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A DREAM FOR LOUISIANA CHILDREN

Current Reform Efforts for children and youth by State Office of Mental Health:

I. POSITIVE BEHAVIORAL SUPPORT

In 2003, Louisiana's Juvenile Justice Reform Act (1225) required that Louisiana's Board of Elementary and Secondary Education (BESE) formulate, develop, and recommend a Model Master Plan for improving behavior and discipline within schools that includes

A DREAM FOR LOUISIANA CHILDREN

We Advocate for Positive and Meaningful Changes for Our Children

the utilization of Positive Behavioral Supports and other effective disciplinary tools. Each city, parish, and other local public school board will be responsible for the development of local master plan that must be approved by BESE. The master plan must include providing improved mental health services in or through schools, with a focus on:

* The identification of student's mental health needs,

* The matching of student's needs with available local resources including public, non-public and/or volunteer organizations.

* The utilization of the pending inclusion of mental health services in the Medicaid Health Services Program.

The plan will also include the following:

* Revising school zero tolerance policies to guarantee compliance with all applicable provisions of law to ensure that schools do not make inappropriate referrals to agencies serving children.

* Providing better assistance to parents in knowing about and accessing family strengthening programs.

* Improving the coordination of special education and agencies serving children.

* Improving classroom management using Positive Behavioral Supports and other effective disciplinary tools.

* Improving methods and procedures for the handling of school suspensions and the referral of students to alternative schools.

In 2004, the OMH was awarded a $610,000 federal grant for the purpose of increasing the use of alternatives to seclusion and restraint in the child and adolescent inpatient facilities. The project is focusing on continuous improvement efforts in the areas of staff training, education, and evaluation in the use of best practices with children and adolescents age 6 to 18. The project implements the Child Welfare League of America's (CWLA) Best Practices in Behavior and Support.

* Of the conditions seen at school-based health clinics, the mental health category was second only to general preventive Medicare (Louisiana Office of Public Health)

* Teen suicide is the 3 rd leading cause of death for adolescents (Louisiana Office of Public Health)

* Approximately 1,229 foster children or 18% annually of all children in foster care are placed in residential treatment facilities due to their complex mental health care needs

* Nearly 40% of the 500 youth placed in secure care have a serious emotional disturbance. (Office of Youth Services)

* Faq Currently 97% of individuals served by the Office of Mental Health are served in the Community by 60% of the OMH's budget and 72% of staff support the inpatient settings

What kind of outrage would there be if a child with asthma was told to "tough it out" no matter how bad their breathing got because they had already used up all of their benefits?

II. EARLY CHILDHOOD SUPPORTS AND SERVICES

Early Childhood Supports and Services (ECSS), implemented in the fall of 2002 and currently operating in nine parishes throughout the state, identifies and mitigates the risks for young children, ages birth through five, who are exposed to risk factors such as abuse, neglect, exposure to violence, parental mental illness, prenatal substance abuse, poverty, and development disabilities.

III. ALTERNATIVES TO SECLUSION AND RESTRAINT

The state of Louisiana is undertaking the development of a statewide coordinated system of care (CSoC) for Louisiana's at risk children and youth with significant behavioral health challenges or co-occurring disorders. The CSoC project is an initiative of Governor Jindal and is being led by executives of the Office of Juvenile Justice, the Department of Children & Family Services, the Department of Health and Hospitals, and the Department of Education.

The CSoC is an evidence-based approach that is part of a national movement to develop family driven and youth-guided care, keep children at home, in school, and out of the child welfare and juvenile justice systems.

IV. LOUISIANA COORDINATED SYSTEM OF CARE

* Incorporates a broad, flexible array of effective services and supports for a defined population

* Is organized into a coordinated network

* Integrates care planning and management across multiple levels

* Is culturally and linguistically competent

* Builds meaningful partnerships with families and youth at service delivery, management, and policy levels

* Has supportive policy and management infrastructure.

An important CSoC goal is the reduction of costly, highly restrictive out of home placements through the creation and maintenance of coordinated and effective community based services. CSoCs also create partnerships with public and private providers of services that target children, youth and their families in a multi-agency, multi-disciplinary system of services.

A System of Care:

* 40% of those placed in Office of Community Services (OCS) foster homes

* 70% of those in Office of Juvenile Justice (OJJ) out of home placements

* 20% of children and parents served in their home by OCS

* 50% of children and parents served in their home by OJJ

It is widely acknowledged that the needs of these children and families are currently being served through a fragmented service delivery model that is not well coordinated, is many times inadequate to meet the families' needs and is usually difficult to navigate. Further, state departments are not currently pooling resources and leveraging the 'smartest' financing to provide a coordinated system of behavioral health services to this population. This too often results in Louisiana's children with the highest level of need often detained in secure or residential settings, which are proven the highest cost services with the poorest outcomes.

RECENT ESTIMATES INDICATE THE FOLLOWING PERCENTAGES OF THESE YOUTH IN LOUISIANA NEED BEHAVIORAL HEALTH SERVICES:

* Lack of home and community-based services and supports

* Patterns of utilization - racial/ethnic disparity and disproportionality

* High cost

* Administrative inefficiencies

* Poor outcomes

* Rigid financing structures

* Deficit-based/medical models, limited types of interventions

(Source: Pires, S. (1996). Human Service Collaborative, Washington, D.C.)

CSOC EFFORTS HAVE BEEN SHOWN TO PROVIDE SOLUTIONS TO COMMON PROBLEMS FOUND IN STATES AND COMMUNITIES THROUGHOUT THE NATION, INCLUDING:

GOALS, VALUES AND POPULATION OF FOCUS

In a recent planning retreat, over forty agency and stakeholder leaders agreed as follows on the goals, values and population of focus for the Louisiana Coordinated System of Care.

* Family-driven and youth-guided

* Home and community based

* Strength-based and individualized

* Culturally and linguistically competent

VALUES AND PRINCIPLES

* Integrated across systems

* Connected to natural helping networks

* Data-driven, outcomes oriented

Louisiana's Coordinated System of Care will initially serve children and youth that have significant behavioral health challenges or co-occurring disorders that are in or at imminent risk of out of home placement. Out of home placements are defined as the following:

POPULATION OF FOCUS:

* Detention

* Secure Care facilities

* Psychiatric hospitals

* Residential treatment facilities

* Development disabilities facilities

* Addiction facilities

* Alternative schools

* Homeless as identified by DOE

* Foster care

* Reduction in the current number and future admissions of children and youth with significant behavioral health challenges or co-occurring disorders in out of home placements.

* Reduction of the state's cost of providing services by leveraging Medicaid and other funding sources as well as increasing service effectiveness and efficiency and reducing duplication across agencies.

* Improving the overall outcomes of these children and their caretakers being served by the coordinated system of care.

GOALS OF SYSTEM OF CARE IMPLEMENTATION INCLUDE:

The initiative is directed and overseen by the CSoC Leadership Team. The Leadership Team receives and acts on recommendations developed and submitted by a Planning Group regarding system design and implementation strategy. The Leadership Team is staffed by the Project Manager and assures departmental staff and external stakeholders work jointly in planning the Coordinated System of Care. The Leadership Team makes consensus-based decisions and is composed of the following individuals:

* Secretary Kristy Nichols, DSS

* Deputy Secretary Tony Keck, DHH

* Secretary Mary Livers, OJJ

* Assistant Superintendent Donna Nola Ganey, DOE

* Deputy Medicaid Director, Randy Davidson, DHH

* Assistant Chief of Staff Tammy Woods and Policy Advisor Camille Conaway, Governor's Office

* Maria Servick, Executive Director, Louisiana's Federation of Families for Children's Mental Health

* Sharon Dufrene, parent and advocate

* Michael Teague, Executive Director, Jefferson Parish Human Services Authority

* Representative of Supreme Court

ORGANIZATION OF THE SYSTEM OF CARE OVERSIGHT AND PLANNING PROCESS:

The planning for the system design and development work of the initiative is being conducted by the Planning Group. As stated above, the Planning Group works at the direction of the Leadership Team and is facilitated by the Project Manager. The Planning Group is responsible for developing recommendations for submission to the Leadership Group. The Planning Group is composed of agency key staff and external stakeholders, including family members, advocates, and providers. The Planning Group will form workgroups as needed to perform activities necessary to meet the goals and timeline of the project workplan; workgroups may be time-limited to accomplish specified planning tasks and objectives and include broader representation than formal Planning Group members.

PLANNING GROUP

For more information about the CSoC initiative, please contact
Shannon Robshaw, Project Manager, at 225-342-0949 or Email: [email protected]

https://ldh.la.gov/index.cfm/page/538/n/225 | This link to the DHH Procurement Library has the updated versions of the LBHP Service Definitions Manuel and other documents pertaining to LBHP/CSoC.