1、The Illinois Department of Children and Family Services: SI/Behavioral Health Team Presents -,The Development of the IDCFS Behavioral Health System - A Paradigm Shift to Focus on Trauma,Part I,Setting the Stage for the “Harmonic Convergence”,Initial Formation of the Behavioral Health Team as part of
2、 the Division of Service Intervention,Organizational concept born out of concerns raised by Consent decrees and Federal Review process Identification of child/youth mental health needs Provision of appropriate services BHT inception June 1, 2004 Core assessment of DCFS programs and services Developm
3、ent of conceptual framework Identification of priorities and implementation of action plans to achieve a “seamless” system of coordinated behavioral health care for wards,“2x4” Assessment Plan,DCFS Programs Integrated Assessment Foster Care System of Care (SOC) Specialized Foster Care Screening, Ass
4、essment & Social Supports (SASS) Shelters Medically Complex,Provider Programs Hospitals Residential LANs MSTDCFS Organization Divisional Structure Information systems Contracts Grants Funding structures Service and contract monitoring,“2x4” Assessment Plan,Other System Linkages Child Mental Health P
5、artnership Schools Downstate issues DHS Developmental Disabilities Substance Abuse Mental Health Community Mental Health Providers,Juvenile Justice Federal Links Courts and Consent DecreesOther Key Considerations PIP BH consent Decree Etc.,IDCFS Organizational Structure,Divisions Placement/Permanenc
6、y Field Operations Monitoring/Quality Assurance Guardian & Advocacy Clinical Practices & Professional Development,Service Intervention Budget & Finance Planning & Performance Management Communications Child Protection,BHT Findings from Core Assessment of Programs and Services,August 4, 2004 Findings
7、 presented to Director Bryan Samuels; August 15, 2004 presented to Deputy Directors Findings and Recommendations Endorsement of Directors lifespan approach Trauma-focused care Utilization of Anticipatory Guidance Principle rather than waiting for acute symptom presentation to signal need Establish b
8、aseline screening for wards strengths, impact of trauma and mental health needs,BHT Findings from Core Assessment of Programs and Services,Findings and Recommendations (continued) Need for cross-divisional information “nervous system” (CANS) Need for uniform methodology to determine impact of trauma
9、/impact of services provided Overall workforce training on trauma and systematic needs/strengths assessment Trans-divisional approach to implementation to decrease duplication of efforts and to increase appropriate utilization of resources & expertise,Conceptual Framework: PARK,Core notions - Promot
10、ing the Abilities and Resilience of Kids Framework for organizing efforts, programs, services & contracts An approach to identifying service gaps, trends and emerging needs,PARK A Public Health Approach to Mental Health Prevention, Early Identification, Assessment and Treatment,Primary/Universal Lev
11、el Addresses the risk factors for all infants, children and youth at large Secondary/Targeted Addresses the specific needs and risk factors associated with DCFS wards Tertiary/Intensive Addresses the needs and risk factors of wards experiencing the impact of trauma and/or serious emotional disturban
12、ce,Development of the BHT Action Plan: FY05 Focus on Infrastructure Development and Workforce Training,Northwestern U Web-based CANS training Illinois CANS website Service-Focused Provider Database Treatment Quality Monitoring Unit Evaluation of Training Curriculum,and StatewideTraining Initiative D
13、VMHPI Curriculum and Training Capacity Development on Trauma U of Chicago Geo-mapping Project,Part II,Focus on Trauma and Its Impact,The Adverse Childhood Experiences Study The Effects of Adverse Childhood Experiences on Adult Health and Well Being,What are the Adverse Childhood Experiences (ACEs)?
14、Growing up (prior to age 18) in a household with: Recurrent physical abuse Recurrent emotional abuse Sexual abuse,ACEs continued,An alcohol or drug abuser An incarcerated household member Someone who is chronically depressed, suicidal, institutionalized or mentally ill Mother being treated violently
15、 One or no biological parents Emotional or physical neglect,DCFS ACEs ,Removal from biological parent(s) Unplanned placement moves Three or more placements in an eighteen month period,Trauma: The Cornerstone of the DCFS Behavioral Health Approach,Exposure to Trauma Increases the Risk for: Major Ment
16、al Illness Substance Abuse AIDS and Sexually Transmitted Diseases Impaired Physical Health Developmental Disabilities,Trauma & Mental Health,Trauma Increases the Odds for Major Depression nearly two-fold. Trauma Increases the Odds for suicide Trauma is associated with poor response to antidepressant
17、 medication and poor overall treatment outcomes.,Trauma & Substance Abuse,Trauma significantly increases the risk for alcohol and drug abuse in adolescents. Trauma is the best predictor of drug and alcohol abuse in women. Trauma is associated with poor treatment outcomes and increased treatment drop
18、 out.,Trauma & HIV/STD Risk,Childhood Trauma dramatically increases risks for HIV-risk behavior. IV Drug Use Promiscuity,Trauma & Physical Health,Adverse Childhood Experiences Study Increased ACES Correlate w/ Smoking Increased ACES Correlate w/ Adult Alcoholism Increased ACES Underlie Chronic Depre
19、ssion According to the World Health Organization, depression is becoming the 2nd most costly illness.,Trauma & Physical Health (cont.),ACES correlate w/ Increased Sexual Partners ACES Correlate w/ History of STD,Trauma & Physical Health (cont.),ACES Correlate w/ Increased Sexual Partners ACES Correl
20、ate w/ Sexual Abuse of Male Children and Their Likelihood of Impregnating a Teenage Girl. ACES Correlate w/ Unintended Pregnancy or Elective Abortion ACES Correlate w/ Rape,Trauma & Academics,Impact of trauma on school readiness Impact of trauma on school performance Impact of trauma on cognitive fu
21、nctioning that may result in behavioral difficulties Increased likelihood of dropping out of high school,Trauma & The Brain Some Key Concepts from Bruce Perry, MD,Brain develops over time (birth thru early-mid 20s) Brain mediates all internal and external processes body, thought, feeling & behavior
22、Trauma affects brain development need to address the developmental element of growth affected by trauma “Body” and psychological memory,Physiologic properties of alarm stress trauma Initial exposure fight or flight biological basis With persistent/significant trauma, one is on constant alert Branchi
23、ng Response Dissociation v Hyper-arousal; impact over time and on “character” Power differential strength v vulnerability “People not Programs change People”,Part III,Implementation of PARK and the CANS-DCFS,Refinement of the CANS Comprehensive into the CANS-DCFS,Promoting Internal Collaboration bas
24、ed on identifying and understanding each others information needs Directors “Big Picture” presentation Presentation and updates to the Deputy Directors Forming a “common table” with Clinical Services, Training, Information Technology, BHT Internal Social Marketing,Development of a “Common Informatio
25、n Language”,Precursor work with DCFS System of Care (SOC) Program and Screening, Assessment & Social Supports (SASS) Determining baseline information about impact of trauma, mental health needs & strengths Integrated Assessment Project Systematic review of responses to care, emergent needs and respo
26、nsiveness to care 6-month Administrative Case Review,Streamlining System Mechanisms,Reworking internal programmatic silos the Child/Youth Investment Team model Utilization of the CANS-DCFS across Residential and Purchase of Services Providers Improving system responsiveness to wards mental health ne
27、eds geo-mapping and resource identification/quality assurance/continuous quality improvement,New Child/Youth Investment Team Model for Decision-Making,Next Stages of Implementation and Anticipated Findings “This time next year”,Expected implementation of the CANS-DCFS July 2005 (CYIT, IA, Residentia
28、l Monitoring) Expected web-based CANS-DCFS training in place by September 2005 with statewide training completed by July 2006 Databases and web-based download of CANS-DCFS data in place by September 2005,by this time next year.,Preliminary analysis of CANS-DCFS data by January 2006 Linking CANS-DCFS
29、 mechanisms with geo-mapping project by March 2006 Trauma curriculum developed and training conferences completed by November 2005 FY07 Contracting informed by CANS data by January 2006 FY06 BHT PIP Proposal re EBP Pilot Projects (through the SOC network),IDCFS BHT Contact Information,Tim Gawron, MS
30、, MSW, LCSW Statewide Administrator, Behavioral Health Services TGawronidcfs.state.il.us Phone (312) 814-1573 Jamie Germain, PhD Downstate Administrator, Behavioral Health Services JGermainidcfs.state.il.us Phone (618) 583-2126 Felicia Guest, BA PSA, Behavioral Health Team Fguestidcfs.state.il.us Phone (312) 814-6851 Ray Wilkerson, MD Psychiatrist, Behavioral Health Team Rwilkersonidcfs.state.il.us Phone (312) 814-5991,
