Design to Implementation: Delivering the New Children & Family - - PowerPoint PPT Presentation
Design to Implementation: Delivering the New Children & Family Treatment Support Services Objectives To provide an overview of the multi-level change that accompanies implementation of new services To describe the different roles
Delivering the New Children & Family Treatment Support Services
accompanies implementation of new services
involved in the oversight and delivery of Children & Family Treatment & Support Services
implementation
new services available Jan 2019
array and phase in the expansion of children eligible for HCBS
State Plan services will become part of the Managed Care benefit on their implementation date
State Plan Service Effective Date draft dates pending CMS approval Other Licensed Practitioner January 1, 2019 Psychosocial Rehabilitation January 1, 2019 Community Psychiatric Treatment and Supports January 1, 2019 Family Peer Support July, 1, 2019 Youth Peer Support and Training January 1, 2020 Crisis Intervention State Plan January 1, 2020
The development of the six new services are intended to:
treatment services
approaches for rehabilitative interventions
comprehensive manner when identified in the treatment plan.
and coordination with the family, caregiver and/or legal guardians.
the treatment goals.
Support Services, an organization must become a designated provider by submitting an application.
Each new Children and Family Treatment and Support Service will have very distinct:
Requires multi-level change:
providers in the community
Astor: Bronx, NY
services was developed to provide community-based services to support the children impacted
services.
their communities and out of restrictive settings.
delivery of these new services.
discharged from our day treatment
Total training time averaged 15 hours Team meetings held frequently to discuss service provision, review data, and identify participant needs
find and hire qualified staff
and experience working with SED population
based services
✓ Described new SPA services ✓ Pilot in schools to support the discharged children
by Tilden closure
Children receiving each service:
*Includes assessments when completed
20 40 60 80 100 120 140 OLP CPST PSR FPSS
Children Receiving Each Service
OPC 8% On Site 12% Other 7% Home 30% School 43%
Off Site 80%
LOCATION
OPC On Site Other Home School
31% 18% 21% 25% 30% 7% 43% 24% 32% 47% 24% 23% 30% 30% 14% 38% 17% 25% 13% 10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Schools Home Tilden SYNC Astor OPC Other Place of Service
Service Type by Location
PSR OLP FPSS CPST
child, caregiver, school, and referral source
include:
Reason for Referral:
Depressive Disorder with Anxious Distress referred by his school Counselor due to school refusal. He was enrolled at ABC Behavioral Health Outpatient Clinic though his attendance was inconsistent. Donald was at risk of losing his school and home placement. Goal:
attendance, and decrease depressive and anxiety symptoms
improve school and outpatient clinic attendance
and identify strategies to promote socialization
caregiver with learning, practicing, and implementing parenting strategies to reinforce positive behaviors
weekly, for 60 minutes, in his home setting, to teach him how his thoughts and feelings influence his depressive moods and avoidant behaviors; teach him how to challenge and stop negative thoughts; and provide him with a 4-step plan to use when feeling anxious.
plan [Cognitive: Anxiety (STOP)] to use when he is feeling anxious. Focused on Steps 2: Thoughts that make him upset (Thoughts) and 3: Think of things to do or think to feel less anxious (Other Thoughts). Assisted Donald with identifying the "negative" thoughts that make him feel anxious and reviewed ways in which recognizing other "positive" thoughts can help in anxious situations. Also, discussed his own ideas about what he can do to better cope with his scared/worried feelings. Provided examples of "Other" coping thoughts that could help him feel less anxious.
Brown, bi-weekly, for 15-30 minutes, in her home setting, to teach her strategies to minimize the negative effects of Donald's depressive moods and anxious distress. For example, Monitoring, Activity Selection, Relaxation, etc.
educate her about depressive and anxiety symptoms and how they impact Donald’s ability to regularly attend school and socialize with others. BHS assisted Ms. Brown with identifying strategies (Cognitive Anxiety STOP, Self-monitoring, Exposure, etc.) to minimize Donald's anxiety and depression and how she can reinforce learned skills.
home for 15-30 minutes to introduce Donald to relaxation and exposure training and its use in affecting the way that he feels (e. g. irritable, anxious, etc.) Donald will learn and implement 3/5 calming skills bi-weekly in the home to reduce overall tension and moments of increased anxiety and/or arousal.
anxiety exposure exercise as the plan was to walk to his school. During their walk, BHS incorporated the cognitive anxiety STOP activity with Donald to minimize anxiety symptoms. Donald described the ‘situation’ (i.e. going to school) and mentioned he did not have any negative ‘thoughts’. BHS encouraged Donald to walk through the parking lot in front of the school. Donald hesitated at first, then engaged in the exercise. Once complete, he smiled at BHS and did not rush to get back home. On their way back home, Donald ‘praised’ himself and stated he was proud of himself for getting closer to the school.
45-60 minutes, to encourage and teach her how to assist Donald in applying newly learned skills (Thought Stopping, Self-Monitoring, Relaxation, etc.) and to increase the frequency of positive family activities (Activity Selection, Attending, etc.)
play strategies that Ms. Brown can utilize to decrease Donald’s excessive worry about going to school. Ms. Brown expressed concern that Donald has a hard time falling asleep and does not sleep through the night. FPA encouraged Ms. Brown to utilize a possible reward system to motivate Donald to turn off the video game when
could decrease Donald’s irritability, anxiety, and school refusal. FPA and Ms. Brown explored the importance of consistent routines.
days per week.
was able to sustain medication management.
Health Homes Services to provide support for Donald’s siblings that resided in the home.
Admission Category N % Not indicated 55 27% Services declined 16 8% TBD 21 10% Admitted 115 56% Grand Total 207 100%
27% 8% 10% 56% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Admission Category Breakdown
Admitted TBD Services declined Not indicated
Referral Category N % DT Discharge 13 11% DT Diversion 10 9% High Needs OPC 18 16% Parent 7 6% SBBHT 40 35% School 27 23% Grand Total 115 100%
11% 9% 16% 6% 35% 23% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Children Served By Referral Source
DT Discharge DT Diversion High Needs OPC Parent SBBHT School
Referral Category Months of Treatment DT Discharge 15.4 DT Diversion 11.1 High Needs OPC 7.9 Parent 8.4 SBBHT 5.3 School 10.6 Grand Total 8.8
15 11 8 8 5 11 2 4 6 8 10 12 14 16 18 DT Discharge DT Diversion High Needs OPC Parent SBBHT School
Average Months of Treatment by Referral Category
Children receiving each service:
*Includes assessments when completed
20 40 60 80 100 120 140 OLP CPST PSR FPSS
Children Receiving Each Service
62% 43% 40% 38% 57% 60% 0% 20% 40% 60% 80% 100% 2016 2017 2018 BHS
Service Type by Staff Title by Year
PSR CPST
Some Activities are unbillable
84% 52% 63% 97% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% CPST FPSS OLP PSR
Billable % by Service Type
a clinic or received the services in support of their clinic treatment
to cap referrals. They are looking for funding to purchase services when pilot ends.)
additional services for their children
children
service package developed including consultation and professional development
school’s variant of these services aside from pilot
agencies has been vital in sustaining relationships
particular children and their families
engagement, yet not reimbursable prior to development of the treatment plan
families but currently only reimbursable under OLP & CPST master’s level.
implementation are considered and planned for!
care.
Health Home?
services in the treatment plan?
actually doing?
software, etc.)
Children’s Managed Care Design: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/childre n/index.htm Trainings on Children’s System Transformation
https://ctacny.org/training/children-and-family-treatment-and-support-services- training
https://ctacny.org/sites/default/files/Final%20FAQ%20for%20CFTSS%20Trainings. pdf
https://ctacny.org/training/billing-childrens-system-transformation
https://ctacny.org/training/utilization-managment-children-and-family-treatment- and-support-services-olp-cpst-and-psr
RESOURCES TO STAY INFORMED:
http://www.omh.ny.gov/omhweb/childservice/
http://www.health.ny.gov/health_care/medicaid/program/medicaid_healt h_homes/listserv.htm
https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medic aid_health_homes/emailHealthHome.action
Visit www.ctacny.org to view past trainings, sign-up for updates and event announcements, and access resources
Please send questions to: mctac.info@nyu.edu Logistical questions usually receive a response in 1 business day or less. Longer & more complicated questions can take longer. We appreciate your interest and patience!