AR System of Care
The Problems
 Not meeting the needs of the child, youth and family
 Increasing number of children being removed from
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their homes and schools.
Increased numbers entering into acute in-patient
programs
Inefficient
Lacking localized services
Escalating costs
Inflexible
Lacking cross agency communication and
coordination
 No identified outcomes
 Services developed in response to funding
not need in response to the needs of the
child/youth/family
 Not meeting the needs of the schools serving
our children
 Many population disparities
Act 2209
 Act 2209 in 2005 Mandated the
establishment of a “system of care”.
 It required in-state stakeholders to develop
and implement the strategies that are present
in System of Care.
 Provided the basis for the State assessment
and a System of Care Framework by Cliff
Davis of the Human Collaborative Project..
Recent Events Timeline
 Cliff Davis Assessment (6/06)
 Stakeholders Planning Committee (7/06 – 8/07)
 Act 1593 (3/07)
 First Lady’s Listening Tour (5/07)
 System of Care 101 (6/07)
 Children’s Behavioral Health Care Commission
(First meeting 8/30/07 - present)
What did Cliff Davis say?
Arkansas needs to improve children’s
behavioral health by FIRST:
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Building family support.
Expanding local capacity to collaboratively
meet children’s needs.
Improving the quality of care
Establishing accountability in the system.
Act 1593 of 2007
 Expanded and established the principles of a System
of Care for behavioral health care services for
children and youth as the “Public Policy of the
State”.
Act 1593
Requires DHS, under Commission advisement, to:
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Ensure that children, youth and their families
are full partners in all aspects of the system of
care;
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Revise Medicaid rules and regulations to
increase quality, accountability and
appropriateness of Medicaid reimbursed
behavioral health care services;
And further required that the State:
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Define a standardized screening and
assessment process designed to provide
early identification of conditions that require
behavioral health care services; and
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Develop an outcomes-based data system to
support an improved system of tracking,
accountability and decision-making.
Established: Children’s Behavioral
Health Care Commission
 Twenty (20) representatives of youth, families,
advocates, providers, and other critical
stakeholders.
 Commission received and approved
recommendations from the previous
Stakeholders group.
 Continues to support an array of workgroups
and subcommittees, preparing additional
recommendations.
Commission:
Work Groups
 Responsibility: To Make Recommendations to the
Commission
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Family and Youth Support Network
Cultural Competence
Services, Supports and Standards
Outcomes/Assessment Tools
Local Infrastructure
Training and Workforce Development
Work groups
 Meet monthly, weekly or biweekly
 Are open to the public
 Have telephone call in access
 Post agendas, notes and related information
on the Commission web site
Moving towards a solution: A
System of Care
A coordinated network
held accountable
to provide a full array of mental health and
other services,
which meet the many needs of children with
serious emotional disturbances and their
families.
“System of Care” for Children
 Not a new concept
 First published definition actually appeared in
1986
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“a comprehensive spectrum of mental health
and other necessary services which are
organized into a coordinated network to meet
the multiple and changing needs of children
and their families.” Stroul and Friedman
System of Care Framework
S.O.C. Foundation in Arkansas
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To become: Family-driven, child centered,
youth guided with family participation at all
levels…. community- based… culturally
competent
Requires: Our system to provide cost effective
behavioral health services in the least restrictive
environment and collaborates across all systems.
SYSTEM OF CARE
Principles
Source: Stroul & Friedman
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Individualized services based on needs
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Comprehensive array of services
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Least restrictive environment
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Families and youth as full partners
And…
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Care management
Early identification and intervention
Smooth transition to adult services
Advocacy
Culturally competent services
Where are we now?
 Work is taking place at the State level and in local
communities.
About Arkansas DHS
 Ten divisions, four offices
 Approximately 7000 employees
 83 local DHS offices
 Serve over 1 million Arkansans
 Child protection, foster care, juvenile justice,
Medicaid, behavioral health and substance abuse,
child care, state preschool, after-school,
developmental disabilities services, Food stamps,
energy assistance, eligibility determination for public
programs, aging/adult services, etc.
Why is this important?
 Affects most, if not all, divisions
 No. 1 priority for DHS
 Many implications for public policy changes
across child-serving systems (e.g. standards
for mental health services)
 Hard for one Division to “own”
 Must connect with other State Departments
(e.g. Dept of Education, Dept. of Health)
AR DHS
 Has hired a Director
 Hiring additional staff
 Seeking federal and private resources to
support State and local efforts
 Reviewing lessons learned from an AR
pilot/evaluation project
Action for Kids
 A collaboration with Mid South Health System, Inc
(CMHC), the State and the families/youth and
communities in Craighead, Mississippi, Lee and
Philips Counties
 Funded by Substance Abuse and Mental Health
Administration and supported by local community and
State match
 Serving children with severe emotional disorders
 Provides:
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An array of evidence
based practices to
children and their families
in their homes, schools
and community settings.
Provides extensive
training and programs to
school personnel and
other providers.
Has included Positive
Interventions and
Supports in the schools.
Work currently focused on those most
in need:
 Under 18 years of age (unless in treatment when turning 18)
with a diagnosed mental, behavioral or emotional disorder of a
long-term nature
 At risk of removal from their natural settings
 Who have a multi-agency needs
 Whose emotional problems are disabling upon social functioning
criteria
…with one or more of the following characteristics:
 Responses so intense or frequent that the
consequences lead to severe measures of control:
seclusion, restraint, hospitalization or chemical
dependency.
 Behaviors judged to be extreme or inappropriate for the
age.
 Behaviors that lead to exclusion from school, home,
therapeutic or recreations settings.
 Intense enough to be considered seriously detrimental to
the child’s growth, development, welfare or the safety or
welfare of others.
Problems: Lack of Services
 Needs consistently identified:
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Flexible dollars to meet the
needs of families
Intermediate levels of care
Respite
Mentors
Family support/education
Substance abuse services
Transportation
Non-school hour activities
Rural services
Issues around dual
diagnosis
And certainly not…
 Not truly driven by the family and youth
 With systems, agencies and individuals who
always work together
What does this mean in at home?
 Learning to creatively work together:
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Families, schools and public and private
providers.
 Regional CASSP teams are developing
comprehensive plans.
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Contact your representative to be involved.
Local Service Teams
 CASSP & Together We Can are moving
towards becoming:
Wrap
Around Teams
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Family - Driven
Youth - Guided
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Child - Centered
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 The Wraparound
Process is an intensive,
individualized care
management process
for youths, children
and families with
serious and or complex
needs.
Evolution: MAPs
Family Wrap Around Plans
 Multi Agency Plans of
Service to Family Wrap
Around Plans.
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Shift the focus from
the agencies to the
families
 CASSP teams will still
use MAPs for some
service delivery
Wrap Around Plans
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Identify:
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Provide:
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Formal and informal
Plans for
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Service planning and supports
Utilize resources: both
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Strengths and needs
Immediate and long term needs
Designates
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Responsibilities
Meetings must:
 Include
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Parent and youth
2 providers besides the local community
mental health center
 Maintain confidentiality
 Be flexible
Teams are striving to ensure that
services are:
 Family driven, child
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centered, youth guided
Community-based
Multi-system
Culturally competent
In the least
restrictive/least intrusive
environment
Wrap around teams
 Participation and team composition
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Driven by the family.
Families can exclude a party’s participation
 Flexible meeting times
 Teams can include:
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Both formal and informal supports.
(immediate and extended family, pastors,
youth providers, family supporters)
 This direction will require changes.
 Discussion:
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Familiarity with Together We Can & CASSP
teams? Experiences and Impressions?
What have you heard about System of Care?
Concerns….apprehensions?
Come and see what is going on …
 Children’s Behavioral Health Commission
website:
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http://ardhs.sharepointsite.net/ARSOC/default.
aspx
 Contact information:
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Elisabeth Wright-Burak –Director of Policy and
Planning - elisabeth.wright@arkansas.gov
Carol Amundson Lee –
carol.lee@arkansas.gov
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System of Care, Director