Division of Child Behavioral Health Services: Overview and Services

1. Workgroup Participants: Wyndee Davis Antoinette Gurden Deb Kennedy Deborah Magee Harry Marmorstein Dr. Nadezhda Robinson Presentation by Antoinette Gurden

2. Department of Children and Families Table of Organization (Three Major Divisions) DCF Division of Child Behavioral Health Services Division of Youth and Family Services Division of Prevention and Community Partnerships DCBHS Overview

3. System of Care Guiding Principles At Home (with their families and not in out-of-home treatment settings) In School (in district) Out of Trouble (not involved with the Juvenile Justice Systemand at risk of detention or incarceration) DCBHS Overview

4. Division of Child Behavioral Health Services Contracted Entities Contracted Systems Administrator Care Management Agency Training and Technical Assistance Youth Case Management Family Support Organization Mobile Response & Stabilization Services DCBHS Overview

5. New Jersey Division of Child Behavioral HealthReport reflects data as of 9/22/08 Services (DCBHS) Summary Report ExcerptsQuarterly Report Statewide (See Report NJ0184.3): •The total number of children enrolled is 38,731. •The total number of children who are active in a CMO is 3,067. •The total number of children who are active in a YCM is 4,177. •The total number of children who are active in MRSS is 851. •The average number of families actively receiving peer support from an FSO is 1,182. •The largest age group served by the DCBHS is children ages 14 through 17. This age group comprises 45% of all children served. •There are 41% females, 59% males served by the DCBHS. DCBHS Overview

6. Acute Care Services Inpatient Treatment Out of Home Treatment Services Intensive Residential Treatment Out of Home Treatment Case Management Services Case Management Services MRSS Services Mobile Response & Stabilization Services IIC Services Intensive In-Community & Behavioral Assistance Services Outpatient Services Outpatient and Addictions Treatment(Not yet integrated into the DCBHS System of Care) AssessmentServices Assessment Services Utilization Management Access and Utilization Management (CSA) DCBHS Overview

7. Current System of Screening Students Youth presents with behavior Youth screened at Psychiatric Emergency Service (PES) PES are not kid-friendly Medical model is not useful for most youth Current screening laws designed for adults Designed to determine if youth meets admission standard rather than what services youth may need Current System of Screening Students

8. Current System of Screening Students Youth presents with behavior threats Youth screened immediately at PES Youth suspended until screened at PES danger to self danger to others Benefits: Drawbacks: Benefits: Drawbacks: Screened for safety Screened for safety Referral to services Referral to services Undue burden on family Undue burden on family Long wait Changes youth’s school experience Inappropriate environment Lost time in school High cost Screened long after event Intense reaction to situation Punishes youth for BH issues Current System of Screening Students

9. Current System of Screening Students Youth presents with behavior threats danger to self danger to others There is currently no standard response for youth who exhibit: mood change change in functioning Current System of Screening Students

10. Proposed Model to Screen Youth in Schools Youth presents with behavior threat to self or others mood change change in functioning Response determined by age and risk factors Regardless of age, youth at high risk for harming self or others referred to PES Proposed Model to Screen Students

11. Step 1 Identify Concern

12. Scenario A Youth needs immediate attention and and/or suggest that youth may be at risk of significant emotional distress or of causing harm to self or others Youth’s behavior within the last 5 or fewer days Youth’s disclosure of information the disruption in youth’s behavior impedes youth’s ability to learn and affect youth’s relationships with peers and/or staff Step 1: Identify Concern

13. Scenario A Youth needs immediate attention Risk factors are perceived within the context of the youth’s individual cognitive and intellectual capacity There is a realistic concern for the safety of the youth or others based on the youth’s individual risk factors Youth has a viable plan to carry out threat as indicated Youth has immediate access to the means to carry out threat as indicated Youth has a sincere intention to do harm Step 1: Identify Concern

14. Scenario A Youth needs immediate attention Consider suicide risk factors when youth threatens to harm self: Significant change in eating, sleeping habits Boredom or loss of interest in previously pleasurable activities Frequent complaints about physical symptoms Sudden cheerfulness after a period of depression Neglect of personal hygiene and friendships Giving hints of not being around for long, such as verbal statements or giving away possessions Step 1: Identify Concern

15. Scenario A Youth needs immediate attention Service Pathways Appropriate for Youth in Scenario A PES Psychiatrist Step 1: Identify Concern

16. Scenario B Youth presents with threatening behavior Response to behavior should be shaped by the youth’s ability to: and his or her subsequent: de-escalate him/herself by venting amenability toward negotiating an alternate plan Youth who is able to De-escalate and or Abide by negotiated plan Utilize existing resources may be appropriate for Scenario C Youth who is NOT able to De-escalate and or Abide by negotiated plan Utilize existing resources may be appropriate for services other than PES Step 1: Identify Concern

17. Scenario B Service Pathways Appropriate for Youth in Scenario B Pediatrician Psychiatrist CSA Private BH Provider MRSS Step 1: Identify Concern

18. Scenario C Youth needs services and and/or suggest that youth may be at risk of significant emotional distress or of causing harm to self or others Youth’s behavior within the last 3 months or less Youth’s disclosure of information The disruption in youth’s behavior has consistently interfered with Youth’s ability to learn and has affected Youth’s relationships with peers and/or staff Step 1: Identify Concern

19. Scenario C Service Pathways Appropriate for Youth in Scenario C CSA Pediatrician MRSS Information and Referral Private BH Provider Assessment Step 1: Identify Concern

20. Step 2 Discuss Concern With Family

21. After a concern is identified at any level, the family and school personnel collaborate on an action plan • Sit down with the family • Develop an action plan • Develop a plan for follow up Many high school aged youth can participate in this discussion Step 2: Discuss Concern With Family

22. Step 3 Family Chooses Response Option

23. Available Options PES Pediatrician Private BH Provider Psychiatrist CSA Information and Referral Community Assessment Mobile Response & Stabilization Services Step 3: Choose Response Option

24. Response Time Frame Service Option Outcome PES Same day Determination of inpatient admissibility Determination of current risk to self/others, diagnosis, referrals Psychiatrist Same day Private Behavioral Health Provider Assessment, family/individual therapy, diagnosis 1-3 months Referrals to services covered by private insurance if appropriate Pediatrician Same day Information and Referral Information about services available locally Immediate Community Assessment Comprehensive biopsychosocial assessment and referral for services CSA 7-10 days Mobile Response and Stabilization Services 72 hour intense intervention and up to 8 weeks of stabilization services 1 hour Indicates confidence in the ability of this option to effect meaningful and lasting change for this youth and family and minimize disruption of school attendance and school relationships Step 3: Choose Response Option

25. Step 4 Follow Up

26. Follow Up Responsibilities Ensure that family’s needs have been met through the requested service Be available to work with provider at family’s request Step 3: Follow Up

27. Benefits of New Screening Model Reduces lost education time Ensures youth is linked to appropriate services Eliminates unintended effect of punishing youth for BH needs Components Necessary for Successful Implementation Working relationship between school and screening and service providers Working relationship with families Acceptance of new model to satisfy “zero tolerance” policies

28. We look forward to partnering with you to meet the behavioral health needs of your students Please feel free to contact the Division of Child Behavioral Health Services Contact Person: Dr. Nadezhda Robinson Phone Number: (609) 292-4741 E-mail Address: Nadezhda.Robinson@dcf.state.nj.us