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


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

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

So, what are the child-serving systems?
  • OCFS (Child Welfare and DJJOY)
  • OMH
  • SED

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

New PilotHillsides Cross Systems Solutions
  • Components Continued
  • Family Advocate
  • Youth Advocates
  • Wrap-around funds (e.g., respite, skillbuilding)

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,
  • 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)

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)

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
  • Improve childrens overall functioning,

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

(No Transcript)
How to Make A Referral
  • At a minimum, send most recent
  • Psychiatric
  • Psychological
  • Bio-social history
  • IEP
  • Any other additional relevant documentation

Send Referrals.
  • To Robert Tocco
  • Cross Systems Solutions
  • 100 Metro Park, Suite 101
  • Rochester, NY 14623
  • (585) 350-2513

Consultation or Training Needs?
  • Contact
  • Jennifer Cathy, LMSW
  • Cross Systems Solutions
  • 100 Metro Park Suite 101
  • Rochester, NY 14623
  • (585) 350-2519
  • jcathy_at_hillside.com

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

Office of Children and Family Services An
  • 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

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

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

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

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

OCFS/DSS Services Wide ranges of services
  • Day Care
  • Preventive services
  • Child Protective Services
  • Housing and emergency shelter
  • Transportation
  • Respite
  • Out of home services
  • Employment Services

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

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

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

  • 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

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

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

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

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)

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

Office of Mental Health An Overview
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

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

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

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
  • Family partnership at every level of services

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

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
OMH Out of Home Services
  • Family Based Treatment Homes
  • Teaching Family Homes
  • Community Residences
  • Residential Treatment Facilities

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

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

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.

Access and eligibility continued
  • School based services Paid by county contract or
    state aid. Eligibility may be contingent on CSE
  • 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

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.

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.

Office of Mental Retardation and Developmental
Disabilities An Overview
Office of Mental Retardation and Developmental
  • Key elements from the OMRDD philosophy
  • OMR makes a lifelong commitment to individuals
    services are available for life!

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!

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

So, what is a developmental disability,
  • (3)Is attributable to dyslexia resulting from a
    disability described above
  • (b) Originates before such person attains age
  • (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.

Five Types of Developmental Disability
  • Mental Retardation
  • Autism
  • Cerebral Palsy
  • Epilepsy
  • Other Neurological Impairments

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
  • 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
  • .

Eligibility continued
  • Social history, psychosocial report or other
    background report establishing disability before
    the age of 22 (this is still needed even for
  • 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

Acceptable Measures of Intelligence
  • Kaufman Assessment Battery for Children
  • The Stanford Binet Scales
  • The Wechsler Series of Intelligence Scale
  • 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)

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

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
  • To request an eligibility determination/review,
    contact the Access to Services Office (through
    the local DDSO)

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

  • 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

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

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.

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)

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.

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

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

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

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

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
  • If an individual is enrolled in HCBS Waiver, that
    individual must have MSC

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

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

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

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

NY State Education Department An Overview
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

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)

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

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

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

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

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

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

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

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

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

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.

Levels of Placement
  • Green Residential
  • Blue Day Treatment
  • Orange BOCES
  • Tan Public School

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.

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).

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
  • Note www.wrightslaw.com

NY State Office of Alcoholism and Substance Abuse
Services An Overview
Office of Alcoholism and Substance Abuse Services
  • 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.

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)

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.

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.

  • 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.

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

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
  • Bupenorphine (dose every few days)
  • Self-help Groups

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

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.

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

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

Potential Challenges to accessing systems.
  • potential solutions.

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

  • Suggestions/tips for anticipating challenges and
    overcoming them

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