Child and Adolescent Task Force Report

Charlotte V. McNulty, Vice ChairPresentation to House Health, Welfare

and InstitutionsGeneral Assembly Building

September 6, 2007

Background

• Three Committees – Access to services for all children

with serious emotional disorders– Access to services for children

involved with juvenile justice services

– Involuntary Commitment

C&A Access Issues

• Many of the access issues for adults are just as evident for children and adolescents

• Inconsistent level of community based services for children across the state

• Need a broader mandate of services to provide an adequate mental health system of care

Proposed Mandated Services – All

CaseManagement

Outpatient

Residential/Housing

In-Home

Respite

Family Supports

Emergency ServicesCrisis Stabilization

Consumer

C&A

Inpatient/Acute Care

Both

Adult

Core Values

• System of care should be– Family focused

•Needs of the child and family dictate the types and mixes of services

– Community based– Culturally competent

Comprehensive Services Act (CSA)

• CSA incorporates the core values• CSA raises additional access concerns

– CSA should be a conduit for access but implementation has been problematic

C&A Access Issues (cont.)

• JLARC study– 16,262 young people served in 2005– One quarter received residential care

• Cost: $194 million

– Some young people are placed in more restrictive settings due to lack of community alternatives

– Costs related to residential care can be reduced by addressing the gaps in access to and availability of community based services

– Effectiveness of residential care is questionable

Medicaid - Mental Health – Other Count %

Yes No N/A Yes No N/A

Does Child have a DSM IV Mental Health Diagnosis?

6223

9486

0 40%

60%

0

Reason for Service Primary

Secondary

Tertiary

Total

Special Education 2496 301 231 3028

Emotional Issues 1001 1084 486 2571

Behavioral Issues 2558 1753 610 4921

Mental Issues 312 284 191 787

Physical Aggression 195 338 244 777

Homicidal 5 8 5 18

Suicidal 55 49 45 149

Disordered Thinking 5 43 45 93

Self-Mutilation 15 32 46 93

CSA Child Data Set FY07 QTR3

Juvenile Justice Committee

• DJJ reports survey of young people in custody for delinquency revealed– 43% are diagnosed with mental and emotional

problems– 70% are diagnosed with a substance use disorder

• Exploration of “Sequential Intercept Model”– At each intersect between juvenile justice and

behavioral health there is a need for• Prompt assessment• Access to community based behavioral health services

• Juvenile justice is NOT the best place to serve children with mental health issues

Model of Intervention

• Capacity Components necessary to improve access to other private and public community based services should be the same as the it is for adults

Early Intervention and Treatment services

Crisis Response Services

Intensive Support Services

Access Options

1) Fund incentives through the Office of Comprehensive Services to limit the use of residential treatment and use the money saved to create more community-based services;

2) Mandate additional services through CSB statute beyond emergency services and case management including crisis stabilization, family support, respite, in-home, day-treatment and psychiatric care. Insure funding is available

Access Options, Cont.

3) Recommend that the Office of Comprehensive Services develop a policy for communities that are over-reliant on residential care that requires that prior to any non-emergency residential placement, FAPT shall:– Obtain care coordinator and mental health evaluation

from CSB;– Explore all possible community-based services;– Document that they are inadequate and cannot be

created;– Develop discharge plan;– Report rationale and seek approval of CPMT

Access Options, cont.

4) CPMT shall review every residential placement within 21 days of placement to determine if crisis stabilization has occurred. Any longer care must be justified.

5) CSBs have legal authority for being “front-door” for behavioral health in community and, therefore, should conduct intake and evaluations for all CSA children needing behavioral health treatment.

Access Options, Cont.

6) An aggressive, clinically knowledgeable case management and utilization management system must be built in, especially in regards to use of residential care.

7) It is recognized that there is a need to build collaborative relationships between communities and universities for development of best practice models and evaluations processes.

Questions?

Contact Info:Charlotte V. McNulty, Executive Director

Harrison-Rockingham CSB1241 North Main Street

Harrisonburg, Virginia 22802cmcnul@hrcsb.org

Phone: (540) 434-1941