MultiSystem Approaches for MultiSystem Children

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Multi-System Approaches for Multi-System Children

• Judge John J. Specia, Jr.,
• Senior District Judge
• Partner Plunkett Gibson, Inc.

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Texas Child Protection System, 2006
6.3 million children in Texas
1.5 million children living in poverty
Over 821,000 calls to DFPS Intake
Almost 348,000 children in CPS investigations
Close to 68,000 confirmed victims of abuse or
neglect
17,536 children removed from home
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Juveniles Served by Probation Departments Are
Often Clients of State Human Service Agencies
Served by Child Protective Services in Same
Year 17
Juveniles Referred and/or Supervised in Texas
Juvenile Probation System 2005 99,173
Received Medicaid or CHIP Service in Same Year 46
Received state MH or Substance Abuse Service in
Same Year 7
Source DSHS Policy Workgroup, State Agency
Matching 2006
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MULTI-AGENCY DATA-MATCHING PROJECTfor The
Policy Academy on Co-Occurring Substance Abuse
and Mental Health Disorders
Texas Department of Family and Protective
Services (DFPS) Texas Department of State Health
Services (DSHS) Texas Education Agency
(TEA) Texas Health and Human Services Commission
(HHSC) Texas Youth Commission (TYC) The
University of Texas Addiction Research Institute
Center for Social Work Research
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Greater Percentage of Victims of Child
Abuse/Neglect (as confirmed by Department of
Family and Protective Services in FY2003) with
Juvenile Justice Contact Had Criminal History in
their Family, Had a Behavior Problem, and/or Had
a Substance Abuse Issue
gt
gt
gt
Source DFPS Child Protective Services and TYC
client databases, from Ruggiero, K.M., and Mason,
M. (2006). The role of behavioral health services
among youth in Texas at risk for juvenile
justice involvement Multi-agency data-matching
project for the Policy Academy on Co-Occurring
Substance Abuse and Mental Health Disorders.
Austin, TX.
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But Less Than Half Received Behavioral Health
Services Funded by the State
Source DFPS Child Protective Services, DSHS
Mental Health and Substance Abuse, HHSC Child
Medicaid, and TYC client databases, from
Ruggiero, K.M., and Mason, M. (2006). The role of
behavioral health services among youth in Texas
at risk for juvenile justice involvement
Multi-agency data-matching project for the Policy
Academy on Co-Occurring Substance Abuse and
Mental Health Disorders. Austin, TX.
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A Greater Percentage of Victims of Child
Abuse/Neglect (as confirmed by DFPS in FY2003)
with a Behavior Problem Had an Earlier
Disciplinary Problem Identified by TEA Mostly
Student Misconduct
Source FY2003 DFPS-TEA Data-Match, TEA, October
2006.
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A Vicious Cycle?
Parental Involvement with Criminal Justice
System
May Become a Parent
TEA Earlier Discipline Problem (Student
Misconduct)
Youth Behavior Problem
DFPS Youth
Juvenile Justice Contact
Youth Substance Abuse Issue
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Policy Implications

• Identify and target interventions for youth at a
  younger age (no later than 10).
• Quality screening and early intervention have
  been found to sharply improve outcomes for
  children with serious emotional disturbances.
• Screening and early interventions are less
  expensive and can be implemented on a larger
  scale.
• Target more interventions/services toward youth
  with a behavior/discipline problem, substance
  abuse issue, and/or a family member with criminal
  justice involvement.

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Data-Sharing Implications

• Children with serious emotional disturbances
  (including co-occurring) have the highest rate of
  school failure, and are at extreme risk for
  injury, death, employment and housing problems,
  criminal justice involvement, and increased state
  costs due to poorer treatment outcomes (Pennell
  et al., 2003).
• Therefore, it is imperative that State agencies
  create data systems that integrate child data to
  better understand child outcomes and to identify
  intervention points. 
• Through the use of a data warehouse, State
  agencies can provide child data to be matched
  using tested algorithms to produce the greatest
  likelihood of integration between datasets. 
• Once matched, de-identified data sets can be
  created to answer questions that unmatched data
  sets cannot address.

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.Protecting the Future by diverting Children to
essential Care today!

• Bexar County
• Childrens Diversion
• Initiative

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Implementation of the Initiative

• Unlike adults, children are routinely in contact
  with a wide range of institutions
• The GAINS Center model that suggests identifying
  intercept points to promote needed access to
  mental health services is used to organize the
  effort
• The full stakeholder group is attended by all and
  meets quarterly to review progress
• Three subcommittees were formed to begin working
  on intercept points and interventions

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Gaps in Intervention

• 18,500 alleged abuse and neglect victims not
  provided coordinated services
• 5,900 juveniles not provided coordinated services
• 77,376 students violate school code of conduct -
  no coordinated intervention

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Gaps in Intervention (contd)

• Research suggests that many behavioral health
  problems crises could be prevented or ameliorated
  with prevention, early detection and
  intervention.
• Early intervention efforts can improve school
  readiness, health status, academic achievement,
  reduce the need for grade retention, special
  education services, juvenile justice services,
  welfare dependency.

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Shared Populations

• 26 of victims of abuse become involved in
  juvenile justice system
• 80 of juvenile families have history of CPS
  involvement

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Children in Need

• Juvenile Probation FY 2005
• 11,000 referrals
• 6,500 juveniles
• Similar risk factors
• 30-50 present with mental health issues
• 60-80 present with substance use difficulties
• 35-45 learning disabled

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Identifying Target Population

• Emphasis on 1st Time Offenders
• Family assault cases frequently detained
• Suspected high rates of mental health needs
• Complexity of behavior results in extended
  detention
• 10-13 years of age
• Severity and duration of behavior results in
  extended detention and involvement in justice
  system

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Gaps in Screening Early Identification

• Child Protective Services
• Does not conduct formal behavioral screenings on
  all alleged victims
• Assessments conducted on confirmed victims who
  receive services
• Juvenile Probation
• Does not conduct formal behavioral screenings on
  all children referred to the department
• Biopsychosocial assessments conducted on those
  requiring residential treatment
• Schools
• Does not conduct formal behavioral screenings
  on youth considered for District Alternative
  Education Placements (DAEP) or other school code
  of conduct violations.

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Goals

• To create an effective system of care to include
  early identification and early prevention of
  mental health and substance abuse crises for
  children involved in child-serving systems.
• To create an improved crisis response system that
  moves children and families to best practice
  supports and services based on level of need.
• To increase community capacity through a Crisis
  Care Model that recognizes early mental health
  and substance abuse needs for children.

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Childrens Crisis Outreach

• Target population
• School children In FY 2005-2006 77,346 students
  received either an expulsion to a JJAEP,
  placement to a DAEP, in school or out of school
  suspension for a Code of Conduct violation.
• Foster family children For FY 2007 through the
  month of April 3,090 children were in foster
  care, of these, 832 have identified emotional
  characteristics and 332 have drug/alcohol
  characteristics.

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Treatment Foster Care

• Target population
• Children whose mental health symptoms have
  contributed to a juvenile detention admission and
  juveniles with a potential admission to a RTC or
  TYC. On average 6,600 youth are detained a year,
  there are 300 RTC placements and 248 TYC
  placements. Data indicates anywhere from 55 to
  70 of juveniles have a mental health or
  co-occurring diagnosis.
• Children in crisis who are NOT involved with the
  juvenile justice system, however, their mental
  health symptoms continue to escalate despite
  traditional outpatient services and two or more
  hospitalizations within an 18 month period.

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C
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Collaboration

• Its Promise The Key Framework for Systemic Reform

The progress we have been able to make through
collaboration is amazingwe function as a
cohesive core committed to the same mission
instead of various groups working
independentlytheres a lot of power to effect
lasting change in that. - Stakeholder,
Alexandria Project Site Source Dobbin, S.A.,
Gatowski, S.I., and Maxwell, D.M. (2004)
Building a Better Collaboration Facilitating
Change in the Court and Child Welfare System,
p2, The Technical Assistance Bulletin, Vol. 8(2).
National Council of Juvenile and Family Court
Judges. Reno, Nevada.
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Collaboration

• Its DangerThe Thief of Time

We have a million committees. A committee gets
started for everything. We have duplicate
committees, committees that have collapsed, some
that are conflicting in recommendations, and no
overall hierarchy -Stakeholder, Charlotte
Project Site Source Dobbin, S.A., Gatowski,
S.I., and Maxwell, D.M. (2004) Building a Better
Collaboration Facilitating Change in the Court
and Child Welfare System, p42, The Technical
Assistance Bulletin, Vol. 8(2). National Council
of Juvenile and Family Court Judges. Reno,
Nevada.
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Collaboration

• The Reality A Critical Tool for System Change

Dont underestimate it the collaborative
process. It reflects an important consensus
building that has a lot of unanticipated
consequences that can be positive or negative.
Develop efficiency and partnerships. The broader
the consensus, the broader the vision. -
San Jose Source Dobbin, S.A., Gatowski, S.I.,
and Maxwell, D.M. (2004) Building a Better
Collaboration Facilitating Change in the Court
and Child Welfare System, p127, The Technical
Assistance Bulletin, Vol. 8(2). National Council
of Juvenile and Family Court Judges. Reno,
Nevada.
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Differentiating Coordination, Cooperation and
Collaboration

• PRECONDITIONS FOR SUCCESS (MUST HAVES)
• COORDINATION Shared objectives, need for more
  than one person to be involved Understanding of
  who needs to do what by when
• COOPERATION Shared objectives Need for more
  than one person to be involved mutual trust and
  respect Acknowledgement of mutual benefit of
  working together
• COLLABORATION Shared objectives sense of
  urgency and commitment Dynamic process Sense of
  belonging open communication mutual trust and
  respect Complimentary, diverse skills and
  knowledge Intellectual agility
• All of the above from Wikipedia

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SILOSTIC AGE
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• UTOPIAN EPOCH

DSS
Mental Health
Kids and Families
Juvenile Probation
TYC
Courts
Schools
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Leading Change The Eight Stage Process of
Creating Major Change

• Establish a Sense of Urgency
• Develop a Vision and Create a Guiding Coalition
• Strategy
• Communicate the Change Vision
• Empower Broad-Based Action
• Generate Short-term Wins
• Consolidate Gains and Produce More Change
• Anchor New Approaches in the Culture
• Evaluate Both the Collaborative Process and the
  Changes Implemented

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Permanent Judicial Commission on Children, Youth
and Families

• Conference of Chief Justices Summit 2005
• Foster Care Consultative Group Dec 2006
• Consultative Group Report March 1,2007
• Supreme Court Public Hearing on feasibility of
  Judicial Commission Sept 25,2007
• Order Establishing Commission

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Statement of Principles

• Texas courts shape the lives and life chances of
  children.
• All children should be treated equally and
  deserve safer permanent homes.
• Children and families should have a voice in
  decisions that affect their lives.
• All parts of the system have joint
  accountability, responsibility and commitment to
  ongoing improvement

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Statement of Principles (contd)

• Sharing appropriate information enhances judicial
  efficiency and is in the best interest of the
  child.
• Efforts to improve the foster care system must
  focus on improving safety, permanency, well-being
  and fairness outcomes for children.
• Best practices should be data-driven,
  evidence-based, and outcome-focused.
• Children should not just be protected but
  equipped for long-term success.

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Statement of Principles (contd)

• The needs of children in foster care extend into
  early adulthood.
• Decisions and services should be mindful of the
  childs clock
• Each child should have a chance to develop at
  least one lasting relationship before leaving the
  system.
• Collaboration among systems, participants and the
  state is essential for achieving the best
  possible outcomes for children and families.

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Mission Statement

• The mission of the Permanent Judicial Commission
  for Children, Youth and Families is to develop
  and implement policy initiatives designed to
  strengthen courts for children, youth and
  families in the child-protection system and
  thereby improve the safety, permanency, and
  well-being of children.

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Goals

• Identify and assess current and future needs for
  the judiciary to be more effective in serving
  children, youth and families
• Improve court performance and accountability in
  achieving child-welfare outcomes of safety,
  permanency, well-being and fairness
• Promote best practices that are data-driven,
  evidence-based, and outcome-focused
• Improve collaboration and communications among
  the courts, child-welfare agencies, and community
  partners.

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Goals (contd)

• Increase awareness of the courts critical role
  in the foster care system and the need for
  enhanced resources
• Identify funding and resource options for child
  welfare services and the courts and
• Provide leadership for meeting the needs of
  children, youth and families in the foster care
  system.