Addressing th the Challenge of f Substance Use: A State and - PowerPoint PPT Presentation

Addressing th the Challenge of f Substance Use: A State and Community Approach Presented by: Elizabeth Manley, Institute for Innovation and Implementation Kathi Way, Acting Assistant Commissioner, NJ Children’s System of Care Kathy Collins, Executive Director, Monmouth Cares Marc Fishman, MD Medical Director Maryland Treatment Centers

Federal Legislation: • Joint CMCS and SAMHSA Informational Bulletin 1/6/15 • Protecting Our Infants Act of 2015 provides the framework to address the challenge of prenatal opioid exposure.  Neonatal Abstinence Syndrome (NAS)  Prenatal Opioid Exposure  Treatment of Opioid Use Disorder (OUD) • CDC Guidelines for Prescribing Opioids for Chronic Pain

Federal Legislation Continued: Comprehensive Addiction and Recovery Act (CARA): included:  increased access to naloxone  Improved prescription monitoring programs  Increase access to treatment programs  Training for professionals 21 st Century Cures Act:  CMCS Informational Bulletin Requirements of providing all medically necessary treatments for individuals under 21  Research and drug development  Opioid epidemic  Informed consent

Federal Legislation Continued: • Family First Act of 2018  Provides for the ability to fund Residential SU treatment for families.  Allows for funding mental health and substance use treatment • Pending Legislation:

https://www.medicaid.gov/Federal-Policy-Guidance/downloads/CIB-11-28-12.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/cib-05-07-2013.pdf http://www.aecf.org/blog/family-first-prevention-services-act-will-change-the-lives-of-children-in-f/ https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf https://gucchd.georgetown.edu/products/FinanceBrief_HCBServices.pdf http://nasadad.org/wp-content/uploads/2016/07/CARA-Section-by-Section-July-2016.pdf

1 Trust, Transfer, Transition, Integration, Transformation How the NJ Children’s System of Care Assumed Responsibility for Adolescent Substance Use Treatment Kathryn Way, Acting Assistant Commissioner July 2018

Department of Children and Families New Jersey Department of Children and Families Commissioner Family Child Protection & Children’s System Office of Adolescent & Community Permanency Division on Women of Care Services Partnerships (formerly DCBHS) (formerly DYFS) (formerly DPCP)

Children’s System of Care • Serves youth under age 21 with emotional and behavioral health care challenges, intellectual/ developmental disabilities, Autism, and/or substance use challenges • CSOC is committed to providing these services based on the needs of the youth and family in a family-centered, community-based environment • Statewide services with access through single point of entry • Voluntary • Medicaid platform • Local System partners are located in the community and aligned with Court Vicinages to assure seamless connections and coordination of care, particularly where youth have multisystem involvement

Children’s System of Care Objectives To Help Youth Succeed … At Home Successfully living with their families and reducing the need for out-of-home treatment settings . In School Successfully attending the least restrictive and most appropriate school setting close to home . In the Community Successfully participating In the community and becoming independent, productive and law-abiding citizens.

Service Array Expansion to Reduce Use of Deep End Servi ces Out of Low Home Intensity Services Intensive In- Community  Wraparound – CMO  Behavioral Assistance  Intensive In-Community Lower Intensity Services Out of Home  Outpatient  Partial Care  After School Programs  Therapeutic Nursery Prior to Children’s System of Care Initiative Today

System of Care Values and Principles Youth Guided & Family Driven Community Based Culturally/Linguistically Competent Strength Based Family Involvement Individualized Unconditional Care Collaborative Home, School & Community Based Cost Effective Promoting Team Based Independence Comprehensive

Language Is Important Our language conveys are attitudes and values Language can hurt, label, stigmatize Client  Instead of “addict/addiction”, say “substance use challenges”  Case Instead of “rehab”, say “treatment intervention”  Instead of “compliance”, say Placement “engagement”  Instead of “abuse”, say “use”

Trauma-Informed Care • Departmental Initiative. • Do not focus on “surface behavior.” • Interventions should address underlying trauma reaction • Implicit trauma indicators • Safe, consistent, nurturing environment • The Six Core Strategies for Reducing Seclusion and Restraint Use

Children’s System of Care History January 2013 2006 Intellectual/developmental The Department of July 2015 disability (I/DD) services for Children and Families 1999 July 2013 youth and young adults (DCF) becomes the NJ wins a NJ wins a federal Substance use treatment under age 21 is transitioned first cabinet-level Federal SAMHSA grant that allowed services for youth under from the Department of department Grant for System us to develop a age 18 is transitioned from Human Services (DHS) exclusively dedicated of Care - system of care. DHS, Division of Mental Division of Developmental to children and Expansion and Health and Addiction Disabilities to the DCF families Sustainability Services, to DCF/CSOC. Children’s System of Care [P.L. 2006, Chapter (CSOC).** 47]. May 2013 December 2000 - 2001 2007 – 2012 Unification of care 2014 NJ restructures the The number of management, Integration of funding system that youth in out-of- under CMO, Physical and serves children. state behavioral is completed Behavioral Health is Through Medicaid health care goes statewide. initiated in Bergen and the contracted from more than and Mercer County system 300 to three.* with expected administrator, Statewide rollout children no longer need to enter the *How did we do this? Careful individualized planning and the development of in-state options (based on research about what youth need) using resources that were child welfare system previously going out of state. to receive behavioral **Youth with I/DD in OOH programs or at risk of OOH, are transitioned July 2012 health care services.

Financing Environment Political Title XIX Funding Perspectives of Leaders -Rehab Option -Targeted Case Mgt Lawsuits/Settlements Child Welfare CSOC Values & Crisis/Tragedy Juvenile Justice Mandates 1915 like (i) or (c) System 1115 Waiver Community Will of Care CHIP/SCHIP Economy Design State Funds Structure Priorities Principles Government Increase Access to Care State vs. County EBPs Existing Reality Care Management Envisioned Ideal System Coordination Medicaid Agency Reduce Institutional Care Locus of Control Particular Populations Leadership Structure Factors that Impact Design

SU SU Transition-Multilayered Approach and Engagement to Assure Be Best Ch Chance of f Success Governor Signs Order for Integration: 1) Extensive Discussion/Negotiation/Information 2) Sharing with the “Sending Division” 3) Stakeholder Groups 4) Provider Training/EHR (42 CFR, Part 2) 5) Inclusion of Wrap Around 6) Convert sub use OOH programs to co-occurring model 7) Movement to fee for service, rate increase, and adjustment 8) Clinical criteria and authorizations to assure intensity of need is appropriate 9) Ongoing research on best practices, policy and program development

CSOC Continuum of Services for Substance Use Outpatient Partial Care Co-Occurring Group Home Co-Occurring RTC Withdrawal Management Substance Use Navigator*

Stakeholder Group Part of readiness: • Important to engage and provide a forum for system partners to understand CSOC and each other • Provided community partners an opportunity to understand potentialchanges • Provided treatment providers an opportunity to foresee their own destiny Representedby: Families ServiceRecipients Care Management Organization (CMO) Outpatient Providers(OP) Out of Home Treatment Providers(OOH) Existing Division (DMHAS) Receiving Division(CSOC) Advocates

Access The most important goal: Easy access for youth andfamilies • Routinely, all access to System of Care (CSOC) services are routed through the single point of entry, Contracted Systems Administrator(CSA) • Prior to transition from DMHAS, access to substance use services occurred through direct contact with provider agencies • It was clear that we needed to adopt and maintain the direct accessprocess  This required the System of Care to adjust itsprocess  As a result, youth/families may access SU treatment services either via contacting the CSA or contacting a contracted provider directly

Access Who may request services? • CSOC System Partners • Child Welfare • Care Management (Wraparound agencies) • Mobile Response • Juvenile Court • County Representatives • Schools • Pediatricians • Youth and Families