Hillside Childrens Centers Cross Systems Solutions An overview of the systems, An overview of the pr

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Hillside Childrens Centers Cross Systems
Solutions An overview of the systems, An
overview of the program..
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What does Cross Systems mean, anyway?

• When a child is cross systems involved, it
  means he or she has multiple needs that involve
  more than one child-serving system.
• Sometimes these young people qualify for services
  in more than one system, but end up getting
  caught between systems. As a result, their needs
  are not met appropriately, or at all.

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So, what are the child-serving systems?

• OCFS (Child Welfare and DJJOY)
• OMH
• OMRDD
• OASAS
• SED

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New PilotHillsides Cross Systems Solutions

• Blended funding from OCFS, OMH, OMRDD, DOH, SED,
  OASAS
• Components
• Evaluation and service planning for 50
  cross-systems youth from OCFS Region 2 catchments
  area, divided into North (Hillside) and South
  (Kinship) teams

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New PilotHillsides Cross Systems Solutions

• Components Continued
• Family Advocate
• Youth Advocates
• Wrap-around funds (e.g., respite, skillbuilding)

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Eligibility Criteria

• Eligible youth must be under the age 18
• They must have needs for services from two or
  more of the following systems (OMH, OMR, OCFS,
  OASAS).
• Eligible youth are also typically at high-risk
  for out-of-home placement and exhibit high-risk
  behaviors (ie fire setting, AWOL, substance
  abuse, sexual offending)

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Eligibility Criteria, continued.

• Youth are not receiving necessary services in
  their current treatment setting.
• Youth must also be from one of the nine counties
  that compose OCFS Region 2 (Chemung, Livingston,
  Ontario, Monroe, Schulyer, Seneca, Steuben, Wayne
  and Yates Counties)

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Cross Systems Solutions Outcomes

• Serve youth in the context of their families (in
  the most familial setting) with community based
  support services.
• Children appropriately served
• Admit enrollees into recommended service systems
  (OMH, OCFS, OMRDD, SED, OASAS)
• Improve childrens overall functioning,

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Outcomes, continued

• Increase Providers systems awareness and
  knowledge will have increased as a result of
  collaborative work with CSS.
• Documentation of service gaps
• Improve parental/family satisfaction with
  services and recommendations and better informed
  families

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How to Make A Referral

• At a minimum, send most recent
• Psychiatric
• Psychological
• Bio-social history
• IEP
• Any other additional relevant documentation

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Send Referrals.

• To Robert Tocco
• Cross Systems Solutions
• 100 Metro Park, Suite 101
• Rochester, NY 14623
• [phone]

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Consultation or Training Needs?

• Contact
• Jennifer Cathy, LMSW
• Cross Systems Solutions
• 100 Metro Park Suite 101
• Rochester, NY 14623
• [phone]
• jcathy_at_hillside.com

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Cross Systems Solutions Website

• www.hillside.com click on Cross Systems Solutions
  icon (scroll to bottom of page)
• What is on the website?
• Overview of the state systems
• Services (adjunct and out-of home) by funder and
  by child need
• Access
• Contact information
• Service providers

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Office of Children and Family Services An
Overview
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• Key elements of the OCFS Mission
• Focus on well-being and safety
• Placements are typically emergency in nature
• Results come through
• Setting and enforcing policies
• Building partnerships
• Funding and providing quality services

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Core Goals of OCFS

• Improved safety and well-being for all children,
  families and communities
• Promotion of self-sufficient families and
  individuals
• Protection of the states most vulnerable
  populations from violence, neglect, abuse and
  abandonment
• Permanency for children and youth

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Key OCFS Principles

• Services should be
• Developmentally appropriate
• Family-centered
• Community-based
• Locally responsive
• Evidence and outcome-based

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Two sides to OCFS

• Child Welfare
• This includes DSS, Child Protective Services,
  foster care, adoption, permanency planning, etc.

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Two sides to OCFS, continued

• Division of Juvenile Justice and Opportunities
  for Youth (DJJOY)
• Rehabilitative services including residential and
  community treatment of JD adjudicated youth,
  detention centers etc

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OCFS/DSS Services Wide ranges of services
including

• Day Care
• Preventive services
• Child Protective Services
• Housing and emergency shelter

• Transportation
• Respite
• Out of home services
• Employment Services

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OCFS Out of Home Services/Placement Options

• Kinship Care
• Foster care (county level and Therapeutic Foster
  Care)
• Group care
• Residential placements (RTC, Emergency,
  Diagnostic, Critical Care)
• Supportive Independent Living Programs (SILP)
• And, of course, Bridges to Health!

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Who operates the out of home services?

• Local Departments of Social Services
• Voluntary agencies such as Berkshire, Crestwood,
  Glove House, Hillside, Kinship, Snell Farm, St
  Josephs Villa

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How do you access out of home services?

• Through the LDSS in one of two ways
• Parents voluntary placement
• Family court
• A child can be ordered into the custody of the
  Commissioner of a Local Department of Social
  Services (foster care and voluntary agencies)
• A child can be ordered into the custody of the
  Commissioner of OCFS (OCFS facility)
• Termination of Parental Rights

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OCFS DJJOY Services

• Key elements
• Promote safe behaviors with youth
• Keep children and communities safe
• The path to placement starts with an arrest, but
  not all arrests lead to placement

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DJJOY out of home placements

• Out-of-home placements are court-ordered for
  youth who have a Juvenile Delinquency
  adjudication and use one of two options
• OCFS managed beds
• Voluntary agencies that also serve children
  placed by DSS

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DJJOY Placements, Continued

• Specialized Placement Options
• Sex Offender Treatment Services (provided in
  discreet facility units)
• Substance Abuse Programs (provided in facilities
  or in discreet units within facilities)
• Mental Health Units

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Institutional Alternatives

• Multidimensional Treatment Foster Care (MTFC)
  Comprehensive foster home and family of origin
  treatment for youth with chronic antisocial
  behaviors, emotional disturbance and delinquency
• Multi-systemic Therapy (MST) Intensive family
  and community-based treatment addressing the
  determinants of serious anti-social behaviors in
  juvenile delinquents

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DJJOY Aftercare

• Provides
• Post-residential counseling for youth who have
  returned to the community
• A range of supervision including various levels
  of supervision by Aftercare Counselors, day
  placement programs (i.e. electronic monitoring
  and evening reporting centers)

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Accessing DJJOY services

• Referral sources can include
• DSS
• Probation
• At the depositional hearing, judge will determine
  if youth is referred to OCFS placement or private
  placement based on the testimony from OCFS,
  Probation, witnesses and a review of the
  diagnostic evaluations

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Office of Mental Health An Overview
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The Office of Mental Health (OMH)

• Key Elements of the OMH Mission
• Promotion of mental health
• Mental illness is not permanent
• Focus on hope and recovery for children with
  Serious Emotional Disturbance

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OMH Core Values

• Recovery the process of gaining control over
  ones life in the context of the personal, social
  and economic losses that result from the
  experience of a psychiatric disability. It is
  highly individual.
• Hope the belief that one can recover

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Core Values, continued

• Excellence superior design, delivery and
  evaluation of services
• Respect esteem for the worth of each individual
  including recognition of dignity, diversity and
  cultural differences
• Safety an environment free from hurt, injury or
  danger

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Unique aspects of OMH

• Parents retain custody of their child when placed
  in residential services
• Parent involvement is essential
• Strength-based and needs driven
• Services based on need regardless of ability to
  pay
• Family partnership at every level of services

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OMH community-based services

• SPOA
• Family Support
• Clinic Treatment
• Day Treatment
• School-based mental health services

• Supportive Case Management
• Intensive Case Management
• Home and Community Based Services Waiver

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SPOAThe purpose of the SPOA is to identify
children with the highest risk of placement in
out of home setting and develop strategies for
managing children in the home community using
individualized approaches. SPOAs support
communities in managing access to intensive
services.
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OMH Out of Home Services

• Family Based Treatment Homes
• Teaching Family Homes
• Community Residences
• Residential Treatment Facilities

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OMH Crisis Services

• Home Based Crisis Intervention
• Crisis Residence (up to 21 days)
• Hospital Based Services
• Inpatient services, in general hospitals (Article
  28), freestanding psychiatric hospitals (Article
  31) and State Childrens Psychiatric Centers
• CPEP access through walk in or mental health
  arrest

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Access and eligibility criteria for each service

• Family Support Free! Families identify having a
  child with an emotional, behavioral or mental
  health need and go directly to the local FS
  provider for services

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Access and Eligibility, Continued

• Day Treatment SED , Medicaid, County OMH funded.
  School identifies child as emotionally disturbed,
  unable to be maintained in local school
  placement, and makes the referral.
• Clinic Fee for service. Referral is made
  directly to the clinic. Continuation of services
  requires a diagnosis.

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Access and eligibility continued

• School based services Paid by county contract or
  state aid. Eligibility may be contingent on CSE
  referral.
• Case Management (SCM and ICM) Medicaid funded.
  Must have SED (Seriously Emotionally Disturbed)
  diagnosis as documented by a mental health
  professional. Referrals go through SPOA

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Access and Eligibility Continued

• Home Based Crisis Intervention State aid funded.
  Requires SED diagnosis. Access through SPOA is
  not always required, in which cases referrals can
  go directly to the providers.
• Waiver services Medicaid funded. SED diagnosis
  is required and risk of psychiatric
  hospitalization. Accessed through SPOA.

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Access and eligibility continued

• Out of Home Services SED diagnosis is required.
  Access is typically through SPOA, but not always
  required. For FBT or CR placements, referrals go
  directly to the providing agency. For RTF
  access, approval from the Preadmission
  Certification Committee (PACC) regarding
  eligibility is required.

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Office of Mental Retardation and Developmental
Disabilities An Overview
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Office of Mental Retardation and Developmental
Disabilities

• Key elements from the OMRDD philosophy
• OMR makes a lifelong commitment to individuals
  services are available for life!

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Key Elements from the OMR philosophy, continued

• Services are person-centered, based on strengths
  and needs, and designed WITH the family/other
  caregivers (unique feature). Individualized
  Service Plans (ISPs) are developed for each
  person receiving services.
• Least restrictive environment is key!

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So, what is a developmental disability?

• As defined in NYS Mental Hygiene Law, a
  developmental disability is a disability of a
  person that
• (a)(1) Is attributable to mental retardation,
  cerebral palsy, epilepsy, neurological impairment
  or autism
• (2) Is attributable to any other condition
  of a person found to be closely related to mental
  retardation because such condition results in
  similar impairment of general functioning or
  adaptive behavior to that of mentally retarded
  persons or requires treatment and services
  similar to those required for such persons or

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So, what is a developmental disability,
continued?

• (3)Is attributable to dyslexia resulting from a
  disability described above
• (b) Originates before such person attains age
  twenty-two
• (c) Has continued or can be expected to continue
  indefinitely and
• (d) Constitutes a substantial handicap to such
  persons ability to function normally in society.
  

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Five Types of Developmental Disability

• Mental Retardation
• Autism
• Cerebral Palsy
• Epilepsy
• Other Neurological Impairments

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What does a DDSO need to determine eligibility?

• Recent general medical report or specialty report
  with established diagnosis (for example, a
  neurological report). Specialty reports are need
  to support a diagnosis other than mental
  retardation.
• Psychological report including assessment of
  intellectual functioning reporting intelligence
  scores, and, for people with IQs above 60, an
  assessment of adaptive behavior reporting scale
  and summary scores
• .

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Eligibility continued

• Social history, psychosocial report or other
  background report establishing disability before
  the age of 22 (this is still needed even for
  children)
• In some cases the DDSO may request further
  information or different reports. They may
  recommend where the test can be completed, or
  arrange for their completion

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Acceptable Measures of Intelligence

• Kaufman Assessment Battery for Children
• The Stanford Binet Scales
• The Wechsler Series of Intelligence Scale
  (III/IV)
• Leiter International Performance Scale
• Other intelligence tests are acceptable if they
  are comprehensive, structured, standardized and
  have up to date general population norms (note
  abbreviated tests are NOT acceptable)

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Acceptable Measures of Adaptive Behaviors

• AAMR Adaptive Behavior Scale
• Adaptive Behavior Assessment System
• Scales of Independent Behavior
• Vineland Adaptive Behavior Scales
• Comprehensive Test of Adaptive Behavior
• Note must be completed and scored by a trained
  professional and must be based on the most recent
  version of the particular instrument

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Service Access

• Starts at the Access to Services Office
• This is sometimes called the Access Team, and
  they serve as a central gatekeeper (like OMHs
  SPOA)
• To request an eligibility determination/review,
  contact the Access to Services Office (through
  the local DDSO)

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Access continued

• An OMRDD Transmittal Form must accompany all of
  the required documentation (specialty reports,
  intelligence reports etc)
• Note A determination of a developmental
  disability does not mean someone is eligible for
  all services. For example, the Waiver program
  requires an additional Level of Care
  determination.

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Considerations..

• OMRDD services are voluntary
• Cant be enrolled in OMH and OMR waiver at the
  same time
• Availability of resources is there an agency to
  deliver the service in a timely fashion?
• OMRDD services are not entitlements / depends on
  eligibility and availability

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3 Step Review Process

• First Step Review DDSO staff review for
  completeness and notifies the person in writing
  that
• They are eligible,
• The request is incomplete OR
• The request has been sent for a second step
  review
• Note Decisions should be made within 30 days of
  receiving a completed packet

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3 Step Review process continued

• Second Step Review
• DDSO clinicians review the additional
  documentation provided after the 1st step review.
  More information is requested as needed.
• Once a complete packet is received, the DDSO
  should make a decision within 14 days.

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3 Step Review Process continued

• If the person is found ineligible, the following
  can occur
• S/he can meet with DDSO staff to discuss the
  determination and
• Request a 3rd Step Review and
• Request a Medicaid Fair Hearing (a 3rd step
  review will occur automatically)

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and still continued

• Third Step Review
• Occurs at Albany
• Committee members include licensed practitioners
  not involved in the 1st and 2nd step review
• Recommendations are forwarded to the DDSO 2nd
  Step review coordinators. 3rd step reviews are
  completed before the fair hearing dates.

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What might prompt a 2nd or 3rd Step Review?

• Not enough historical data supporting the age of
  onset (early intervention)
• Application for services from a referral source
  that in the past submitted inaccurate information
  regarding other people

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What else?

• Applying for services for a person for a
  condition that varies greatly from individual to
  individual, and in which the severity and
  breadth of the functional limitations are not
  adequately assessed. Examples
• -Aspergers Syndrome -TBI
• -Learning Disability -ADHD
• -PDD NOS

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What else?

• Applying for services for a person with a past or
  present psychiatric disability when documentation
  of a development disability previous to or
  concurrent with the psychiatric disability is
  unavailable or when findings are limited to
  results obtained at times when the persons
  psychiatric disability is marked (i.e. person in
  crisis)

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Service Array

• Information and Referral
• Family Support Services
• Family Reimbursement
• Respite
• Crisis Intervention
• Advocacy
• Recreation

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Medicaid Service Coordination (MSC)

• Can be the first service offered, and serves as
  the central hub of services and supports
• Professional staff works with the individual and
  their family to identify and obtain services and
  supports
• If an individual is enrolled in HCBS Waiver, that
  individual must have MSC

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Waiver Services

• A flexible array of services, funded by Medicaid.
  Can include
• Family education and training
• Hourly respite
• Environmental modifications/adaptive technology
  individualized
• Residential Habilitation
• Day Habilitation
• Prevocational Services

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Out of Home/Residential Services

• Accessed through the Central Entry Team (located
  in Rochester), made up of DDSO reps and voluntary
  agency reps
• An out of home residence licensed by OMRDD is
  considered the childs home (very unique to this
  system!)

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Examples include

• Family Care
• Individual Residential Alternatives ( IRA )
• Intensive Support Unit
• Specialized Intermediate Care Facilities

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Additional examples of adjunct services

• Article 16/28 clinics
• Offers health related services such as PT/OT when
  they cannot be obtained through the CSE process
• Forensic Services
• Provides case consultation for people in the OMR
  systems involved in the criminal justice system

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NY State Education Department An Overview
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State Education Department (SED)

• Key Elements
• Committed to educating children appropriately,
  but need sufficient time to plan
• No Child Left Behind (2001) qualified teachers,
  research-based instructions, parental rights,
  school choice
• Individual with Disabilities Education Act
  (2004) inclusion, accountability, high
  expectations, least restrictive, effective
  transitions to vocation/higher learning,
  independence and self-sufficiency

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Regular Education..

• Most youth receive their education in the school
  district in which they reside, in general
  education classrooms, without any accommodations
  or modifications.
• Some youth may attend a BOCES operated vocational
  or trade program as part of their school day.
  Some youth require accommodations and
  modifications in order to participate in the
  general education curriculum (504 Plan)

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Regular Ed, continued

• The key is to exhaust ALL efforts before
  requesting special education services
• Building Support Team efforts
• Be prepared!
• Get Functional Behavior Assessment in place
  before the CSE if behavioral issues are of
  concern

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Special Education Process

• Initial Referral
• Written request to the principle or CSE
  requesting evaluation for special ed services
• Physical exam, psychological exam, social
  history, observation, other assessments

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Eligibility for Special Education

• Autism
• Deafness
• Deaf-Blindness
• Emotional Disturbance
• Hearing Impairment
• Learning Disability
• Mental Retardation
• Multiple Disabilities
• IDEAs impact no longer discrepancy b/t
  performance and intellect response to
  intervention

• Orthopedic Impairment
• Other Health Impairment Acute health problems
• Tourettes
• ADHD
• Speech or Language Impairment
• TBI
• Visual Impairment including Blindness

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How are decisions made?

• Committee on Special Education (CSE)
• Parent/guardian
• Student
• Teachers
• School Psychologist
• District Representative and Parent Rep
• Someone to interpret results of evaluations

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Individualized Education Plan Process

• Obtain and consider evaluation information
• Determine eligibility for special education
  services (the MAIN disability interfering with
  academic performance)
• Identify present levels of performance
• Identify post secondary goals

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IEP Process Continued

• Set realistic and measurable goals
• Determine special education services
• Determine coordinated set of transition
  activities
• Determine where those services will be provided
• Implementation

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IEP continued

• Any changes to services must be documented within
  the IEP
• Annual reviews occur updating goals, progress and
  measures
• If changes are made after the annual review, they
  are written up as an amendment
• All evaluations must be updated every three
  years.

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Special Ed Support Services

• Related Services (ex. Speech, OT)
• Consultant Teacher (direct and/or indirect) must
  be subject specific minimum 2 hrs per wk
• Resource Room (supplemental instruction) minimum
  3 hrs per wk

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Services Continued

• Special Class
• Home/Hospital
• Interim Alternative Educational Setting
• In-state or out-of-state private schools
• 12 month special education service and/or program

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Where are services provided?

• The CSE must consider providing these special
  education supports to the student in the general
  education classroom unless, even with these
  supports, the student will not be able to
  participate and make progress in the curriculum.
  Then the CSE may consider removing the student
  from the general education classroom to receive
  part or all of the instruction in a special
  education environment.

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Levels of Placement

• Green Residential
• Blue Day Treatment
• Orange BOCES
• Tan Public School

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Overview of settings and access

• BOCES Provides a variety of programs that
  individual districts may not be able to provide
  such as special education programs. Available to
  youth living at home, in community-based
  out-of-home placements, or when appropriate, by
  youth in a residential program.

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Settings continued

• Day Treatment In order for an educational
  program to be titled a Day Treatment it is a
  jointly certified program, by State Ed and OMH.
  Services include crisis intervention, behavior
  support, Social Work Support, etc
• Residential Approved by State Ed as a special
  education program and, with a few exceptions,
  approved by another agency (i.e. OCFS, OMH).

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Key time frames

• Evaluations must be completed and a CSE must be
  scheduled within 30 school days after the
  consent to test is completed
• After the CSE, the school has 30 additional
  school days to put services in place for the
  student
• Note www.wrightslaw.com

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NY State Office of Alcoholism and Substance Abuse
Services An Overview
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Office of Alcoholism and Substance Abuse Services
(OASAS)

• Mission
• To Improve the Lives of New Yorkers by Ensuring
  Quality Prevention and Treatment Services for
  Chemical Dependence and Compulsive Gambling,
  Promoting Recovery from Addiction.

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Key Considerations

• OASAS is responsible for the funding, oversight
  and regulation of chemical dependency and
  prevention services
• OASAS runs state treatment facilitates know as
  Addiction Treatment Centers (ATC)

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Considerations continued

• Though limited by available funding, it is OASAS
  desire to have a full continuum of care available
  to individuals in need of chemical dependency
  treatment services.
• It is OASAS desire to work with counties and
  communities to develop plans to identify and
  implement proven strategies and program models
  for effective treatment and prevention.

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Additional Considerations

• Services rendered to patients family members
  during the patients treatment may be critical
  to long term success for the family as well as
  recovery for the patient.
• Treatment providers initiate recovery, but rely
  on other services and systems to help patients
  sustain and grow in recovery after discharge.

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Funding

• In our region, OASAS services planning and
  funding occurs through the counties and their
  local governmental units.They are operated as
  either the local Community Services Board in
  non-charter counties or the Department of Mental
  Health in Charter counties.
• Those in need must have access to state aid
  funded services regardless of their ability to
  pay. Insurance covers other programs.

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Court related issues

• With the implementation of drug courts, more
  youth are being mandated into chemical dependency
  services
• Yet, mental health law continues to state that
  treatment is voluntary

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So What Services Are Available?

• Adjunct Services
• Withdrawal Services
• Outpatient Services
• Methadone Services (dose every day to treat
  opiate addiction v dose and then live your
  life)
• Bupenorphine (dose every few days)
• Self-help Groups

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Services continued.

• Residential Services for youth in our region
• Residential Rehabilitation for Youth Services
  (RRSY)
• Serves youth up to age 21
• Short or long term (3 or 9 months)
• 24 hour supervision

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How do you access these services?

• Youth are screened by an evaluation felt to be
  appropriate by the credentialed professional
  providing the evaluation.
• Least restrictive options will be utilized
  first. With any recurrent issue, more intensive
  supports may be warranted.

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Access continued

• Residential support is determined appropriate if
  the individual is assessed as having
• (1) an active dependence or abuse condition (2)
  is unable to participate outside of a 24-hour
  setting (3) has substantial deficits in
  functional skills (4) has complications or
  co-morbidities that require daily medical
  management.

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Access continued.

• Individuals seeking treatment must be made aware
  of the voluntary nature of treatment in New York
  State.
• Individuals must be informed of program rules and
  regulations.
• Individuals must participate in their treatment
  and discharge planning.

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Potential Challenges to accessing systems.

• potential solutions.

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Discussion

• What are the potential challenges for accessing
  each of the service systems?
• OMR
• OMH
• OCFS
• SED
• OASAS

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Discussion

• Suggestions/tips for anticipating challenges and
  overcoming them

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Questions?