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Building FASD State Systems

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Statewide FASD Surveillance System. ... FASD diagnostic data provided clear picture' of youth ... Make up new acronyms: TIMS Treatment Intervention Mentors ... – PowerPoint PPT presentation

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Title: Building FASD State Systems


1
Utilizing Mentoring Modeling to Improve
Services to Youth Through a Medicaid Waiver
  • Building FASD State Systems
  • May 13-14, 2009
  • Presenters
  • L. Diane Casto, MPA Barbara Knapp
  • Alaska DHSS, Behavioral Health Alaska DHSS,
    Behavioral Health
  • Dan Dubovsky, MSW Cheri Scott
  • FASD Center for Excellence Stone Soup Group

2
Alaskas FASD History
  • Alaska Native Medical Center with IHS funding
    began early alcohol-use screening for all
    pregnant women using Alaska Native Health
    Services in mid-1980s.
  • Established statewide advocacy and services for
    Alaska Native women and children to reduce and
    prevention FASDprogram eliminated in mid-1990s.
  • 1997 Alaska Department of Health Social
    Services holds first Alaska FAS Summit.
  • 1998 Alaska Office of Fetal Alcohol Syndrome
    established with 300,000 seed-money from AK
    Mental Health Trust.

3
Alaskas FASD History
  • Alaskas FASD Project4 primary outcomes
  • Prevention of alcohol-exposed births
  • Statewide system of community-based FASD
    Diagnostic Teamsimproved diagnostic services
  • Quality system of services for individuals with a
    fetal alcohol spectrum disorder and their
    families
  • Statewide FASD Surveillance System.
  • October 2000 -- 29 million federal earmark to
    establish a statewide FASD system of services and
    program 5.8 million per year for 5 years

4
Laying Foundation for FASD Waiver Project
  • FASD diagnostic data provided clear picture of
    youth with co-occurring SED and FASD diagnoses.
  • Able to document need for Medicaid Waiver for
    youth ages 14-21 at high risk for out-of-state
    placement in RPTC with SED and FASD.
  • Applied for SED Medicaid Waiver Demonstration
    Project in 2007 awarded 1 of 10 Waiver grants.
  • 5-year award to expend 10 million in existing
    Medicaid funds on waivered services.

5
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Select the project
  • Locate a federal grant Request For Proposal (RFP)
  • Pick a project no one else has tried
  • Call a meeting
  • Policy makers
  • Program designers
  • Computer software designers
  • Regulations writers
  • National experts on the subject
  • Stakeholders

6
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Pick a population to serve
  • Youth age 14-20 years old
  • Meet level of care for Residential Psychiatric
    Treatment Center, and
  • With known prenatal exposure to alcohol or a
    Fetal Alcohol Spectrum Disorder Diagnosis

7
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Make up new acronyms
  • TIMS Treatment Intervention Mentors
  • 3M Modeling, Mentoring, Monitoring
  • RPTC Residential Psychiatric Treatment Center
  • Define new services
  • Mentor
  • Training Consultative Services
  • Community Transition
  • Supported Employment

8
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Define Service Providers
  • Collaborative ventures between two previously
  • unrelated service providers
  • Home and Community Based Agencies
  • Community Mental Health Centers

9
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Home and Community Based Service (HCB) Agencies
  • Traditional Medicaid Waiver Service Providers
  • Habilitation
  • group home
  • foster home
  • day habilitation
  • Supported employment services
  • Hourly daily respite
  • Community Transition services

10
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Community Mental Health Centers (CMHC)
  • All HCB Agency services CMHC services
  • Individual Group Skill Development
  • Case Management
  • Training Consultative Services

11
An Alaskan Alternative to Residential Psychiatric
Treatment
  • The ResultA Program Like No Other
  • Alaskas 3M Project Modeling, Mentoring,
    Monitoring
  • Unique person centered plan for each youth
  • who still receives Mental Health services and
    Medicaid health care services - - -
  • All this and Wraparound Services, too

12
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Pivotal role Mentor
  • A person chosen by the family who works under the
    direction of the Mental Health Agency providing
    the regular mental health services.
  • The mentor models positive behaviors and spends
    quality, one to one time with the youth.
  • Also, reviews the effectiveness of the services
    and family supports, can connect family
    providers to specialized trainers consultants
    to assist family, school providers of other
    services.

13
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Stumbling blocks- Agencies
  • Mental Health Agencies are often unfamiliar with
    how Medicaid works fee for service vs. prior
    authorization for services
  • HCB Agencies - not getting a large enough share
    of the service to make it worth while
  • Youth in RPTCs often out of State have to be
    released before they stop meeting Level Of Care
    (LOC) for RPTC.
  • Easier to find clients close to age 18
  • Harder to find younger 14-18 year olds, who could
    stay with the program longer.

14
An Alaskan Alternative to Residential Psychiatric
Treatment
  • Trouble points - Agencies
  • Finding mentors starting out with activity
    therapists with Mental Health Agency
  • Finding out-of-home placements FASD group homes
  • Community placements may never have been in
    RPTC
  • Getting psychological evaluations done and
    reports back in a timely manner
  • Using psychiatric hospital staff
  • Pioneering telemedicine for Mental Health
    clinical services

15
An Alaskan Alternative to Residential Psychiatric
Treatment
  • More stumbling blocks
  • Unable to identify mentor
  • Family wants youth in out-of-home placement but
    agency has no empty beds
  • Workforce development issues

16
An Alaskan Alternative to Residential Psychiatric
Treatment
  • 3M Training
  • Original training in 3M Model
  • Started with 2x year large, week long training
  • Agencies cant release staff that long
  • New training model
  • Moved to on-line training for FASD 101 and Core
    training
  • Webinar follow up training (4 times/year)
  • Bring training to the community providers train
    staff,
  • do Level of Care sign off on plans on same day

17
Why the 3-M Model?
  • Individuals with an FASD often learn most by
    modeling the behavior of those around them
  • Individuals with an FASD do better having a
    one-to-one person with them
  • A mentoring type approach has been shown to be
    very effective in the prevention of FASD
  • Mentoring for persons with an FASD is beginning
    to be tested
  • Relationships are key to positive outcomes
  • Monitoring and evaluation are an essential
    component to ensure continuation

18
What is Mentoring?
  • A form of teaching that includes walking
    alongside the person and inviting him or her to
    learn from your example
  • Participating in activities with the person
    rather than connecting the person with activities
    and then giving the person the responsibility to
    follow through (as is typical with case
    management)
  • Pointing out misinterpretations of words,
    actions, and body movements when they occur

19
What is Mentoring?
  • Providing advice, counsel, guidance, and
    one-to-one encouragement
  • Helping the person become aware of, and engage
    in, opportunities
  • Identifying strengths in the individual and
    family and building on those strengths

20
What is Mentoring?
  • Helping improve a persons feeling about him or
    herself (self-esteem)
  • Increasing a persons competence in various areas
  • Forming a positive relationship with the person
  • Respect
  • Caring
  • No eject
  • A therapeutic approach but not a clinical service

21
Mentoring Is Not…
  • Typical case management
  • Therapy
  • Respite
  • Guardianship
  • Guarding
  • A mentor is not a warden

22
What is Modeling?
  • The activity of recreating the steps of an
    activity so the person can mimic them
  • Shaping or molding by demonstrating the best way
    to do something in a variety of situations
  • An activity
  • An emotion
  • A method of expressing an emotion

23
Modeling Is Not…
  • Telling someone what to do
  • Once and done
  • Do as I say
  • Just do it

24
What is Monitoring?
  • Review and evaluation of specific aspects of an
    activity or program to include
  • Measuring performance
  • Assessing adherence to regulations, structure,
    and terms of the program
  • Assessing progress
  • Of the individual and family
  • Of the program
  • Of the approach
  • Providing technical assistance as needed

25
What is Monitoring?
  • A key to the ability to examine whether a program
    or approach produces positive outcomes
  • An ongoing process
  • Begins with gathering baseline data
  • Continues with gathering data on an ongoing basis
  • Data gathered is analyzed for change and trends

26
Monitoring Is Not…
  • Checking in with a person once in awhile
  • Vague reports of work being accomplished
  • A generalized overview of what has occurred
  • Documenting events long after their occurrence

27
Treatment and Intervention Mentor (TIM) Role
  • Is
  • Mentor
  • Role model
  • Coach
  • Cheerleader
  • For youth and family
  • Is not
  • Sitter
  • Disciplinarian
  • Spy for the family
  • Reward for good behavior

28
Caregiver Perspective Past experiences with
behavioral health system
  • Few or no support services available until youth
    in full blown crisis
  • Services not available in home community
  • Caregivers had limited understanding of
    screening, placement decision making process
  • Limited effective treatment options for youth
    with FASD once placed in treatment setting
  • Difficulty getting proper diagnosis

29
Caregiver Perspective Past experiences with
behavioral health system
  • Few treatment staff understood FASD
  • Limited contact with youth after placement
  • Limited training of caregivers to provide needed
    structure after discharge home
  • No contact with treatment staff after discharge
  • Few services available in home community after
    discharge
  • Damaged trust

30
Caregiver Perspective Present Hopes
  • Triage team works with family, educating about
    options, process
  • Increased awareness of impact of FASD on all
    facets of treatment
  • Continually expanding interest in staff training
    and consultation across state
  • Caregivers at table in BTKH and Waiver planning

31
Caregiver Perspective Present Hopes
  • Agencies exploring innovative, alternative
    approaches to meet needs of youth with FASD
  • Caregivers and youth able to access training and
    peer support more easily
  • Wrap-Around Model

32
Caregiver Perspective Dreams for the future
  • Early and accurate diagnosis available statewide
  • Supports available at first signs of difficulty
  • Supports always address strengths of the youth
    and family family-centered care
  • Services provided in home community or at least
    in region no leaving the state
  • Services continue into adulthood seamlessly

33
And the Demonstration Continues…
  • Project has 3 more years of demonstration
    project status
  • Data collection and evaluation of effectiveness
    will determine permanent status of the Medicaid
    Waiver
  • Alaska only state focusing on youth with
    co-occurring SED-FASDproject has the potential
    to establish an evidence-based model of
    intervention for this high-risk population this
    project is a great opportunity to establish a new
    way of serving this population.

34
For More Information
  • Barbara Knapp, Project Director
  • Alaska DHSS, Division of Behavioral Health
  • 3601 C St, Ste 878 Anchorage, AK 99503-5935
  • barbara.knapp_at_alaska.gov
  • 907-269-3609
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