is advocating, working together to identify resources, offering support, and connecting with other parents and youth with mental health challenges. All three organizations are members of the Family and Youth Assistance Network (FYAN) and the National Federation of Families. PBIS, an expanding partnership between 41 schools in the four county area served by AFK, is a systems approach for establishing the culture and behavioral supports needed for schools to be effective learning environments. The key concepts of PBIS include: • Prevention-based school-wide systems of positive behavior support; • Data-based decision-making for instruction of behavior and academics; • Wraparound planning for students with complex emotional and behavioral needs and their families; and • Community-based supports for families, youth and schools. During this no-cost extension year, AFK has focused on sustainability of the programs through a partnership with Arkansas State University (ASU) Center for Community Engagement. ASU has worked with AFK to develop training, evaluation, and technical assistance support to assist current PBIS sites and to expand PBIS services to schools outside the AFK four county area.

13. ACTION for Kids ACTION for Kids Makes a Movie:Rise Up The ACTION for Kids (AFK) Project held the red carpet premier of the film “Rise Up” in Jonesboro, Arkansas on May 24, 2011. The film tells the story of a young man named Eli Jamison, a high school senior in a small town, who suffers from depression following a traumatic childhood. A product of his environment, Eli is desperate to break free. Having just been arrested for a second time, Eli is facing jail if he stumbles again. He is court-ordered to participate in the Arkansas Systems of Care (AR SOC) Project called AFK, an innovative program for youth and their families who are dealing with serious mental health issues. The program brings community providers together to “wrap” youth and their families with the intense services they need to make positive changes. The film captures a realistic, at times slightly forlorn, youth perspective. However, there is a clear underlying message that communities can provide hope to Arkansas’s children, youth, and families. Filming took place in Arkansas and the script was written based on interviews with families and youth participating in the AFK program to create an authentic feel. As Eli’s story is told, it is clear that each family will have their own unique journey through the AR SOC, but the struggles and barriers do not have to be faced by families alone. The film comes with a booklet that provides information on AR SOC and Wraparound. “Rise Up” was showcased at the Clinton School of Public Service and First Lady Ginger Beebe introduced the film to the audience. The film was also viewed at the Annual Behavioral Health Care Institute in Hot Springs, Arkansas in August 2011. The film was made possible through a collaborative agreement with the Substance Abuse Mental Health Services Agency (SAMHSA). For more information regarding “Rise Up”, please contact Tullos Franks at the Department of Human Services (DHS) Division of Behavioral Health Services at (501) 686-9164. Shown above are scenes from “Rise Up”.

14. Youth M.O.V.E. Arkansas Youth Engagement Increases in System of Care Over the last five years, Youth Motivating Others through Voices of Experience (M.O.V.E.) Arkansas has grown into an organization that produces respected community leaders who partner with systems, programs and agencies to meet youth needs. Youth M.O.V.E. Arkansas has already made strides toward their vision through peer-to-peer counseling, speaking engagements, and several statewide initiatives with a focus on improving services for children, youth, and families. Youth MOVE is currently financially sustained through a no cost extension from the Substance Abuse and Mental Health Services Administration (SAMHSA) Arkansas System of Care (AR SOC) grant, which will end September 30, 2012. In 2012, strategic planning summits are being held with multiple AR SOC stakeholders and a national consultant to move towards solidifying sustainability plans. Several youth from Youth M.O.V.E. presented at the first annual Advanced Wraparound Training in February 2012. Feedback from participants demonstrated that the youth’s involvement was one of the most inspiring parts of the training. One hundred youth were present at the first statewide conference presented by Youth M.O.V.E. Arkansas in June 2011. The keynote speaker was Dr. Gary Blauof SAMHSA. On day two of the conference, there was a presentations from MY LIFE, and another by Tennessee Voices for Youth from Columbia, Tennessee. The youth shared the challenges and successes of building their youth organizations and the importance of these experiences. The conference ended with a closing celebration and a commitment from all participants to join the movement to create change for youth in Arkansas. This conference was a wonderful opportunity for youth, families, providers, and policy makers to network, and join together for the causes that affect youth. Pictures shown above were taken at the 2011 Youth M.O.V.E. Arkansas conference held in Jonesboro, Arkansas. Plans are once again underway for the 2012 conference to be held in Hot Springs, Arkansas.

15. Family Support Partners The Department of Human Services (DHS) Division of Behavioral Health Services (DBHS) has continued to work with the Family and Youth Support Partners (FYSP) work group to implement Family Support Partners (FSP) in Arkansas. FSPs are peer counselors who model recovery and resiliency in overcoming obstacles common to those who live with children or youth with behavioral health care needs. FSPs work alongside Community Care Directors (CCDs) and Wraparound Specialists to help engage and support local families in the wraparound process. In the spring of 2011, the FSP Coordinator along with Child and Adolescent Service System Program (CASSP) and the Arkansas System of Care (AR SOC) CCDs identified Legacy Families1 in their area that were interested in being trained to become FSPs. Twelve family members from eight areas of the state were identified and committed to the intensive six day training in July 2011. After the training was completed, nine family members were hired as FSPs to serve in the eight areas of the state. The FSPs have their own experiences with various services systems, including the DHS Divisions of Children and Family Services, Youth Services, and Behavioral Health Services. Several are grandmothers, one is a great grandmother, and one is a sibling that took over the care of a younger brother living with mental illness after her mother died. Across the board each FSP has her own legacy that has helped her gain insight and wisdom she is able to bring to the families that she supports. Their passion and commitment guides the program at the local level. The FYSP work group finalized the Arkansas System of Care Family Support Partner Services Survey in August 2011. The FSP’s in eight areas of the state asked families to complete the surveys at intake and then every six months until transition. The FYSP work group continues to meet quarterly. At the end of the calendar year, 48 families involved in the wraparound program were being provided support from the FSPs. Arkansas’ first class of certified Family Support Partners were introduced to Community Care Directors on August 5, 2011. 1Legacy Family – Describes a family that has multiple experiences with the mental health and other social service system often spanning generations and family members.

16. Youth Outcome Questionnaire (Y-OQ ) ® Arkansas implemented the Youth Outcome Questionnaire (Y-OQ®) to guide service decisions and outcomes for children and youth in Rehabilitative Services for Persons with Mental Illness (RSPMI) agencies. The Y-OQ® and OQ Analyst® (the database used to generate clinician reports) is the only outcome system to be registered as Practice Based Evidence with Substance Abuse and Mental Health Services Administration. The Y-OQ® uses the parent and youth voice to guide treatment, while feedback from the OQ Analyst® system allows clinicians to quickly assess behavioral health symptoms. Throughout 2011, clinical consultation calls were held monthly to assist clinicians in using the Y-OQ® to address difficult treatment issues. An Implementation Plan, designed by OQ®Measures, identifies reports to be generated by Hewlett-Packard (HP). HP stores the YOQ® data and is responsible for all technical aspects of the outcome system, including helping RSPMI agencies set-up the OQ Analyst®, develop reports, and monitor data quality. The Implementation Reports for 2011 focused on compliance, data quality, and data integrity. Numerical Results Reported: • 19,418 • 86,095 • 3,213 • Youth, ages 12-18 completed 37,265 self-assessments • Young adults, ages 18-21completed 5,444 Outcome Questionnaires (OQ®) • YOQs® were completed by parents or guardians for 41,836 children of the ages of 4-18

17. Arkansas Indicators The Arkansas Indicators, developed by the Outcomes and Assessment Tools Work Group of the Arkansas Children’s Behavioral Health Care Commission, provide additional information to identify placement of children, school attendance and achievement, and satisfaction with treatment. Parents, youth, and young adults complete the Arkansas Indicators at regular intervals throughout their involvement with treatment. During 2011, parents/guardians completed Arkansas Indicators for 34,363children/youth, 14,405 youth (ages 12-18) completed the youth version, and 2,029 young adults (ages 18-21) completed an adult version. • This graph depicts Arkansas System of Care (AR SOC) latest data regarding parents/guardians’ perspective on their children ages 4-18 who are receiving Rehabilitative Services for Persons with Mental Illness (RSPMI) treatment. The graph shows the satisfaction level of 14,498 unique parents/guardiansfrom October through December 2011. • This graph shows the perspective of youth (ages 12-18) regarding their satisfaction with services, involvement in treatment, culturally appropriate treatment, and if treatment helped them to stay in school or live at home. The graph depicts an unduplicated count of the satisfaction level of 2,209 youth from October through December 2011. In the future, Arkansas System of Care (AR SOC) staff will be able to utilize Arkansas Indicators data in conjunction with YOQ ® data to gain a better understanding of the needs and progress of Arkansas youth receiving behavioral health services.

18. Youth Advocate Program The Department of Human Services (DHS) Division of Youth Services (DYS) has continued the Youth Advocate Program (YAP) that was first piloted in January 2010. The YAP receives referrals from juvenile courts, which allows an opportunity for diversion from the court system. The program allows a trained advocate to spend up to ten hours of paid face-to-face time with the referred youth and family. The advocate is then able to identify any needed and available services, including referrals for Supportive Workforce for eligible youth. YAP strives to match juveniles with an advocate who has the greatest chance of helping them achieve their goals in the program. During orientation and training, the advocates are thoroughly trained in mentoring and problem-solving. Advocates are aware of the YAP procedures, protocols, goals, and purpose.  There is an emphasis on presenting opportunities to entire families as opposed to separating the juveniles’ needs from the family environment.  Wraparound for YAP means referring and connecting families to needed services and striving to increase family engagement.  Providers are encouraged to participate in the Care Coordinating Councils (CCC’s) and to work within the Arkansas System of Care (AR SOC) to increase families’ awareness of community resources and to improve families’ access to these services. Currently, YAP is available in Judicial District 6, District 11-West, and District 20, which cover Pulaski, Perry, Jefferson, Lincoln, Faulkner, Van Buren, and Searcy counties. During the second half of the State Fiscal Year 2012, Judicial District 13, which covers Dallas, Cleveland, Ouachita, Calhoun, Union, and Columbia counties,was added as a site. This site is currently in the training and recruitment phase. These judicial districts were selected for participation due to high levels of youth commitment in these areas of the state. Due to the success of the program and cost savings YAP has produced, DYS plans to expand YAP to additional sites in the upcoming year.

19. Arkansas Access to Recovery Arkansas Access to Recovery (ATR) is an initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA), funded for four years, beginning October 1, 2010. This project is administered by the Department of Human Services (DHS) Division of Behavioral Health Services (DBHS), with support from the University of Arkansas for Medical Sciences (UAMS) Partners for Inclusive Communities. ATR is meant to shift the focus of behavioral health care from acute treatment in to building on the strengths of people with drug and alcohol use problems by providing vouchers to pay for treatment and recovery support services that best meet their needs. Care Coordinators work closely with participants to identify needed services and to assist in accessing identified services. This approach has a history of success in other states and is being piloted in thirteen counties in Arkansas: Benton, Washington, Crawford, Sebastian, Craighead, Garland, Saline, Pulaski, Lonoke, White, Faulkner, Jefferson, and Independence counties. To be eligible to participate in ATR, one must be: • Eighteen years of age or older; • A resident of one of the pilot counties; • Screen positive for or with documented substance use disorder; • Be at or below 200% of the Federal poverty level; and, • Meet one of the targeted groups listed below: • A member of the active military, Reserves, Arkansas National Guard and/or combat veteran; or • A pregnant woman or adult family member of child(ren) with Division of Children and Family Services (DCFS) or Division of Youth Services (DYS) involvement, or at risk for child welfare involvement; or, • Person with a Drinking Under the Influence/Driving While Intoxicated conviction (targeting multi-offenders).

20. Arkansas Access to Recovery The Access to Recovery (ATR) initiative has demonstrated the significant impact of substance abuse on Arkansas children and families as evidenced by the extensive data that is being collected. The ATR program also serves as a model for how to measure outcomes of recovery and treatment programs by comparing various factors relating to employment, housing, substance use, and legal involvement at the time of intake and then six months later. There were improvements in most categories. Perhaps the most encouraging outcome measure is that 60% of ATR clients were attending program self-help groups, 11% were attending religious self-help groups, and 21% were attending other alcohol, tobacco, and other drug self-help groups six months after intake into the ATR program. With the ATR project’s flexible and holistic approach to substance abuse treatment and long-term recovery, a new and effective model has been introduced that could potentially transform how substance abuse treatment is provided in Arkansas. There is great anticipation that by the end of the four-year grant period the initial obstacles to ATR will be overcome, resistance to changes in how to define services and how they are delivered will be minimized, and data will continue to confirm the program’s effectiveness at reducing drug and alcohol addiction in Arkansas. For more information, please visit: http://humanservices.arkansas.gov/dbhs/Pages/AccessToRecovery.aspx#Access to Recovery Program

21. Mental Health in Schools The Children’s Behavioral Health Care Commission’s Mental Health in Schools Work Group began their work in February 2010. The Work Group was open to all interested parties, but a defined group of individuals are voting members, similar to the Commission’s other work groups.  The Work Group consists of members from education and behavioral health sectors, as well as families. The Work Group developed a framework and model for Mental Health in Schools. The Work Group agreed that a complete picture must address prevention, early intervention, and treatment for severe and chronic problems. Additionally, the Work Group developed Mental Health in Schools guidelines to provide a consistent model for delivery of services in school programs across the State and a plan for coordination between providers and schools and for enhancement of the quality of the provision of behavioral health care services. • The guidelines specify that mental health service provision falls into two categories: School Based and School Linked. • School Based services include: • Primary Prevention, a school-wide system for all students to promote positive behaviors and social interactions and prevent misidentification of mental health disorders. • School Run Rehabilitative Services for Persons with Mental Illness (RSPMI), which allows School Districts and Educational Service Cooperatives (ESC) to enroll as providers of school-based mental health services through the Arkansas Department of Education (ADE).  Services to students are funded through Medicaid with School Districts or ESC providing Medicaid matching funds. • School Based RSPMI, which allows a RSPMI provider in good standing to have a contract or memorandum of understanding with a school to deliver services at the school. • School linked services are limited services to allow for an existing therapeutic relationship to continue. A RSPMI provider may serve existing (or new, based on consumer/family choice) students in the school site. • Due to the proposed rate increases for the School Based Mental Health Program within the Mental Health in Schools Work Group recommendations, the Department of Human Services (DHS) Division of Medical Services (DMS) will need to review and determine their potential impact in the context of the broader Payment Improvement Initiative prior to moving forward on these efforts.  • Before the guidelines were presented, an Interim Study Proposal (ISP) was submitted to the Joint Committee on Education.  As a result, the Mental Health in Schools Work Group's recommendations regarding behavioral health options for schools was removed from the committee agenda and a recommendation was made to move forward with the prevention component of the ISP.  Additional information is available at www.arkleg.state.ar.us/assembly/2011/Lists/Meetings/Attachments/16461/I10221.pdf. 

22. Mental Health in Schools School and Community Resource Guide The chart above displays the school and community resources available to students requiring different levels of care. This guide was developed by the Children’s Behavioral Health Care Commission’s Mental Health in Schools Work Group.

23. Juvenile Drug Courts Juvenile drug courts serve youth within the juvenile justice system that have been identified as having problems with substance abuse. The juvenile drug court judge maintains close oversight of each case through frequent status hearings with the parties involved. The judge both leads and works as a member of a team that is comprised of representatives from behavioral health, juvenile justice, social services, school and vocational training programs, law enforcement, probation, the prosecution, and legal defense. Together, the team determines how best to address the substance abuse and related problems of the youth and his or her family that resulted in involvement with the justice system. In State Fiscal Year 2011, 283 juveniles received substance abuse services through juvenile drug courts across the state. As of January 1, 2012, three new juvenile drug courts were established in the second, fifth, and north eighth Judicial Districts. This expands juvenile drug courts from ten sites to thirteen sites statewide. These additional courts introduce juvenile drug court services in to Clay, Craighead, Crittenden, Greene, Mississippi, Poinsett, Franklin, Johnson, Pope, Hempstead, and Nevada counties. The Division of Behavioral Health Services (DBHS) continues to work closely with the Arkansas Administrative Office of the Courts to ensure quality behavioral health services are at the center of juvenile drug courts and that these therapeutic based courts utilize evidence based practices. As of August 1, 2012, all juvenile drug court providers will be operating under a new and updated contract that places a stronger emphasis on evidence based practices. Distribution of Arkansas Juvenile Drug Courts

24. Multi-Systemic Therapy Multi-Systemic Therapy (MST), an evidence based practice utilizing intensive family and community based intervention, continues to be provided in three judicial districts, District 4, District 19-East, and District 19-West, which cover Benton, Carroll, Madison, and Washington counties. To date, twenty-five juveniles have been accepted in to the program, and there are eleven juveniles with current active cases. Twelve juveniles have successfully completed the program, meaning the juvenile required no out-of-home-placement, was attending school, remained free of new legal charges, completed the full course of treatment, and was not committed to DYS. During State Fiscal Year 2011, there was only one commitment to the Department of Human Services (DHS) Division of Youth Services (DYS) from MST and this occurred after the MST case had been closed. The services provided to family and youth are dependent on the identified needs of the family and may include individual and family therapy.MST provides around a 24 hour/7 days a week, on-call system to provide coverage when MST therapists are unavailable. Additionally, there is a clinical supervisor to conduct weekly team clinical supervision, to facilitate a weekly MST telephone consultation, and to be available for individual clinical supervision for crisis cases. MST caseloads do not exceed six families per therapist and the normal range is four to six families per therapist. The average duration of treatment is three to five months. Additionally, MST utilizes a home-based model of service delivery.  Since the therapists are licensed clinicians, a full array of service options are available when needed and provided in the community. Program Data from July 1, 2011 to Present:

25. RSPMI Re-Certification The Department of Human Services (DHS) Division of Behavioral Health Service’s (DBHS) current Rehabilitative Services for Persons with Mental Illness (RSPMI) Certification Policy went into effect on January 1, 2011. All RSPMI providers were to be in compliance with the new policy by February 14, 2011. Some of the major changes in the new policy include the addition of supervision requirements for mental health professionals and paraprofessionals, enhanced quality improvement standards, and minimum staffing requirements. Implementation of the 2011 policy has been a major division effort that was coordinated with Division of Medical Services (DMS) and Value Options to review each of the 321 RSPMI service sites for compliance elements so that those sites may be re-certified under the current policy. Additionally, the RSPMI moratorium was extended through December 2012 to allow adequate resources to be dedicated to the re-certification process. As of March 2012, 217 service sites have been reviewed. As a result of the reviews, eleven sites have been decertified and ten sites have been suspended. Even with the closing and suspending of several service sites, all residents in Arkansas have access to at least one RSPMI service provider within 50 miles of their home location. The site reviews for re-certification have helped to develop a highly coordinated monitoring system among the DHS divisions and has streamlined documentation needs for divisions and providers. Providers have reported that the new policy requirements along with the technical assistance provided in the re-certification process have strengthened their programs and enhanced the quality of their services by increasing accountability among performing providers and supervisors and following dedicated treatment outcome plans.

26. Atypical Antipsychotics In 2008, the Department of Human Services (DHS) established the Atypical Antipsychotics Work Group to reflect on the safest ways to continue to provide psychopharmacological treatment to children and adolescents. In July 2009, DHS implemented a new policy requiring a manual prior authorization for the prescription of atypical antipsychotics to children less than five years of age. In November 2011, a new age requirement was added for dosing antipsychotics in children. Under the new guidelines, a child psychiatrist must review the use of all antipsychotics in children under the age of six years. Additionally, the DHS Division of Medical Services (DMS) implemented a new policy as a result of the work done by the Atypical Antipsychotic Work Group under the chairmanship of Dr. Larry Miller, Division of Behavioral Health Services (DBHS) Medical Director. Under the new policy, all youth under the age of eighteen years must have informed consent and lab monitoring forms signed by a parent or legal guardian before they can receive antipsychotic medication. Labs must be drawn on all antipsychotic medication every six months and a new informed consent form signed whenever a new antipsychotic medication is prescribed. After eighteen months, labs must be conducted once a year. This additional information will allow for more intensive monitoring of the child’s progress and any complications with the prescribed medications. The safety of children is the pri­mary goal of this project. The new policy raises provider awareness of the importance of the utilization of informed consent and monitoring labs. It also educates family members regarding safe practices surrounding the use of psychopharmacological medication in children and youth. Greater parent engagement and increased use of non-medication therapies will ultimately lead to better health for children with serious emotional disturbance.

27. Parenting Class During a trip around the state to meet with key juvenile justice stakeholders, judges expressed to the Department of Human Services (DHS) Division of Youth Services (DYS) Director a need to provide prevention programs to address the rise in the number of children ages five to nine that were referred to court.  Many judges asked if DYS could offer parenting classes as a resource to the courts.  Based on the identified need for parenting classes, DYS utilized Arkansas System of Care (AR SOC) funding to provide evidence based parenting classes statewide.  The feedback from providers has been that the courts are utilizing the parenting classes and there is a need to expand the offerings.  To date, there has been a duplicated count of 301 participants in parenting classes funded through AR SOC. Below is a list of providers and the evidence based program implemented: • 301 participants since July 1, 2012 • In all 28 Judicial Districts

28. Foster Parent Training Arkansas System of Care (AR SOC) funds were designated to provide specialized training for foster parents. Sharon Long with the Centers for Youth and Families’ Parent Resource Center provided a train the trainer session in February 2011. Participation through video-conferencing was available for those who could not participate in person.  The “train the trainer” session improves consistency statewide in how the curriculum is presented.  It also ensures that the public mental health system has licensed therapists that are familiar with this evidence-based curriculum and can use this knowledge with the general population in their communities.   During the spring of 2011, twelve Community Mental Health Centers (CMHCs) from across the state conducted training for the Department of Human Services (DHS) Division of Children and Family Services (DCFS) foster parents. The training curriculum “Managing the Defiant Child” was developed by Russell A. Barkley, a nationally known expert in Attention-Deficit/Hyperactivity Disorder (ADHD) and related disorders, including childhood defiance.  The training reached a total of 187 foster parents. This curriculum is evidence-based and gives foster parents increased skills in managing children and youth with behavioral issues that often result in disrupted placements.  The curriculum focuses on: • Understanding their child's misbehavior; • Motivating their child and increasing compliance; • Decreasing disruptive behavior; • Establishing proper disciplinary systems without corporal punishment; and • Improving school behavior with a new home-based reward system. Participants completed a Perception of Services Survey during the training. This survey measured the participants’ perception of their interaction with the trainers and their overall perception of the training. Below is a more detailed depiction of the survey results.

29. Preventing Sexually Abusive Behaviors Training In April 2011, twenty-one individuals completed a train the trainers curriculum titled, Primary, Secondary and Tertiary Prevention of Sexually Abusive Behaviors in Childhood and Adolescents. The training was conducted by Gail Ryan, MA from the Kempe Children’s Center at the University of Colorado School of Medicine. Participants included early childhood educators, foster care parents, mental health providers, child welfare providers, and others working with those juveniles that have sexually offended. The training occurred over three full days to prepare participants to replicate a variety of related workshops for professionals, paraprofessionals, and parents in their communities. Trainers were provided with curricula, visual aids, and certificates to document their hours of training and to authorize their replication of handout materials. At the end of the three day training, participants will be able to use the materials to train staff, therapeutic foster parents, foster parents, and other community stakeholders. In June 2011, a conference call was conducted to plan trainings with various audiences in the community. After attending the training, all participants reported that they expect to use the materials to train others. Other comments from the participants are shown below.

30. Infant Mental Health Infant mental health is the social and emotional well-being that results when infants and toddlers are supported by nurturing relationships. It also describes a multidisciplinary field focusing on early relationships, which are primary in a child's learning and form the basis for all later relationships. Infant Mental Health is enhanced by: • As part of Arkansas System of Care (AR SOC) prevention level efforts, AR SOC contributed funding towards the Arkansas Association for Infant Mental Health (AAIMH) first statewide conference held in June 2011. The attendees, which included multiple AR SOC staff members, learned more about how relationships, both with family caregivers and early childhood interventionists, impact brain development in the first three years of life, and the consequent ability to develop relationships throughout a life time. • One of the primary goals off AAIMH is to provide education and awareness throughout Arkansas. Presentations prepared for this purpose are available on the association’s website (www.AAIMH.org). • Infant Mental Health informational presentations have been made to the following groups and organizations: • Arkansas Department of Health Nurses; • Area Health Coalition; • Arkansas Parenting Education Network; • Arkansas Head Start Conference; and, • Central Arkansas Branch of National Association of Social Workers. AAIMH will be co-sponsoring a two day conference on September 24-25, 2012. Dr. Joshua Sparrow, Associate Clinical Professor in psychiatry at Harvard Medical School and Director of Strategy, Planning, and Program Development at the Brazelton Touchpoints Center at Children’s Hospital in Boston, is scheduled to speak. An Infant Mental Health track will be offered during the conference.

31. Fetal Alcohol Spectrum Disorders • The Fetal Alcohol Syndrome Disorders (FASD) project is funded by Substance Abuse and Mental Health Services Administration (SAMHSA) through the Department of Human Services (DHS) Division of Children and Family Services (DCFS) and Northup Grumman beginning in February 2008 and ending in May 2012. Although funding through SAMHSA for the project is ending, DCFS has agreed to continue the work started by this project and expand it statewide. • The Pulaski County FASD project is located within DHS DCFS in the foster care unit.  It is a pilot project serving Pulaski County children in foster care between the ages of 2 to 7.  The FASD project provides early and timely screening, diagnosis, and interventions for children ages two to seven who are in DHS custody. Additionally, the project provides comprehensive, coordinated, and timely case planning, case management, and follow-up to ensure appropriate care for children with FASD and their families in order to decrease secondary disabilities. • The goal is to identify children with FASD as early as possible to begin the necessary interventions, help stabilize the home environment as much as possible, and ultimately assist permanency planning with their biological family whenever possible or with an adoptive family when reunification is not possible.  • By identifying FASD early in life, secondary disabilities, which can occur when children are not diagnosed and appropriate interventions do not occur, can be prevented. There are multiple secondary disabilities associated with FASD, including  Behavioral Health Disorders, Disrupted School Experience, Criminal Justice Involvement, Inappropriate Sexual Behavior, Alcohol/Drug Problems, Dependent Living, and Problems with Employment. The FASD project will continue to serve the children and families of Arkansas to prevent, identify, and treat FASD.

32. ZERO TO THREE andSafe Babies Court Team • In 2009, the Arkansas Department of Human Services (DHS) Division of Children and Family Services (DCFS) began implementing the Safe Babies Court Teams model in Little Rock. The Safe Babies Court Team is a system change initiative focused on improving how the courts, child welfare agencies, and related child serving organizations work together, share information, and expedite services for children. The goal of the project was to meet the developmental needs of maltreated infants and toddlers and hence prevent the developmental delays, health problems, and poor life outcomes associated with early maltreatment. The Arkansas Pilot Court Team is led by the Honorable Joyce Williams Warren. • Since 2011, the Arkansas Pilot Court Team for Safe Babies has sponsored 31 training events that reached 807 people and presented the case for focusing on infants and toddlers in foster care. Every constituency involved in serving young children in foster care has participated in training: court personnel; attorneys representing children, parents, and the State; Early Head Start professionals; mental health clinicians; primary health care providers; early intervention specialists; domestic violence service providers; representatives from universities; foster parents; and children’s advocates. • While establishing the need for change, the Arkansas Pilot Court Team began putting together a team of multidisciplinary stakeholders who could meet the needs of infants, toddlers, and their families. Arkansas has a myriad of service providers, leading to a team of 61 professionals committed to improving the outcomes of the children and families monitored by the Court Team. The Team has sponsored 31 Training Events reaching 807 people.

33. ZERO TO THREE andSafe Babies Court Team The Court Team Improves Outcomes for Children The Arkansas Pilot Court Team is practicing new and enhanced ways of working with the families of maltreated infants and toddlers by monitoring cases heard in the 10th Division of Pulaski County Juvenile Court. Thus far, the Arkansas Pilot Court Team has monitored fourteen children across eleven families. • Developmental Assessment • Because maltreated children are so likely to experience developmental delays, the Court Team conducts developmental screenings for all children. All fourteen children have received a screening. • Placement Stability • Every change in placement is a difficult adjustment for the child. As a result, the Arkansas Pilot Safe Babies Court Team has tried to limit placement changes with six children remaining in their first placement. • Family Contact Frequency • Frequent contact is needed for young children to develop secure relationships with their parents. Research shows that frequent visitation increases the likelihood of reunification, reduces time in out-of-home care, and promotes healthy attachment. All fourteen children have participated in at least three weekly visits. • Permanency • The Adoption and Safe Families Act of 1997 put a focus on decreasing the length of time children “were languishing in foster care.” The standard for achieving permanency was set at one year from removal. In the 21 months that the Court Team has been working with families, ten children have already achieved permanency. Six of these children were reunified with their birth parents. The average time to permanency for these ten children was approximately eleven months.

34. The Arkansas Children’s Behavioral Health Care Commission 2011 *In 2012, Dr. Benjamin Nimmo replaced Ann Brown as a commission member to represent the Arkansas Hospital Association. **In 2012, Jennifer Gallaher of the Division of Behavioral Health Services replaced David Laffoon as a commission member. A special thanks goes out to Ann Brown and David Laffoon for their service to the Arkansas Children’s Behavioral Health Commission.