CAPTA Summit
March 26, 2008
Working Session
Alyce Mastrianni MPA
Children and Families Commission
of Orange County
alyce.mastrianni@cfcoc.ocgov.com
Orange County’s Shared Learning
• Developmental Pathways Planning
• Focus on Foster Children
• Related Studies
Developmental Pathways
Planning
CA Developmental Service
Opportunities
State of California
ABCD Initiative
State of California
Mental Health
Services Act
Children with Special
Needs Demonstration
Project
Early Childhood Mental
Health Systems Change
Planning Grant
First 5 California
First 5 Association
of CA
Assuring Better Child Health & Development
(ABCD) Screening Academy
• 15 month national consortium to improve policy
and clinical practice so that children’s
developmental and behavioral conditions are
identified and treated at an early age.
• Administered by the National Academy of State
Health Policy, funded by The Commonwealth
Fund
• 18 states participate, including California
• CA Department of Health / MCAH Branch is lead
ABCD Logic Model: System /
Policy Level Strategies
• Incentives and Motivation
• Shared Vision and Engagement
• Community Supports for Recognition and
Response
• Promote Leadership and Collaboration
• Capability and Capacity for Care
• Promoting Continuous Learning Culture
• Performance Measurement
Mental Health Services Act (MHSA):
Prevention and Early Intervention (PEI)
• MHSA, passed in November 2004 (Prop 63) will expand
mental health care for children
• Funds will be directed to new or expanded programs based on
models proven to be effective
• PEI documented strategies include: Mental Health
Consultation in Primary Care, Nurse-Family Partnership, First
Steps, Healthy Steps, Integrated Primary Care and Mental
Health Services, ASQ and ASQ-SE, Brief Infant-Toddler
Social Emotional Assessment, Parental Depression Screening,
Early Start, Infant Parent Program, Partners in Prevention,
CHDP & other Screening, Universal Access to Voluntary
Screening, Healthy Start, Professional Development, FRC’s,
Early Childhood Mental Health Resources
$10 Million invested over 4 years to support
demonstration sites in California. There is a local
match of equal value. Emphasis areas include:
• Universal access to screening for early identification
• Improved access to and utilization of services
• Inclusion of children with special needs in appropriate,
typical preschools and other settings
• Workforce Development
• Evaluation of effective practices to improve programs
http://www.first5caspecialneeds.org
First 5 Definition:
Children with Special Needs
• Children with identified disability, health,
or mental health conditions requiring early
intervention, special education services, or
other specialized services and supports
- or • Children without identified conditions, but
requiring specialized services, supports, or
monitoring
First 5 Association – Early Childhood
Mental Health (ECMH) Systems Change
• California Endowment funded project to
explore systemic barriers to the delivery
and funding of mental health services for
children 0 – 5 and their families.
• Project participants include First 5
representatives and other key partners
(mental health, child care, Regional
Center, R&R, SELPAs, community
agencies)
ECMH – Key Strategies
Strategies identified for development of an action plan includes:
• Universal screening for mental health at appropriate
periodicity at well child and prenatal visits.
• Reimbursement for early childhood mental health
screening, assessment and treatment.
• Statewide social marketing campaign to promote the
importance of early childhood social-emotional wellbeing.
• Statewide system for training, recruiting and retaining
multi-disciplinary early childhood mental health
professionals with uniform competencies.
Children and Families Commission of Orange County
Developmental Strategies
Vision: All children are healthy and ready to learn
Pyramid of Needs for
Developmental / Behavioral Services
Assessment and Therapy
Provision
4-6%
20%
Secondary Screening
and Surveillance
Mid-Level Developmental
Assessment and Interventions
40%
100%
Community-Based
Developmental
Surveillance &
Screening
Model based on UCLA Center for Healthier Children, Families and Communities in July 2004
Pathways Report
Formation of Pathways Leadership Committee
• Commission convened diverse array of
organizations representing health care,
government, education, and communitybased organizations to form Committee
• Committee built on the Commission’s
vision and the framework developed in the
UCLA report with charter to:
“Lead implementation planning and build
community consensus for an enhanced
developmental services system”
Pathways Leadership
Committee Representation
•
•
•
•
•
•
•
American Academy of Pediatrics
CalOptima
CFCOC
Children’s Hospital of Orange
County (CHOC)
CHOC/UCI Neurodevelopmental
Programs
Coalition of Orange County
Community Clinics
County of Orange Health Care
Agency
– California Children’s Services
– Behavioral Health Services
•
•
•
•
•
•
•
•
County of Orange Social Services
Agency
Family Support Network
HealthCare Foundation for
Orange County
Kaiser Permanente
Newport Mesa Unified School
District
Orange County Department of
Education
Regional Center of OC
University of California, Irvine
Medical Center
Four Primary Goals to Achieve Outcome
All children, birth through age five, in Orange County will
have recommended developmental/behavioral baseline
screenings at milestone ages with linkage to appropriate
services.
Build
Infrastructure
Strengthen
Service
Coordination
Develop
Relationships
Among Providers
Raise
Awareness
Goals, Strategies & Action Steps
The recommended goals, strategies and action steps in the
proposed plan are designed to:
– Increase the number of children, birth through age five, that
receive regular developmental screens as part of their
primary care visits at intervals defined by AAP
– Ensure all services are family centered
– Establish Help Me Grow as the “Gateway” to Pathways
system and services
– Provide on-going management and measurement of the
overall system of care to stimulate improvement and
innovation
Goal 1: Develop the Infrastructure
•
•
•
•
Build system capacity to maximize
identification of all children with
developmental/behavioral needs and ensure
availability of resources
Implement universal release of information
form
Promote use of validated assessment and
screening tools
Monitor and evaluate Pathways system
Goal 2: Develop Relationships
Among Community Partners
•
•
•
•
Promote networking among community
partners to ensure effective collaboration
and service coordination
Develop and sustain linkages among
community partners to ensure children and
families are referred to needed services
Develop and sustain collaborative projects
Utilize incentives (e.g. policies, innovative
financing, etc.) to facilitate and sustain
relationship-promoting strategies
Goal 3: Strengthen Service Coordination
•
•
•
•
Build strategic alliances to improve delivery
of coordinated developmental and
behavioral services
Implement developmental/behavioral
screenings of children, birth through age
five, with community partners
Ensure and sustain a trained and culturally
competent workforce
Increase surveillance of children, ages birth
through 5, by early education and
community-based service providers (e.g.,
WIC, social service agencies)
Goal 4: Raise Public & Professional Awareness
•
•
Launch a public awareness campaign
aimed at Orange County families,
providers and the general public
Encourage all parent education programs
to support families in promoting healthy
childhood development
ABCD Pilots
Orange County Outcomes
• Increase the number of appropriate, high quality
developmental screens performed in practice settings
• Increase the number of age-appropriate referrals to sites
that provide developmental services
• Increase the number of children ages 0 – 3 who receive
developmental services and family supports
• Developmental screenings are routine at well-child
visits in the pediatrician’s office
• Parents understand developmental milestones /
behaviors and ways to facilitate healthy development
ABCD Pilots
Orange County Projects
• American Academy of Pediatrics, Chapter 4
– 1 community clinic, 3 MD offices, 3 early care & education
centers located in South County. Formal developmental
screenings to be completed at well child visits.
• County Clinic
– Primarily CHDP services
• Medi-Cal Managed Care (CalOptima)
– Healthy Families providers in Santa Ana and Anaheim
• Help Me Grow
– Support primary health care sites by implementing an ASQ
developmental monitoring program with enrollment at well
child visits, starting with 4 – 5 practice sites
First 5 Special Needs Demonstration Project
LEAPS - Learning, Early-intervention, & Parent Support
• Grantee: Newport-Mesa Unified School District
• The LEAPS Program Builds on a School Readiness Program
Foundation to provide universal access for screening for early
identification and referrals for physical and developmental
concerns, including socio-emotional concerns.
• Key Partners: University of California, Irvine, Orange County
Mental Health, Providence Mental Health, Matt Kline Head
Start, Regional Center of Orange County, Families Costa Mesa,
Harper Assessment Center, BRIDGES for Newborns Program,
Children’s Hospital of Orange County, Hoag Hospital
• Strategies: Preschool Program, Kindergarten Transition,
Healthy Start, Parent Empowerment, Adult Education - Family
Literacy /English and GED, Professional Development, School
Readiness Resource Center, Public Awareness -
Help Me Grow Orange County
Gateway - Improve Developmental Outcomes for Children
Connect children & families to
developmental resources and services
Create a network of community resources
with relationship building of community
providers & maintenance of an updated
resource inventory
Identify gaps & barriers to services
Educate providers about importance of
developmental surveillance & screening
Train providers on use of evidence based
screening tools including ASQ & ASQ-SE
Toll Free Number 1.866.GROW.025
Activated January 2007
160
Number of entries in CMIS
140
120
100
80
60
40
20
0
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Months
In Partnership with 2-1-1
Orange County
N=750
Focus on Foster Children
Early Childhood System of Care (ECSOC)
• Collaborative of the OC Health Care Agency and Social
Services Agency
• 4 Public Health Nurses provide intensive case
management services for a 3 month period to children
0-5 entering the dependency system
– Ensure children are connected to a medical home
– Develop care plans & coordinate medical,
developmental & behavioral health services
– Ensure children receive developmental screenings
– Refer children for developmental assessments as
needed
– Link children and caretakers to community resources
– Provide education and support to caregivers
• Implemented in 2006 to address the high rate of
developmental delays, disabilities & behavioral and
emotional problems experienced by children entering the
child welfare system
• Approx. 120 cases per PHN each month
• 1545 children 0-5 served from July 1, 2007 to December
31, 2007:
– 593 individual care plans developed
– 476 referrals made to community health providers
– 265 developmental screenings
– 288 referrals made for psychosocial & developmental
services
ECSOC Community Partners
• Western Youth Services
• CHOC/UCI Neurodevelopmental Programs
– For OC Kids
– Early Developmental Assessment Center
(EDAC)
– Help Me Grow
• School Districts
– School Readiness Nurses and Coordinators
• Regional Center
• Family Support Network
• Family Resource Centers (FRCs)
The Kinship Center
• The Seedling Project: Early Intervention Program
– Developmental and behavioral screenings are provided to
Orange County dependent children;
– Child/family specific plans are developed and early intervention
support services are provided to support placements, improve
attachment & increase school readiness
• The Adoption Clinic
– Mental health and counseling services provided to children who
are adopted or in foster care with a permanent plan of adoption
or legal guardianship;
– Services provided by child and family therapists include
individual, group & family counseling, psychological
evaluations, psychiatric services, occupational & speech
therapy & more
Related Studies
Study Group on Children in the
Welfare System
• The Commission convened a process to study the needs of
young children in the child welfare system, and in particular
foster children, and gaps and barriers to service.
• Participants includes Social Services, Health Care, Dept of
Education, Juvenile Court Judge, CASA, Foster Parent Asso.,
Regional Center, AAP, & others.
• Recommendations included the need to develop a
comprehensive system for assessment of young children who
were entering the foster care system.
• Fiscal Leveraging opportunities were identified including
Medi-Cal, EPSDT and Title IVE
Profile of Physical Abuse and Neglect of Children
Less than Two Years of Age Placed in Foster Care
• Study of the patterns of abuse experienced by very young
children and the characteristics of the children and their
perpetrators.
• Two thirds of the children in the study were less than 6 months
old at the time of removal.
• Common characteristics of the perpetrators of physical abuse
were that they were the biological parents, had been arrested,
had a history of substance abuse, and had a history of violence.
• Common characteristics of perpetrators of child neglect were
that they were the biological parents, had a history of
substance abuse, had been arrested, and had experienced
unstable housing.
Assessment of Prenatal Substance Use
• The purpose of the anonymous study was to assess
the prevalence rate of babies exposed to drugs &
alcohol prior to birth.
• 2,600 pregnant women participated representing
about 15% of the births during the study period.
• Compared to non-users, substance users were more
likely to have initiated prenatal care later or received
no prenatal care and have babies born with shorter
gestational age and lower birth weight.
www.ochealthinfo.com/seb