Transcript The Development of the IDCFS Behavioral Health System

The Illinois Department of Children and Family
Services:
SI/Behavioral Health Team
Presents -
The Development of the
IDCFS Behavioral Health
System - A Paradigm Shift
to Focus on Trauma
Part I
Setting the Stage
for the
“Harmonic Convergence”
Initial Formation of the Behavioral Health Team
as part of the
Division of Service Intervention
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Organizational concept born out of concerns raised
by Consent decrees and Federal Review process
 Identification of child/youth mental health needs
 Provision of appropriate services
BHT inception – June 1, 2004
 Core assessment of DCFS programs and services
 Development of conceptual framework
 Identification of priorities and implementation of
action plans to achieve a “seamless” system of
coordinated behavioral health care for wards
“2x4” Assessment Plan
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DCFS Programs
 Integrated Assessment
 Foster Care
 System of Care (SOC)
 Specialized Foster Care
 Screening, Assessment
& Social Supports
(SASS)
 Shelters
 Medically Complex
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Provider Programs
 Hospitals
 Residential
 LANs
 MST
DCFS Organization
 Divisional Structure
 Information systems
 Contracts
 Grants
 Funding structures
 Service and contract
monitoring
“2x4” Assessment Plan
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Other System Linkages
 Child Mental Health
Partnership
 Schools
 Downstate issues
 DHS
• Developmental
Disabilities
• Substance Abuse
• Mental Health
 Community Mental Health
Providers
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Juvenile Justice
Federal Links
Courts and Consent
Decrees
Other Key Considerations
 PIP
 BH consent Decree
 Etc.
IDCFS Organizational Structure
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Divisions
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Placement/
Permanency
Field Operations
Monitoring/Quality
Assurance
Guardian & Advocacy
Clinical Practices &
Professional
Development
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Service Intervention
Budget & Finance
Planning &
Performance
Management
Communications
Child Protection
BHT Findings from Core Assessment
of Programs and Services
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August 4, 2004 – Findings presented to Director Bryan
Samuels; August 15, 2004 – presented to Deputy
Directors
Findings and Recommendations
• Endorsement of Director’s lifespan approach
• Trauma-focused care
• Utilization of Anticipatory Guidance Principle rather
than waiting for acute symptom presentation to signal
need
• Establish baseline screening for wards’ strengths,
impact of trauma and mental health needs
BHT Findings from Core Assessment
of Programs and Services
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Findings and Recommendations (continued)
• Need for cross-divisional information “nervous
system” (CANS)
• Need for uniform methodology to determine
impact of trauma/impact of services provided
• Overall workforce training on trauma and
systematic needs/strengths assessment
• Trans-divisional approach to implementation to
decrease duplication of efforts and to increase
appropriate utilization of resources &
expertise
Conceptual Framework: PARK
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Core notions •
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Promoting the
Abilities and
Resilience of
Kids
Framework for organizing efforts, programs,
services & contracts
An approach to identifying service gaps,
trends and emerging needs
PARK – A Public Health Approach to Mental
Health – Prevention, Early Identification,
Assessment and Treatment
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Primary/Universal Level – Addresses the
risk factors for all infants, children and
youth at large
Secondary/Targeted – Addresses the
specific needs and risk factors associated
with DCFS wards
Tertiary/Intensive – Addresses the needs
and risk factors of wards experiencing the
impact of trauma and/or serious emotional
disturbance
Development of the BHT Action Plan:
FY05 Focus on Infrastructure
Development and Workforce Training
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Northwestern U
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Web-based CANS
training
Illinois CANS
website
Service-Focused
Provider Database
Treatment Quality
Monitoring Unit
Evaluation of
Training Curriculum
and Statewide
Training Initiative
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DVMHPI
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Curriculum and
Training Capacity
Development on
Trauma
U of Chicago
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Geo-mapping Project
Part II
Focus on Trauma
and
Its Impact
The Adverse Childhood Experiences Study
The Effects of Adverse Childhood
Experiences on Adult Health and Well Being
What are the Adverse Childhood
Experiences (ACEs)?
Growing up (prior to age 18) in a
household with:
 Recurrent physical abuse
 Recurrent emotional abuse
 Sexual abuse
ACEs continued
An alcohol or drug abuser
 An incarcerated household member
 Someone who is chronically depressed,
suicidal, institutionalized or mentally ill
 Mother being treated violently
 One or no biological parents
 Emotional or physical neglect
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DCFS ACEs –
 Removal
from biological
parent(s)
 Unplanned placement moves
 Three or more placements in an
eighteen month period
Trauma:
The Cornerstone of the DCFS
Behavioral Health Approach
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Exposure to Trauma Increases the Risk
for:
 Major Mental Illness
 Substance Abuse
 AIDS and Sexually Transmitted
Diseases
 Impaired Physical Health
 Developmental Disabilities
Trauma & Mental Health
Trauma Increases the Odds for Major
Depression nearly two-fold.
 Trauma Increases the Odds for suicide
 Trauma is associated with poor
response to antidepressant medication
and poor overall treatment outcomes.
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Trauma & Substance Abuse
Trauma significantly increases the risk
for alcohol and drug abuse in
adolescents.
 Trauma is the best predictor of drug
and alcohol abuse in women.
 Trauma is associated with poor
treatment outcomes and increased
treatment drop out.
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Trauma & HIV/STD Risk
 Childhood
Trauma dramatically
increases risks for HIV-risk
behavior.
 IV Drug Use
 Promiscuity
Trauma & Physical Health
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Adverse Childhood Experiences Study
 Increased ACES Correlate w/ Smoking
 Increased ACES Correlate w/ Adult
Alcoholism
 Increased ACES Underlie Chronic
Depression
• According to the World Health
Organization, depression is becoming the
2nd most costly illness.
Trauma & Physical Health (cont.)
 ACES
correlate w/ Increased
Sexual Partners
 ACES Correlate w/ History of STD
Trauma & Physical Health (cont.)
ACES Correlate w/ Increased Sexual
Partners
ACES Correlate w/ Sexual Abuse of Male
Children and Their Likelihood of
Impregnating a Teenage Girl.
ACES Correlate w/ Unintended Pregnancy
or Elective Abortion
ACES Correlate w/ Rape
Trauma & Academics
Impact of trauma on school readiness
 Impact of trauma on school
performance
 Impact of trauma on cognitive
functioning that may result in
behavioral difficulties
 Increased likelihood of dropping out of
high school
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Trauma & The Brain – Some Key
Concepts from Bruce Perry, MD
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Brain develops over time
(birth thru early-mid 20’s)
Brain mediates all internal
and external processes –
body, thought, feeling &
behavior
Trauma affects brain
development – need to
address the developmental
element of growth affected
by trauma
“Body” and psychological
memory
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Physiologic properties of
alarm – stress – trauma
Initial exposure – fight or
flight – biological basis
With persistent/significant
trauma, one is on constant
alert
Branching Response –
Dissociation v Hyper-arousal;
impact over time and on
“character”
Power differential –
strength v vulnerability
“People not Programs change
People”
Part III
Implementation of PARK
and the
CANS-DCFS
Refinement of the CANS Comprehensive
into the CANS-DCFS
Promoting Internal Collaboration based on
identifying and understanding each other’s
information needs
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Director’s “Big Picture” presentation
Presentation and updates to the Deputy Directors
Forming a “common table” with Clinical Services,
Training, Information Technology, BHT
Internal Social Marketing
Development of a
“Common Information Language”
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Precursor work with DCFS System of Care
(SOC) Program and Screening, Assessment
& Social Supports (SASS)
Determining baseline information about
impact of trauma, mental health needs &
strengths – Integrated Assessment
Project
Systematic review of responses to care,
emergent needs and responsiveness to care
– 6-month Administrative Case Review
Streamlining System Mechanisms
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Reworking internal programmatic silos – the
Child/Youth Investment Team model
Utilization of the CANS-DCFS across
Residential and Purchase of Services
Providers
Improving system responsiveness to wards’
mental health needs – geo-mapping and
resource identification/quality
assurance/continuous quality improvement
New Child/Youth Investment Team Model for
Decision-Making
Next Stages of Implementation and
Anticipated Findings
“This time next year”
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Expected implementation of the CANSDCFS July 2005 (CYIT, IA, Residential
Monitoring)
Expected web-based CANS-DCFS training
in place by September 2005 with
statewide training completed by July
2006
Databases and web-based download of
CANS-DCFS data in place by September
2005
……by this time next year….
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Preliminary analysis of CANS-DCFS data
by January 2006
Linking CANS-DCFS mechanisms with
geo-mapping project by March 2006
Trauma curriculum developed and training
conferences completed by November
2005
FY07 Contracting informed by CANS data
by January 2006
FY06 BHT PIP Proposal re EBP Pilot
Projects (through the SOC network)
IDCFS BHT Contact Information
Tim Gawron, MS, MSW, LCSW
Statewide Administrator, Behavioral Health Services
[email protected]
Phone (312) 814-1573
 Jamie Germain, PhD
Downstate Administrator, Behavioral Health Services
[email protected]
Phone (618) 583-2126
 Felicia Guest, BA
PSA, Behavioral Health Team
[email protected]
Phone (312) 814-6851
 Ray Wilkerson, MD
Psychiatrist, Behavioral Health Team
[email protected]
Phone (312) 814-5991
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