Because Minds Matter: Collaborating to Strengthen Management of
Psychotropic Medication for Children and Youth in Foster Care
Washington, D.C. August 27-28, 2012
Maximizing Opportunities to Improve Child and Family Well-Being
through Innovative Funding:
Transforming Rhode Island System of
Care for Children, Youth and
Families
Dr. Janice DeFrances, Ed.D.
Director, RI Department of
Children, Youth and Families
1
Rhode Island’s Commitment
to System of Care Transformation

1989, CASSP – Child and Adolescent Service System Program (Infrastructure) Grant , SAMHSA

1991-Present, Statewide Family Network Grant – Parent Support Network of RI

1992, Project REACH grant – Center for Mental Health Services (youth with serious emotional
disorders and their families) SAMHSA

1997, Project HOPE grant – Center for Mental Health Services (youth adjudicated) SAMHSA

2003, Report of RI System of Care Task Force: Toward An Organized System of Care for RI’s
Children, Youth and Families

2005, RI Positive Educational Partnership – Center for Mental Health Services (early
childhood and positive behavior supports and interventions- infrastructure) SAMHSA

2009, RI Family Care Community Partnership Implemented

2011, Expansion Grant – Planning Year, Center for Mental Health Services, SAMHSA

2012, RI Networks of Care Implemented July 1st
2
System of Care Planning in RI: Overview
 1992 through 2003-Statewide Children’s Mental Health Advisory Board/
CASSP Board/ and 8 Local Coordinating Councils
 2001-2003 Governor’s Task Force meets to produce report to guide planning
 State Redesign planning: Focus groups and Public meetings to gain
community, family and youth input with concept papers and then final RFPs
 Ongoing bi-annual retreats with state agencies, current and potential
providers, community, family, and youth involvement
 Present: Statewide Family Community Advisory Board and four regional
Boards
 Rhode Island State Expansion Team: Strategic Plan and National Consultation
3
System of Care Planning in RI:
The Foundation
 2001, the RI System of Care Task Force was
established with joint Leadership
 Key leadership from House, Senate and the
Department of Administration
 Stakeholders met over the course of 2 years to
develop the final report
4
System of Care Planning in RI:
The Foundation
Result:
The Report of the RI System of Care Task Force, “Toward an Organized
System of Care for RI’s Children, Youth and Families”, January 2003 was
submitted to the incoming governor and legislative leadership which
included these key statements:
“With this letter, we send to you the report of the Rhode Island System of
Care Task Force and ask for your full support and your strong leadership
in moving us closer to an organized system of care for Rhode Island’s
children, youth and families.”
“The members of the System of Care Task Force unanimously endorsed
the vision and principles of this report and acknowledged that
considerable work needs to yet be accomplished.”
(page 7, The Report of the Rhode Island System of Care Task Force, January 2, 2003)
5
System of Care Planning in RI:
The Foundation
 The Report became a blueprint for the statewide
development toward an organized system of care for
Rhode Island
 The work of this Task Force became the springboard for
our current system of care transformation in RI
6
Transforming RI’s System of Care: Transition
 Until 2005, innovative programs remained separate
and a statewide integrated system had not been
achieved
 The outcomes for children, youth and their families
had not changed significantly.
 In 2005, RI DCYF Senior Leadership committed to
full system transformation based on system of care
(SOC) principles
7
Transforming RI’s System of Care:
Implementation

Phase I - Family Care Community Partnerships (FCCP)Implemented January of 2009
- Designed for families not involved with the
Department: Prevention and early intervention
through family preservation and community-based
behavioral health programs and family supports

Phase II - Networks of Care- to implemented July of 2012
- For families and youth active with the
Department
8
System of Care - Phase II Implementation
Date: July 1, 2012
RI Family Care Networks:
Ocean State Network and
RI Care Management Network
 Phase II is serving families who are open to the department and actively
receiving services. The department established two Statewide Networks of
Care that partner with the department and families to consolidate the
management of services and supports for each child and family according to
their unique strengths and needs.
 Each Network of Care has a Network Lead that is responsible for building a
collaborative, comprehensive array of accessible formal and informal services
and supports, including residential and home-based services and support that
will strengthen and support the home setting during and following out-ofhome placement.
 The Networks must integrate wraparound principles, trauma and evidencedbased practice into service delivery and include strong partnerships with
education and other entities in order to improve educational stability and
success.
9
Governance in Rhode Island
Statewide Family
Community
Advisory Board
EOHHS / DCYF
Global Consumer Choice
Medicaid Wavier
Medicaid/RIte Care,
Behavioral Health and
Child Welfare dollars
Statewide Protocol &
Implementation Team
Contracted Care
Management
Networks
State Expansion Team
4 FCCPs
2 Networks
of Care
Community
Networks
10
Anderson, J., Conlan-Lewis, L., (2012. Primer Hands On, Orlando, FL: RI Department of Children Youth
and Families)
RI Outcomes:
Over the past five years, the Department of Children, Youth and
Families has:

Reduced the number of youth placed out of state by over 77%
from 2008 -2012

Lowered the number of children entering out of home care by 39%
from 2007 – 2012

Developed and implemented Phase I of the System of Care (FCCP) as
a
front end diversionary program that has successfully reduced the
number of families becoming open to the department and
reduced
the number of children in our care

Launched Phase II of System of Care (Networks of Care)
11
RI Outcomes:
Reduction in Residential Placements
Residential Census
1,500
1,000
500
FY2007
1,202
FY2009
965
FY2011
809
FY2012
503
0
12
RI Outcomes: Reduction in Out-of-State
Residential Placements
•As of June 2012 – Reduced to 44 Out-of State
•Most are nearby
13
Current RI System of Care Management Structure and Funding for Promoting
Safety, Permanency, and Well-being
Executive Office of Health and Human Services
Department of
Children, Youth,
and Familiesbehavioral health,
child welfare, and
juvenile justice
State Appropriations
Title IVB & E
Medicaid/RiteCare
Children’s Trust Fund
CMHS , SAMHSA System of Care Grants
Family Care Community Partnerships
Networks of Care
4 Lead Provider Agencies and
2 Lead Provider Agencies and
Regional Networks
Statewide Networks
At risk child welfare
Formal involvement with child welfare
Wraparound
Service Navigation
Intensive Care Coordination
Child & Family
Partnerships
Partnerships
Teams
Community Providers, Family Support Organizations,
and Natural Helping Networks
14
Anderson, J. , Conlan-Lewis, L., (2012. Primer Hands On . Orlando, FL.: RI Department of Children, Youth, and Families)
Structuring the Array of Services
and Supports in Rhode Island: Funding
 DCYF utilized prevention and earliest intervention, community-based
dollars to support the preservation of families, early childhood and
school-based programs:

The state established the foundations of an evolving infra-structure
to support:
- The strengths of families;
- Develop and connect families to effective, evidence based
practices;
- Identify kinship and protective factors, ensuring that
families are connected to natural helping networks.
15
Structuring the Array of Services
and Supports in Rhode Island: Funding
 Community agencies are working together in partnerships to reduce
duplication and identify the appropriate resources for families
 Prevention dollars are being utilized across the state for mental health
awareness and prevent child abuse events to support families in
healthy, fun and “normalized” activities
 State inter-agency collaborative work is demonstrating fruitful results:
1. RI DCYF and RI Medicaid are working to ensure the best use
of State and Federal Funds
2. The Activities of the Wraparound process are now billable through the
Global Consumer Waiver, (1115 Demonstration), “Cost Not Otherwise
Matchable” (CNOM)
16
Evidence-Based and Effective
Practices in Rhode Island – Building the Base
 Established a Continuous Recruitment Request for
Qualifications (CR-9) in 2002 for Evidence-based And Promising
Practices: Child And Family Intervention.
 Result: current array of practices including Multi-Systemic
Therapy, Strengthening Families, Functional Family Therapy,
Parents as Teachers, Cognitive Behavioral Therapy (CBT) and
Alternatives for Families-CBT, Parenting with Love and Limits (PLL),
Incredible Years and other promising practices.
17
Building the Base: Family and Youth Peer Support
 PSN peer mentor program- Medicaid feasibility study with
state mental health block grant
 Family members hired as Family Support Partners within
Family Care Community Partnership agencies
 State Expansion Team working on definition Medicaid service
definition that incorporates family and youth support partner
service components
 Exploring Family Support Partner role hired within family
organization and/or Networks of Care
 Family and Youth Support Partner wraparound certification
18
Evidence-Based and Effective Practices in
RI: Additional Supports

DCYF collaborated with large community child welfare provider,
received funding by the National Child Traumatic Stress Network to
establish training in trauma specific treatments.

DCYF partnered with Department of Health for Infant and Early
Childhood Evidence-Based Home Visiting practices development such as Nurse
Family Partnership.

Cross-agency commitment among Health, Education and Children, Youth
and Families to collaborate to establish integrated system to insure
coordinated assessment and referral/access to most appropriate
evidenced-based treatments.

RI is an “Appointed State” in the Quality Improvement Collaborative on
improving management of psychotropic medication for children and youth
in foster care, managed by the Center for Health Care Strategies.
19
Evidence-Based and Effective Practices in
RI: Continuous Commitment
 Currently collaborating with Annie E. Casey Evidence
2 Success initiative in Providence RI, to better match
proven Evidence-Based Practices to specific
populations of need.
 Collaboration with contracted System of Care
providers to shift practice to those that demonstrate
the best outcomes for child and family well-being.
20
RI’s Collaboration with Annie E. Casey, Evidence2Success in
Providence, combines the best of what works to improve
children’s health and development: Logic Model
Child/Family
Schools
Community
Public Agencies
Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey
Foundation, August 16, 2012
21
Evidence2Success Strategies Complementing
RI efforts
Business
as Usual
#1:
Create a
Vision,
Build
Support
#2:
Assess the
Needs of
All
Children
#3:
Develop an
EvidenceBased
Service
Continuum
#4:
Finance
EvidenceBased
Programs
#5:
Drive
Lasting
Change
Business
as Should
Be
Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey
Foundation, August 16, 2012
22
Utilizing National Resources to Enhance Service
System Development (Evidence2Success)
 Shift focus to improving child well-being
through evidence-based approaches
 Build and enhance partnerships with school
district(s), mental health, Medicaid, legal
system, education, etc.
 Assess the needs of all children (in the
aggregate)
Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey
Foundation, August 16, 2012
23
Utilizing National Resources to Enhance Service
System Development (Evidence2Success)
 Administer youth well-being survey
 Analyze survey data to determine priority
outcomes and areas of elevated risk and
protection
 Estimate the proportion of youth that may be
better served in less restrictive placements
 Compare to city and neighborhood data to
understand populations at risk of entering child
welfare
Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey
Foundation, August 16, 2012
24
Utilizing National Resources to Enhance Service
System Development (Evidence2Success)
Well-being surveys of:
 Youth in Providence
public schools
Providence
 Youth involved with public
systems
Partner
neighborhoods
DCYF
involved
youth
25
Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey
Foundation, August 16, 2012
RI: Successes
 Families staying together at an increasing rate
 Children are remaining safely at home and in their schools
 Youth are Transitioning from the Youth Development Center (YDC) to home
 Children with behavioral health challenges and their families are receiving supports
to help ensure growing stability and wellness
 Reduction in Caregiver Strain
 Prevention and early intervention with early childhood and elementary school
settings is occurring at an increasingly coordinated and integrated manner
 The RI System is continuing to develop skilled Wraparound Facilitators and
recognizes the significant need for a Family Leadership and Family Support
Partners
26