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Systems of Care

An overview of the Systems of Care WISe program in Washington, providing mental health services to over 208,000 residents, with a focus on youth with complex mental health needs.

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Systems of Care

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  1. Systems of Care WISe

  2. A Brief Overview

  3. Mental Health Overview • During the 2011-2013 Biennium, the Division of Behavioral Health and Recovery (DBHR) provided mental health services to over 208,000 Washington residents through contracts with 11 Regional Support Networks (RSNs). Over 66,000 of these individuals were youth (0-20 years old). • The RSNs are responsible for… • Subcontracting with licensed community mental health agencies to provide services; and • Managing crisis and involuntary treatment services • …for the following priority groups: • Acutely mentally ill children and adults • Chronically mentally ill adults • Severely emotionally disturbed children • Seriously mentally disturbed children and adults

  4. Regional Support Networks Focus on Youth with Complex Mental Health (MH) Needs Regional Support Networks and their contracted Community Mental Health Agencies address moderate to intensive / acute mental health challenges. Health Plan providers address mental health concerns through identification, direct intervention, and referral to MH providers or to RSNs for additional services.

  5. Regional Support Networks

  6. What are the new boundaries for • Behavioral Health Organizations (BHOs)?

  7. What is Systems of Care? A spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families… Organized into: a coordinated network that builds meaningful partnerships with families and youth and addresses their cultural and linguistic needs …in order to help them to function better at home, in school, in the community, and throughout life.

  8. 1.Family driven and Youth guided, with the strengths and needs of the child and family determining the types andmix of services and supports provided. 2. Community based, with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level. 3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports and to eliminate disparities in care

  9. Washington’s History of Innovation and Awesomeness!

  10. Youth Voiceand Choice Young people have the right to be empoweredand educated and are given a decision-making role in the care of their own lives as well as in the policies and procedures governing care for all youth in the community…

  11. 2. The Goal of WISe The goal is for eligible youth to live and thrive in their homes and communities, as well as to avoid or reduce costly and disruptive out-of-home placements.

  12. 5. WISe is Guided by Principles Family and Youth Voice and Choice Team based Natural Supports Collaboration Home and Community Based Culturally Relevant Individualized Strengths Based Outcome Based Unconditional 18

  13. Traditional / Categorical Care Education Juvenile Justice Child Welfare Primary Care MH & DD Plan Plan Plan Plan Plan Other Systems Substance Abuse Plan Family & Youth Plan

  14. Traditional/ Categorical Care Can Create… Duplication and Waste Competing Agendas Youth & Family Burnout Confusion Disempowerment

  15. Coordinated / Collaborative Care Juvenile Justice Education Primary Care Child Welfare MH & DD Coordinated Care Family & Youth Other Systems Substance Abuse One Plan

  16. Organizations often work in isolation… DD MH OSPI PC DD MH JJ JJ CW OSPI CW PC CategoricalChange Isolated Impact …on the same challenge

  17. WISe Wraparound with Intensive Services!

  18. History • T.R. et al. v. Kevin Quigley and Dorothy Teeter - No. C09-1677 – TSZ • Federal class action lawsuit filed in November 2009 against DSHS (and later the Health Care Authority) alleging inadequate availability of intensive mental health services for children and youth in home and community based settings. • A Settlement Agreement was reached in December 2013. • The Agreement calls for a new statewide program model, Wraparound with Intensive Services (WISe) to be available within every county across Washington by June 30, 2018.

  19. Wraparound with Intensive Services • Consistent screening and assessment, and comprehensive behavioral health services and supports to Medicaid-eligible individuals, up to 21 years of age, who have complex behavioral needs. Youth and their families are served. • Required Elements of WISe: • Intensive Care Coordination • Intensive Services provided in Home and Community Settings • Mobile Crisis Intervention and Stabilization Services

  20. WISe Implementation as of September 2015 (counties offering WISe are identified shown in color)

  21. WISe Implementation Efforts – Year 1 • For children and youth aged 5 to 20 years old, 1,402 WISe screens were provided between July 1, 2014 and June 30, 2015 • Out of these screens, 74% resulted in a referral to the WISeprogram • 903 youth have received at least one WISe service between July 1, 2014 and July 1, 2015, based on ProviderOne service encounters

  22. Katie Hayden & Her Son • Katie’s son was unable to adjust in school. He was always acting up and getting suspended. Then he would run away leaving Katie to wonder and worry endlessly. • “Child Protective Services referred us to Wraparound. We started learning skills and my son eventually got a therapist he connected with.” • “I feel confident that now I have the skills that allow us to sit down as a family and address what is going on. And we are doing amazing.” • Katie is now working as a Family Partner for WISe comprehensive. She helps families learn to advocate for themselves and their youth. She shows them different skills and helps them discover for themselves a path that will work for their family.

  23. CLINICALLY SIGNIFICANT IMPROVEMENTS OVER TIME Behavioral and Emotional Needs • Top 5 behavioral and emotional needs at intake shown • A decline at the time of 6-month reassessment represents improvement for these measures Total Youth Age 5-20 = 147 (SFY 2015) INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL ASSESSMENT REASSESSMENT REASSESSMENT REASSESSMENT REASSESSMENT REASSESSMENT 0

  24. CLINICALLY SIGNIFICANT IMPROVEMENTS OVER TIME Risk Factors • Top 5 risk factors at intake shown • A decline at the time of 6-month reassessment represents improvement for these measures Total Youth Age 5-20 = 147 (SFY 2015) INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL INITIAL REASSESSMENT REASSESSMENT 0

  25. STRENGTHS DEVELOPMENT OVER TIME Child and Youth Strengths • Top 5 child and youth strengths by growth over time shown • An increase at the time of 6-month reassessment represents improvement for these measures Total Youth Age 5-20 = 147 (SFY 2015) INITIAL ASSESSMENT INITIAL ASSESSMENT INITIAL INITIAL ASSESSMENT INITIAL REASSESSMENT REASSESSMENT REASSESSMENT REASSESSMENT 0

  26. Progress on the T.R. Settlement Agreement • Statewide screening tool, the Child and Adolescent Needs and Strengths (CANS), established to determine whether a youth might benefit from WISe. • DSHS Division of Research & Data Analysis developed an estimate of WISe capacity needs by RSN. • Provision of WISe through five RSNs and their providers starting in July 2014.

  27. Progress on the T.R. Settlement Agreement • Completed the Quality Management Plan (QMP)in December 2014. The QMP will assist with monitoring access, engagement, and service effectiveness. • A “Workforce Collaborative” has been designed and was established in January 2015. This collaborative support local and statewide trainings as well as provide technical assistance. • As of May 2015, more than 500 participants attended WISe trainings or WISe community meetings.

  28. You should consider referring youth for a WISe screening if; the youth who, primarily due to a suspected or identified mental health difficulty, is: • Receiving frequent Behavioral Referrals, has frequent absences, and has frequent referrals to school health services. • Exhibiting behavior that leads to expulsions and suspensions. • Involved in multiple systems (i.e. child welfare, juvenile justice, substance use disorder treatment). • At risk of out-of-home placements, such as foster/ group care, Children’s Long Term Inpatient (CLIP) or acute hospitalization. • In Special Education and/or has a 504 Plan, with multiple school suspensions for mental health and/or behavioral issues. • At risk based on a history of running away or disengaging from care due to mental health difficulties.

  29. As a Key Partner, We need YOU! WISeuses a team-based approach to meeting the needs of each youth and family. You may be invited to participate on a youth’s Child and Family Team, to strategize and support the team in meeting the team’s mission. Child-serving system partners are critical for achieving successful outcomes.

  30. Lorrin Gehring, CPC • Youth Engagement Specialist • Children and Youth Behavioral Health Unit • Division of Behavioral Health and Recovery gehrila@dshs.wa.gov Gregory C. Endler, MA Program Administrator Children and Youth Behavioral Health Unit Division of Behavioral Health and Recovery gregory.endler@dshs.wa.gov www.dshs.wa.gov/dbhr/cbh-wise.shtml

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