Ohio Family and Children First

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OFCF Overview

• Ohio Family and Children First (OFCF) is a partnership of government agencies and community organizations committed to improving the well-being of children and their families.

• OFCF started as an initiative of the Office of the Governor in 1991 building upon previous legislation (Cluster Process).

• The Ohio General Assembly codified OFCF in 1993.

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Child Well Being Indicators

1. Expectant Parents and Newborns Thrive

2. Infants and Toddlers Thrive

3. Children Are Ready for School

4. Children and Youth Succeed in School

5. Children and Youth Engage in Healthy Behaviors

6. Youth Successfully Transition into Adulthood

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Two Levels of Implementation

• State Cabinet Council

Section 121.37 of the Ohio Revised Code

outlines

that:

The OFCF Cabinet Council was created

to streamline and coordinate government

services for families needing help for

their children.

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Cabinet Council MembershipMembership is comprised of the directors of the Ohio Departments of:

Alcohol & Drug Addiction Services

Budget & Management

Education

Health

Job & Family Services

Mental Health

Developmental Disabilities

Youth Services

Aging

Rehabilitation and Correction

Rehabilitation Services Commission

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Role of the Cabinet Council

Review service & treatment plans for children when requested and provide assistance to county Councils to meet child needs

Help Me Grow: supervision of a statewide, multi-disciplinary, system for infants and toddlers with developmental disabilities or delays. (federal grant under IDEA of 2004).

Develop an annual plan that identifies state-level agency efforts to ensure progress towards child well-being.

Implement system to guide and monitor progress toward increasing child well-being in the state and in each county.

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Local FCF Councils

ORC 121.37 (B)(1) outlines that:

The board of county commissioners shall establish a county family and children first council.

The board of county commissioners may invite any local public or private agency or group that funds, advocates, or provides services to children and families to have a representative become a permanent member or temporary member of its county council.

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Local Council Mandatory Membership –ORC. 121.37 (B)(1)(a-o)

At least three youth or parents

The directors of :

Board of alcohol, drug addiction and mental health services.

County department of job and family services.

Public children services agency

The health commissioner

County Head Start

County’s early intervention collaborative.

local nonprofit entity serving children and families.

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Local Council Membership Continued…

The superintendent of the

county board of developmental disabilities.

the largest school district

school superintendent representing all other

school districts.

Largest municipal corporation

President of the board of county commissioners,

Department of youth services.

The juvenile court judge may advise the county council

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Purpose of Local FCF Councils

To streamline and coordinate existing

government services for families

seeking services for their children. In

seeking to fulfill it’s purpose, a county

council shall provide for the

following:

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Local Roles & Responsibilities ORC 121.37

1.Referrals to the cabinet council of those children for whom the county council cannot provide adequate services.

2.Annually evaluate and prioritize services, fill service gaps where possible, and invent new approaches to achieve better results for families and children.*

3.Maintain an accountability system to monitor the county council’s progress in achieving results for families and children.*

*This planning function was more specifically defined in Amended Substitute HB 289

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Local Roles & Responsibilities Continued….

4. Participation in the development of a

countywide, comprehensive, coordinated, multi-

disciplinary, interagency system for infants and

toddlers with developmental disabilities or

delays and their families. (Help Me Grow)

5. Ensure ongoing input from a broad

representation of families who are receiving

services within the county system.

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Local Roles & Responsibilities Continued….

6. Development of a County Service Coordination Mechanism that includes the following:

• Referral process that can be accessed by agencies or families seeking services.

• Invite families and all appropriate agency and school staff to all service coordination meetings initiated by team or family.

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Typical Service Providers

• Probation Officer

• CPS case manager

• School Principal

• Teachers

• School counselor or social worker

• Speech therapist

• Occupational therapist

• Child or family mentor

• Respite provider

• DD case manager

• JFS benefits caseworker

• Psychiatrist

• Counselor /therapist

• Behavior plan developer

• Physician

• Nutritionist

• After-school/childcare provider

• Summer camp provider

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MH

therapist

Speech

specialist

Diversion

worker

DJFS

worker

School

Teacher

Probation

officer

Physician

Managed

Care

workerGroup Home

Representative

Day

Treatment

case

manager

MH

therapist

DJFS

worker

Group Home

Representative

Probation

officer

?

HFWA

Facilitator

Grandma

Diversion

worker

School

TeacherSpeech

specialist

Managed

Care

worker

Physician

!

Day

Treatment

case

manager

Church

Pastor

Parent

Advocate

Attachment A

Navigator System (Service Coordination)

• Assess the needs and strengths of the child and family; families must have opportunity to participate.

• Develop Family Team consisting of the parent, professionals and natural family supports and advocates.

• Host team meetings to develop a Comprehensive Family Plan that will increase access to services to maintain the child in the least restrictive environment while stabilizing and protecting both the child and family members

• Monitor and track the outcomes of family services and coordination plan.

16

Comprehensive Family Plan• Designed to meet family needs while reducing the

need for the child to be removed from the home

• All team members engaged and responsible for the family plan

• Service plan identifies services, providers, goal completion timelines and source of payment

• Prior to any non-emergency out-of-home placement being considered; meeting conducted within 10 days on an emergency out-of-home placement.

• Includes a short-term crisis/safety plan for each family

• Ensure that family and child information is confidential, and that services are culturally responsive, and provided in the least restrictive environment.

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Hi Fidelity WrapAround Service Coordination

Guiding Principles

• Family Voice & Choice

• Team Based

• Natural Supports

• Collaboration

• Community-Based

• Culturally Competent

• Individualized

• Strengths-based

• Persistence

• Outcome-based

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Characteristics of Hi-Fi Wrap

• Highly intensity of work with family (ratio is 1 to 8 families)

• Based on mutually trusted relationship

• High frequency of contact by well trained, credentialed staff

• Family is center of the process to define needs

• Plan balances family needs and system needs

• Effective with high need multi-system families

• High implementation cost, but cost effective by reducing high cost services and residential stays

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Attachment B – Integrated Systems of Care

80%

15%

Treatment/ Maintenance –

Hi-Fidelity Wraparound

Universal/Selective –

Prevention & Health

Promotion

Selective/Indicated – Targeted

Intervention and

Individualized Services

Less

complex

needs

More

complex

needs

2-5%

Con

tin

uu

m o

f C

are

Age Range

Birth to 5 6-11 12-17 18-21 Years Old

Service Range

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40

25

15

36

26

16

20

12

5

15

42

13

53

86 7

0

5

10

15

20

25

30

35

40

PROPERTY

OFFENSES

OTHER

OFFENSES*

ASSAULTS SEX OFFENSES WEAPONS

OFFENSES

DRUG OFFENSES

YEAR PRIOR TO ENROLLMENT

DURING ENROLLMENT

YEAR FOLLOWING DISENROLLMENT

*Consist primarily of disorderly conduct

n = 890

Specific Legal Offense Referrals Before, During & After Wraparound Milwaukee

PER

CEN

TAG

E R

EFER

RED

ON

OFF

ENSE

Wraparound Milwaukee youth showed long-term reductions in offending behavior across most offense categories

Data through 5/31/05

Impact of Wraparound Milwaukee on Utilization & Cost

15.216.0

8.8

6.2 5.86.9

10.110.8

14.5

15.4

18.4

0

2

4

6

8

10

12

14

16

18

20

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

*324

328

337

273

229

152

135

* AVERAGE DAILY CENSUS IN RTC

July 1996 – Wraparound Milwaukee assumes responsibility for ALL Child Welfare/Juvenile Justice RTC Placements

105

75 67

$ M

ILLI

ON

S

78

RTC care were decreased by $12 million and redirected to serving more youth in community placements

Variability of Services Across the State

The services that a child and his family are able to access should not depend on his zip code.

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Sources of Support for FCFC Service Coordination

•County FCFC’s receive $15,750

• Family Centered Supports and Services (FCSS) funds range based on county specific data from about $20,000 to $ 250,000. This can be used for salaries or to purchase goods and services

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Alternative Funding

• Home Choice provides up to $2,000 per youth transitioning out of residential or hospitalization for goods and services and up to $6,000 for transition coordination

• ENGAGE provides $2,000 to assist youth with mental health diagnoses transition to adulthood.

• Grants

•Local contributions / Levy funds

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Other System Challenges

Lack of service options:• Availability of in-state residential treatment for high end violent

youth• In-home service continuum limited and/or staff untrained to be

effective with high-end youth• Treatment foster homes and group homes reducing• Availability varies by service and across counties (metro vs. rural)• Medicaid rate not high enough to incent more providers

Loss of benefits related to treatment choicesWaivers lost when placed in residential treatmentHome Choice not applicable when placed out -of -state

Payment inequity• Medicaid payments often better coverage than private insurance• Difficult to have caps waived – decisions based on insurance

company policies not child need (private and public)

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Accountability

•Will

• Risk Assessment Tool

• Tracking Tool

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CASII

• Child and Adolescent Service Intensity Instrument (CASII) identifies the level of risk for children Service Coordination

• Used to:

• Assess strengths and challenges

• Guide selection of services for family

• Measure progress of the child and family

• Readjust the goals and services in the Family Service Plan

• Track final outcomes

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Domains Assessed

RISK OF HARM: Child or adolescent's risk of harm to self or other,assessment of potential for victimization, and accidental harm.FUNCTIONAL STATUS: Assessment of the child's ability tofunction in all age-appropriate roles, as well as basic daily activitiesof daily living.CO-MORBIDITY: Co-existence of disorders across four domains:Medical, Substance Abuse, Development Disability or Delay andPsychiatric.RECOVERY ENVIRONMENT: Two subscales: EnvironmentalStress and Environmental Support. Strengths/weaknesses of thefamily, neighborhood and community (including services).RESILIENCY AND TREATMENT HISTORY: Child's innate orconstitutional emotional strength, capacity for successful adaptation,history of successful use of treatment.ACCEPTANCE AND ENGAGEMENT (Scale A--Child/Adolescent,Scale B-- Parents/Primary Caretaker): Child and family'sacceptance and engagement in treatment. Only higher scale used.

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Child and Adolescent Services Intensity Instrument (CASII)

Identifies the level of risk for children referred for services

• Level 6: Secure, 24hr Services with Psychiatric Management (score range 28+)

• Level 5: Non-Secure, 24hr Services with psychiatric Monitoring (score range 23 - 27)

• Level 4: Intensive Integrated Service without 24-hr Psychiatric Monitoring (score range 20 - 22)

• Level 3: Intensive Outpatient Services(score range 17 - 19)

• Level 2: Outpatient Services (score range 14 - 16)

• Level 1: Recovery Maintenance and Health Management(score range 10 - 13)

• Level 0: Basic Services (score range 7 - 9)

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Effectiveness of Service ApproachAverage of CASII Scores Entry vs. Exit2014 (n=36)

20

20.5

21

21.5

22

22.5

23

23.5

Initial Score Average Closure Score Average

scores

scores

Decrease in Youth Requiring Funded Services in Order to Reach Goals

47%

31%29%

26%

16%16%

53%

69%71%

74%

84%84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

FY2014 n=203FY2013 n=156FY2012 n=130FY2011n=148FY2010 n=140FY2009 n=113

Service Coordination only

Service Coordination plus Funding

Trauma Impact• Event Based Trauma

• Most commonly recognized

• Defined as a child experience a traumatic event such as abuse, tornado, car accident, death of a parent, school shooting etc.

• Developmental Trauma or Toxic Stress

• Living in a highly stressful environment; housing or food insecurity, unsafe neighborhood, household with drug or alcohol abuse, domestic violence, depression ,etc.

• Chronic neglect, maternal depression, lack of bonding or attachment

• Intra-uterine insult or stress

• Has same impact as one or more traumatic events

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Neurological Research Findings

• Toxic stress / trauma affects both physical health and mental health not only in childhood but throughout life. Neglect can actually reduce the size of a child’s brain

• Trauma negatively impacts the way a brain establishes its pattern of thinking; it increases reactivity, impulsiveness, fear, aggression

• Changing the way that pattern develops becomes increasingly difficult after the age of five

• Dysregulation in childhood sets a neurological trajectory for reducing a person’s ability to learn, make decisions, hold a job, maintain relationships, choose safe as opposed to risky behavior and to parent effectively as adults.

• Families living with a child with uncontrollable aggressive behaviors often experience toxic stress every day with the same negative impact as maltreatment.

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