IN INVE VESTIN STING G IN IN LIES FA FAMI MILIES A - - PowerPoint PPT Presentation

IN INVE VESTIN STING G IN IN FA FAMI MILIES LIES

“A misbehaving child is a di a disc scouraged

• uraged chi

hild. ld. Eac ach child ld ne need eds s con

• ntin

tinuou uous s en encou

• uragement

ragement ju just st as as a plant needs water”

(Rudolph Dreikurs, 1964)

Cu Current rrent Pro Progra gramming mming

Cent ntral al MN Ment ntal al Heal alth th Cent nter Current nt Model

Adult Services: Children’s Services: Grant Opportunities: * Outpatient * Outpatient /Schools *Children’s 0-5 Grant * Specialized * Day Treatment *Adult Integrative Grant * CD Services * Crisis Services

Out utpati patient ent Serv rvic ices

• Individual and Couples Therapy
• Group therapy
• Day Treatment
• School Counseling for children and adolescents
• Psychiatry
• Psychological testing
• Chemical Dependency programming

What’s missing . . . . .?

Fa Family ily Fo Focused sed Su Supp pport

• rt

Sp Specialty ialty Progr grams ams

• ARMHS-Adult Rehabilitative Mental Health Services
• ACT-Assertive Community Treatment
• IRTS- Intensive Residential Treatment Services
• TCM-Adult and Child Targeted Case Management
• Crisis Mobile Unit, Crisis beds and Detox

What’s missing....?

In In-hom home e Fa Fami mily y Su Suppo pports ts

Minnesota Department Of Human Services Children’s 0-5 Grant And Adult Integ egrati rative ve Grant

PURP RPOS OSE: : The Minnesota Department of Human Services

Children’s Mental Health Division has worked with many agencies and communities to create an early childhood mental health system of care to meet the needs of the state’s

• children. This requires integrating services to include the

many systems that serve young children and their families.

Minnesota DHS Children’s 0-5 5 Gran ant

• Targets children age 0-5 specifically focusing on the effects of trauma on

development.

• Creates trauma–informed care systems by providing training opportunities

for mental health professionals at community mental health centers.

• Addresses the impact of trauma and subsequent changes in the child’s

behavior, development and relationships.

• Supports and promotes positive and stable relationships in the life of the

child. (University of Minnesota Extension, March, 2011)

Mi Minneso sota ta Depar partm tment ent of Hum uman n Serv rvices ces Adul ult Integrati egrative e Gra rant

• Serves primary caregivers diagnosed with serious mental illness or serious and

persistent mental illness with 0-5 year olds.

• Research is being conducted to determine the most resourceful ways to meet the

needs of this population.

• Mental Health Practitioners working with adults will be trained to identify

developmental concerns in 0-5 year olds to refer for early intervention services.

• Partnering with the Children’s 0-5 grant to include trauma informed care for the

families experiencing the effects of past or present trauma.

• Assessing and identifying the best course of treatment for the whole family to

prevent future patterns from the effects of mental illness and poverty.

Ov Over eral all l An Anal alys ysis is

Posit sitive ive Programmin ramming

• Each individual service at CMMHC is delivering a client driven recovery

model approach based on the level of care assessed.

• Outpatient and specialty services provide a wide range of service delivery

models to choose from each within their own specific programs.

• We offer the above services all “under one roof” to enhance service delivery

and offer clients easier access without duplication.

• We are on the cutting edge in serving 0-5 year olds and their families through

the Children’s 0-5 and Adult Integrative grants.

Ana naly lysis sis Cont nt.

However…..

• Day to day functioning of each separate service often promotes a tunnel vision

approach.

• Focus is on resolving crisis situations and maintaining mental health stability of clients

rather than a preventative focus.

• A strategic plan is needed to continue implementing services resulting from the

grants.

• Staff need to partake in changes within the agency by participating in specialized

training opportunities and applying their expertise.

Ana naly lysis sis Cont nt.

• There is limited support for parenting with serious mental illness.
• There is limited support for 0-5 year olds in need of mental health services.
• To reach both these populations delivery modes need to be adjusted.
• There is a need for mental health professionals trained in trauma informed care to

work with young children and their families.

• Collaboration and communication between adult and child services needs to

increase to establish effective, unified care.

Enc ncoura uraging ging

• On the brink of a systems change that can lead other community mental

health centers.

• Moving towards a holistic approach of treatment centered on health and

wellness of the whole family unit.

• Developing a plan that includes trauma informed care and secure attachment

focus.

• Ability to step out of the individual focused model and expand.
• Ability to integrate services already in place with evidence based family

support services.

Pr Pres esenting enting Re Reaso asons ns fo for r Program Changes…

Chi hildr ldren en in in pov

• verty

erty…..need supports to…..thriv

thrive.

Definition tion of 'Return urn on Investm stment ent - ROI'; a performance measure used to evaluate the efficiency of an investment or to compare the efficiency of a number of different investments. To calculate ROI, the benefit (return) of an investment is divided by the cost of the investment; the result is expressed as a percentage or a ratio.

(www.nvestopedia.com/terms/r/returnoninvestment.asp)

Inve vestment stment: Integrated adult and children’s services Ben enefit efit: : Healthy children and families Cos

• st:

Agency implementation Res esult: lt: The following statistics

are greatly reduced…..

Env nvir ironmental nmental Ris isk Fact ctor

• rs
• “Research suggests that up to 50 percent of the impact of income on children’s

development can be mediated by interventions that target parenting”

• “Inadequate screening prevents recognition of social, emotional, and behavioral

problems”

• “40 percent of preschoolers in specialty mental health services are children of color”
• “Nearly two to three times more pre-school age children exhibit symptoms of

trauma-related impairment than are diagnosed”

• “Children age 6-10 years old were four times more likely to access developmental

services than birth to two years old”

Furthe ther r St Studie ies

• “Unfortunately, studies have shown that children from economically disadvantaged homes
• ften know half as many words as children from high-income households. Worse still, fewer

than half of low-income children are prepared to start kindergarten, compared to more than 75% of toddlers from high-income homes” (Thrive by five, Washington State, 2013)

• Another study found that “children who had four or more adverse childhood experiences

were more likely to suffer from a range of chronic diseases as adults, including heart and lung disease, as well as increased risk for depression, alcoholism, suicide attempts and drug use” (The San Francisco Chronicle, 6/23/13).

Addre dress ssing ing Eth thni nic c an and Rac acia ial l Min inoritie rities

• “Children in America are the poorest members of society. One in five children live

below the federal poverty line, and almost one in two are poor or near poor, with a disproportionate burden falling on the very young, racial and ethnic minorities, Native Americans and children from immigrant families” (The Washington Post, 5/14/13).

• As clientele changes to include more minorities the agency must adapt to

accommodate all ethnic and racial backgrounds.

• Understanding cultural differences specific to family belief systems will lead to better
• verall implementation of services.

Fun undam ament ental al Ideal als

“Love and belonging are irreducible needs of all men, women, and children. We’re hard- wired for connection-it’s what gives purpose and meaning to our lives. The absence of love, belonging, and connection always leads to suffering” (Brown, B, 2012).

Ear arly ly Brai ain n Deve velopment lopment

• Infants of depressed mothers are found to be more likely at risk to develop mental and

socioemotional problems.

• Studies indicate that “as the mother-infant bond develops through an accumulation of

social interactions, the behavioral and neural underpinnings of this relationship also change in concert with one another”

• “One critical way to map the young child’s move from dependence to competence is

through the study of self-regulation”

• “Children internalize the regulating speech of their caregivers, which becomes part of the

child’s internal self-regulatory dialogue”

• “Parent-child interaction is an important mediator of risks that affect both language and

emotional expressiveness and regulation” (Ayoub, C., et al, 2011).

Cas ase Exam ample

• A young mother, Lani, has a scheduled individual therapy appointment. She is a single

parent of three children under five. Knowing the children cannot attend her appointment she arranges for daycare.

• Lani, does not have a car. She cannot use medical transportation to bring the children to
• daycare. To take the bus to the daycare and make it to her appointment she will need to

transfer two times.

• Lani plans on a two hour trip to the appointment and two hours back . She gets her

three children ready and takes them on the bus to the daycare. The next bus is a half hour wait. She takes that bus downtown and then transfers again to get to her appointment.

• The return trip is the same although she misses her first bus by five minutes due to

scheduling her next therapy appointment.

• Lani now has spent six total hours attending her therapy appointment. She also spent any

extra money she had for the month.

• Lani decide

des s to skip her next xt appoint ntment ment.

• “The quality of mother-child interactions is predicted by family

contexts such as poverty and by parenting related stress.

• Researchers have found that poorer mothers and mothers with

psychological distress tend to have more hostile, more intrusive, and less sensitive interactions with their young children than mothers who have less demographic risk factors”

• Parents need…..

Num umbe ber One ne Reas ason

• n For Progr

gram am Chan anges es

…..flexible opp pportu

• rtunities

nities to

• su

succe ceed. ed.

Sa Samp mple le Mo Mode dels ls

Inf nfan ant t Ment ntal al Heal alth/E th/Early arly Head ad St Star art t St Stud udy, y, 2007 07

Four elements crucial to an effective Infant Mental Health initiative: 1. 1.Teamwork, especially the use of trans disciplinary teams to review family cases,

• 2. Reflective supervision,
• 3. Development of an integrated and empathic understanding of the child’s needs and

the parent’s challenges in meeting those needs, and

• 4. Dynamic ecological understanding of children, families, and communities in which

psychosocial and socioeconomic factors are viewed as mutually important and interactive. (McAllister, C. L., & Thomas, T., 2007).

Def efinition

• n
• f

Del elivery ery Sys ystems ems

*On a trans disciplinary team all members contribute their own knowledge and expertise, and efforts are then collective in determining best ideas or approaches in delivery. *On an interdisciplinary team an individual specialist works with the client, with interaction occurring at meetings, but not in delivery of service.

Mental Health Medical Education/ Family/ Vocation Social meetings Client

ent

Mental Health professional and practitioner Medical Client

ent Education/

Vocation Family/Social

Tran ans s dis isciplinary ciplinary ap approach

• ach
• Transition from interdisciplinary teams to trans disciplinary teams can be

difficult.

• Building on relationships established buy in-home adult services such as,

ACT, ARMHS and TCM can lead to an easier transition for therapeutic services.

• “What we argue is that the family support principles already employed by the

program provided key vehicles for a successful IMH initiative” (McAllister, C. L., & Thomas, T., 2007).

Reflect lective ive cons nsult ultation ation provides…

• Ability to self-reflect within a group of peers who have an understanding of the

complexities of working with caregivers with mental illness struggling to parent young children.

• Provides tools to reach for when faced with unforeseen circumstances that launch us into

the midst of chaos our clients live in daily.

• Opportunity to receive feedback not only on client care but to provide insight into how
• ur own biases and triggers may affect how we react in situations.
• A place to share our inadequacies and doubts without fear of blame and judgments.
• We all flounder at times and grasp at ideas that will address issues while trying to be fair

to both the parent and child despite our own values, but we are human and we will stumble.

Bal alan ancing ing Act

• Delicate balance promotes an ability to acquire insight from two

separate perspectives when working with primary caregivers and children 0-5.

• “Becoming aware that a parent’s social and emotional development, and thus current

behavior, has been shaped by experiences in the past, in the same way their child’s development is being shaped in the present, allows two simultaneous insights:

• first, the analytic insight that does not shy away from recognizing and trying to reduce the

harm created by intergenerational processes of emotional wounding and stunting;

• and second, the empathic insight that the parent too requires and deserves compassion”

(McAllister, C. L., & Thomas, T., 2007).

Ass ssertive ertive Comm mmuni unity ty Treat atmen ment

• 2013 study comprised of interviews of seventeen parents being served on

ACT, Assertive Community Treatment teams demonstrated a need to focus

• n parent-related treatment services and support.
• “ACT teams are not consistently addressing the mental health and

community support needs of all parent consumers, especially parents of young, dependent children”

• By incorporating parenting focused skill building into the treatment plans,

enhancing attachment, and increasing supports, outcomes for parents with serious and persistent mental illness and their children will hopefully improve. (White, McGrew, & Salyers, 2013, p. 22).

Core Team Focus on Recovery Rehabilitative Services Specialized Mental Health Secure Attachment Focused Interventions Early Childhood Services Crisis/Basic Needs Education Vocation Medical Services

Sa Samp mple le Fam amil ily y Team am Model

• A Core team including a care

coordinator or case manager, rehab services, and therapeutic care with a focus on recovery for the whole family.

• A Whole
• le team approach is utilized to

address crisis care, meeting basic needs, medical wellness and other services as needed.

Comm mmunit ity Menta tal l Heal alth th Se Servi vice ce Deliv livery ry Model el

Integrate evidence based practices within existing clinical models:

• Acute and Emergency Response
• Community Continuing Care Services
• Assertive Rehabilitation Teams
• Early Intervention Services
• Partnerships with other human service agencies.

Limitations:

• An Integrative Family Focused Model needs to be cost neutral with a capacity to

adapt and develop as funding opportunities arise.

• The model needs to fit in to an already existing larger mental health service model

with its own political, structural and resource context.

PL PLAN ANNING NING FOR R TH THE E FUT UTURE URE

St Strat ategic gic Pla lann nnin ing

“Ideas, then, are our paths to both reality and self-

• delusion. We don’t typically recognize ourselves as

engaged in idea construction of any kind, whether good or

• ill. In our everyday life we don’t experience ourselves

shaping what we see and constructing the world to our advantage”

(Dr. R. Paul, Dr. L. Elder, 2011).

Bui uild ld on n Exis isting ting Models els

• Access

ss clients in need of specialized services for adults and children through referrals building on existi isting ng relationships with mental health practitioners.

• Offer

fer parenting education and therapeutic programming to provide needed support and tools for parenting with a mental illness.

• Problem

blem solve barriers to service including childcare and transportation.

• Offer

fer positive programming focused on strengths rather than fears.

Pla lans ns for Expan ansion sion

Current grant opportunities allow for implementing staff training in evidences based practices with minimal short term investment while promoting long term gain. Mental Health Practitioners

• Development across the life span

training and evidence based relationship training focused on mothers with SMI with 0-5 yr. olds.

• Family focused rather than a silo

adult approach.

• Ability to better identify needs of

families and access to a specialized team for referrals and consultation. Mental Health Professionals

• Specialized trainings: SDQ, DC 0-

3R, ECSII, PCIT, Trauma Informed Care, The Incredible Years.

• In-home therapeutic care in

conjunction with established adult rehab services.

• Reflective consultation to ensure

quality client and self-care.

In In-hom

• me

e Psy sychotherapeu

• therapeutic

tic Se Servi vice ces

• Target primary caregivers with young children.
• Therapist meets client in their own environment.
• Appointment follow through is higher due to already established relationships with in-

home providers.

• A broader assessment of needs is conducted, including housing, environmental stress,

interaction of family members, effects on the children. Problem: Children in the home hear intense information. Solution: Partner with area colleges, enlist volunteers in need of internship hours to accompany and assist with the children during in-home therapy sessions. Problem: Travel time is not conducive to productivity. Solution: Assign therapists specifically for in-home sessions and provide case by case.

Continue adult and children services already provided:

• Specialized Services
• Outpatient Services
• Chemical Dependency
• Psycho-educational
• Day Treatment

Target populations:

• Primary Caregivers with Serious Mental Illness or Serious and Persistent Mental Illness

with a 0-5 year old

• Minnesota Medical Assistance recipients
• MN Family Investment Program Recipients (MFIP)
• Low Income/Poverty Level/At Risk of Losing Custody

Proposed posed Se Servi vices ces

Lead Coordinator

Coordinator Coordinator

CHILDREN’S 0-5 AND INTEGRATIVE GRANTS

Family nights to invite participants for research to gather information on how to best serve population Early Childhood 0-5 Grant; awarded to CMMHC in 2010-1 of community MH centers selected

Early childhood trainings for MH Professionals are provided including the DC 0- 3R, ECSII, PCIT, Incredible Years, Trauma care

MH professionals begin to implement early childhood programming that meets the needs of 0-5 year olds and their families Referrals for specialized services to meet the needs of 0-5 year olds and their families are accessible at community MH centers Targeting ACT, TCM, ICRS, ARMH’s, primary caregivers with 0-5 year

• lds

Provide early childhood trainings for mental health practitioners to be able to identify developmental concerns with 0-5 yr. olds Specialized professionals partner with in-home staff to build on established relationships to address identified needs of families

Integrative Adult and Early Childhood Grant; awarded to CMMHC in summer 2012-1 of 3 community MH

centers selected CMMHC is able to provide family services focused on early interventions that strengthen families and promote overall wellness

*ACT, ARMHS, TCM staff

trained in development of 0-5 year olds *Mental Health Professionals part of a MN registry for specialized services

Par artn tnering ring wit ith Comm mmun unity ity Agencie encies

Partne tner with: h:

• Head Start, and other Early childhood programs, New Beginnings, Salvation

Army, Anna Marie’s, Journey home, County MFIP recipients and other area agencies who are referral sources for high risk clientele with 0-5 year olds.

• Collaborate with child placement and child protection at the counties to

work with them in reuniting parents with their children with strong supports in place for higher success rates.

• Provide additional Children’s Therapeutic Support Services through

referrals to other agencies or by creating a program within CMMHC for in- home rehab CTSS.

• Provide opportunities to consult and maximize areas of expertise from a

pool of area agencies to best serve families.

Pro Proje jected cted Ou Outco comes mes

Sp Speciali ialized zed St Staf aff

• Trauma informed care
• Circle of Security
• The Incredible Years
• PCIT
• EMDR
• Mental Health Practitioners able to identify developmental concerns in 0-5 year olds
• Part of a MN state registry
• Opportunities for clinical trainees

Fam amil ily y Focus us

• Supported community
• Hope for families to thrive
• Decrease in parents losing custody due to mental health symptoms
• Early interventions leading to increased success in addressing developmental

concerns

• Increased parenting confidence with increased self esteem
• A strong future with strong families

Oppor

• rtun

tunities ities

• Ability

ity to access grants specific to family centered trauma informed care treatments.

• Ability

ity to provide evidence based approaches approved by insurance companies to ensure payment.

• Movem

ement ent towards health homes including several services available within one agency.

• Motiv

tivati ation

• n for other agencies to contract with CMMHC to provide treatments for

the whole person including medical, vocational, housing and mental health services.

• Ex

Expansion nsion of services that reach out to meet the needs of the communities we serve.

PLANTING SEEDS

*By planting nurturing seeds filled with supports for families, we can grow children who will have healthy human experiences. “Courage, an optimistic attitude, common sense, and the feeling of being at home on the crust of the earth will enable us to face advantages and disadvantages with equal firmness” Alfred Adler

Cent ntral al MN Ment ntal al Heal alth th Cent nter Current nt Model

Adult Services: Children’s Services: Grant Opportunities: * Outpatient * Outpatient /Schools *Children’s 0-5 Grant * Specialized * Day Treatment *Adult Integrative Grant * CD Services * Crisis Services

Proposed Integrative Model

• Adult, children’s and family services

intertwined with a clear path towards recovery.

• Guided by Mental Health Practitioners and

Mental Health Professionals with specialized training.

• Partnering with other professionals to provide

a whole person approach addressing mental, physical, emotional and social wellness. We can create a family systems delivery model…

…and be a leader in breaking the cycle.

References

Professional Psychology: Research and Practice, Vol 43(4), Aug, 2012. pp. 315-327 McAllister, C. L., & Thomas, T. (2007). Infant mental health and family support: Contributions of Early Head Start to an integrated model for community-based early childhood programs. Infant Mental Health Journal, 28(2), 192-215. Stevenson-Hinde, J. (1990). Attachment Within Family Systems: An Overview. Infant Mental Health Journal, 11(3), 218-227. White, L. M., McGrew, J. H., & Salyers, M. P. (2013). Parents served by Assertive Community Treatment: Parenting Needs, Services, and Attitudes. Psychiatric Rehabilitation Journal, 36, 22-27. Ayoub, C., Vallotton, C. D., & Mastergeorge, A. M. (2011, March/April). Developmental Pathways to Integrated Social Skills: The Roles of Parenting and Early Intervention. Child Development, 82, 583-600.

References

Flannery, F., Adams, D., & O’Connor, N. (2010). A Community mental health service delivery model: integrating the evidence base within existing clinical

• models. Psychiatric Services, 49-55.

Dreikurs, R. (1992). children the challenge. New York, New York: Penguin Books, USA. Inc. “Child Poverty can Be Alleviated”, The San Francisco Chronicle, 6/23/13 “The Most Important Problem Facing Children Today” , The Washington Post, 5/14/13 Paul, D., & Elder, D. (2011). Ethical Reasoning. Tomales, CA University of Minnesota Extension, March, 2011