Workgroup Participants:

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Workgroup Participants Wyndee Davis Antoinette
Gurden Deb Kennedy Deborah Magee Harry
Marmorstein Dr. Nadezhda Robinson Presentation
by Antoinette Gurden
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Department of Children and Families Table of
Organization (Three Major Divisions)
DCF
Division of Child Behavioral Health Services
Division of Youth and Family Services
Division of Prevention and Community Partnerships
DCBHS Overview
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System of Care Guiding Principles
At Home
(with their families and not in out-of-home
treatment settings)
In School
(in district)
Out of Trouble
(not involved with the Juvenile Justice
Systemand at risk of detention or incarceration)
DCBHS Overview
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Division of Child Behavioral Health
Services Contracted Entities
Contracted Systems Administrator
Care Management Agency
Training and Technical Assistance
Family Support Organization
Youth Case Management
Mobile Response Stabilization Services
DCBHS Overview
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New Jersey Division of Child Behavioral Health
Report reflects data as of
9/22/08 Services (DCBHS) Summary Report
Excerpts Quarterly Report
Statewide (See Report NJ0184.3) The total
number of children enrolled is 38,731. The
total number of children who are active in a CMO
is 3,067. The total number of children who are
active in a YCM is 4,177. The total number of
children who are active in MRSS is 851. The
average number of families actively receiving
peer support from an FSO is 1,182. The largest
age group served by the DCBHS is children ages 14
through 17. This age group comprises 45 of all
children served. There are 41 females, 59
males served by the DCBHS.
DCBHS Overview
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Acute Care Services
Inpatient Treatment
Out of Home Treatment Services
Intensive Residential Treatment
Out of Home Treatment
Case Management Services
Case Management Services
MRSS Services
Mobile Response Stabilization Services
IIC Services
Intensive In-Community Behavioral Assistance
Services
Outpatient Services
Outpatient and Addictions Treatment(Not yet
integrated into the DCBHS System of Care)
AssessmentServices
Assessment Services
Utilization Management
Access and Utilization Management (CSA)
DCBHS Overview
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Current System of Screening Students
Youth presents with behavior
Youth screened at Psychiatric Emergency Service
(PES)
PES are not kid-friendly
Medical model is not useful for most youth
Current screening laws designed for adults
Designed to determine if youth meets admission
standard rather than what services youth may need
Current System of Screening Students
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Current System of Screening Students
Youth presents with behavior
threats
Youth screened immediately at PES
Youth suspended until screened at PES
danger to self
danger to others
Benefits Drawbacks
Benefits Drawbacks
Screened for safety
Screened for safety
Referral to services
Referral to services
Undue burden on family
Undue burden on family
Long wait
Changes youths school experience
Inappropriate environment
Lost time in school
High cost
Screened long after event
Intense reaction to situation
Punishes youth for BH issues
Current System of Screening Students
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Current System of Screening Students
Youth presents with behavior
threats
danger to self
danger to others
There is currently no standard response for youth
who exhibit
mood change
change in functioning
Current System of Screening Students
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Proposed Model to Screen Youth in Schools
Youth presents with behavior
threat to self or others
mood change
change in functioning
Response determined by age and risk factors
Regardless of age, youth at high risk for harming
self or others referred to PES
Proposed Model to Screen Students
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Step 1 Identify Concern
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Scenario A Youth needs immediate attention
and
and/or suggest that youth may be at risk of
significant emotional distress or of causing harm
to self or others
Youths behavior within the last 5 or fewer days
Youths disclosure of information
the disruption in youths behavior impedes
youths ability to learn and affect youths
relationships with peers and/or staff
Step 1 Identify Concern
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Scenario A Youth needs immediate attention
Risk factors are perceived within the context of
the youths individual cognitive and intellectual
capacity
There is a realistic concern for the safety of
the youth or others based on the
youths individual risk factors
Youth has a viable plan to carry out threat as
indicated
Youth has immediate access to the means to carry
out threat as indicated
Youth has a sincere intention to do harm
Step 1 Identify Concern
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Scenario A Youth needs immediate attention
Consider suicide risk factors when youth
threatens to harm self
Significant change in eating, sleeping habits
Boredom or loss of interest in previously
pleasurable activities
Frequent complaints about physical symptoms
Sudden cheerfulness after a period of depression
Neglect of personal hygiene and friendships
Giving hints of not being around for long, such
as verbal statements or giving away possessions
Step 1 Identify Concern
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Scenario A Youth needs immediate attention
Service Pathways Appropriate for Youth in
Scenario A
PES
Psychiatrist
Step 1 Identify Concern
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Scenario B Youth presents with threatening
behavior
Response to behavior should be shaped by the
youths ability to and his or her subsequent
de-escalate him/herself by venting
amenability toward negotiating an alternate plan
Youth who is able to
De-escalate
and
or
Abide by negotiated plan
Utilize existing resources
may be appropriate for Scenario C
Youth who is NOT able to
De-escalate
and
or
Abide by negotiated plan
Utilize existing resources
may be appropriate for services other than PES
Step 1 Identify Concern
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Scenario B
Service Pathways Appropriate for Youth in
Scenario B
Pediatrician
Psychiatrist
Private BH Provider
CSA
MRSS
Step 1 Identify Concern
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Scenario C Youth needs services
and
and/or suggest that youth may be at risk of
significant emotional distress or of causing harm
to self or others
Youths behavior within the last 3 months or less
Youths disclosure of information
The disruption in youths behavior has
consistently interfered with
Youths ability to learn
and has affected
Youths relationships
with peers and/or staff
Step 1 Identify Concern
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Scenario C
Service Pathways Appropriate for Youth in
Scenario C
CSA
Pediatrician
MRSS
Information and Referral
Private BH Provider
Assessment
Step 1 Identify Concern
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Step 2 Discuss Concern With Family
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After a concern is identified at any level, the
family and school personnel collaborate on an
action plan

• Sit down with the family
• Develop an action plan
• Develop a plan for follow up

Many high school aged youth can participate in
this discussion
Step 2 Discuss Concern With Family
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Step 3 Family Chooses Response Option
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Available Options
PES
Pediatrician
Psychiatrist
Private BH Provider
CSA
Community Assessment
Mobile Response Stabilization Services
Information and Referral
Step 3 Choose Response Option
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Response Time Frame
Service Option
Outcome
PES
Same day
Determination of inpatient admissibility
Determination of current risk to self/others,
diagnosis, referrals
Psychiatrist
Same day
Private Behavioral Health Provider
Assessment, family/individual therapy, diagnosis
1-3 months
Referrals to services covered by private
insurance if appropriate
Pediatrician
Same day
Information and Referral
Information about services available locally
Immediate
Community Assessment
Comprehensive biopsychosocial assessment and
referral for services
CSA
7-10 days
Mobile Response and Stabilization Services
72 hour intense intervention and up to 8 weeks of
stabilization services
1 hour
Indicates confidence in the ability of this
option to effect meaningful and lasting change
for this youth and family and minimize disruption
of school attendance and school relationships
Step 3 Choose Response Option
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Step 4 Follow Up
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Follow Up Responsibilities
Ensure that familys needs have been met through
the requested service
Be available to work with provider at familys
request
Step 3 Follow Up
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Benefits of New Screening Model
Reduces lost education time
Ensures youth is linked to appropriate services
Eliminates unintended effect of punishing youth
for BH needs
Components Necessary for Successful Implementation
Working relationship between school and screening
and service providers
Working relationship with families
Acceptance of new model to satisfy zero
tolerance policies
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We look forward to partnering with you to meet
the behavioral health needs of your students
Please feel free to contact the Division of Child
Behavioral Health Services
Contact Person
Dr. Nadezhda Robinson
[phone]
Phone Number
E-mail Address
Nadezhda.Robinson_at_dcf.state.nj.us