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HomeMy WebLinkAboutCASSP Newsletter September 2013Editor:s Note’When the Child and Adoles, cent Service System Program (CASSP) began in Pennsylvania more than 20 years ago- funding was provided for each county to hire a CASSP coordinator to help de, velop an infrastructure for an effecttve children:s mental health system at the county level. Over ttme- the roles of CASSP and children:s mental health coordinators have evolved- and many of them serve a variety of functtons in their counttes. Sam Whitesel was one of the original CASSP coordinators. I someitmes refer to myself as a “re– covering” CASSP coordinator: although it seems doubttul that full recovery is possi– ble? I was no wide–eyed newcomer to human services in 1990 when I was hired by the local drug and alcohol provider in Hunitngdon County? I had served for two years as a VISTA volunteer and spent four more years working in state hospitals in two states? The dozen or so years I spent as a carpenter also served me well - my new job was all about building and re– modeling? The agency had been contracted to hire someone to provide CASSP services in the county: regardless of whether or not anyone knew what that meant? I set about reading all the literature that prompted the creaiton of the Child and Adolescent Service System Program in Pennsylvania: meeitng with the state leadership in what was then the Ofce of Mental Health: and meeitng individually with each school su– perintendent: program and agency direc– tor in the county? Within six months we had a team up and running? There was a lot of enthusiasm for cre– aitng something that addressed the issues of children with social and emoitonal chal– lenges? At this itme: Behavioral Health Re– habilitaiton Services (BHRS) and Family–Based Mental Health Services (FBMHS) didn!t exist: and there was no family group conferencing: no children!s intensive case management? In fact: there wasn!t even a therapist in the county des– ignated to provide children!s services? The Adolescent and Children!s Team (ACT) team had to rely on each other!s creaitvity and the commitment to put together a plan for the child and family? Rules gov– erning how the team operated: including referral procedures: confidenitality proto– cols: meeitng schedules and paritcipants were hammered out at monthly meeitngs I held with agency directors: administra– tors: and superintendents? Those advisory committee meeitngs were rarely pretty: but formed the basis for a host of iniita– itves in the ensuing years? The partner– ships were born with handshake agreements? Although I have oflffien cited the number of pro– fessionals who attended the ACT team meeitngs as evidence that our county offered a good example of collaboraiton (385 dif– ferent individuals signed confidenitality state– ments): one hard lesson for me was that hand– shake agreements do not last? For example: in Hunitngdon County alone: since 1991 there have been 19 su– perintendents in the four school districts as well as six children and youth directors and an untold number of provider agency leaders? During the next several years the child–serving systems: not just in Hunitng– don County but across Pennsylvania: ex– perienced some huge changes? In Hunitngdon: Mifflin and Juniata counites: this included the introduciton of BHRS and FBMHS: as well as the transfer of the PA CASSPPA CASSPNewsletterNewsletter Pennsylvania Child and Adolescent Service System Program A comprehensive system of care for children- adolescents and their families Volume 22- Number 3 September 2013 Expect Change( by Sam Whitesel conttnued on page 7 page 2 September 2013 September 2013 Volume 22- Number 3 Tom Corbeti Governor Beverly Mackareth Secretary of Public Welfare Carolyn Dumaresq Acitng Secretary of Educaiton Michael Wolf Secretary of Health Julie K’ Hearthway Secretary of Labor and Industry James E’ Anderson Juvenile Court Judges! Commission Children.s Commitiee of the Office of Men: tal Health and Substance Abuse Services Advisory Commitiee Coychairs Connell O:Brien Gloria McDonald Dennis Marion Deputy Secretary for Mental Health and Substance Abuse Services Stan Mrozowski Director- Bureau of Children:s Behavioral Health Services Harriet S’ Bicksler Newsletier Editor Department of Public Selfare Ofce of Mental Health and Substance Abuse Services Bureau of Children:s Behavioral Health Services DGS Annex Complex Beechmont Building- 2nd toor P. O. Box 2675 Harrisburg- PA 17105 Telephone’ (717) 772,7984 Fax’ (717) 705,8268 E,mail’ c,hbicksle@pa.gov Website’ www.dpw.state.pa.us Subscriptton informatton- The PA CASSP Newsletier is distributed exclu– sively in electronic format and online? Subscribe to the CASSP News listserv to receive e–mail noit– ficaiton when a new ediiton is available at http,••listserv?dpw?state?pa?us•cassp–newslet– ters?html? Access back issues since 2002 by click– ing on the “2011” link? For issues before 2002: contact the editor? Please feel free to print: copy and distribute the newsletter freely? Voices from the Field As a communicaitons professional and not a program or policy specialist person in the Bureau of Children!s Behav– ioral Health Services: I don!t get out much? That is: I don!t make site visits to provider agencies around Pennsylvania and I don!t have much direct contact with the children and families served by the behavioral health system? I listen: however: and I hear lots of stories? Some of the stories aren!t very pretty? In fact: I!ve heard my share of hor– ror stories of how individuals have taken financial advantage of the system: mis– treated the children in their care: or blamed and disrepected their parents and other caregivers? On the other hand: I have met and talked to many individuals working with children and adolescents with emoitonal and behavioral needs who are extremely dedicated: care deeply about children and families: and have worked itrelessly in the system their whole professional lives? Over more than 20 years of publica– iton: this newsletter has featured many aritcles from providers and clinicians de– scribing their work and the children and families they serve? The purpose of these aritcles has usually been to highlight a specific program (such as an evidence– based pracitce like Parent–Child Interac– iton Therapy): a diagnosis (e?g?: atteniton–deficit hyperacitvity disorder): or an issue: like trauma or eaitng disor– ders? Several itmes: whole ediitons of the newsletter have been devoted to telling the stories of children and adolescents with emoitonal and behavioral problems and their families? Oflffien these stories have been told by the children and fami– lies themselves? Some stories have not painted a paritcularly rosy picture of the children!s behavioral health system and some personnel who work in it: but oth– ers praised staff members at various lev– els who were compassionate and went beyond the call of duty to address the challenging behavioral health issues many of these children and adolescents face? The inspiraiton for this issue of the newsletter was a conversaiton between the director of the children!s bureau and a friend who has worked in the behav– ioral health field for many years? This per– son was expressing his exasperaiton with issues he faces daily on the job: saying something like: “Do you know what!s re– ally happening out here.” Aflffier listening to his friend speak frankly about what it!s like “out there” in the field: the bureau director thought it could be helpful for a variety of people who work in children!s behavioral health to share honest per– specitves about the work they do? A “no– holds–barred” approach: he said? Well: the result in this ediiton of the newsletter is probably not really no– holds–barred: but it does explore some of the challenges of working with children and adolescents and their families in the current environment? Early on: when the newsletter was first created: one of its primary purposes was to “share suc– cesses” and we!ve done that? But it!s worth noitng that while there are suc– cesses: and children do get better and receive the kind of help they need to suc– cessfully manage their mental illness: there are many frustraitons and road– blocks along the way and it!s not easy to work in the children!s behavioral health system? At the same itme: it!s also worth noitng that even as they describe the re– aliites they face and express their frustra– iton: all the contributors to this ediiton also write with conviciton: passion: and the desire to do the right thing? Despite the challenges they face: they persist in their efforts to improve the quality of life of the children in their care? Harriet S? Bicksler: editor Editor.s Note-A future ediiton of the newsletter will featurethe perspecitves of the children and families we serve? If you or anyone you know would like to share your story: please contact me? Also: the children!s bureau encourages diverse perspecitves: but publicaiton in the newsletter does not imply endorsement of those views by the Commonwealth? page 3 September 2013 Walt Sitne has been working with children and adolescents with behavioral health needs and their families for more than 25 years: so when he wonders aloud about what!s happening in the system and why he is oflffien frustrated: it!s worth pay– ing atteniton? “I am an idealist and I!m very passionate about what I do:” he says? “I love the kids I work with: and it breaks my heart to see them struggle so much and not receive the support they need in community?” Originally: Walt thought he might like to go into church youth ministry: but when he was interviewed for a new resi– denital treatment program: he decided: “This is what I want to do?” He was the first direct care worker hired for the resi– denital program? He talks about how the youth taught him about himself and chal– lenged the biases he had about youth in the mental health system? He realized early on that he and the other staff members had to be aware of themselves and how they interacted with the youth? If they paid atteniton only to the youths! behaviors and aitftudes: they could not be effecitve? They had to under– stand that many of the youth had experi– enced trauma in their lives: and for the most part: they did not set out to be “bad kids” or to make life miserable for their parents and therapists? He also found that the biggest challenge was figuring out how to engage and empower the parents of the youth and give them the tools they needed to help their children manage their emoitonal and behavioral issues? In the residenital program: staff had direct access to a good psychiatrist for support; they could call him any itme day or night? The psychiatrist followed the progress of the youth on a regular basis: not just a once–a–month medicaiton check that seems to be the focus nowadays? Walt once heard a supervising psychiatrist say that “good outcomes are the result of good medicaiton and good therapy?” Good psychiatry: self–awareness: and everyone sending the same message resulted in success for the youth he served? Unfortunately: while Walt enjoyed his work with the youth: it was also disheart– ening? Many of the youth who were in residenital treatment had significant is– sues; they had experienced abuse: some were fire–starters: some were very aggres– sive in their behavior: and many couldn!t funciton successfully in the community? When they leflffi the program: they oflffien went back into the same environment they came from: without the structure and support they needed to maintain their progress? Aflffier working in the residenital pro– gram for almost 15 years: Walt leflffi the or– ganizaiton for another human service opportunity? He later returned and worked in a Family–Based Mental Health Services program for five years before transiitoning to his current posiiton as a mobile therapist? This varied experience over 25 years gives Walt a birds–eye view of the children!s behavioral health system in Pennsylvania: and leads him to make the following observaitons that are an in– teresitng combinaiton of love for the kids he works with and frustraiton with what is happening in the system, / Many youth need someone to advocate for them with their parents? In turn: many parents seem to think that their children are being difcult for no good reason other than to make them angry? This creates a self–fulfilling prophecy in that the youth begin to think they!re “bad kids:” and so they act in ways that prove it? If their parents or other care– givers only see a “bad child:” it!s dif– cult to change this pattern? So Walt believes it!s very important to help par– ents understand what!s really going with their children? Oflffien: he says: par– ents will say to him: “We had no idea?” / In many cases: the issues a child is deal– ing with are generaitonal: and parents are struggling with their own emo– itonal: financial and marital issues and can!t engage in their child!s treatment? So it takes a major effort to engage them and give them the tools they need to be able to sustain their child!s progress during treatment? If parents don!t buy into it: the best program in the world is not going to work? Some– itmes parents really understand: but then in the stress of everyday life: they can!t sustain their progress when the child is constantly pushing back? / The system seems broken and it!s hard to know what to do to fix it? One thing that seems clear is that EVERYONE needs to work together: especially the family: the school and the therapist? Since a mobile therapist (like Walt: for example) is only with a child for a cou– ple hours a week: it is really important for the school and the family to be on the same page: to understand what is driving the child!s behavior: and to col– laborate in reinforcing what the other is doing? Too oflffien: however: parents and schools are not in sync with each other? Plus: the educaitonal system is changing rapidly: especially with the push toward mainstreaming and no longer providing full–itme emoitonal support classes? As Walt talks about his experience over many years and expresses his frustra– iton with the system and pessimism about any lasitng soluitons in today!s environ– ment: it!s easy to wonder why he keeps doing what he!s doing? But the passion in his voice is also unmistakable and it!s clear that he genuinely cares about kids and wants the system to work as intended so they will succeed? And of course there are those moments when everyone really does get it: when Walt is able to connect with parents and youth in a way that helps them change the way they interact with each other? Walt Sttne is a mobile therapist for a provider in central Pennsylvania. This artt, cle is based on a telephone interview with the editor. An Idealist Faces Reality page 4 September 2013 Toward Regulattons That Make Sense by Robert Bartelt Silver Springs – Maritn Luther School started in 1859 as the children!s program at the Lutheran Home for Orphans and Aged in Germantown? Silver Spring – Mar– itn Luther School opened its Plymouth Meeitng campus in the early 1970s? Sys– tems have changed over the years? Inpa– itent hospital stays were longer: someitmes many weeks: but now stays can be only days before referrals come to our psychiatric residenital treatment pro– gram? In the past: Silver Springs occasionally served children in residenital treatment who were sexually abused? However: a his– tory of severe sexual abuse and other traumaitc events unfortu– nately is the norm for many of the children we serve in resi– denital treatment today? Some of the children have endured unspeakable terror: from being ited to a chair in a basement: smeared with feces and having a gun held to their head: or wit– nessing a father shoot a mother and then place her body in the bed with his child: telling him to never tell anyone what he did? Some of the sexual acts perpetrated on children are too ex– plicitly horrific to describe? All of the children carry burdens and memories and their behavioral reacitons can range from shuitfng down to violent aggression and self–abuse? SS•MLS pro– vides a range of evidenced–based and promising pracitces to help children heal and hope for a brighter future? Silver Springs was honored when Community Behavioral Health selected us as the first children!s residenital seitfng to paritcipate in cogniitve therapy training with The Beck Iniitaitve staff from the University of Pennsylvania? In addiiton to cogniitve therapy: our therapists use Dr? Lyndra Bills! Trauma Art Narraitve Therapy to help reduce the children!s symptoms that oflffien result from being exposed to trau– maitc experiences? As a ceritfied Sanctuary agency: we help children cope with the “bad: sad and scary things” that have happened: know– ing they are Safe: able to acknowledge their Emoitons: accept their many Losses and visualize a more posiitve Future !SELF)? Silver Springs has a talented team of mental health workers who are highly trained in trauma–informed approaches that promote healing? They work every day to teach the children more effecitve ways of managing emoitons? Silver Springs recognizes how difcult it is for children and families when a child needs to be placed in a residenital treat– ment program? We value and encourage acitve involvement of families and care– givers: and we view families as true part– ners? We are committed to providing a safe environment and quality services so children and families can heal: learn and find hope for a brighter future? When pos– sible: we try to reunite children with their families? Over the past several years: the majority of the children in the residenital program have been discharged to a family member (including adopiton)? To assess the impact of our services: in 2001 we developed an aflffiercare survey to determine whether children who were discharged from residenital treatment are “At Home:” “In School:” “Out of Trouble” and “Healthy?” Silver Springs interviews families three: 12: 24 and 36 months aflffier placement and has found that 72 percent of the children have remained in a less re– stricitve seitfng (most oflffien with a family member) three years aflffier discharge from residenital treatment? While the work itself is challenging and rewarding: we deal with other stres– sors: including an environment of overreg– ulaiton? We are inspected and evaluated by four Ofces of the Department of Pub– lic Welfare: four separate managed care organizaitons: the Pennsylvania Depart– ment of Health: Philadelphia Department of Human Services and The Joint Commission (TJC): to name a few? The person hours and costs these organizaitons ex– pend are enormous and they oflffien are examining the same records and the same processes? While we agree that quality care is essenital and it is criitcal that residenital treat– ment programs are regulated and audited: a more cost–ef– cient approach is needed? Some states have begun to use TJC ac– creditaiton as a “Deemed Sta– tus:” wherein agencies that meet TJC!s rigorous standards are consid– ered to be in compliance with state regu– laitons and do not need to undergo repeititve inspecitons? The Common– wealth may want to consider adopitng “Deemed Status” in an effort to save money and to streamline regulaiton and oversight processes? Though difcult: working in a residen– ital program can bring joy? We are hon– ored to help children and families? They are survivors and work incredibly hard to overcome challenges? Many of our staff members keep in touch with children who have been in our care? We are pleased when children and families share their successes as they journey through life healthier and happier? Robert Bartelt is executtve vice president at Silver Springs,Marttn Luther School in Plymouth Meettng. page 5 September 2013 As supervisor for Funcitonal Family Therapy (FFT) at Valley Youth House: I oflffien receive referrals for families with se– rious risk factors such as drug abuse: do– mesitc violence: chronic mental health issues: and repeated exposure to trau– maitc events? I!m forced to confront the full range of the human condiiton every day? The families that have received FFT have leflffi an indelible imprint on me? I!ve had to modify my aitftudes: beliefs and percepitons about people living in poverty: inequaliites in public educaiton: and government assistance? This job re– quires me to constantly evolve as a clini– cian and human being: because as any trained FFT therapist would tell you: fami– lies can sense hypocrisy and disingenu– ousness a mile away? I try to approach my clinical work ob– jecitvely: taking into account all the infor– maiton: including immediate safety concerns (such as suicidal•homicidal risk): symptoms of decompensaiton that might require psychiatric oversight: and possible drug and alcohol abuse or dependence? If I am able to proceed without crisis inter– veniton: I begin to analyze the family to get an idea about who will need to be en– gaged in order to most effecitvely improve the family!s funcitoning? Tatyana!s story il– lustrates this? Tatyana!s grandmother contacted us for help because Tatyana was destroying property and engaging in a variety of high risk behaviors? Her grandmother needed help in order to keep Tatyana at home? The strain on her marriage was almost too much bear? This criitcal informaiton clued therapist Christopher Lee into the ab– solute necessity of not only engaging Tatyana and her grandmother in the ther– apeuitc situaiton: but also the grand– mother!s husband? The iniital challenge my staff and I face is moitvaitng repeatedly traumaitzed family members to buy into the noiton that they can trust: be helped and de– serve help? This means matching language and communicaiton patterns so family members feel heard and respected: not alienated and judged? Diffusing hardened patterns of negaitvity through interven– itons that address the depth of the fam– ily!s issues is the crux of the FFT model and the most challenging yet exciitng ele– ment for me? For example: Tatyana!s grandparents were overwhelmed and terrified when Tatyana was agitated and aggressive: and they typically responded in a similar way in their franitc efforts to calm the situa– iton? Chris explained that Tatyana was try– ing to communicate her distress and she needed help to de–escalate? Her grand– mother understood that Tatyana was not simply being disrespecttul: selfish and out– of–control: but because her own mother chose an abusive partner over her chil– dren: Tatyana had a habit of creaitng situ– aitons to force the adults in her life to care for her needs? Tatyana worried about being invisible in the midst of her grand– mother!s job dissaitsfaciton and marital strife? She and her grandmother both de– sired a close “mother–daughter” relaiton– ship: and through their work in FFT were able to form a rewarding surrogate par– ent–child experience characterized by un– derstanding and mutual respect? I cannot think of anything more pow– erful than the “lightbulb moment” when detrimental: painful blockages are dis– lodged and families experience the liber– aitng effect of a new narraitve for their lives? For Tatyana and her family: Christo– pher was able to hone in on the central theme of Tatyana!s response to past aban– donment which was compounded by her grandmother!s own loss and abandon– ment issues? As the family began to openly look at their history: they realized that although damage had occurred: they could choose to live the healthier lives they deserved? Relentlessly pushing fami– lies towards growth while refusing to allow them to return to familiar unhealthy patterns is the essence of VYH!s FFT pro– gram? Tatyana and her grandparents were taught skills in communicaiton and healthy contict management? Chris was very direcitve in helping the family learn and pracitce new skills: despite their dis– comfort? The right skills need to be taught in the right away: so we always have to proceed cauitously? When we!re thought– ful and pracitce fidelity to the FFT model: posiitve outcomes are the norm? The fam– ily!s angry and anxious demeanor was re– placed with calm and hopefulness? Tatyana began spending less itme with negaitve peers and more itme with her grandmother and other extended family members? She was passing the 10th grade and not acitng out at school? She became a babysitter to her younger cousins as her grandmother grew to trust her again? She no longer used alcohol or other drugs: and she began to make plans to join the track team? Her grandmother became more aware of her own stressors and how they contributed to her parenitng strug– gles? She began the process of changing jobs because the one she had was taking a toll on her health and well–being? When I contacted the family to get permission for this story: the grandmother reported conitnued success for the family? Tatyana is sitll doing well in school and at home: and her grandmother has changed jobs to one that is less stressful? Most im– portantly: their relaitonship conitnues to be strong? Everyone involved in the FFT process must courageously confront defensive– ness and resistance: manage the ebbs and slows in relaitonships with others: and stop re–enacitng unhealthy patterns from the past? When this is done successfully: the rewards are great: not only for the family but also for the therapists and provider’ Josh Snyder is a Functtonal Family Thera, pist supervisor at Valley Youth House- and May Ambrogi is program supervisor and FFT nattonal consultant. Valley Youth House has offered FFT to families since 2001 and has been recognized for success, ful outcomes and commitment to model fidelity. The Rewards of Helping Families Break the Cycle by Josh Snyder with May Ambrogi Over the last 6–7 years in Pennsylva– nia: an interesitng and financially neces– sary shiflffi has occurred in the juvenile jusitce system that has yielded some posi– itve results: but has also had unintended consequences? When the recent economic recession took hold in America: the human services sector was hit paritcularly hard and significant budget re– ducitons were implemented to assure that county govern– ments would be able to sur– vive financially? In response: funding for juvenile jusitce (JJ) was reduced (plus: overall re– ferrals to the system began to wane) and the stakeholders responsible for responding to the needs of the children in the system began to develop unique strategies to secure funding to provide the care that those children needed? The most significant strategy that was em– braced was introducing mandated juve– niles to the behavioral health (BH) system to help fund treatment? This unusual mar– riage between a mandated system of in– terveniton and supervision (JJ) and a voliitonal system of treatment sought by the paitent (BH) remains intact? I began working in the JJ world in 1997 at a small inpaitent treatment facility for juvenile sex offenders? I was trained as a clinician whose goal was to provide the appropriate care to those mandated to the facility? The work was challenging: yet rewarding? The literature and empirical ev– idence have proven rather consistently that cogniitve behavioral therapy is the most effecitve manner to meaningfully re– duce the level of risk a client poses to the community in the future while concur– rently improving their quality of life? Therefore: therapeuitc philosophies were the cornerstone of our intervenitons? Be– tween 1997 and 2006: the care we pro– vided was funded by the Juvenile Court: which allowed for essenital communica– iton between the treatment team and the probaiton ofcer? The work we did to– gether was important for the clients we saw in both inpaitent and outpaitent: as well as the community? However: in 2006: as Juvenile Court funding decreased: we were asked to move to a new strategy of reimbursement overseen by the world of behavioral health? Iniitally: moving into an arena in which therapeuitc dictates reigned seemed like a no–brainer for us: but difculites quickly emerged? Right from the beginning of this shiflffi (more commonly known as the “tip”): nomenclature issues were a significant challenge? In our previous incarnaiton: the juveniles ordered to our care were known as offenders? Gradually: even before the tip: we began referring to the juveniles as our clients? Aflffier the tip: the juveniles be– came known as consumers? The subtle change in locus of control cannot be un– derstated and is related to the rules dictat– ing the care provided based on the overarching philosophies of the regulatory body providing funding (BH)? In 1997: a ju– venile adjudicated delinquent for involun– tary deviate sexual intercourse (IDSI) was ordered into treatment as an offender? In 2013: the juvenile is a consumer who is typically referred to the least restricitve environment to receive care? This defini– itonal pivot is simply related to a change in funding: but the ramificaitons could be far more concerning than iniitally thought? In most cases: for a juvenile to be placed in our facility: an independent screener must idenitfy the care as med– ically necessary for the child to be funded through his insurance? In the case of sex– ual crimes: there are oflffien many details of the crime and the juvenile!s history that are not evident at the itme of iniital evalu– aiton (which is oflffien post–adjudicaiton: but pre–disposiiton)? Many attorneys rec– ommend that their clients not meaning– fully paritcipate with the evaluator: which contributes to the dearth of informaiton available with which to make a determina– iton of medical necessity? Moreover: sex– ual crimes are shrouded in mystery and the accused frequently don!t want to dis– cuss embarrassing issues that might help determine the need for treatment? Conse– quently: the evaluator is leflffi with very lit– tle informaiton with which to formulate an opinion regarding medical necessity? More oflffien than not: since funding for care is being provided through the BH world: the evaluator recommends the least restricitve level of care for the child? Of course: this puts the child and other children at risk because of the lack of in– formaiton with which to make a recom– mendaiton for appropriate care and because the juvenile being evaluated is: more oflffien than not: uninterested in pur– suing treatment voliitonally; in fact: he or she is generally invested in avoiding treat– ment? Recently: some juveniles have been placed in the least restricitve level of care where: by definiiton: there are fewer checks and balances for oversight? More– over: they are comingled with others who have no history of interpersonal sexual boundary violaitons or engagement in the legal system? Sadly: this has resulted in acts of sexual abuse against peers in those placements creaitng other vicitms and re– inforcing the inappropriate sexual behav– ior that previously brought the juvenile to the atteniton of the court? Rather than in– vesitng in an intensive diagnositc and ther– apeuitc interveniton from the front end: the mandated client was placed in a least restricitve environment designed for youth who are genuinely seeking treatment and interveniton? These blurred lines have re– sulted in poor outcomes for other inno– cent children and have done a disservice to the juvenile referred to treatment for is– sues he likely doesn!t think he has? page 6 September 2013 Blurred Lines by Jay Deppler conttnued on page 7 CASSP contract to the newest and ulit– mately largest children!s mental health provider and the introduciton of another CASSP coordinator to the joinder counites of Mifflin and Juniata? There were a lot CASSP meeitngs’ The majority of those meeitngs author– ized BHRS? The requirement for a mulitdis– ciplinary team to recommend the new services seemed to mesh well with the es– tablished teams? I struggled oflffien trying to balance CASSP principles with team recommendaitons? Maybe I!m being a bit harsh: but quality of service delivery did not appear to matter as much as filling a void? I oflffien hoped that the intervenitons did no harm? In the mid to late 90s: the Hunitng– don: Mifflin and Juniata County joinder hired a new administrator who had previ– ously worked as a CASSP coordinator in another county and as the state CASSP contact before that? More changes? The CASSP posiitons became county posiitons within the MH•MR administraitve ofce? There were again two of us: although a different two? I remained responsible for Hunitngdon County: and Barb was respon– sible for the other two? Early 2000s? More changes? New job duites for Barb and new job duites for me? CASSP coordinator for all three counites and some other duites as assigned got added to my job descripiton? Given that the majority of the team meeitngs were related to exisitng services: we began training children!s case managers: children and youth case workers: probaiton of– cers and others in how to facilitate intera– gency meeitngs? Our hope was that for– mal CASSP meeitngs would be reserved for the most complex or vexing cases? What we did not count on was just how onerous this task was to those who don!t like process and do not feel comfortable running meeitngs: let alone meeitngs that can get contenitous? CASSP meeitngs be– came more rare? With numerous iniitaitves working their way through state program ofces: including Integrated Children!s Service Plans: I kept meeitngs with the system leaders in all three counites going? I saw one of my roles as a conduit for informa– iton between the state and county au– thoriites? If nothing else: I was going to keep everyone up to date on best prac– itce? There were oflffien complaints that people missed the old days of having CASSP meeitngs run by a CASSP Coordina– tor? In 2006 came another big adjust– ment? I was assigned responsibility for Early Interveniton (EI) as well as CASSP in all three counites? The learning curve was steep? There are not a lot of similariites between the two systems? The providers and the EI staff from the base service units put up with my ignorance and ran things well in spite of it? My job as EI coor– dinator presented an opportunity to focus some atteniton on the social and emo– itonal delays of young children and we are doing that now in our county joinder? My commitment to this stems in part from the years around CASSP tables hearing folks say they wished they could start ear– lier with children? We are opening up the EI system to help make that difference? This fall we will be offering depression screening for caregivers when their child enters service? Three years ago: during the creaiton of the annual Integrated Children!s Service Plan we hatched a plan for the re–intro– duciton of the CASSP coordinator posi– iton? The beauty of the proposal was that the children and youth agencies from each of our counites would split the costs for the posiiton with the mental health program? Given the choice of posiitons: I chose EI? Megan was hired as the CASSP Coordinator? She runs a lot of meeitngs? The change has been a successful? One of the most saitsfying accom– plishments over the last 20+ years is that CASSP principles have been adopted and insittuitonalized within behavioral Health– Choices? It will be up to the next genera– iton to make sure they are operaitonalized? Obviously I no longer have any CASSP responsibiliites but I!ll conitnue to promote pracitces within the EI system that are in keeping with them? There used to be annual statewide CASSP conferences? At one of them: dur– ing one of the breakout sessions we dis– cussed recommending to all the attendees that they include in everyone!s job descripiton and drill into every profes– sion!s training the expectaiton of “change?” It seems so hard for so many: but change will happen: so expect it’ Sam Whitesel is now the early interven, tton coordinator for Hunttngdon- Mifflin and Juniata Counttes. page 7 September 2013 conttnued from page 1 The need to respect each individual!s dignity is the essence of successful treat– ment and care? The success of treatment is hard to refute when reviewing the liter– ature for this specific populaiton? How– ever: it seems counterproducitve to provide a juvenile who has a documented history of interpersonal violence (that he does not want to discuss) with the oppor– tunity to act out in a less structured envi– ronment? Instead: it makes more sense to place a juvenile with a documented his– tory of interpersonal aggression in a re– stricitve seitfng loaded with therapeuitc intervenitons and demand that he demonstrate a level of insight and appro– priateness before he can step down to a less restricitve environment? That way we all could deliver more meaningful inter– venitons to our consumers without put– itng others at risk? If voliiton could be mandated: our blurred lines would come into focus and our ability to protect the community and provide successful inter– venitons would improve by leaps and bounds? Jay Deppeler is president and CEO of Edi, son Court- Inc. in Doylestown. Edison Court provides therapeuttc and evaluattve services to at risk youth and victtms of crime- and specializes in the treatment of juvenile sex offenders- sexual abuse vic, ttms and families. conttnued from page 6 page 8 September 2013 PA CAWWP Newsletter published by Penns-lvania Department of Public Selfare Office of Mental Health and Wubstance Abuse Wervices Bureau of Children:s Behavioral Health Wervices My ittle is a mouthful, clinical care manager supervisor at Community Behav– ioral Health (CBH): working with the Spe– cial Needs and Asseritve Aflffiercare Outreach Teams? But the mouthful of words says something about the amount of work we do? We are a unique team in our department – the first of its kind – in that we manage an outreach iniitaitve with our members to ensure that they are linked to quality behavioral health serv– ices? We have been in existence a little over four years and have worked with more than 5:000 members? Most of the members we work with are at high risk with severe mental illness requiring much support in the community? Our team pro– vides knowledge: resources and support to the CBH members we serve? While our vision and mission is to connect and assist with the stabilizaiton of our members in the community: there are days when we deal with obstacles and crises where it takes much more than a telephone call to assist? We typically follow a member for about one year to ensure reintegraiton into the community and implementaiton of behavioral health services as recom– mended and authorized? One itme: how– ever: we were involved with a member for over three years? Yes: that is correct; for three years we worked with Amy: an ado– lescent who was transiitoning into adult– hood out of residenital treatment in Georgia and back to Philadelphia? Amy was dually diagnosed with an intellectual disability and a severe mental illness? While most of the members we follow have extreme socioeconomic issues and stressors added to the behavioral health component: Amy seemed to carry the whole gamut of issues? When we met her: we were amazed by her charming person– ality and resilient characterisitcs that had carried her thus far? Despite abuse by family members as a child: she conitnued to have love for them: as well as a desire to have a relaitonship with them? Throughout the itme we worked with Amy: however: it was clear that her family was frequently contribuitng to her down– fall: enabling decisions she was making that would put her in danger instead of help her to grow? This was an extremely difcult situaiton for us? There were many itmes we felt powerless and hopeless about her situaiton? But even as she leflffi the placements we assisted with: and leflffi behavioral health services that were put in place: she always called our team and told where she was and that she was safe? The relaitonship and rapport we had built with her along the way conitnued to be reinforced? Unfortunately: Amy!s story did not end in an ideal way? We wished she could have received a residenital placement with funding through the Intellectual dis– ability system; we wished she would con– itnue to paritcipate in behavioral health services: but that is only part of her story? She became pregnant and further compli– cated the situaiton? We met endlessly with the different systems involved - child welfare: behavioral health and intellectual disability - in order to develop the most comprehensive plan for her and her un– born child? We were able to connect her to one of the most supporitve case man– agement enitites through the Department of Behavioral Health: the Conitnuity of Care team: which assisted her throughout her pregnancy in areas that we could not? She connected to her team and was able to secure most of the supplies needed for the baby: in addiiton to temporary hous– ing? Eventually she transiitoned from the Conitnuity of Care team to a more perma– nent mental health case management team that would be able to follow her long–term and assist her needs? So while everything we wanted and hoped for her did not happen as we had hoped: as a team we learned so much from this situaiton? We learned about one person!s resilience and right to make her own decisions for her life? We learned that we can conitnue to be supporitve to our members just by answering the phone when they want to talk? Or we can simply be a part of a face–to–face meeitng to show we care? We learned that there is always a silver lining in the lives of our members and it takes just one person to find it? We feel Amy definitely showed us that? Marta Warner is a clinical care manager supervisor at Community Behavioral Health in Philadelphia. working with the Special Needs and Asserttve Aflffiercare Outreach Teams. The Life of a Care Manager by Marta Warner