Division of Child Behavioral Health
Collaborating to Serve the Children and
Families of New Jersey
1
DCBHS Court Liaisons
Kim Maloney
Liaison to Detention and Juvenile Justice
(609) 888-7193
[email protected]
Mike Higginbotham, MSW, LCSW
Liaison to the Judiciary, Trial Courts
(609) 888-7198
[email protected]
2
NJ Department of Children and Families
New Jersey Department
of Children and Families
Commissioner
Division of Child
Behavioral Health
Services
Division of
Youth and Family
Services
Division of
Prevention
& Community
Partnerships
Office of
Adolescent
Services
Child Welfare
Training
Academy
3
System of Care Values and Principles
Accessible
Unconditional Care
Accountable
Team Based
Collaborative
VALUES:
Strengths Based
Promoting
Independence
Comprehensive
Child Centered & Family Driven
Cost Effective
Community Based
Culturally Competent
Outcome Based
Family Involvement
Flexible
Needs Driven
Individualized
Home, School &
Community Based
DCBHS Overview and Data
Presentation.pptxDRAFT - Jan 3 2011
4
DCBHS Objectives
We want to keep kids…
At Home
(with their families and not in out-of-home treatment settings)
In School
(in their regular school in their school district)
Out of Trouble
(not involved with the Juvenile Justice System or at risk of
detention or incarceration)
5
The Role of Assessment within DCBHS
The vision of DCBHS is to create positive
outcomes for children with emotional and
behavioral needs by:
• Identifying the child and family’s needs
• Determining the most appropriate
Intensity of Service
• Delivering the most appropriate services
for the most appropriate length of time
• Using standard assessment tools –
the foundation of DCBHS’
System of Care.
Positive
Outcomes
Appropriate
Length of Stay
Appropriate
Services
Appropriate
Intensity of Service
Child and
Family Needs
Assessment
Tools
6
Mission
Serve youth with emotional and/or behavioral needs
and their families through strength-based,
individualized, and efficacious services.
Key Components
CSA Single portal for access to care
CMO
Intensive care management utilizing a Wraparound model of care
serving youth with complex needs & their families
YCM
Linkage for youth with moderate needs, assist youth discharged
from CCISs, complete 14-day plans
FSO
Family-led support for CMO & UCM involved families, community
education, warm lines, advocacy
MRSS
Crisis planning for youth with behavioral/emotional needs, available
24/7/365
7
In-Community Services
Our in-community services are flexible therapy services
that are provided at the home or other in-community
sites to youth involved with YCM or CMO/UCM.
IIC
Intensive In-Community Services –
Psychotherapy services provided in the youth’s
home.
BA
Behavioral Assistance – Under a plan
developed by an IIC therapist, the BA will work
to modify specific behaviors of the youth.
8
The 14-day Plan
9
Juvenile Justice Access to the SOC
A youth appears
before the court who
is believed to have
behavioral healthcare
needs
The Judge
Orders a
DCF 14-day
Plan
The DYFS
Court
Liaison
receives and
reviews the
court order
14-day Plan Process Begins
Fourteen Day Plan Process Detail
14 day plan to be
developed by
DYFS
1. Youth has abuse, neglect or
permanency Issues?
2. Youth has a currently open DYFS
case?
3. Youth has one and/or two above
and behavioral healthcare needs?
4. Youth has behavioral healthcare
needs only?
14 day plan to be
developed by Youth
Case Management
continued
10
Juvenile Justice Access to the SOC
Youth Case Management 14-day Plan Process Flow Chart
The DYFS
Court Liaison
refers youth
to Youth Case
Management
continued
The Youth Case
Management Supervisor
reviews the referral and
assigns the youth to a
Youth Case Manager
1. The YCM contacts PerformCare (Contracted
System Administrator) at 877-652-7624 to
register the youth in the CYBER system.
2.
The YCM ensures that the CSA:
a.
b.
c.
d.
e.
Registers the youth in the CYBER
system;
Checks the youth’s eligibility for
services;
Checks to see if the youth has a preexisting CYBER record;
Provides the YCM with electronic
access to the youth’s CYBER record;
Authorizes a minimum of days of
behavioral healthcare services for the
youth.
The Youth Case
Manager (YCM)
conducts the
following activities
3. The YCM completes the Medicaid Presumptive
Eligibility (PE) process.
4. The YCM completes the Strengths & Needs
Assessment.
5. The YCM arranges for the services the youth
needs.
6. The YCM completes the 14-Day Plan Report.
If at any time during the process
of completing the 14 Day Plan,
the youth’s family refuses to
cooperate, the Youth Case
Manager must notify the Court
immediately and continue
planning.
continued
11
Juvenile Justice Access to the SOC
14-Day Plan Submission Process
The Youth Case Manager (YCM) or DYFS
completes the 14-Day Plan Report
The 14-Day Plan Report is received by
Public Defender or youth’s attorney in
writing from the YCM or DYFS.
IS YOUTH ADJUDICATED?
No
Attorney determines whether
to release the plan to the
Judge
Yes
Plan is released
to the Judge
The Judge:
1. Accepts the plan,
or
2. Orders
additional
services that
may include
out-of-home
treatment
YCM, DYFS or other
appropriate entity
carries out the courtordered plan.
12
BioPyschoSocial (BPS) Evaluation
• Resource for Juvenile Detention
Centers, if case management (YCM
or CMO) is not involved.
• Provides recommendations for
youth suspected of having mental
health issues and / or score a
‘warning’ on the MAYSII.
13
Out-of-Home Treatment
14
Principles of Out of Home Treatment
 Family commitment to ongoing active
involvement
 Child Family Team
 Clinically Based
 Community based first
 Short term
 In State
15
Referring a Youth to OOH Treatment
To refer a youth to OOH Treatment:
1
2
3
The youth’s Family Team must have determined
that a referral to OOH treatment is warranted
Care Managers have no legal authority to start
OOH referral process without parental permission
or court order.
The referral paperwork must be compiled:
 Referral Summary for OOH Treatment
 Referral Packet
16
Residential Referral Packet
• Cover letter with identifying information including:
Youth’s name/CYBER#
Youth’s current location
Date of OOH Referral request/Telephonic Review
Current Intensity of Service (IOS)
DYFS Involvement
Efforts to secure OOH Treatment
E-mail and phone # of both case manager and supervisor
Supervisor’s Signature confirming review of packet
• Thorough Out of Home Referral Summary
(must be updated each time an OOH referral is initiated)
OUT OF HOME REFERRAL PACKET CHECKLIST located at:
http://www.state.nj.us/dcf/behavioral/providers/ReferralPacket.pdf
17
Residential Referral Packet
Do not send incomplete packets to PerformCare
Thorough Out of Home Referral Summary
• Recent Clinical Information
(Within six months; if within one year, include updated report(s) from therapist):
Bio-psychosocial or Psychological Evaluation
Psychiatric (if on medication and/or recent hospitalization)
• Specialized Evaluations, if applicable (within the last year):
Fire Setting Evaluation with Risk Level
Psychosexual Evaluation with Risk Level
Substance Abuse Evaluation
• Previous Out of Home Outcomes
Discharge Summaries or Rejection Documentation from prior or current Out of Home Treatment Setting
Transitional Joint Care Review
• Court Involvement
Status and Copy of legal charges
Probation reports
Pre-sentencing report
Court order for residential treatment
• Other reports
Status of DDD involvement, if applicable
School-IEP, if classified
Medical Reports (if child has a medical condition)
18
Out-of-Home Treatment
Intensity of Service: levels of OOH treatment based
on intensity, frequency, and duration of treatment:
•
•
•
•
•
•
•
CCIS – Inpatient Treatment
Intensive Residential Treatment Services
Psych Community Residences
Specialty Beds
Residential Treatment Centers
Group Homes
Treatment Homes
19
Out-of-Home Treatment
Treatment Home
• This IOS is for children/youth requiring Out of Home
treatment with minimal clinical care. The child/youth is
placed in the safe environment of a private home setting
in which treating parents have received specialized
training in the care of children/youth with emotional and
behavioral challenges.
• Treatment parents receive supervision and are
supported by the staff and programs of the treatment
home agency.
• The goal of a Treatment Home is to maintain the
child/youth in the community while preparing for
transition: return to family of origin, adoption,
permanency placement, kinship care, or independent
living.
20
Out-of-Home Treatment
Treatment Home Service Delivery
• TH parents reside in the home with youth.
• Youth attend school in the community.
• The Agency provides up to one hour a
week of individual counseling and up to
four hours a week case management.
• Medication monitoring as needed.
• Youth can access additional therapeutic
supports from the community, if needed.
21
Out-of-Home Treatment
Group Home
• A Group Home is a community-based IOS designed for
youth with behavioral and emotional challenges and
needs who have the capability to engage in the
community.
• Comprehensive services include individual, group, and
family therapy, rehabilitation, and skill building.
Programs are staffed around the clock. Residents go
into the community for school and outside activities.
• Interventions are directly related to established goals
and objectives with the aim of transitioning to a lower
intensity of service or home.
• Family/guardian/caregiver involvement is extremely
important and, unless contraindicated, should occur on a
regular basis as determined in the treatment plan.
22
Out-of-Home Treatment
Residential Treatment Center
• Residential Treatment provides a 24-hour service for
youth who have demonstrated severe and persistent
needs in social, emotional, behavioral, and/or psychiatric
functioning. .
• RTC’s provide clinical treatment, psychiatric
consultation, and medication monitoring, coupled with
social, psychosocial, educational, and rehabilitative
services. These are delivered through a highly
structured therapeutic programming in a safe, controlled
environment with a high degree of supervision.
• Residential Treatment is provided in freestanding, nonhospital settings on campuses or in the community.
• Some RTC programs have on-ground school services,
which may require youth to be educationally classified.
23
Out-of-Home Treatment
Specialty Bed Program (SPEC)
• A Specialty Service Residential Program (SPEC)
provides supervised, licensed, 24-hour care within an
intensive treatment program for youth with significant
emotional and/or behavioral psychopathology which is
specifically correlated with significant life events that
have impacted their personal development and progress.
• The individual focus should implement therapeutic
principles which are directly focused on the etiology of
each individual youth’s psychopathology. Examples of
therapeutic modalities which may be used include
Functional Family Therapy, Cognitive Behavioral
Therapy, the Sanctuary Model, and Trauma Affect
Regulation.
24
Out-of-Home Treatment
SPEC Criteria
• Significant Trauma Indicators: History of multiple
placements, substantiated history of physical, sexual, or
emotional abuse and/or substantiated history of moderate
to severe neglect.
• Fire Setting: Within the past two years; low, moderate, and
high risk with fire setting evaluation;
• Assault: Within the last two years; with or without a
weapon and causing injury; history of repetitive assaults;
• Sexually Reactive Behavior: Within the last two years;
low, moderate, or high risk with psychosexual evaluation;
predatory or non-predatory; adjudicated or non-adjudicated;
Tier I or II Megan’s Law.
25
Out-of-Home Treatment
Specialty Bed (SPEC)
Treatment in a Specialty program should include
regular and ongoing family involvement, when
clinically appropriate. When there is no active family,
the DCF case management entities should act as (or
develop) a surrogate family and be responsible for
their participation in treatment meetings. The individual
focus should implement therapeutic principles which
are directly focused on the etiology of each individual
youth’s psychopathology. Examples of therapeutic
modalities which may be used include Functional
Family Therapy, Cognitive Behavioral Therapy, the
Sanctuary Model, and Trauma Affect Regulation.
26
Out-of-Home Treatment
Psychiatric Community Homes (PCH)
• Psychiatric Community Homes (PCH) are designed to
provide community based treatment to youth whose
DSM IV diagnosis indicates that they are in need of
acute care. There are programs that serve youth from 520 years old, who may have been receiving inpatient
Children’s Crisis Intervention Services (CCIS) or
Intensive Residential Treatment Services (IRTS), and
require ongoing psychiatric care in a safe, highly staffed,
and supportive residential milieu before they can return
home or transitioning to a less intensive out of home
treatment setting.
• These services may also be accessed by youth as a
deterrent to psychiatric hospitals.
27
Special Needs Homes
 DD/MI - Treatment home settings, with additional
supports, for youth with both clinical needs and lower
intellectual functioning.
 Diabetes Homes – Therapeutic settings that accept youth
with a diabetic condition.
 Pregnancy Homes (SRTU Access)
 Detention Alternative Program (DAP) - For youth in
detention awaiting therapeutic out of home treatment.
Priority population: post dispositional youth in DYFS
custody. Accessed through DCBHS – gatekeeper Jennifer
Holder at [email protected] or 609-888-7198.
• Klemmer – nine male beds
• NJ Mentor – five male/female beds
• Project Chance – four male/female beds
28
Referring a Youth to OOH Treatment
Once Intensity of Service (IOS) is determined:
1
The CYBER electronic system automatically posts
the child on Youth Link.
2
Interested providers “assign” youth to their
programs
3
Care Manager (CM) monitors assignments in
CYBER and contacts potential provider(s) if
necessary to advocate for assignment of youth
4
CM contacts the facility(ies) and sends packets to
programs assigned to the youth.
29
Referral Process
Once a youth has been assigned to a program, the
Care Management Entity (CME) is responsible to:
OVERNIGHT the referral packet to the provider
1
2
**Packet must arrive at the provider within 72
hours of their accepting the referral
Call provider to follow up and clarify youth’s needs
30
Referral Process
Once a youth has been assigned to a program, the
Care Management Entity is responsible to:
3
4
Provide the youth and family with all available
information about the program the youth has been
assigned to or facilities or providers that have
expressed interest.
Provide families with enough information to make an
informed decision about which referral(s) to pursue.
31
Referral Process
Once a youth has been assigned to a
program, the CM is responsible to:
5
6
Schedule a “Meet & Greet” with youth and family’s
preferred provider.
CM contacts all facilities where a packet has been
sent:
to encourage them to accept the youth,
to clarify any additional information needed,
for decisions and timelines.
32
DCBHS Specialized Residential Treatment Unit (SRTU)
CRITERIA FOR REFERRAL TO DCBHS SPECIALIZED
RESIDENTIAL TREATMENT UNIT
•
A youth who has been assigned a SPEC (Specialty) Intensity of Service; PCR
(Psychiatric Community Residence) Intensity of Service; a youth in need of a
treatment program for pregnant teens;
•
A youth who has been on Youth Link for 30 days with lower IOS
determinations and there are no prospects for acceptance into any out-ofhome treatment programs;
•
SRTU is not an emergency placement resource.
Detailed information on accessing SRTU services are located at:
http://www.state.nj.us/dcf/behavioral/providers/AccessSRTU.pdf
DCBHS Specialized Residential Treatment Unit
Attn: SRTU
50 East State Street, 4th Floor
PO Box 717
Trenton, N.J. 08625
33
DCBHS Specialized Residential Treatment Unit
PerformCare informs CM to send packet to SRTU at time of IOS
determination when criteria are met.
CM overnights to SRTU the required Referral Packet immediately and
confirms receipt within 72-hours with Olivia Townsend at 609.888.7214.
Ms. Townsend assigns the child to a SRTU consultant.
The CM contacts the SRTU consultant by email. SRTU consultant
informs the CM of the next steps and the CM follows through with the
recommendations. It is the CM’s responsibility to initiate, update, and
maintain communication with the SRTU consultant.
If the child is accepted to OOH Treatment Setting, the OOH Treatment
Setting contacts PerformCare to attach the provider to the youth’s
referral to the provider.
34
Things that delay the referral process:
 Poor documentation
 Failure to present child in a strength
based manner
 Missing set timelines
 Failure to communicate with SRTU
Consultant
 Procrastination
 Incomplete Packet
35
Ways to Expedite Placement




Include all requested information listed in the OOH Referral Checklist
when submitting packet to PerformCare, SRTU and/or OOH
providers.
Ensure OOH packet contains adequate clinical information that
supports requested Intensity of Service.
Make certain that youth is presented in a strength-based manner.
Meet all set submission timelines:
• Submit OOH Referral to PerformCare as soon as possible;
• Immediately send packet to SRTU when youth receives SPEC or PCH
determination;
• Immediately send packet to assigned providers, regardless of bed
availability.


Maintain e-mail communication with pending providers on a regular
basis to ensure youth receives a timely meet-and-greet even when
there are no current openings.
Ongoing e-mail communication with SRTU Consultant, if assigned.
36
Transitional Care
Present OOH treatment setting submits Transitional Joint
Care Review (TJCR) with either a recommendation for a
lower, higher, or same level of care. The current OOH
Treatment Setting contacts a specific alternative OOH
Treatment Setting to transition the child.
Youth is placed on Youth Link in CYBER so providers can view
the OOH referral summary.
OOH treatment setting shares clinical information with
prospective new placement entities and CM. CM receives &
follows-up on the information from the current placement and
contacts the perspective new OOH treatment setting(s).
37
Problem Solving for Court-involved Youth
Issues Regarding:
Contact:
Case Management Entity
Specific Youth
System Issues
•
•
•
•
Care Manager
Supervisor
Clinical Director
Executive Director/CEO
Juvenile Justice - Kim Maloney
Judiciary – Mike Higginbotham
38
For more information…
1
www.nj.gov/dcf/behavioral
PerformCare Member Services:
1-877-652-7624
www.performcarenj.org
39
Out-of-Home Treatment
Glossary of Acronyms and Terms
•
•
•
•
•
•
•
DCBHS (Division of Child Behavioral Health Services) – The Division within DCF that
provides a comprehensive approach to the provision of mental and behavioral health
services to eligible children, youth, and young adults.
DCF (Department of Children and Families) - The Department that includes DCBHS,
DYFS, and DPCP (Division of Prevention and Community Partnerships).
Youth Link – The technology in CYBER by which both case managers and OOH
treatment providers manage referrals, admissions, and discharges. It is a dynamic
real-time process.
CSA (Contracted System Administrator - PerformCare) - An administrative
organization contracted by the DCBHS to provide utilization management, care
coordination, quality management, and information management for the Children’s
System of Care that provides mental and/or behavioral health services and supports
to eligible children, youth, and young adults.
CYBER (Child Youth Behavioral Health Electronic Record) is a fully functional, multisystem electronic medical record. The protected health information (PHI) contained in
CYBER is protected by HIPAA regulations and should be accessed only on a need to
know basis. Please review HIPAA regulations and address any questions with your
supervisor to ensure compliance.
IOS (Intensity of Service) – Frequency, intensity, and duration of treatment services.
SRTU - Specialized Residential Treatment Unit is a part of DCBHS. It works toward
quality OOH programming and provides consultation to case managers for who have
been on the Youth Link for 30+ days as well as the SPEC, PCH, and Special Needs
Homes Utilization Management.
40
Thank you
41
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REQUEST FOR PROPOSALS FOR New Jersey Task Force on Child