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Building FASD State Systems


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

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

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.

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
  • 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

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.

An Alaskan Alternative to Residential Psychiatric
  • 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

An Alaskan Alternative to Residential Psychiatric
  • 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

An Alaskan Alternative to Residential Psychiatric
  • 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

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

An Alaskan Alternative to Residential Psychiatric
  • 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

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

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

An Alaskan Alternative to Residential Psychiatric
  • 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

An Alaskan Alternative to Residential Psychiatric
  • 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.

An Alaskan Alternative to Residential Psychiatric
  • 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
  • Getting psychological evaluations done and
    reports back in a timely manner
  • Using psychiatric hospital staff
  • Pioneering telemedicine for Mental Health
    clinical services

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

An Alaskan Alternative to Residential Psychiatric
  • 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
  • Webinar follow up training (4 times/year)
  • Bring training to the community providers train
  • do Level of Care sign off on plans on same day

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

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
  • Pointing out misinterpretations of words,
    actions, and body movements when they occur

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

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

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

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

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

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

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

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

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

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

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
  • Damaged trust

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

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

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

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
  • 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.

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