Youth and Co-occurring Disorders Incorporating Evidenced Based Practices

1. Youth and Co-occurring Disorders Incorporating Evidenced Based Practices Presenters: Peter Panzarella, Director of Substance Abuse Connecticut Department of Children and Families, Julie Revaz, MSW, Program Manager II, State of Connecticut - Judicial Branch Court Support Services Division, Juvenile Program and Services, Michael Williams, MST Program Manager & Robyn Anderson, Director of MDFT QA and the Hartford Youth Project

2. A skewed system: 70% of all BH dollars are spent for inpatient psychiatric hospitals and residential care Lack of Service Coordination: Children and families receiving behavioral health services in the public system often receive services from multiple agencies Service Fragmentation: Child Welfare and Juvenile Justice Lack of Family Involvement Insufficient Drawdown of Federal Funds: Medicaid System Gridlock: Connecticut saw a 40% increase in out of state placements in the three years (1997-2000) Connecticut Issues in 2000 Report on the CT Behavioral Health System

3. Connecticut 3 years is the average years of use prior to treatment

4. Co-Occurring is the Norm in YouthDCF GAIN-I Data at Intake, September 2010(Mean age 15.5, N=1770) %

5. Differences Between DCF Outpatient and Residential DCF GAIN-I Data at Intake, September 2010 (N=1718)

6. Youth in Treatment are Involvedin Multiple Systems

7. Differences of Drug Use by Gender DCF Residential GAIN-I Data at Intake, September 2010 (N=201) Mean Days of Use During the Last 90 Days in the Community Mean Days

8. What are we learning What Does Not Work ? • Treatment of adolescents in adult units and/or with adult models/materials (particularly outpatient) Needs to be developmentally appropriate • Careful with a group composition with a high number of high deviant individuals (QA and monitor) What has seems to have little effect ? • Passive referrals • Substance abuse educational units alone • Probation as usual • Outpatient treatment as usual

9. Connecticut Evidenced Based Programs andPromising Practices for Youth • Multi Dimensional Family Therapy • Multi-Systemic Therapy • Functional Family Therapy • Brief Strategic Family Therapy In-Home and Family Interventions:

10. Number of MST and MDFT Teams in CT(DCF and Courts)

11. Co-Occurring Problems: Past Year, Mod-High RESIDENTIAL (GAIN-I) % IN-HOME (GAIN-Quick) %

12. Collaborating Partners • Department of Children and Families (DCF) • Court Support Services Division (CSSD) • Advanced Behavioral Health (ABH) • Private Contractors • Advocate Community • Legislature • Judges • Families

13. Multisystemic Therapy MST “Whatever It Takes”

14. ABH Fast Facts • ABH incorporated in 1995 • Non-profit behavioral health company located in Middletown, Connecticut • 170+ Employees • 13 member voluntary Board of Directors • Licensed Utilization Review Company in Connecticut and Rhode Island • Serving over 60,000 unduplicated users annually

15. What is MST? • Community-based, family-driven treatment for antisocial/delinquent behavior • Focus is on empowering caregivers (parents) to solve current and future problems • MST client is the entire ecology of the youth: family, peers, school, neighborhood • Highly structured supervision and quality assurance processes are employed

16. How is MST Implemented? • Single Therapist working intensively with 4 to 6 families at a time • 4 months is the typical treatment time • Work is done in the community: home, school neighborhood, etc. • MST staff deliver all treatment • MST staff take a “lead” role in clinical decision making for each case

17. MST in Connecticut 26 Teams: (ABH provides consultation for the 21 “traditional” MST teams; MST Services, MST Associates, and the University of Washington provide consultation for the other 5 “pilot” or “specialty” teams) 6 Provider Agencies: • North American Family Institute (NAFI) • Community Solutions, Inc. (CSI) • Wheeler Clinic • Connecticut Junior Republic (CJR) • Connecticut Renaissance • Child Guidance of Greater Bridgeport

18. MST in Connecticut(Cont’d) 2 Funding Streams: • Department of Children & Families (DCF) • Court Support Services Division (CSSD) QA Provided at ABH by: • 3 System Supervisors; 1 Program Manager • Service Capacity: Over 800 Families Per Year Client Demographic: • Youth Ages 12 – 17 • At risk of out of home placement • Predominantly externalizing behaviors • Typically substance abusing • Typically juvenile justice involved

19. MST in Connecticut(Cont’d) ABH Provides: • Quarterly MST 5 day trainings • MST Quality Assurance • Program development • Weekly telephone consultations • Quarterly onsite booster trainings • Supervisor development and training • Facilitation of stakeholder collaboration (DCF & CSSD, provider agencies etc.) • MST call center

20. MST Teams Growth in CT

21. Connecticut Strengths • MST championed by the two state agencies most involved with juvenile justice population (DCF and CSSD) • All MST QA/QI integrated under ABH Network Partnership • Economies of scale (fiscal, data, research) • Other evidence based and promising practices are being implemented (MDFT, FFT, ICAPS, BSFT, MTFC, etc.) • Opportunities for MST research platform (25+ teams integrated under one Network Partner within small geographical area)

22. Connecticut Strengths • Both funding agencies have created data bases for client tracking (including outcomes) • Small geographic area reduces barriers associated with distance • Relatively stable funding stream (currently grant funding, potential move to 3rd party) • Pilot Program interest/support /involvement (MST-FIT, MST-EA/TAY, Building Stronger Families)

23. Connecticut Challenges • Extremely rapid growth • Insufficient workforce (other EBT’s drawing from the same applicant pool) • Provider infrastructure sometimes struggling to keep pace • Sixteen Year olds as adults (upcoming changes with new legislation) • Zero Tolerance (probation officers, courts) • JJ adolescents treated in a “split system” • CSSD carries responsibility for front end • DCF carries responsibility for back end

24. CT Specific MST Developments • Bi-monthly statewide MST provider meetings • CT specific universal MST screening form • MST workforce development committee • MST statewide safety protocol • Participation in an evidence based and promising practices graduate level course • ABH has initiated the development of the Alliance to Support Evidence Based and Promising Practices (ASEP)

25. Connecticut Outcomes Since 2003 • 4,454 Families served. • 83% of MST clients remained in the community at discharge. • 84% of MST clients were in school or working at discharge. • 73% of MST clients had not been rearrested at discharge.

26. MDFT • CT - Multidimensional Family Therapy

27. What is MDFT?

28. What is MDFT? Treatment is mainly in-home, 2-3 times per week for 3-6 months. • Interventions are multidimensional and target: • 1) adolescent, • 2) parent, • 3) family, • 4) systems external to the family (education, juvenile justice, peers, social-services, etc..). • Therapy itself is based on tenets of structural and strategic family therapy

29. MDFT IN CT 2010 • MDFT • MDFT – CARE • FSAT – MDFT • RESIDENTIAL/GROUP HOMES • MDFT RAFT • MDFT-DTC

30. MDFT in Connecticut

32. Referral Sources MDFT Providers

33. MDFT SUPERVISION Trainer/ Consultant MDFT

34. QUALITY ASSURANCE • Adherence to the fidelity of model • Monthly site reports • Weekly supervision logs • Quarterly reports to funding sources • Therapist session planning and implementation sheets • Therapist assistant task, planning, and implementation logs • Mid-term and final exams • Tapes sent to University of Miami for rating

35. MDFT Works • Served over 300 families per year • Reduction of substance use • Reduction of legal involvement • Increase in school involvement • Improved family relationships

36. MDFT Works What people say about MDFT: • “MDFT helped my son to go back to school and do something with himself, I feel like I finally have my son back!” • “MDFT helped our whole family to get along better together, now we are not fighting all the time and being at home is so much easier”

37. MDFT Works What Professionals say about MDFT: • “MDFT helps you to see families in a different way; even when they have a lot of problems and they seem just not to care, this approach teaches you how to get the best out of difficult families.” • “What I like about working with MDFT is that it offers you a guide to work with families and the individual, but at the same time is flexible. It requires you to get very involved with the families, but at the same time it teaches you how to help them build their strengths so that they can keep going without you.”

38. Next Steps • Continue efforts for workforce development • Continue growth of the program • Implementation of MDFT residential, groups homes, MDFT-DTC and RAFT projects

39. MST 3rd Quarter Dashboard Report

44. Numbers of Cases of DCF MST and MDFT Compared to SA Residential by Year

45. Changes in DCF Adolescent SA Beds Licensed Capacity

46. System Level Outcomes • 70% Mean length-of-stay is more than 90 days in all levels • 70% Diversion rate from Juvenile Justice Detention Centers and residential care to community based • Over a 50% reduction in residential substance abuse treatment beds and savings in out of home care • Created new level of care in-home capacity for over 2000 youth being treated in their community • Significant increase in family treatment approaches and creating new family partners

47. Client Level Outcomes Post Treatment Hartford Youth Project

48. Client Level Outcomes Post Treatment Hartford Youth Project

49. Client Level Outcomes Post Treatment Hartford Youth Project

50. MST and MDFT DCF BH Data Ohio Scales Percent Increases Parent Self report in Pre-Post Measure (N=336)