connie conklin kim batsche-mckenzie amy shears · mdch sponsors parent management training oregon...
TRANSCRIPT
Connie Conklin
Kim Batsche-McKenzie Amy Shears
11/20/2015
Kim Batsche-McKenzie
Amy Shears
Connie Conklin
11/20/2015
11/20/2015
Key issues in children’s mental health System of care framework Common terms and Acronyms Populations Served How to access services Service Array Funding for Services Current advocacy and policy issues Outcomes and Evaluation Questions and Answers
11/20/2015
http://www.bing.com/videos/search?q=children's+mental+health+video+clip&qpvt=children%27s+mental+health+video+clip&FORM=VDRE&adlt=strict#view=detail&mid=5E1CA68F3CCFDCA1139A5E1CA68F3CCFDCA1139A
11/20/2015
PIHP: Prepaid Inpatient Health Plan CMHSP: Community Mental Health Services Programs SED: Serious Emotional Disturbance ID/DD: Intellectual Disability/Developmental Disability CAFAS: Child and Adolescent Functional Assessment
Scale PECFAS: Preschool and Early Childhood Functional
Assessment Scale IEPC: Individualized Education Planning Committee EPSDT: Early and Periodic screening, diagnosis and
treatment DHS: Department of Human Services MDHHS: Michigan Department of Health and Human
Services
11/20/2015
Moved from a child focus to a family focus/Family Centered Planning
Services to support the parent valued
Focus on more intensive community based treatment
Collaboration with other systems vital-children and families exist in a community
11/20/2015
1 in 5 children have a diagnosable mental disorder. For nearly two million of children, this means extreme functional impairment. And, serious mental illness in adults often begins during adolescence. Children’s Mental Health Network
Use of psychotropic medication for behavioral health for children and adolescents trends
Increased awareness of Autism
The needs of children/youth with both a serious emotional disturbance and developmental disabilities are complex and need more individualized planning
11/20/2015
Children/youth need a collaborative approach across child serving systems to be successful at home, school and in the community.
Children/youth services should adopt a family-centered approach with parents and caregivers.
The importance of prevention and early intervention
Children/youth with mental health needs in the criminal justice system and child Welfare system
Health care integration Substance use risk: Lethal and high risk drugs Partnerships with DHS
11/20/2015
(1) contends that mental health problems of children and adolescents are less understood than those of adults. Childhood depression, in particular, provokes uncertainty and clinical controversy
(2) and is among the least likely of all childhood mental health problems to receive treatment
(3). Whereas parents seek treatment for children with disruptive disorders, youths with depression typically receive treatment only when they recognize need and ask adults for help
11/20/2015
Suicide is 2nd leading cause of death among college students
Suicide is 3rd leading cause of death among 15 – 24 year olds
Suicide is 6th leading cause of death among 5 – 14 year olds
Source: American Foundation for Suicide Prevention
11/20/2015
Suicide Rates by Age
In 2012, the highest suicide rate (19.88) was among people 45 to 59 years old. The second highest rate (17) occurred in those 75 years and older. Younger groups have had consistently lower suicide rates than middle-aged and older adults. In 2012, adolescents and young adults aged 15 to 24 had a suicide rate of 10.9 (Figure 3).
11/20/2015
Seven and one-half percent of children aged 6–17 years
used prescribed medication during the past 6 months for emotional or behavioral difficulties.
A higher percentage of children insured by Medicaid or the Children’s Health Insurance Program used prescribed medication for emotional or behavioral difficulties than children with private health insurance or no health insurance behavioral difficulties.
A higher percentage of children in families having income below 100% of the poverty level used prescribed medication for emotional or behavioral difficulties than children in families at 100% to less than 200% of the poverty level.
More than one-half of children who used prescribed medication for emotional or behavioral difficulties had a parent report that this medication helped the child “a lot.”
11/20/2015
RESEARCH SHOWS: The adolescent brain is different than an adult’s brain
RESEARCH SHOWS: The significant areas are in motivation, impulse control, judgment, culpability and physiological maturation
JJDPA Fact Book: ACT 4 Juvenile Justice Resource
11/20/2015
In addition, stigmatizing attitudes toward mental illness are fueled, in part, by media reports linking depression with youth violence, which lead to perceptions of dangerousness and instill fear
Many people in the United States embrace popular representations of childhood depression as resulting from poor parenting—an attitude that stigmatizes families and creates barriers to care.
Psychiatric Services Study 2007
11/20/2015
http://www.bing.com/videos/search?q=Mental%20Illness%20Stigma%20with%20children&qs=n&form=QBVR&pq=mental%20illness%20stigma%20with%20children&sc=0-28&sp=-1&sk=#view=detail&mid=4720AF7C53729BFE0F0D4720AF7C53729BFE0F0D
11/20/2015
For children served by CMHSP: ◦ Children with a Serious Emotional
Disturbance ◦ Children with an
Intellectual/Developmental Disability
* For children with mild to moderate conditions- served by Medicaid Health Plan
11/20/2015
Definition of Serious Emotional Disturbance
Prevalence of Children with a serious emotional disturbance
In FY13 there were 38,370 Medicaid children served with SED (42,789 including Non- Medicaid)
Focus on intensive community-based services and some psychiatric inpatient services identified in the Michigan Medicaid Provider Manual
11/20/2015
Qualification of Services
Number served in Michigan: 5800 in FY13
Many are served with intensive community-based services and some psychiatric inpatient services and are identified in the Michigan Medicaid Provider Manual
The array of services may vary for these children
11/20/2015
11/20/2015
Multiple referral sources for services
Different than adults because children and families touch multiple child serving systems-school, DHS, Juvenile Justice, other community providers
Wraparound-Community Team involved
Parent and Family involvement a must
http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4899-178824--,00.html
11/20/2015
Outlined specifically in the Michigan Medicaid Provider Manual which is frequently updated
http://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf
Continuum ranges from outpatient services to intensive home based, to Inpatient psychiatric services.
11/20/2015
Medicaid
General Fund (limited)
Mi-Child
Children’s Special Health Care
Private Insurance
Children’s Mental Health Block Grant (limited)
Innovation funding for non-Medicaid (limited)
Medicaid C Waivers
Family Support Subsidy
Other blended funding and local funding (limited)
11/20/2015
Two C Waivers for children: ◦ Typically designed to “waive” parental income to
make the child Medicaid eligible.
◦ Focus on high need, hospital/institutional level of care children
◦ Provide community based behavioral health services to keep child out of more restrictive care.
◦ Children’s Waiver for children with I/DD with private insurance (statewide)
◦ SED Waiver for children with SED (only certain counties at this time- GF match
11/20/2015
An annual average of 9.3 percent of children ages 5-17 had some health care expenses for mental health disorders.
Average annual direct medical spending to treat mental health disorders totaled $10.9 billion with 44 percent for prescription medications.
Annual expenditures for mental health among school-age children with such expenses averaged $2,192 per child.
Nearly half of expenditures for treatment of mental health disorders for children ages 5-17 years were paid by Medicaid.
11/20/2015
Mental Health and Wellness Commission priority for Children’s Mental Health
MHFA Video clip: ◦ http://youtu.be/7R2j-gxPePE
Children in Juvenile Justice (including Juvenile Competency) Focus on children served by Child Welfare/
DHS Health Care Integration models for children Need for flexible funding to serve the entire
family
11/20/2015
MDCH sponsors Parent Management Training Oregon (PMTO) and Trauma Focused Cognitive Behavioral Therapy training
There are other evidenced based models implemented around the state for children and families
11/20/2015
The CAFAS is used as part of the determination of functional impairment that substantially interferes with or limits the minor’s role or results in impaired functioning in family, school, or community activities for children aged 7-17.
The PECFAS is used as part of the determination of functional impairment that substantially interferes with or limits the minor’s role or results in impaired functioning in the family, childcare/school or community activities for children aged 4 through 6 years.
11/20/2015
There are four levels of impairment: Severe (30), Moderate (20), Mild (10), and No or Minimal (0) Impairment. A higher score indicates greater impairment.
Average CAFAS at Initial: 94.14
Average CAFAS at Most Recent: 77.66
Difference Between Average Scores for Initial
and Most Recent Assessments: 16.48
11/20/2015
Average PECFAS at Initial: 85.03
Average PECFAS at Most Recent: 71.94
Difference Between Average Scores for Initial
and Most Recent Assessments: 13.09
11/20/2015
Measures of Functioning Sample Information (Active and Inactive)
CAFAS
Sample size: 5,958
Mean age: 12.7 years
Age range: 5-20 years
Gender: 57% Male,
43% Female,
<1% Unspecified
Average CAFAS at Initial: 94.14
Average CAFAS at Most Recent: 77.66
Difference Between Average Scores for Initial and
Most Recent Assessments: 16.48
How severe are the needs of the children served by the PIHP/CMHSP System?
Youth showed the most severe impairment in the areas of
School/Work, Home, and Behavior Toward Others at Initial
Assessment.
PECFAS
Sample size: 1,038
Mean age: 5.0 years
Age range: 3-7 years
Gender: 65% Male,
35% Female
Average PECFAS at Initial: 85.03
Average PECFAS at Most Recent: 71.94
Difference Between Average Scores for Initial and
Most Recent Assessments: 13.09
Young children showed the most severe impairment in the
areas of Home, School/Daycare, and Behavior Toward
Others at Initial Assessment.
19 30
7
26 21 11 5 10
31 30
16
50 60
18
5
5
34 28
5
16 12
6
4 1
0
10
20
30
40
50
60
70
80
90
100
% o
f Y
ou
th
CAFAS Subscale
Percent of Youth with Impairment on CAFAS Subscales at Initial Assessment
(n=19,485)
Mild Subscale Score Moderate Subscale Score Severe Subscale Score
20 17 7
21 31
20 10
26
40
7
43
47
6 5
33
39
2
31 11
2 3
0
10
20
30
40
50
60
70
80
90
100
% o
f C
hil
dre
n
PECFAS Subscale
Percent of Children with Impairment on PECFAS Subscales at Initial Assessment
(n=2,217)
Mild Subscale Score Moderate Subscale Score Severe Subscale Score
WHAT and WHO?
This report analyzes outcomes for children and youth with Serious Emotional Disturbance (SED) who receive services from Prepaid Inpatient Health Plans/Community Mental Health Service Providers (PIHP/CMHSP). The sample of participants for this report includes children and youth who had CAFAS/PECFAS assessments.
WHEN?
Data were collected between October 1st, 2013 and September 30th, 2014.
WHY?
Aggregate data are used to demonstrate the impact of mental health treatment of children and youth with SED served by the PIHP/CMHSP system. Data are used to inform statewide policy and program decisions.
CAFAS and PECFAS
The Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 1990) and the Preschool and Early Childhood Assessment Scale (PECFAS; Hodges, 1990) are used to determine the level of youths’ functioning. Assessments are completed at intake, quarterly, and at exit.
This report was created as a part of the Level of Functioning
Evaluation Project. This project is led by Dr. John Carlson,
professor of school psychology at Michigan State University, with
assistance from Allison Siroky and Mohammed Palejwala.
Top Three High-Risk Behaviors (Initial Assessment)
CAFAS (n=19,485) PECFAS (n=2,217)
Aggressive or threatening behavior in school, at home, or in the community (n=4,149; 21%)
Possibly suicidal, as suggested by ideation, verbalizations, or behavior (n=3,508; 18%)
Serious suicide attempt or potentially suicidal
(n=1,413; 7%)
Aggressive or threatening behavior in school, at home, or in the community (n=813; 37%)
Possibly suicidal, as suggested by ideation, verbalizations, or behavior (n=131; 6%)
Sexual behavior (n=84; 4%) 11/20/2015
What changes in functioning were seen over time and across various CAFAS/PECFAS subscales?
The three CAFAS and PECFAS subscale scores showing the most
severe impairment at the Initial Assessment were less severe at Exit.
Note: Subscale scores range from
0 (No or Minimal Impairment) to 30 (Severe Impairment).
In general, youth and young children saw improvement across
CAFAS/PECFAS subscales from Initial to Most Recent Assessment.
Subscales showing the most severe impairment at the Initial saw the
greatest improvement from Initial to Most Recent Assessment.
18
22
2
21
16
4 3
14
19
2
17
14
2 3
0
5
10
15
20
25
30
Ave
rag
e S
ub
sc
ale
Sc
ore
PECFAS Subscale
Average PECFAS Subscale Scores: Initial and Most Recent Assessment
(n=1,038)
Initial
MostRecent
19 18
6
18 18
7
3 3
17 16
6
15 16
4 2 3
0
5
10
15
20
25
30
Ave
rag
e S
ub
sc
ale
Sc
ore
CAFAS Subscale
Average CAFAS Subscale Scores: Initial and Most Recent Assessment
(n=5,958)
Initial
MostRecent
23
37 35
27
24
41
27 22 9
0
10
20
30
40
50
60
70
80
90
100
School/Work Home Behavior Toward Others
% o
f Y
ou
th
CAFAS Subscale
Percent of Youth with Impairment on Three Most Severe CAFAS Subscales at Exit
(n=1,947)
Mild Subscale Score Moderate Subscale Score Severe Subscale Score
28 30 38
26
35 33
18 22
18
0
10
20
30
40
50
60
70
80
90
100
School/Daycare Home Behavior Toward Others
% o
f Y
ou
th
PECFAS Subscale
Percent of Young Children with Impairment on Three Most Severe PECFAS Subscales at Exit
(n=331)
Mild Subscale Score Moderate Subscale Score Severe Subscale Score11/20/2015
WHAT? A report provided to the Michigan
Department of Community Health
(MDCH), Division of Services for
Children and Families, Bureau of
Community Based Services.
WHO? This report analyzes outcomes for
children and youth who receive
Wraparound services across the state of
Michigan. The sample of Wraparound
participants for this report includes
youth who have initial and exit
CAFAS/PECFAS data available. There
are a total of 350 7-18 year olds and 30
3-6 year olds included in this report.
WHEN? This data report analyzes data collected
through September 30, 2014.
WHY? By analyzing Wraparound data, the
Wraparound Evaluation Project (WEP)
is able to assess how well the
Wraparound Program is meeting its
goals and to inform future efforts to
improve and strengthen the Wraparound
process in the state of Michigan.
Wraparound Evaluation Project FY 2014: Annual Report, October 2014
Where are youth living while receiving Wraparound services?
The majority of
youth are living
in community
placements at
the initial and
exit time points.
CAFAS and
PECFAS The Child and Adolescent
Functional Assessment Scale
(CAFAS; ages 5-19; Hodges, 1990)
and the Preschool and Early
Childhood Assessment Scale
(PECFAS; ages 3-7; Hodges, 1990)
are used to determine the level of
youths’ functioning. Scores are
calculated and recorded during
every quarter.
Family Status
Report (FSR) The FSR is a 5-page questionnaire
that is designed to gather a holistic
picture of the children receiving
Wraparound services. Examples of
information collected in the FSR
include CAFAS/PECFAS data,
residential living status, and
funding source.
Data Analysis Forms
Fidelity A fidelity measure was created to
assess the reliability of the
Wraparound process, adherence to
Wraparound principles, and team
member satisfaction with
Wraparound services. Fidelity
forms include 25 statements and
total fidelity scores range from 0
(indicating very low fidelity) to 100
(indicating very high fidelity).
Updated 11/4/14
100% 100% 96% 96%
0%
20%
40%
60%
80%
100%
Initial Exit
Per
cen
t o
f Y
ou
th L
ivin
g i
n t
he
Co
mm
un
ity
Time Point
Youth Living in the Community Across Time
Young Children
(Ages 3-6)
Children/Adolescents
(Ages 7-18)
11/20/2015
How does youths’ mental health functioning change over time? How does youths’ engagement in risky behavior change over time?
The vast majority of youth had clinically significant improvements in
mental health functioning from the initial to the exit time point.
Youth had a general decline in risky behavior from the initial to the
exit time point.
80%
10% 3% 7%
73%
7% 7% 13%
0%
20%
40%
60%
80%
100%
Clinically
Significant
Improvement*
Improvement No Change Decline
Per
cen
t o
f Y
ou
th
Type of Functional Change
Change in Functioning from Start to End of
Wraparound Services
Young Children (Ages
3-6)
Children/Adolescents
(Ages 7-18)
56%
12% 13%
75%
29%
8% 7%
46%
0%
20%
40%
60%
80%
Harm to Self
or Others*
Substance Use Trouble with
the Law*
Presence of
One or MoreRisky
Behavior(s)*
Per
cen
t o
f Y
ou
th w
ith
Ris
ky
Beh
av
ior
Type of Risky Behavior
Changes in Youth Risky Behavior from Initial
to Exit
Initial
Exit
How do school suspensions change over time? How do the presence of resiliency factors change over time?
Both in-school and out-of-school suspensions decreased significantly
over time.
21%*
14%*
9%*
2%*
0%
5%
10%
15%
20%
25%
Initial Exit
Per
cen
t o
f Y
ou
th w
ith
Sch
oo
l
Su
spen
sio
ns
Suspension Type
School Suspensions from Initial to Exit
Out-of-
School
Suspensions
In-School
Suspensions
*Statistically significant difference between time points (Out-of-School: b = .54, p = .018 In-
School: b = -1.69, p = .001)
*Clinically Significant Improvement in CAFAS/PECFAS Scores (≥ 20 Points) *Statistically significant difference between time points (Harm to Self or Others: b = 1.13, p < .001;
Trouble with the Law: b = .67, p = .011; One or More Risky Behavior[s]: b = 1.29, p < .001
52%
76% 86%
40%
66%
91% 96%
72%
0%
20%
40%
60%
80%
100%
Involved in
programs related
to interests and
hobbies*
Positive
connections in
the community*
Positive
connections at
home*
Coping skills
needed to
manage stressful
situations*
Per
cen
t o
f Y
ou
th w
ith
Res
ilie
ncy
Fa
cto
rs
Resiliency Factor
Resiliency Factors at Initial and Exit Time Points
Initial
Exit
*Statistically significant difference between time points (Interests/Hobbies: b = .61, p = .001;
Community: b = 1.13, p < .001; Home: b = 1.23, p < .001; Coping: b = 1.38, p < .001)
A significantly greater number of youth had resiliency factors at the
exit time point compared to the initial time point.
11/20/2015
Opportunities Challenges
Youth Peer Support Specialists Service
Expansion of Parent Support Partner Service
Mental Health First Aid and Youth Mental Health First Aid Training
Trauma informed practice and system of care
Children’s Services has not always been a priority population
General funds cuts can impact flexibility of providing services
Cross System involvement Models are necessary to successfully treat children, youth and families
The system does not always focus or fund family-centered work
11/20/2015
11/20/2015
Internet Resources: ◦ www.surgeongeneral.gov
◦ www.afsp.org
◦ www.suicidology.org
◦ www.aacap.org (Facts for Families)
National Suicide Hotline: 1-800-SUICIDE
11/20/2015
11/20/2015
Connie Conklin, Executive Director, Livingston County Community Mental Health
517-548-0081 email: [email protected]
Kim Batsche-McKenzie, Manager of Programs for Children with Serious Emotional Disturbance, MDHHS (517) 241-5765 email: [email protected]
Amy Shears, Statewide Parent Support Partner Coordinator, (989)324-9218 email: [email protected]
11/20/2015