SERVICE DELIVERY AND
DEVELOPMENT
Best Practice Recommendations
The WV Commission to Study the Residential Placement of Children
charged the Service Delivery and Development Work Group to create
specialty specific task teams Their charge was to explore creative best
practice recommendations for designated target populations identified in
the initial out of state review, judicial survey, regional clinical reviews
and community assessments completed in
.
These specialty specific task teams are comprised of diversified
stakeholders and experts. They include family members, providers,
policy makers, and administrators. On June 4, 2009, this report was
presented to the WV Commission to Study the Residential Placement of
Children to make recommendations on how to improve the system for
three target populations. The three target populations selected were
based on the out of state review of youth ages 16 and older and the
judicial survey. The target populations included in this report are: youth
with co-occurring disorder, youth with co-existing disorders, and youth
transitioning to adulthood.
This report includes the findings, recommendations and implementation
strategies from the specialty specific task teams’ integration of thorough
research of proven practices and active discussion integrated with WV
practice wisdom.
Report to the West Virginia Commission to Study the Residential
Placement of Children
6/4/2009
INTRODUCTION
The work described in this report was performed as part of the ongoing oversight and planning by the
Commission to Study the Residential Placement of Children; particularly the Service Delivery and
Development Work Group. The specific charge for the Service Delivery and Development Work Group
was to create specialty specific task teams to explore evidence based best practice interventions for three
target populations. The three target populations; youth with co-occurring disorder (substance use/abuse
and mental illness), youth with co-existing disorders (mental retardation/developmental
disabilities/mental illness), and youth transitioning to adulthood, have been identified repeatedly in
West Virginia’s out of state placement population. In addition, planning for these populations is
difficult, even when and if in-state options exist. In November, 2008, the Service Delivery and
Development Work Group recruited additional individuals from multiple systems and began their work
on the three target populations. Three broad outcomes were defined:



To develop an approach to earlier identification of MR/DD/MI disorders so that services and
support can be introduced much sooner to the child and their families to allow the child to grow
into a self sufficient adult.
Identification of evidence based practices for youth with co occurring disorders and develop
practice guidelines for treatment services for this population.
WV youth will have access to the needed support guided by defined best practice standards to
achieve their personal level of independence regardless of system involvement or funding source.
While working separately each group followed the same process. The process involved analysis of
current systems with strengths and opportunities for improvement, individual research and literature
review, group discussion and consensus, and production of the draft recommendations. The data was
then shared with the West Virginia System of Care Implementation Team for additional input prior to
the final report.
Research done by the team members included what level of ‘evidence’ supported the interventions and
programs being examined. Many programs in the United States were reviewed with a critical eye and
the work done by the three teams was extensive. All team members serving were sensitive to the need to
make responsible recommendations to the Commission. It was understood that program development
and accessibility has a lasting and profound effect upon the children, youth and their families in West
Virginian.
The report and recommendations of the three teams follows.
EXECUTIVE SUMMARY
For all three target populations there were a number of commonalities with regard to findings and
recommendations.
Findings:




There currently exists in WV a practice wisdom that incorporates the culture and values of WV
in the provision of best and promising practices.
We need to continue to build upon existing initiatives that demonstrate promise to achieve the
desired outcomes.
In all child serving systems there is often a lack of understanding of the developmental stages
and needs of youth, as well as the impact of childhood experiences (both positive and negative)
and disabilities or handicapping conditions/disorders.
WV adheres to the System of Care philosophy; promoting partnerships and collaboration that
meet the changing needs of children, youth and families. However, continued efforts to reduce
silos that serve as barriers to service provision and coordination are needed.
Recommendations:






All current and future policies, programs and services for these populations will be guided by
and evaluated against current research, promising practices and West Virginia Practice wisdom.
In order for WV children and youth to attain their maximum potential and independence, they
must receive the necessary services, supports and guidance. A major barrier that must be
addressed is stigma associated with remaining in care and/or the existence of a disability or
handicapping condition or disorder.
A youth development approach (self-determination, strength based, mentoring, and promoting
resilience) will guide decision making, program development and implementation for WV
children and youth and families.
WV youth will have strong connections to caring, stable adults.
Standardized protocols for screening and assessment will be implemented across all child serving
systems.
A formal comprehensive and collaborative approach to coordinated service delivery is needed.
The Commission to Study the Residential Placement of Children can provide the leadership and
oversight to accomplish this.
Youth With Co-Existing Disorder Best
Practice Team Recommendations
CO-EXISTING DISORDERS EVIDENCE BASED PRACTICE TEAM EXECUTIVE
SUMMARY
Currently in WV, we are serving children/youth/young adults that are diagnosed with these identified
co-existing disorders: mental retardation, mental illness, and developmental disabilities. However, the
services are often being provided by different agencies that specialize in one of the three areas. The
need to provide services in an integrated approach for these co-existing disorders is paramount to
providing services that truly address assessed needs as well as providing transition or aftercare services
to maintain or increase the skills learned/progress made while in treatment.
Because these co-existing disorders are lifelong disorders, that can’t just be addressed short term and
then ameliorated, this task team identified our target population as any person from birth – 21 years of
age who has been diagnosed with both a mental illness and Moderate Mental Retardation through
Borderline Intellectual Functioning (IQ between 35 and 84). The following developmental disorders are
included: Pervasive Developmental Disorder, Autism Disorder, and Asperger’s Disorder.
Because the target population is broadly defined, it was difficult to find research on evidence-based
practice that addressed all disorders within the target population. There were evidence-based practices
associated with each category (developmental disabilities, mental retardation, and mental illness) and
those were highlighted in the review of the literature and recommendations. There were numerous
articles/research that indicated best practices for this targeted population.
In order to meet our task team goal, the team identified current strengths, weaknesses, opportunities and
challenges associated with WV’s current system in treating this population. In doing so, it was clear that
WV has made strides in providing services to these individuals. Many of the weaknesses or challenges
identified were discussed throughout this process and it became clear that reconfiguration of services
already in place or additional training would be some quick implementation strategies that would
positively impact the service delivery for this population. One major strength identified was WV’s
cultural belief that “we take care of our own.” Many persons who fall into this target population are
being taken care of by immediate or extended family that with additional supports provided in an
integrated manner would be able to maintain the person in their home/community.
Some of the issues identified
as needing improvement,
Searching for a better
in order to increase the life
domain functioning of
this population, were access
system for working with to services either by
geographical distance or
financial inability. In
MR/DD/MI
children
and
addition, many of these
children/youth are not
involved in the CPS/youth
service system and
adolescents
therefore do not have
MDT’s (MultiDisciplinary Teams) to assist with guiding their care or providing advocacy for their needs.
Because each area identified in the target population requires different types of best practice approaches,
it became more clear through research review and discussion that all systems/agencies involved in
providing treatment must communicate frequently and clearly so that services are delivered in a manner
that maximizes the resources available so that treatment or maintenance/support services can be
effective.
Some of the key findings from the team’s research and discussions were:

















The earlier these diagnoses are identified the better the prognosis.
Maintenance of improvements for this population is just as crucial as treatment.
Financial barriers prevent services from being delivered in an integrated fashion.
People included in this population show up for services in all service delivery systems i.e. outpatient,
in-home, respite, residential, inpatient hospitalization, etc.
Medication is often utilized as a way to address behavioral dyscontrol instead of treatment strategies
being implemented to target behavioral dysfunction.
Advocacy for this population is often lacking. Fewer agencies are providing advocacy services.
Often services provided for this population are not tailored around the child/youth, but the
child/youth is made to try to “fit” into the established program.
A service gap exists for persons with IQ’s between 55 and 70.
Teaching socialization and interpersonal skills are integral in assisting this population to reach their
potential.
Our workforce is not trained in the area of providing integrated treatment to all of the disorders
identified in our target population.
There are stigmas attached to being diagnosed with these disorders.
Historically, this target population wasn’t expected to make measurable improvements, but rather
maintenance was the expectation.
The lack of transition services creates the opportunity for this population to regress.
This population is at great risk for being exploited, victimized, abused, and neglected.
Increased parental support is pivotal in working with this population.
No clear data exists regarding how many children/youth/young adults fall into this category. Many
persons are receiving services but the services are specialty based, meaning the person is only
counted as MI, MR or DD. In addition, many of these persons are being cared for by families in
their homes and are not involved with any system i.e. schools, agencies, etc.
Many resources exist, but not all systems are knowledgeable of the resources which leads to
underutilization.
Based on these key findings, along with research, the task team identified our desired outcome: To
develop an approach to earlier identification of MR/DD/MI disorders so that services and support can be
introduced sooner to the child and their family to allow them to grow into a self-sufficient adult and to
achieve their maximum potential with the resources available to support them in their efforts throughout
the life span.
In addition, training of program/agency staff as well as other child serving systems will be paramount in
improving/changing the delivery of services for this population. We must change the belief of our
culture that this population can only be maintained with no expected measureable improvements.
Changing this belief will open many doors/opportunities for this population.
CO-EXISTING DISORDERS DEFINITION/OUTCOME/ GOALS AND
RECOMMENDATIONS
TARGET POPULATON
Any person from birth – 21 years of age who has been diagnosed with both a mental illness and
Moderate Mental Retardation through Borderline Intellectual Functioning (IQ between 35 and 84). The
following developmental disorders are included: Pervasive Developmental Disorder, Autism
Disorder, and Asperger’s Disorder.
GOAL
To develop an approach for earlier identification of MR/DD/MI disorders so that services and support
can be introduced sooner to the child and their family to allow them to grow into as self sufficient an
adult and to achieve their maximum potential with the resources available to support them in their
efforts throughout the life span.
DESIRED OUTCOMES



WV will have a standardized screening and if needed comprehensive assessment process for this
identified population.
WV will include family whenever possible and they with the child/youth will be the centerpiece in
building a successful individualized plan.
WV will build treatment and support systems to address the needs of this population in an integrated
approach.
BEST PRACTICE GUIDELINES/RECOMMENDATIONS









Develop a standardized screening and if needed formalized assessment process for each child who
enters a child serving system to assist with early identification.
Assure individualized service planning based on comprehensive assessment and protocols.
Develop a work group which consists of members of all of agencies serving this population to
develop strategies to integrate treatment, increase service capacity, identify outreach/support
opportunities, reconfigure beds if needed, and blend/identify funding opportunities/strategies.
Identify outcomes as a measure of success for treating/supporting this population.
Utilize identified outcomes as a source in developing or evaluating programs or services.
Identify administrative policies/procedures that inhibit the integration of service delivery.
Utilize service array data to identify and improve services needed for this population.
Establish parent training programs to educate on diagnoses and teach skills.
Expand parent support networks, case management services/hours, supported employment programs,
community based treatment, specialized family care and specialized foster homes.




Develop day treatment or drop in centers for socialization opportunities.
Establish school based mental health in all counties.
Expand waiver criteria to include symptoms/need (not just diagnosis driven) and streamline the
waiver application/continuation of services process.
Expand socially necessary services to all children/youth with these diagnoses regardless of their
system status. Collaborate with higher education to build a stronger curriculum for working with this
specific population
Youth With Co-Occurring Disorder
Best Practice Team
Recommendations
Moving the system
toward the most effective
treatment for youth with
co-occurring substance
use/abuse and mental
health disorders.
CO-OCCURRING DISORDERS EVIDENCE BASED PRACTICE TEAM EXECUTIVE
SUMMARY
The need for substance abuse services for both youth and adults has been frequently voiced throughout
West Virginia. The co-occurrence of substance abuse and mental health problems has emerged as an
important issue for consumers of services, those who plan and fund services, and those who provide
direct services. Both problem areas are highly correlated with suicide, academic failure, criminal
behavior, and further penetration into child serving systems. Failure to receive appropriate services
ultimately results in substantial costs to society.
The Co-occurring Disorders Task Team conducted an exhaustive review of the literature to identify
evidence-based practices for children and youth with co-occurring (substance abuse and mental health)
disorders and develop practice guidelines that are based on sound and proven clinical practice. Both
evidence based and promising practices were evaluated and included in the team’s findings and
recommendations. Additionally, the team examined services within West Virginia and determined that
there exists, within the State, services and programs that are based on evidence based practices.
The target population for this task team is youth between the ages of 10 and 21 who meet the criteria for
DSM-IV-TR diagnosis for mental health and substance disorders (abuse or dependence) and who are
experiencing difficulties in at least one life domain.
The task team conducted an analysis of current practice that included strengths, weaknesses, challenges,
and finally, opportunities for improving the service delivery system for children, youth and families. It
was gratifying to learn that there are numerous strengths upon which to improve services to children,
youth and families.
There was overwhelming evidence to suggest that the best approach to treatment of persons with cooccurring disorders is an integrated treatment approach. This means that substance abuse and mental
health treatments are provided by the same clinicians/support workers, or team of clinicians/support
workers, to ensure that the individual receives a consistent explanation of the illness/problems and a
coherent prescription for treatment rather than a contradictory set of messages and disjointed services
from different providers.
There are specific components of integrated treatment that have proven effectiveness. In addition to
identifying specific evidence based interventions, the task team has made recommendations for practice
guidelines in the following areas:

Identifying the possible existence of a potential substance use/abuse or mental health disorder
through development and implementation of a universal screening protocol/tool for use in all child
serving systems.


Development/implementation of a comprehensive assessment protocol/tool for use if and when a
potential substance abuse/mental health disorder is screened as being present. This assessment would
investigate more conclusively the nature and severity of the disorders and how they are related and
impact each other.
For those determined to have co-occurring disorders, provision of integrated treatment and support
for the immediate problem, as well as long-term recovery, based on evidence-based practices. It is
critical that families and other supportive people be involved in treatment and support in order to
foster recovery.
The task team also identified a number of barriers. Existing philosophy among clinical staff/programs
needs to change to expect the presence of co-occurring disorders. Common philosophy that supports
existence/components of co-occurring disorders does not now exist. In addition, criteria for clinical
services and programs sometimes acts as a barrier, and those who need treatment the most may be
excluded or prevented from remaining in treatment programs.
A lack of cross-trained clinical staff with demonstrated competencies and access to clinical supervision
throughout the State was identified as a barrier, although the State has been actively engaged in
increasing clinical capacity over the past several years. Family inclusion in treatment and recovery is
often impeded by policy/funding stipulations. Understanding the behavioral and psychological
manifestations of co-occurring disorders by staff in other child serving systems was also identified as
problematic. Finally, established outcomes and service/program accountability do not routinely exist.
Key Findings:







The majority of youth referred for substance abuse treatment have at least one co-occurring mental
health disorder.
- Adolescents with substance use disorders are at a six times higher risk of having a cooccurring psychiatric disorder.
Trauma/victimization in youth with substance use disorders range from 25% for males to 75% for
females.
In juvenile justice settings 75% of males and 50% of all females have a co-occurring disorder.
Co-occurring disorders are associated with poorer treatment outcomes, both physical and
psychological, when either disorder is not treated.
Children and youth with co-occurring disorders require increased frequency and levels of services
and bounce between levels of care with greater frequency.
Integrated treatment is shown to decrease recidivism & promote stabilization.
Some providers in WV currently provide integrated treatment or components of integrated treatment
with measured outcomes. WV has been engaged in a variety of training initiatives for integrated
treatment for several years.
CO-OCCURRING DISORDERS DEFINITION/OUTCOME/ GOALS AND
RECOMMENDATIONS
TARGET POPULATON
Youth between the ages of 10 and 21 who meet the criteria for DSM-IV-TR diagnosis for mental health
and substance disorders (abuse or dependence) and who are experiencing difficulties in at least one life
domain.
GOAL
To move the system toward the most effective treatment for children and youth with co-occurring
substance use/abuse and mental health disorders.
DESIRED OUTCOMES


Identification of evidence based practices for youth with co-occurring disorders
Development of practice guidelines for treatment services for this population.
BEST PRACTICE GUIDELINES/RECOMMENDATIONS











Develop a set of standardized outcomes;
Connect to the service array initiative to identify service capacity/gaps within specific geographic
areas;
Establish an interagency planning group that will formalize inter-agency partnerships to foster
integration of services, minimize duplication of services, increase access to services and blend
funding;
Implement standardized screening & assessment tools & protocols that cross all child serving
systems, including mental health, primary care, child welfare, education, and juvenile justice;
Identify administrative & infrastructure issues/barriers & make recommendations to address these
issues/barriers;
Adopt the principles of integrated treatment (found in Appendix) and evaluate programs and services
against these principles;
Increase school based mental health resources;
Training and education must be centerpiece of service development and delivery, including cross
training of clinical staff, continuing education, and clinical supervision, as well as education of staff
in youth serving systems such as education, child welfare, juvenile justice, and physical
health/primary care;
Establish youth focused peer support/self-help groups
Inclusion of family as integral part/focus of treatment;
Integrate these services with primary care; and,
YOUTH TRANSITIONING TO ADULTHOOD BEST
PRACTICE TEAM RECOMMENDATIONS

Establish State funding policy that supports/requires integrated treatment, e.g., block grants,
demonstration projects, RFIs. These principles should be included in all contracts and RFIs for grant
funding and adherence should be included in evaluation of programs/services.
Making sure WV youth have access to the
needed support guided by defined best
practice standards to achieve their
personal level of independence,
regardless of system involvement or
funding source.
YOUTH TRANSITIONING TO ADULTHOOD BEST PRACTICE TEAM EXECUTIVE
SUMMARY
For the hundreds of young people transitioning to adulthood in West Virginia, the pathway is often
challenging, the odds great, and the reality sometimes frightening. Many of these youth have been
diagnosed with serious mental illness, have substance addictions, and have experienced multiple
traumatic events during their lifetime. Often, as these youth age out of the system, they find themselves
homeless and jobless. These youth are often viewed and provided services based on their chronological
age versus being provided flexible support and services appropriate for their developmental age. The
goal of the Youth Transitioning to Adulthood Best Practice Task Team is to break this cycle and
improve the outcomes for youth transitioning to adulthood by putting forth recommendations and
providing information on promising practices that will guide decision makers in planning,
implementing, and overseeing a comprehensive youth transitioning to independence model in WV.
The Service Delivery and Development Youth Transitioning to Adulthood Task Team conducted a
comprehensive review of the literature on the independent living needs of older youth in out-of-home
care and have subsequently identified recommendations for best practice. Additionally, the Task Team,
experienced and invested in transitioning youth to adulthood, used real WV case examples, WV practice
wisdom and thoroughly appraised the current WV services and supports available for youth aging out of
care. Emerging firmly and quickly within the Task Team was an overarching mission that WV is
impelled to strengthen service delivery to ensure that WV youth will have access to the needed support
guided by best practice standards to achieve their personal level of independence regardless of system
involvement or funding source.
During the research of literature and WV practice, the Task Team reviewed numerous service
interventions both State and nationally. As the Team considered promising practices, gaps of services
among and between traditional child welfare, services for transitioning youth and adult services became
apparent. Additionally, as the Team processed the traits and characteristics of youth aging out of foster
care in WV, there was consensus that mental health stressors combined with inadequate independence
preparation often lead to insurmountable challenges as these older, unaccompanied youth tried to
navigate leaving care and becoming independent. From these discussions, the solution-focused Task
Team formulated opportunities for improvement and proposed service delivery best practice
expectations.
The Task Team was encouraged that there are numerous WV providers and care givers passionate about
working with and empowering older foster youth as they approach adulthood. Though an array of
formalized systems seemed to be lacking, the Task Team was able to identify the State’s Chafee
Transitional Living Program as an invaluable asset; both in its current delivery as well as in the
opportunity to further enhance the State’s Plan and utilization of Chafee funds. Additional strengths
identified were WV Tuition Waiver made possible by the State Legislature as well as the emerging work
from the current educational advisory groups.
Concurrent opportunities for improvement were discussed and as deficits were identified, the Task Team
was charged with offering solution focused options for consideration. From discussion, for example,
despite best efforts, many youth reached age 18 years without copies of birth certificates, social security
cards, State issued IDs, etc. Rather than regulating this to the responsibility of a single entity such as the
DHHR, providers stepped to the table and identified ways that the provider community could help youth
work through application processes, and can assist in developing a competency checklist that moves
with the youth as they travel through the service system. The same spirit of cooperation was found when
the Task Team identified youths’ perception of stigma with remaining in care after age 18 years; the
entire care giving community can start communicating opportunities for remaining in care and walking
youth through decision making earlier and with more realism (such as assisting youth in interviewing
and touring transitional living programs, colleges, etc.).
The Youth Transitioning to Adulthood Task Team epitomized the spirit of collaboration and the value of
WV Practice Wisdom. This Executive Summary merely provides highlights of the work and vision of
the Task Team. The complete findings of the Task Team are presented in the full report which includes
a comprehensive literature review and annotated bibliography of pertinent research. In summary, Key
Findings are offered as follows:
KEY FINDINGS: Literature and Current Practice
 Youth ages 16 and over comprises 30% (1,070) of the WV youth in out of home care as of March
2009.
 Youth transitioning from Foster Care to Adulthood are twice as likely as same age peers to be unable
to pay rent and utilities and four times as likely to be evicted (Chapin Hall, 2004).
 The Chapin Hall study also found a third of the youth were diagnosed with mental illness, substance
dependency or substance abuse.
 Nationally, youth aging out of foster care lack support and are often more vulnerable to
homelessness, higher rates of unemployment, poor educational achievement, hospitalization,
incarceration, mental illness and unplanned pregnancy.
 Traditional mental health support services do not accommodate the particular needs of young people
entering adulthood who are struggling to further their education, live independently and find and
keep jobs. Eligibility requirements for adult services differ from child and youth services and the
gaps and confusing application process often result in loss of services.
 Strengthening State policies, promoting cross system collaboration, better utilizing resources and
meaningfully engaging youth in service development will result in effective transitioning
opportunities for youth aging out of the foster care system.












Many youth transitioning to adulthood have a history of abuse and neglect and have experienced
multiple moves in congregate care settings (residential treatment, juvenile services, inpatient, etc).
These youth are most often absent a safety net.
The Chapin Hall follow up study (2007) found strong evidence that when youth are allowed to stay
in care past the age of 18 they are more likely to pursue higher education, have increased earnings,
and delay pregnancy. Many studies most prominently the Chicago Law School Study concur with
this finding. The literature research promotes extending the age of independent services for foster
youth up to age 25 years.
WV can improve outcomes for youth transitioning to adulthood by providing a comprehensive safe
and affordable housing continuum that specialize and focus on preparing youth living in congregate
care to successfully transition to supported and pre-independent living
WV has a service gap in providing treatment to young adults over the age of 18 who cannot safely
live in the community without continued treatment, structure and supervision.
Cross system training , and ongoing coaching on Youth Development Principles will have
significant and quick impact.
WV can improve outcomes and better support youth as they transition to adulthood by utilizing
comprehensive assessment and screening to guide decision making as to housing continuum needs
and necessary support for successful and safe transition to adulthood.
WV has the opportunity to build upon the current Chafee program by thoroughly examining other
state independent living plans and revising the WV plan as applicable.
The WV Legislature has provided the Foster Youth Tuition Waiver to fund foster youth in postsecondary education opportunities.
WV is supporting and evaluating two demonstration projects that are transitioning older youth from
foster care to adulthood.
WV has an opportunity to better and more fully utilize the provider community who are trained and
located in communities to provide transitional coaching, support, training and linkage.
Promising practice themes include academic support, post-secondary education, life skills training,
financial literacy, career and employment development, mentoring, community connections,
extended health care, independent living programs, housing and supervised practice living
(supervised apartments, transition homes, etc). (The Youth Transition Funders Group Foster Care
Work Group With The Finance Project, 2003).
The Commission to Study the Residential Placement of Children can provide cross system
leadership and quickly improve the outcomes for youth transitioning to adulthood by requesting all
decision makers to:
- immediately develop and implement necessary policy revision, training and resources to make
sure that every youth in out of home care has access to and/or possession of a certified copy
of their birth certificate, social security card, a state approved picture ID, and
health/dental/immunization records by age 17 at the latest.
-
-
develop, train and incorporate into policy the use of an independent living plan (standardized
template) that is focused on achieving permanency while simultaneously preparing youth for
transition to adulthood
develop a developmental (milestones age 16, 17, 18, etc) & discharge checklist.
YOUTH TRANSITIONING TO ADULTHOOD DEFINITION /GOAL/OUTCOMES
& RECOMMENDATIONS
TARGET POPULATON
Youth age 14-25 years old who need support to achieve their personal level of independence.
GOAL
WV youth will have access to the needed support guided by defined best practice standards to achieve
their personal level of independence regardless of system involvement or funding source
DESIRED OUTCOMES





WV Will Have a Comprehensive Integrated Youth-Guided Transition System for Youth ages 14-25.
Upon achieving independence WV youth will be educated and ready for lifelong learning.
Upon achieving independence WV Youth will be experienced and ready to enter the workforce.
Upon achieving independence WV Youth will be confident and ready for life.
Upon achieving independence WV Youth will be connected to adults, peers, and services.
BEST PRACTICE RECOMMENDATIONS






All current as well as future transition to adulthood programs and services in WV will be guided by
current research, promising practices, and WV practice wisdom.
In order for WV youth to receive the necessary support, guidance and services needed to achieve
their personal level of independence, current negative perceptions of remaining in care will be
addressed to remove any “stigma” about receiving support and linkage.
WV youth transitioning to adulthood will have access to a safe, affordable housing continuum.
WV youth will have access to high quality standards based education regardless of setting as well as
the support services and access to bridge youth to higher education.
WV youth will have information about career options and exposure to the world of work, including
structured internships.
Youth Development Principles will guide all decision making and program implementation in WV
for youth transitioning to adulthood.



Youth will have access to education, training and support that will provide opportunities for lifelong
economic well being.
WV Youth will have strong connections to caring stable adults.
WV Youth will have opportunities for safe socialization, engagement and connection opportunities
as well as opportunities for to develop social, civic and leadership skills
GLOSSARY
Best Practice: A technique, method, process, activity, incentive or reward that is believed to be more
effective at delivering a particular outcome than any other technique, method, process, etc. The idea is
that with proper processes, checks, and testing, a desired outcome can be delivered with fewer problems
and unforeseen complications. Best practices can also be defined as the most efficient (least amount of
effort) and effective (best results) way of accomplishing a task, based on repeatable procedures that have
proven themselves over time for large numbers of people
Co-occurring Disorder: Two or more disorders or illnesses that occur in the same person,
simultaneously or sequentially, most commonly referring to a mental health and substance
use/abuse/dependence disorder. The existence of co-occurring disorders implies interactions between
the disorders that affect the course, treatment and prognosis of both.
Co-existing Disorder: The term co-existing disorders refers to an individual who has more than one
mental disorder as described in the DSM-IV-TR. The disorders exist independently of each other and
there is no implied interaction between the disorders. Typically co-existing disorders occur on more
than one diagnostic axis of the multiaxial diagnostic system. An example would be a person with a
developmental disability such as mental retardation who is also depressed.
Developmental Disability: Developmental disabilities are a diverse group of severe chronic conditions
that are due to mental and/or physical impairments. People with developmental disabilities have
problems with major life activities such as language, mobility, learning, self-help, and independent
living. Developmental disabilities begin anytime during development up to 22 years of age and usually
last throughout a person’s lifetime.
Integrated Treatment Principles: A model that integrates the treatment of patients with both a mental
illness and substance use/abuse disorders. The model emphasizes the parallels between the standard
biopsychosocial illness-and-recovery model for treatment of emotional disorders and the treatment of
addiction. An integrated treatment model is characterized by specific principles that include:





Each person has a primary clinician who coordinates ongoing treatment interventions for both disorders.
Each disorder receives specific and appropriately intensive primary treatment which takes into account
the complications resulting from the co-occurring disorders.
Ideally, each person can receive integrated and coordinated treatment for both disorders in a single setting
or service system.
Emphasize the commonality of treatment philosophy, in that a disease and recovery model can be applied
to the treatment of both mental illness and substance disorders.
Recommended treatment interventions for persons with co-occurring disorders should be individualized,
and matched according to the specific diagnosis of each disorder, the phase of treatment and recovery for
each disorder, and acuity, severity, disability, and motivation for treatment of each disorder at any point in
time.
Evidence Based Practice: The terms Evidence-based Practice and Evidence-based Treatment are often
used synonymously. Evidence-based practice (EBP) refers to a decision-making process that integrates
the best available research, clinician expertise, and client characteristics. EBP is an approach to
treatment rather than a specific treatment. It is used to make clinical decisions. The term evidence-based
treatment (EBT) refers to preferential use of mental and behavioral health interventions for which
systematic empirical research has provided evidence of statistically significant effectiveness as
treatments for specific problems.
Mental Illness: Mental Illness refers to any of various conditions characterized by impairment of an
individual's normal cognitive, emotional, or behavioral functioning, and caused by social, psychological,
biochemical, genetic, or other factors, such as infection or head trauma. Mental disorders are health
conditions that are characterized by alterations in thinking, mood or behavior (or some combination
thereof) associated with distress and/or impaired functioning.
Mental Retardation: Mental retardation is a condition characterized by impairment of intellectual
functions present at birth with no further neurologic deterioration during life. It is evidenced by
significantly sub- average general intellectual functioning (Full Scale IQ of less than 70) existing
concurrently with deficits in adaptive behavior and manifested during the developmental period. Mental
retardation means unusually slow or impaired learning ability, plus impairment in adaptive functioning
(life skills, social skills), and usually evident long before adolescence. People with mental retardation
are limited in their ability to learn and are generally socially immature. Note: For the purpose of this
initiative, those with IQs in the borderline mentally retarded range are included in this target
population.
Socially Necessary Services: Services for Child Protective and Youth Services cases to promote safety,
permanency and well-being. These services are necessary to improve relationships and social
functioning, with the goal of preserving the individual’s tenure in the community or the integrity of the
family or social system.
Youth Development Philosophy: Acknowledges both youth as resources in rebuilding communities and
that helping young people requires strengthening families and communities. A youth development
approach views youth and families as partners, involves them in designing and delivering programs and
services, gives youth access to both prevention and intervention services that meet their developmental
needs and offers youth opportunities to develop relationships with caring, supporting adults.
WV MR/DD Waiver: The MR/DD Waiver Program is a health care coverage program that reimburses
for services to instruct, train, support, supervise, and assist individuals who have mental retardation
and/or developmental disabilities in achieving the highest level of independence and self-sufficiency
possible in their lives. Services are provided in natural settings, homes and local communities where the
member resides instead of Intermediate Care Facility/Mental Retardation (ICF/MRs).
WEST VIRGINIA PRACTICE WISDOM: An understanding of West Virginia's unique culture,
geography, needs and resources gained from years of service delivery and clinical knowledge and
practice to West Virginia children and families