STATE OF WISCONSIN SENATE CHAIR ASSEMBLY CHAIR . at Alberta Darling 4? . John Nygren 309 East, State Capitol PO. Box 8953 Madison, WI 53708-8958 Phone: (608) 266-2343 317 East, State Capitol PO. Box 7882 Madison, WI 53707-7 882 Phone: (608) 266-5830 JOINT COMMITTEE ON FINANCE MEMORANDUM To: Members Joint Committee on Finance From: Senator Alberta Darling Representative John Nygren Date: I January 4, 2016 Re: OCMH Report to JFC Attached is the Wisconsin?s Office of Children?s Mental Health 2015 Report pursuant to 5.51.025l2), Stats. This report is being provided for your information only. No action by the Committee is required. Please feel free to contact us if you have any questions. Attachments in) E..- -- State of Wisconsin Scott Walker, Governor Of?ce 91? Children ?5 EliZabeth Hudson, Director Mental Health January 2, 2016 Governor Scott Walker State Capitol Senate President Mary Lazich Speaker Robin Vos 219 South, State Capitol 211 West, State Capitoi Dear Governor Walker, President Lazich, and Speaker V05: 1 am pleased to present you with the Wisconsin?s Office of Children?s Mental Health 2015 Report to the Legislature as required in s. Wis. Stats. As you may recall, the Wisconsin?s Office of Children?s Mental Health 2014 Report to the Legislature provided an overview of the Office of Children?s Mental Health?s mission, goals and conceptual framework as well as extensive reporting on chiidren?s mental health in Wisconsin. This year?s report outlines subsequent steps taken by the Office of Children?s Mental Heaith to address many of the previously identified issues. While much remains to be done, our staff made great strides in promoting the importance of parent and- youth participation in policy-making, furthering stakeholder collaboration, building a common infrastructure for action, and identifying data to help understand and successfully address challenges. We look forward to 2016 and our continued work with Wisconsin families and policy leaders to ensure that every child is socially and emotionally prepared to enter adulthood. As always, please do not hesitate to contact me if you have any questions. Sincerely, Director, Office of Children?s Mental Health 608?266?2771 eth. ud so Enclosure 1 West \Wilson Street 0 Room 656 I Madison, WI 53707?7850 0 Telephone 608?266-2771 0 Fax 608267?8798 Helping Wisconsin ?3 Children Improve their Social and Emotional Well?Being EXECUTIVE SUMMARY ..2 INTRODUCTION ..4 INNOVATE ..5 INTEGRATE ..7 IMPROVE ..9 RECOMMENDATIONS "11 APPRECIATION .. ?13 2015 Wisconsin Office of Children?s Mental Health Staff Kim Eithun?Harshner, Operations Lead Elizabeth Hudson, Director Kate McCoy, Research Analyst Joann Stephens, Family Relations Coordinator Wisconsin Office Of Children?s Mental Health 1 W. Wilson Street, Room 656 Madison, Wisconsin 53707 608-266?2771 Wisconsin Office Of Children?s Mental Health Annual Report, 2015 Page The Wisconsin Office of Children?s Mental Health (OCMH) has a unique charge. instead of focusing on program development or providing direct services, the OCMH was created to enhance communication within and between state agencies serving children and families, coordinate initiatives, and monitor program performance. Additionally, the OCMH is charged with identifying administrative efficiencies and improving access to services provided by the Department of Children and Families, Department of Corrections, Department of Health Services, the Department of Public instruction, as well as county and communitybased organizations serving Wisconsin?s children. The 2014 Report to the Wisconsin Legislature? set the stage for these activities by providing an overview of children?s mental health in Wisconsin.2 Based on the findings, the OCMH established three action?based categories to address identified issues: innovate, integrate, and Improve. Goal Statement: Systems, policies, and programs are driven by parents and youth with lived experience. The OCMH incorporates a public health approach to mental health that includes increasing awareness of Adverse Childhood Experiences and promoting resilience.4 To promote this goal in 2015, the OCMH: 0 Supported parent and youth collective impact partners leadership and participation; 0 Provided technical assistance to state agencies and other stakeholders committed to including parent and youth voice in policy and program development; - Assisted the Department of Health Services in the development of certified parent peer speciaiists; Participated as a member of the Fostering Futures Steering Committee; a initiated a public/private partnership designed to raise awareness of the impact of ACES and to promote resilience in a select number of workplaces. RATE Goal Statement: Children?s mental health stakeholders create a unified vision, aligned goals, effective intervention, and shared metrics. To address this goai in 2015, the OCMH: - Provided backbone support to the Children?s Mental Health Collective impact (CMHCI) leading to the solidification of the Children?s Mental Health Collective impact Executive Council and the creation of three workgroups; i fbiifcitepettsi Docu 2Every three years the OCMH will provide an overview of various mental health?related metrics similar to those published in the 2014 report. The next overview will be pubiished in in 2017. 3 4 Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 2 a Facilitated cross?state agency collaborative group meetings and distributed information outlining state agency partnership activities. IMPROVE Goal Statement: Services and supports are accessible and lead to recovery and resilience. In 2015, the OCMH led or participated in state-sponsored workgroups aimed at quality improvement and the provision of technical assistance to both state and county agencies in the following issue areas: 0 Crisis response and youth emergency detentions 0 Youth suicides a prescribing patterns 0 Racial disparities in child and youth outcomes 0 School?based mental health 0 Cross-system integration of tra um a?inform ed care 0 infant mental health policy 0 Mental health consultation for infants and toddler - Mental health training for juvenile justice services 0 Data collection and integration. CONCLUSION While much remains to be done, in 2015 OCMH staff made great strides in promoting the importance of parent and youth participation in policy-making, furthering coiiaboration, building a common infrastructure for action, and identifying data to help ?There is significant power in Wisconsin?s motto, understand and ?Forward.? This concept is reflected in the Office of address Challenges- Children?s Mental Health?s focus on innovation, integration, and improvement. More specifically, the Children?s Mental Health Collective impact process is the epitome of what it is to move ?Forward.? As the backbone of this collective impact initiative, the OCMH facilitates a diverse group of people who are creating a forward direction that will lead to a healthier and more prosperous state for all who call Wisconsin home.? ?Tina Buhrow Coilective impact Parent Partner Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 3 2015 marked the first year that the Office of Children?s Mental Health (OCMH) was fully staffed. Under the categories of innovation, integration and improvement, the OCMH staff supported the Children?s Mental Health Collective Impact,5 strengthened the influence of the Children?s Mental Health Collective lm pact parent and youth partners, disseminated data and recommendations about issues facing Wisconsin?s children and families, won a competitive national grant, and met regularly With stakeholders to address a Wide?range of issues impacting children and families. The Office of Children?s Mental Health Action Map (see diagram below) captures many the OCMH concepts. The triangle represents a public health approach,6 the orange arrows indicate staff committement to promoting collective impact and trauma?informed care, and the left corner highlights some of Wisconsin?s most pressing children?s mental health issues. Activities related to these topics will be explained in more detail throughout the report. Additional details related to the activities may be found on the OCMH Logic Model (see Appendix A). ?ffice of Children?s Mental Health Action Map Raise Awareness if High {are Understand ACEsan? hea?ltalizatien; resil?-iamca rate-s Recognize triggers Hligl't growth Hecagjmize silng a? suicide rates emotinrmal l'liigl't y?mtl?i diysregmlaltlam degressrlesm rates Learn: basic sell?? {wild?omths regaiatiom and) de- escal atlas}: efitil 5 masticatiem Shift yer prescribing marital ?leak?? ma?a and perspeda?we tram: pati: ems ?a wmm?m l?tarhiati-E arm mg t-?a?llil?tz that per-mm?? ta: ?What might have haupemedi ta that arse: - ?mliedgeabiiem- has Consist-em Media Messaging 5 See Appendix C1 and the following websites for more information about Collective Impact i1tin:iiWiriiwiyeetarelapse te a 5.5 201 an 0 ice ectivexi tr: 9 a ct: i3 a sit ecti vagranact 5 See 2014 Annual Report (pages 6-8) for a description of the public health approach to children?s mental health Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 4 Goal Statement: Systems, policies, and programs are driven by parents and youth with lived experience. OCMH incorporates a public health approach7 that includes increasing awareness of Adverse Childhood Experiences (ACES) and promoting children, family and community resilience. The following is a review of the 2015 activities regarding this goal. PARENT AND YOUTH INVOLVEMENT AND LEADERSHIP Collective impact Partners: The Family Relations Coordinator recruited and trained ten parents and four youth to serve on the Children?s Mentai Health Collective impact (CMHCI) Executive Council and workgroups. Together, these Collective impact Partners brought decades of lived experience to their participation and leadership in CM Executive Council meetings and workgroups and are changing the content and tenor of state discussions about mental health and resilience. The Collective lmpact Partners? Language Guide (see Appendix 84) is one example of their work. With their guidance and support, state agencies wili be able to better recognize gaps in services, failing programs and unhelpful or cumbersome policies and practices. State infrastructure for Parent and Youth Leadership: The Family Relations Coordinator helped state agencies build an infrastructure for parent and youth involvement extending beyond collective impact. This effort took the form of the group called Leading Together, an initiative bringing parent perspectives into program and policy discussions focused on mental health, education, child welfare, and juvenile iustice (see Appendix 8-2). Drawing on the work of existing family and peer agencies, Leading Together will recruit and train parents to participate in and lead state agencies? workgroups and committees. Technical Assistance and Training to State Activities: The Family Relations Coordinator provided a lived experience perspective to many state initiatives inciuding the following: 0 Review of the Department of Children and Families Child Welfare Practice Model; 0 Training on trauma-informed care to teachers for deaf and hard of hearing students through the Department of Health Services (DHS) Deaf and Hard of Hearing Steering Committee; 0 Participation in the deveiopment of the DHS parent peer specialist state certification; 0 Initiation of the Department of Public instructions (DPI) Parent Advisory Workgroup; 0 Participation in the DPI Trauma Sensitive Schools workgroup and the Safe Schools/Healthy Students Family Engagement Workgroup; 0 Participation as a core team member of a cross-agency Juvenile Justice Policy Academy aimed at diverting youth with trauma and/or mental health issues from the juvenile justice system. 7 Additional information can be found in the following document, A Public Health Approach to Children?s Mental Health: A Conceptual Framework Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 5 INCREASE AWARENESS OF THE IMPACT OF ACES AND THE POWER OF Mobilizing Action for Resilient Communities: Early in 2015, the Health Federation of Philadelphia (with support from the Robert Wood Johnson Foundation and The California Endowment) asked the OCMH to apply for a competitive grant to expand Wisconsin?s innovative work in addressing ACES. The application was subsequently chosen (see Appendix 83) and will focus on introducing ACEs information and strategies to increase resilience in select workplaces. The OCMH will provide oversight and distribute the funding ($50900) to ?These states and cities [award recipients] are living contractual partners Branchz,8 Center for lnvesti gating Healthy Minds,9 and Saint/NO). laboratories that can teach all of us what it takes to transform cycles of trauma into a Culture of Health. Anyone who is interested in strengthening the By bringing this information to the resilience of their community should pay attention to general population, Wisconsin will what these communities are doing.? move towards a universal - Martha 3_ Davis understanding of ACES and I Robert Wood Johnson Foundation resilience. a 9 Wisconsin Office of Chiidren?s Mental Health Annual Report, 2015 Page 6 Goal Statement: Stakeholder collaboration leads to a unified vision, aligned goals, shared metrics, and successful outcomes. The following is a review of the 2015 activities regarding this goal. Children?s Mental Health Collective Impact (CMHCI) Backbone: Collective impact literature outlines that in order to maintain a vital collective impact change process, there must be ?a separate organization dedicated to coordinating the various dimensions and collaborators involved in the OCMH enthusiastically assumed this role which, in collective impact parlance, is called ?the backbone organization.? Children?s Mental Health Collective Impact (CMHCI) Executive Council: The OCMH planned and facilitated eleven Executive Council meetings during which the group developed a common mission (?We wili create an integrated system of care?), a statement of hope (?Every chiid is safe, nurtured and supported to promote optimal health and and three workgroups. Additionaliy, the Executive Council began examining the allocation of state resources in order to identify opportunities to blend or braid funding with the goal ?Our AWARE grant activities were greatly in?uenced by of reducing service silos and the Children?s Mental Health Collective impact. Being a increasing efficiency in financial participant in this process led our team to align the Spending (see direction of our project to reflect state?wide priorities At the dose Of the Year: the and leverage new federal money to achieve the greatest stakeholders created a impact for children and families in Wisconsin.? iist of poiicy-related activities they believe would promote . - Monica Wightman SOClaliY arid emOtlonany Advancing Wellness and Resiliency Education (AWARE) healthy children and families Department of Public Instruction (see Appendix 04). CMHCI Workgroups: The CMHCI Executive Council established three workgroups with the following goals. 0 Access Workgroup Goal Statement: Wisconsin?s children, youth, and families have timely access to high quality, trauma?informed, cuiturally appropriate mental health services that promote children's social and emotional development. In 2015, this group began to identify barriers to access, strategies to remove the barriers, and outcome measures to track progress. 0 Traumawlnformed Care (TIC) Workgroup Goal Statement: Systems are famiiy?friendly, trauma? informed, easy to navigate, equitable, and inclusive of people with diverse cultures, ethnicity, ?2 Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 7 race, gender identity, sexuai orientation and socio?economic status. This group Wiil adapt and distribute a trauma~informed care implementation framework from Missouri (see Appendix C- 5). To assist this group and other stakeholders in recognizing the current scope of counties? transformation, OCMH coordinated the collection of TIC implementation information from county human service directors and tribes (see Appendix C-6). Resilience Workgroup Goal Statement: All Wisconsin?s children, youth and their families have accurate and timely information and the supports needed for social emotional development, optimal mentai health and resilience, including relationships and social networks that provide friendship, love and hope. This group established a cuituraiiy?informed definition of resilience and identified state?level activities focused on developing resilience in children and families. WestEd, an organization supporting the Department of Public instruction, provided this group with a nationai scan of reiated activities. State Agency Stakeholder Collaboration: The held meetings with leadership from the Department of Children and the Department of Corrections, the Department of Health Services, and the Department of Public instruction in order to foster collaboration and exchange information about activities reiated to children?s mental health. To keep stakeholders up?to~date on coiiaborative activities, the OCMH created a living document describing joint projects and initiatives (see Appendix 07). Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 8 Goal Statement: Services and supports are accessible and lead to children and families? recovery and resilience. The following is a review of the OCMH activities regarding this goal. Hospitalizations and Crisis Response: The facilitated the Children?s Emergency Detention and Crisis Services (CEDCS) Workgroup. Over the course of five meetings, this group accomplished the following: . Reviewed data on hospitajiza?ons ?it?s been very helpful to have the Office of and youth access to outpatient Children?s Mental Health present counties and mental health services; providers with data about what?s happening with Received background information kids in our public mental health system, especially arid Updates regarding areas 01? regarding hospitalizations.? greatest need, crisis grants and regional collaborations; - Iris Ostenson . Developed a ?St of Emergency Services Director Northwest Connections recommendations. From the list of recommendations, three smaller workgroups were created to accomplish the following: 6 Collect and disseminate crisis services best practices to all counties; 0 Create a standard training for county staff for state-wide quality assurance; 0 Design and pilot a regional group home that can be used in lieu of hospitalization for the purposes of crisis stabilization. The CEDCS Workgroup will reconvene in April 2016 to review accomplishments and identify next steps (see Appendix D1-3 for a collection of the CEDCS related documents). Drugs: The OCMH participated in a workgroup created by the Department of Health Services (DHS) and the Department of Children and Families (DCF) focused on learning about drug prescribing practices for children on Medicaid as well as children in foster care. The information was gathered by linking Medicaid claims and prescription data with foster care enrollment data to analyze prescribing patterns and non?pharmacological therapies. in addition, group members shared information related to: - DHS project requiring prior authorization before prescribing to children seven years of age and younger; - DHS project which identified children on high doses of stimulants followed by prescriber education regarding best practices in children?s stimulant dosing; CareaKids project developed quality measures in polypharmacy and metabolic monitoring. Wisconsin Office of Children?s Mental Health Annual! Report, 2015 Page 9 Disparities: The OCMH has found that all of Wisconsin?s child?serving systems contend with racial disparities. To deepen understanding of this issue, the OCMH convened two meetings which included representation from the Department of Children and Families, the Department of Corrections, the Department of Health Services, the Department of Justice, and the Department of Public instruction. The meetings revealed varied approaches to the addressing disparities. The OCMH followed up these discussions with a presentation focused on historical trauma and its impact on racial minority groups. The OCMH anticipates that this important issue will be addressed by the Children?s Mental Health Collective impact Resilience Workgroup. School-based Mental Health Services: As noted in the OCMH 2014 report, school?based mental health is viewed by many as a solution to many of the barriers facing children and families seeking mental health services. As was also noted, successful implementation of this model is' contingent on the supportive qualities of the school culture13 and increasing the schools? commitment to trauma sensitivity.14 Other elements include teacher and parent consultation to ensure that the child?s skill development is reinforced in home and classroom environments and those connections are made with community services and supports. To this end, the OCMH participated in related efforts sponsored by the Department of Public Instruction Safe Schools/Healthy Students State Management Team and Advancing Wellness and Resilience Education initiative),15 and also provided consultation to the Coalition for Advancing School~Based Mental Health. infant Mental Health: The OCMH hosted the Infant?Toddler Policy Committee, facilitated by the Wisconsin Alliance for Infant Mental Health, focused on raising awareness of infant mental health in early care and education, medical, and human services systems. Data Analysis Workshops: The OCMH organized five informational workshops for state agency employees with attendance ranging from 40?60 participants. These workshops were recorded and posted online16 and addressed the following topics: 0 Data visualization techniques 0 Tracking trends - isolating causal effects - Designing web-based surveys 0 Matching records across data sources. ?3 ?4 15 ?5 Matching Records Across Data Sets, a814ssqu6c?a?is8 The Nuts and Bolts of Web Surveys, 5c: Time and CaUSality, ti i15.c:.a.t9a i 8.8. a Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 10 To further the momentum in improving the lives of children and families in Wisconsin, the Office of Children?s Mental Health (OCMH) offers the following recommendations. 1. Use 2013 Senate Joint Resolution 59 as a guide to create and/or examine legislative, state agency, and county policy With the passage of 2013 Senate Joint Resolution 5917, Wisconsin became a national leader in defining a role for legislators in the promotion of healthy early brain development.18 Specifically, the resolution advises that, ?policy decisions enacted by the Wisconsin state legislature will acknowledge and take into account the principles of early childhood brain development and will, whenever possible, consider the concepts of toxic stress, early adversity, and buffering The recommends that this resolution, along with the guidance offered in The Science of Early Brain Development: A Foundation for the Success of Our Children and the State Economy,19 become central tools for legislators and other policy makers committed to reducing children?s exposure to toxic stress and increasing children?s resilience. As such, the OCMH will sponsor several workshops in 20i6 outlining how to use this resolution to examine policy proposals. 2. Establish Wisconsin?specific indicators to monitor children?s mental health in order to monitor Wisconsin?s progress in meeting children?s mental health needs, the OCMH will establish, in collaboration with stakeholders, a list of Wisconsin-based indicators that will represent the overall status of children?s mental health in Wisconsin. 3. Develop strategies to further create, develop, and sustain an integrated child and family- serving data system that includes service outcomes Wisconsin state agencies are rich with information related to the well?being of Wisconsin?s children and families. Despite the extent of Wisconsin?s data collection, there are challenges that prohibit much of the data from being used for predictive analytics, policy analysis, system recommendations, and quality improvement. These challenges include the following: data is largely isolated within each state agency and not designed to interface with other datasets; many state programs lack data on outcomes; many services are offered through counties with minimal information filtering to the state; and, with some exceptions, there is a lack of standard protocol for how to access available data. alb' ?9 eed alh i unloadsijzo i Bio? ?3 Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page ll Many divisions across the Department of Children and Families, the Department of Corrections, the Department of Health Services, and the Department of Public instruction have or are undertaking efforts to address some of these issues. For instance, the Department of Children and Families has established public-facing, interactive dashboards and regularly publishes performance reports,20 and, notably for children?s mental health and the reduction of data silos, the Department of Children and Families and the Department of Public Race to the Top Early Learning Challenge grant21 is initiating an Early Childhood Integrated Data System With regard to data standardization, the Department of Corrections is moving towards a data system that will allow its juvenile iustice data to interface with its adult inmate data. The Department of Health Services is working to integrate Medicaid and mental health and substance abuse data. Additionally, the Department of Public Instruction has created a data governance structure which is very user-friendly. The OCMH recommends that state leadership support current efforts while also pursuing a truly integrated child and family-serving data system that prioritizes the inclusion of service outcomes within all data collection activities. 2? cilwisco 2? Wisconsin Of?ce of Children?s Mental Health Annual Report, 2015 Page 12 The following people have dedicated a great deal of time and attention to ensuring that the Office of Children?s Mental Health (OCMH) goals and activities are successful and that the OCMH efforts translate into the improvement of the lives of Wisconsin?s children and families. Children?s Mental Health Collective Impact Executive Council Joyce Alien Micheal Bostrom Fredi Bove Paula Buege Tina Buhrovv Susan Cochran Kimberlee Coronado Kim Eithun Terri Enters Mina Esser Catherine Foster Martina Collin?Graves Greenberger Linda Hall Jennifer Hammei Hanson Judie Hermann Jon Hoelter Jill Hoiting Elizabeth Hudson Cheryl atczak Michelle Jensen Goodwin Sheri Johnson Robin Joseph Rob Kaminski Zofia Kaminski Arianna Keil Kia LaBracke Leah Ludium Bonnie MacRitchie Linda McCart Steven Michels Charlene Kathy Mullooly Rebecca Murray Department of Health Services Collective impact Youth Partner Department of Children and Families Collective impact Parent Partner Collective impact Parent Partner Department of Health Services Collective Impact Parent Partner Office of Children's Mental Health Department of Health Services Collective impact Parent Partner Collective impact Parent Partner Mental Health America of Wisconsin Disability Rights Wisconsin Wisconsin Association of Families and Children's Agencies Children's Hospital of Wisconsin Anu Family Services Department of Children and Families Department of Health Services Supporting Families Together Association Office of Children's Mental Health Department of Health Services Wisconsin Child Abuse and Neglect Prevention Board Medical College of Wisconsin Department of Health Services Collective impact Parent Partner Collective impact Youth Partner Children?s Health Alliance of Wisconsin Wisconsin American Academy of Pediatrics Department of Health Services Department of Children and Families Department of Health Services Wisconsin Economic Development Corporation United Way of Wisconsin Collective impact Parent Partner Child Abuse and Neglect Prevention Board Wisconsin Office of Children?s Mental Health Annual Report? 2015 Page 13 Gail Nahwahquaw Lana Nenide Tracy Oerter Karen Ordinans Mechelle Pitt Chuck Price Donovan Richards Lisa Roberts Romilia Schueter Kayla Sippl Carolyn Stanford Taylor Corbi Stephens Joann Stephens Bill Swift Cari Taylor Dimitri Topitzes Sarah Tweedale Susana Valdez?Shogren Mai Zong Vue Cody Warner Paul Westerhaus Monica Wightman Doug White Alison Wohc Department of Health Services Wisconsin Alliance for infant Mental Health Children's Hospital of Wisconsin Children's Health Alliance of Wisconsin Anu Family Services Wisconsin County Human Services Association Collective impact Youth Partner Waukesha County Human Services Supporting Families Together Association Department of Health Services Department of Public instruction Collective impact Youth Partner Of?ce of Children?s Mental Health Wisconsin American Academy of Child and Adolescent Department of Corrections University of Wisconsin Milwaukee Coliective impact Youth Partner Collective impact Parent Partner Department of Health Services End Domestic Abuse Wisconsin Department of Corrections Department of Public Instruction Department of Public instruction Collective impact Parent Partner Children?s Mental Health Coliective impact Partners Micheal Bostrom Catherine Foster Tina Buhrow Robert Kaminski Kim Coronado Zotia Kaminski Mina Esser Corbi Stephens Children?s Mental Health Collective Impact Workgroup Members Kathy Sarah Tweedale Susana Valdez?Shogren Alison Wolf Access Workgroup Joyce Allen, Co-Chair Rob Kaminski, Co-Chair Amber Arb Vaughn Brandt Bush Susan Cochran Kimberlee Coronado Jennifer Hastings Cheryl 'Jatczak Sarah Kate Johnson Robin Joseph Linda McCart Department of Health Services Collective impact Parent Partner Department of Health Services Department of Children and Families Department of Public Instruction Department of Health Services Collective impact Parent Partner Kids Matter inc. Department of Health Services Department of Health Services Department of Health Services Department of Health Services mm Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page 14 Kathy Schoff Teresa Steinmetz Joann Stephens Naomi Westerman Family Service Madison, inc. Department of Health Services Office of Children?s Mental Health Children?s Hospital of Wisconsin Trauma-informed Care Workgroup Tina Buhrovv, Co-Chair Kia LaBracke, Co-Chair Donna Burns Michelle Buehi Amy D?Adarrio Nic Dibble Kasey Kaepernick Susan LaFiash Leslie Mechelle Pitt Ann Rolling Dana Romary Lori Wittem an Resilience Workgroup Susana Vaidez~Shogren, Co-Chair Cody Warner, Co-Chair Linda Benton Paula Brown Carrie Finkbiner Peggy Helm-Quest Laurice Lincoln Jeneil Lorek Rebecca Murray Schueter Rebecca Wigg?Ninham Monica Wightman Alison WohC Collective impact Parent Partner Wisconsin American Academy of Pediatrics Wisconsin Trauma Project Department of Corrections Children?s Health Alliance of Wisconsin Department of Public instruction Waupaca County Human Services Department of Health Services Department of Children and Families Anu Family Services Children?s Hospital of Wisconsin Department of Health Services Department of Health Services Collective impact Parent Partner End Domestic Abuse Wisconsin Department of Health Services Department of Children and Families Wisconsin Alliance for Children?s Mental Health Department of Health Services Department of Health Services Children?s Hospital of Wisconsin Child Abuse and Neglect Prevention Board Supporting Families Together Association Department of Health Services Department of Public instruction Collective impact Parent Partner OCMH Advisory Council and Special Advisers Joyce Allen Eloise Anderson Fredi Bove Paula Buege Patrick Cork Christie Gause?Bemis Casey Himebauch Cheryl Jatczak Michelle Jensen Goodwin Robin Joseph Gail Nahwahquaw Department of Health Services Department of Children and Families Department of Children and Families Collective impact Parent Partner Department of Health Services Department of Public instruction Office of the Governor Department of Health Services Child Abuse and Neglect Prevention Board Department of Health Services Department of Health Services Wisconsin Office of Children?s Mental Health Annual Report, 2015 Pageig Deb Rathermei Department of Health Services Kitty Rhoades - Department of Health Services Paul Westerhaus Department of Cerrections State Agency Collaborative Activities Committee Joyce Alien Department of Health Services Fredi Bove Department of Children and Families Patrick Cork Department of Health Services Christie Cause-Semis Department of Public instruction Casey Himebauch Office of the Governor Elizabeth Hudson Office of Children?s Mental Health Paul Westerhaus Department of Corrections Doug White Department of Public instruction OCNIH 2015 Annual Report Reviewers Joyce Allen Department of Health Services Fredi Bove Department of Children and Families. Tina Buhrow Collective impact Parent Partner Jason Fischer Department of Health Services Christie Gause?Bemis Department of Public instruction Shel Gross Mentai Health America of Wisconsin Kelsey Hill Department of Corrections Casey Himebauch Office of the Governor mm Wisconsin Office of Children?s Mental Health Annual Report, 2015 Page ?16 INTRODUCTION Appendix A: IN NOVATE Appendix B: 8-1 8?2 3?3 INTEGRATE Appendix C: C-1 C?2a?2f IMPROVE Appendix D: D-t D-B Wisconsin Office of (iniiclren?s Mentai Heaith Annual Report, 2015 Logic Modei Coiiective impact Partners? Language Guide Framework for Parent and Youth Leadership OCMH and Heaith Federation MARC Press Reieases Coiiective impact State Agencies? and Tribai Financiai Tabies Chiidren?s Mentai Heaith Coiiective impact Recommendations Missouri Modei of Trauma-informed Care impiementation and EBP County and TribaiActivity Tabie System Coiiaboration Tabie Emergency Detention FAQ CEDCS Workgroup Summary CEDCS Workgroup Recommendations Crisis Response Continuum of Services Page17 Problem: Target Population: Vision: Mission: Guiding Principles: Gaps: Inputs: Goals: Appendix A: OCMH Logic Model Wisconsin?s Office of Child Mental Health Logic Model (2015-2016) Child and family services focused on social, emotional and mental health are often inaccessible and reactive. Services often lack coordination, outcome data, parent and youth input, cultural competence and a trauma-informed orientation. OCMH was created to serve state agencies, tribes, legislators and policy makers that serve children and families. vision is that Wisconsin?s children are safe, nurtured and supported to achieve their optimal mental, social and emotional well~being. OCIVE l-l?s mission is to innovate, integrate and improve Wisconsin?s human service systems resulting in thriving children, youth and families. Family and youth lead system - Stakeholder collaboration leads to efficiency, effectiveness and cost?reduction 0 Systems share common goals and metrics - Best and promising practices are available in the right place at the right time - Services are tailored to the child and family and reSpect the child and family?s unique cultural heritage 0 Systems and services are trauma-informed - Services promote family and youth connections to natural supports 0 Decision?making is grounded in science, information and evaluation Gaps in Resources: Provider shortage Gaps in Systems? Knowledge: TIC and ACE awareness are not integrated across all service systems and programs - Limited awareness of the importance of including parent and youth with lived experience in policy and program development Gaps in Data and Information Sharing: Lack of integrated data system 0 Lack of outcomes across child and family serving systems 0 Inconsistent county service reporting 0 Disparity (racial, socio-economic) in existing outcome measures and no systematic, cross departmental strategy to reduce disparities OCMH Staff (4) 0 Government agencies - Stakeholders (parents/youth with lived experience, county and regional partners, mental health provider groups, private sector/businesses, providers, advocacy groups, higher education) 0 Schools - Financial and community resources - Evidence?based practices/policy - Policy makers - Data and technology systems Innovate: Parents and youth with lived experiences drive systems, policies and programs. OCMH incorporates a public health approach to mental health that includes ACE awareness and the promotion of resilience. Integrate: Stakeholders collaborate to create a unified vision, coordinated services, aligned goals, shared metrics, and successful outcomes. Improve: Services and supports are accessible and effective leading to children and families? recovery and resilience. Innovate Families and Youth: (1) Create and sustain parent and youth collective impact partners? (CIPs) leadership and participation, (2) Provide technical assistance (TA) to stakeholders committed to including parent youth in poiicy and program I: development, (3) Assist in establishing certi?ed pa rent peer specialists (PPSs). Public Health 8: Science: (1) Promote strategies to increase parent and children?s resilience and increase awareness of the impact of ACES. Families and Youth: (1) Recruit and train eight parents and three youth to lead and participate as UPS, (2) Support by holding eleven preparation and debriefing meetings for coliective impact Executive Councii meetings and eieven prep and debriefing for CIPs participating in collective impact workgroups, and (3) Famiiy Relations Coordinator will provide 35 TA contacts with state and county agencies, inciuding those working to integrate PPS services. Pubiic Health and Science: (1) Initiate and support one statewide pubiic health project integrating ACE awareness and pa rent/child resilience building strategies. Innovate Systems, policies and programs are driven by parents and youth with lived experience and incorporate a public heaith approach to mental health that includes awareness of ACES and the promotion of Integrate Children?s Mental Heaith Collective Impact: (1) Collective Impact Executive Councii and subsequent workgroup activities, (2) Maintain stakeholder participation and satisfaction with the collective impact processandou-tcomes, (3) Facilitate the developmentofa Unified vision, I: aiisned maisand-fsbat?d mama-.235 - State .Agen cy .Col__la_ho_rati__o_n_:? Document .a nd- . . - distribute state agEncies? partnership activities. Pian, facilitate and document eleven Ci Executive Committees, (2) Plan, facilitate and document 33 Cl workgroups, (3) Maintain wide? ranging stakeholder representation and satisfaction inciuding ClPs, state and county service systems, public and private provider groups, medical community, funders, businesses, and advocacy groups documented through attendance sheets and satisfaction Surveys, and (3) Document Cl vision, goais and metrics. Stakeholder Coiiaboration?State Agency: (1) Update table of shared activities six times per year, Facilitate state agency leadership team meeting six times per yea r, and (3) Create an annual yearly state agency service landscape highlighting type of service, ages served, location, numbers served and service cost. Improve Workgroups and Annual Report: Lead/participate in state and county-sponsored workgroups that increase access to services and recovery: (1) Improve crisis response and reduce youth emergency detentions; (2) Reduce youth suicides; (3) Reduce over?prescription of medications; improve access to I: school based mental health; (5) increase integration of trauma-informed care; (6) Support the development of infant mentai health poiicy, (7) Promote mental health consultation; (9) Participate in MH training forjuvenile justice services; (9) improve data coliection and integration; and (10) Submit annual report to legislators summarizing activities and providing recommendations. Workgroups: (1) Document workgroup activities and recommendations re. improving crisis response and reducing youth emergency detentions, (2) Assist in developing ?Zero Suicide? grant, (3) Document ?ndings and results related to youth prescribing patterns, (4) Provide TA to groups working to increase access to schooi based mental health and improved mental health support in the school (5) Provide TA to systems and workgroups focused on increasing integration of trauma? informed care, (6) Work with early child care systems to promote infant mental health, (7) Submit grant to pilot children?s mental heaith consuitation in rural WI, Ensure parent representation in MH training forjuvenilejustice services, and (9) Host five state agency workshops to improve data collection and integration. Annual Report: (10) Submit final draft to legisiature by January 2016. resilience. Integrate >Stakeholders? collaboration ieads to a unified vision, aiigned goais and shared metrics. Improve Services and supports are accessible and effective leading to children and recovery and resilience. Appendix 13-1: Language Guide Wisconsin Children?s Mental Health Collective impact Partners (ClPs) Language Guide Deficit-Based Language 2015 Strength?Based, Recovery?Oriented, Person-First, Trauma? Informed Alternative Ming?a?ersoh Schizophrenic, a borderline, bipolar Addict, junkie, substance abuser Consumer, patient, client Frequent flyer, super utilizer Describing Behavior Good bad, right I wrong High- vs. low-functioning Suffering from Acting-out, "having behaviors" Attention-seeking Criminogenic, delinquent, dangerous Denial, unable to accept illness, lack of insight Manipulative Oppositional, resistant, non? compliant, unmotivated DTO, DTS, GD (Danger to Others, Danger to Self, General Danger) Entitled Puts self and/or recovery at risk . Weakness, deficits Person diagnosed person who experiences the in recovery Person who uses substances; a person with substance use issues Person in recovery, a person working on recovery, a person participating in services Frequently uses services and supports, is resourceful, a good self? advocate, attempts to get needs met Different, diverse, unique Doing well vs. needs supports Person is experiencing, living with, working to recover from Person's behaviors may indicate a trauma memory has been triggered, person is upset Seeking to get needs met, seeking assistance to regulate Specify unsafe behavior, utilizing unsafe coping strategies Person disagrees with diagnosis, person sees themselves in a strength based way (Honor the individual's perception of self) Resourceful, trying to get help, able to take control in a situation to get needs met, boundaries are unclear, trust in relationship has not been established Constraints of the system don't meet the individual?s needs, preferred options are not available, services and supports are not a fit for that person (Assume that people do well if they can) People should not be reduced to acronyms; describe behaviors that are threatening Person is aware of her/his rights, empowered Person is trying new things that may have risks Barriers, needs, opportunity to develop skills Information adapted from Tondora, et al., Yale University School of Medicine Program for Recovery and Community Health, 2007 Wisconsin Children?s Mental Health Collective Impact Partners (CIPs) Language Guide Deficit?based Language 2015 Strength-Based, Recovery Oriented, Person?First, Trauma Informed Alternative Describing Service Activity BaseHne Clinical decompensation, relapse, faHure Discharged to aftercare Maintaining clinical stability, abstinence Minimize risk on-com pliant with medications, treatment "Treatm ent works" Case manager Enable Front?line staff, "in the trenches" Treatment team Seif?determined quality of life that was established at the first meeting Crisis as an opportunity to develop and or apply coping skills and to draw meaning from an adverse event; recovery is not linear relapse is expected and support is increased as necessary Person is connected to long?term recovery support Promoting and sustaining recovery, building resilience Maximize growth, presume competency Person prefers alternative strategies, therapies and interventions; not reliant on medical model treatment; has a crisis or WRAP plan; person is thinking for herself Person uses treatment to support his/her recovery Recovery coach, recovery guide, recovery support, care coordinator not a case, and you're not my manager?) Empower through empathy, emotional authenticity, and encouragement Avoid using war metaphors and develop language that promotes strong relationships Recovery team, recovery support system, care team Information adapted from Tondora, et al., Yale University School of Medicine Program for Recovery and Community Health, 2007 Appendix OCMH Framework for Parent and Youth Involvement Trainings Document Councils Work? groups State and County Agency Activities Legislative reviews groups Program policy reviews Certified Parent Peer Specialists within child serving agencies The H?Ai?i?i g??g?ii?N cf Philadelphia October 29, 2015 Contact: Clare Reidy For Immediate Release [215) 567-8001 x3014 Communities Poised to Expand Groundbreaking Work in Childhood'Trauma 14 Localities tojoin National Initiative on Adversity and Resilience Launched by The Health Federation ofPhiladelphia Philadelphia, PA Fourteen communities from across the country now have an opportunity to expand their innovative work in addressing childhood adversity through a new project launched by The Health Federation of Philadelphia, with support from the Robert Wood johnson Foundation and The California Endowment. Called Mobilizing Action for Resilient Communities (MARC), the project supports communities building the movement: to create a just, healthy and resilient world, It will foster solutions to prevent traumatic childhood experiences like neglect, abuse and abandonment in families throughout the nation. Known as Adverse Childhood Experiences (ACES), these events have been proven to have lifelong impacts on children?s health and behavior and the communities they live in. Each of the 14 communities which range from Tarpon Springs, FL, to Alaska will receive grants of and join a two?year learning collaborative where they will share best practices, try new approaches and become models for other communities in implementing effective solutions for combating ACES. (The full list of communities and states can be found at the end of this release.) ?There can be no Culture of Health without preventing or healing the impact of childhood adversity and trauma,? said Natalie Levkovich, CEO of The Health Federation. ?The 14 communities selected for MARC are leading the nation?s most innovative efforts to reduce ACES and promote resilience.? Already, the communities have made significant strides in addressing childhood trauma, most by forming diverse coalitions across sectors that bridge the work of health care and social service providers, educators, policy-makers, law enforcement officials, business leaders and community members. - Most importantly, all communities have raised awareness of the significant impact ACES have on children and families, which a growing body of research shows can leave long term tracks on the developing brain. 215.567.8001 215.567.7743 FAX 1211 Chestnut Street Suite 801 Philadelphia, PA 19107 ?These states, counties and cities are living laboratories that can teach all of us what it takes to transform cycles of trauma into a Culture of Health,? said Martha B. Davis, senior program officer for the Robert Wood Johnson Foundation. ?Anyone who is interested in strengthening the resilience of their community should pay attention to what these communities are doing.? The project?s advisers include leading researchers, health care providers and policy-makers in the field ofACEs and resilience. The first facewto?face gathering of MARC collaborative members and advisers will take place in Philadelphia, November 9?10, 2015, The following is a list of communities, their networks and backbone organizations, selected to be part of the MARC initiative: 9 ALASKA Alaska Resilience Initiative [Alaska Children's Trust) a ALBANY, NY The HEARTS Initiative for ACE Response [University at Albany Foundation) a BOSTON, MA Vital Village Community Engagement Network [Boston Medical Center] a BUNCOMBE COUNTY, NC Buncombe County ACES Collaborative [Buncombe County Health and Human Services) a THE DALLES, OR Creating Sanctuary in the Columbia River Gorge [Columbia Gorge Health Council) a ILLINOIS Illinois ACES Response Collaborative [United Way of Metropolitan Chicago) 0 KANSAS CITY, MO Trauma Matters KC [Chamber of Commerce of Greater Kansas City Foundation) a MONTANA Elevate Montana [ChildWise Institute) - PHILADELPHIA, PA Philadelphia ACE Task Force [Scattergood Foundation) a SAN DIEGO, CA San Diego Trauma Informed Guide Team 82 Building Healthy Communities Central Region [Harmonium, Inc.) 0 SONOMA COUNTY, CA Sonoma County ACES Connection [County of Sonoma, Department of Health Services) 0 TARPON SPRINGS, FL Peace4Tarpon, Trauma Informed Community [Local Community Housing Corporation) 0 WASHINGTON w- ACES /Resilience Team 8% Children?s Resilience Initiative [Whatcom Family and Community Network) - WISCONSIN Wisconsin Collective Impact Coalition [Wisconsin Office of Children's Mental Health) About the Health Federation of Philadelphia: The Health Federation of Philadelphia is a public health organization whose mission is to improve access to and quality of health care services for underserved and vulnerable individuals, families and communities. The organization coordinates and convenes a network of the community health centers in Southeastern and is the hub for issue-specific collaboratives such as the Philadelphia ACE Task Force. The Health Federation also delivers organizational consultation, professional development, technical assistance and training around many public health issues; mentors future public health professionals through its National Health Corps program; and runs innovative direct services programs for families in need. For more information about the Health Federation of Philadelphia, please visit rationerg. 1211 Chestnut Street Suite 801 Philadelphia, PA 1910'? Appendix 83: MARC Press Release State of Wisconsin Scott Walker, Governor O??ice 0f Children ?8 Elizabeth Hudson, Director Mental Health FOR IMMEDIATE RELEASE November 5, 2015 Contact: Elizabeth Hudson, Elizabeth.Hudson@wi.gov [608] 266?2771 Wisconsin?s Children ?3 Mental Health Collective Impact Coalition Poised to Bring Awareness and Mindfulness to the Workplace Madison ?Wisconsin has been chosen as one of fourteen communities from across the country to expand their innovative work in addressing childhood adversity through a new project launched by The Health Federation of Philadelphia, with support from the Robert Wood johnson Foundation and The California Endowment. Called ?Mobilizing Action for Resilient Communities? the project supports communities building the movement to create a just, healthy and resilient world. It will foster solutions to prevent traumatic childhood experiences like neglect, abuse and abandonment in families throughout the nation. Known as Adverse Childhood Experiences (ACES), these events have been proven to have lifelong impacts on children?s health and behavior and the communities they live in. The Office of Children?s Mental Health serves as the ?backbone? agency supporting the Collective Impact Coalition and will distribute the funding to the MARC project partners. is the opportunity we?ve been waiting for,? states Elizabeth Hudson, Director of the OCMH. "By bringing this information to the workplace, we are heeding the call to adopt a universal, public health approach to address toxic stress and build resilient communities.? Wisconsin?s proposal outlines a two year public-private initiative bringing together multiple partners including BranchZ, a technology company. "It's a privilege to be a partner on this project," said BranchZ CEO Reggie Luedtke. "We think the issues at stake here are paramount to building healthy communities and we're excited to work with OCMH, the Center for anestigating Healthy Minds and others, to deploy smartphone~based mindfulness programs at worksites around the state. It's a great opportunity to build awareness around ACES and measure the impact on community wellbeing." Other central partners include University of Wisconsin?s Center for Investigating Healthy Minds, SaintA, Wisconsin?s Children and Families? Collective Impact Coalition, and the Wisconsin Economic Development Corporation. Together, this group will pilot an ACEs and resilience workplace curriculum where, after learning about the impact of adversity and toxic stress, workplace participants will be given the option to participate in a research-based ?resilience-building? mindfulness practice. Doing so will promote both an awareness of ACES and a culture of health which will help reduce risk factors and boost resilience for Wisconsin families. ?These states and cities are living laboratories that can teach all of us what it takes to transform cycles of trauma into a Culture of Health,? said Martha B. Davis, senior program officer for the Robert Wood johnson Foundation. ?Anyone who is interested in strengthening the resilience of their community should pay attention to what these communities are doing.? 1 West Wilson Street 0 Room 656 0 Madison, XVI 537017850 0 Telephone 608266?2771 9 Fax 608?267?8798 Helping All of Wisconsin ?5 Children Improve their Social and Emotional Well?Being Appendix 01: Collective lm pact lant? Wisconsin Office of Children?s Mental Health: Collective Impact Collective impact: Collective impact1 is an innovative and structured approach to systems change. The process brings together a wide variety of stakeholders who use data to identify root causes of a problem. Once the problem?s complexity is understood, the group implements solutions and monitors outcomes by using shared measures. This approach consists of five characteristics which include (1) a common agenda, (2) a shared measurement system, (3) mutually reinforcing activities, (4) continuous communication, and (5) a backbone organization. Collective impact differs from more conventional change methods in several ways. For instance, organizations are typically evaluated on their isolated work. The Stanford Social Innovation Review calls this, isolated impact.2 Unfortunately, it is impossible for one single organization to solve highly complex social problems. Instead, complex problems require cross~sector collaborations to address the interplay between government agencies, private for profit businesses, non?profits, educational institutions, and, most significantly, people who are directly impacted by the social issues being addressed. Early adopters report that the success of collective impact initiatives requires a shift in how programs are designed and implemented, how funders operate, and how policies are developed. Theory of Change (TOC): Another difference in the collective impact approach is the use of the Theory of Change method which used for planning, participating, and evaluating long-term goals while also outlining causal links showing each outcome in logical relationship to all the others) and then map-ping backwards to identify necessary preconditions.3 I TOC differs from the more commonly used logic model in several ways. TOC links outcomes and activities to explain how and why the desired change is expected, while a logic model illustrates program components and helps stakeholders clearly identify outcomes, inputs and activities. TOC is best Used when starting with a goal before deciding what programmatic approaches are needed versus a logic model which typically starts with a program. Lastly, TOC requires justifications at each step demonstrating why activities are expected to produce outcomes, while logic models require the existence of program components and outcomes which are then examined as in or out of with inputs and activities. 1 impact library/pdf/TOCs and Logic Models forAEApdf and Loeic Models forAEApdf Appendix C~3a: DCF Financial Table Wisconsin Office of Children?s Mental Health: Department of Children 8: Families Financial Table aois W?m?m? Funding Title Purpose Amount Total Amount Children and Family Aids (2014 - 15) target populationsiApproximately 50% of the CFA is used for child abuse and-neglect, 27% for 23%?for' community- based juvenile-justicecorrections placements. Counties are required to match at Counties may use financial aids for services related to "child-abuse and 'neglect,ifetal abuse (including and treatment), juvenile justice, and other $66,475,500 General Purpose Revenue $29,226,900 Title funding for a portion ofthe cost of services for children who meet financial eligibility criteria and are placed in out?of?home care. distributes federal reimbursements to counties.'" 526, 194,900 Title IV-B, Subpart 1 funding is primarily used to keep children with their families. These services include respite ca re, intensive family treatment, and individual and family counseling. Funds are distributed to states on the basis of their under?21 population and per capita income. States are required to provide a 25% funding match to the federal grant.iv $2,968,800 Social Services Block Grant (5586) funding-is used to address at least one offive goals: or'mainta'inself? sourciencyra) prevent-8r remedy of adults j, prevent ?iria p'p?ro'ptiate ad rh?ils'?i'ohfb r7 referral fOr institutional care when other forms of care are not appropriate. Up to 10% of the allotment can-be trar?isferred?to preventative health and health services,- behavioral health and childhealth services, and Iow?income h'Ome energy assistance block funds may also be used for staff training, ad evaluation, an 't'ech'n'ica'l?assistance to r'n'ent, or administer Wisconsin?s soCi'a'l service program." $3,996,300 10% of this allocation for purposes consistent with the requirements of the 8586. Temporary Assistance for Needy Families Block Grant (TANF). The state may use up to $4,088,600 Title Subpart 2 (FFY2014) intended to promote safe and stable families through family preservation, family support, family reunification,-adoption promotion, and support services. The federal Department of Health and Human Services distributes funds to states based on the $5,085,300 Wisconsin Office of Children?s Mental Health: Department of Children 8; Families Financial Table 201% share of children whose families receive supplemental nutrition assistance. The state i must provide 25% match.? State-ievel adoption, promotion and support $1,063,700 Training and technical assistance to counties and tribes $238,300 ACE Study and Trauma Project $189,600 Family support, preservation and reunification Program $3,593,700 Description Amount Total Amount Empowering Families of Milwaukee Home Visiting Program (2014 15) Services provided to pregnant and post?partum Milwaukee women in eleven zip codes that have high rates of poverty, child abuse and neglect referrals, and poor birth vii outcomes. TANF Funds: $812,000 Family Foundations Home Visiting Programs (2014 - 15) Services focused on improving birth outcomes, supporting maternal and child health, enhancing family functioning, promoting safety and development, and preventing child abuse and neglect. General Purpose Revenue $985,700 Formula grant $1,206,500 Com petitive gra nit? $8,563,400 Brighter Futures $6,371,200 Supports positive youth development and prevention programs in high?risk and high? '5 poverty neighborhoods. Programs serve infants, children, youth and families and focus on high school graduation, vocational preparedness, improved social and other interpersonal skills, and responsible decision~making.ix General Purpose Revenue $1,729,900 substance Abuse Block Grant $1,707,100 Temporary Assistance to Needy Families $577,500 Title abstinence education grant $644,300 $4,658,800 SAFE Milwaukee (2015) This is a shortwterm, behaviorally oriented family therapy program targeted to youth ages 10 to 18 who have severe behavior challenges, are frequently and/or at resik of being delinquent. United Neighborhood Centers of Milwaukee (UMOS) facilities are located in theneighborboods with the youth at highest risk of delinquencies" $850,000 Post Reunification Services 3 Waiver the child and family. The plan may inciude trauma?informed services,__crisis stabilization Case managers develop a twelve month post-reunification plan based on the needs of $2,000,000 2[Paee Wisconsin Office of Children?s Mental Health: Department of Children Families Financial Table gaotg services, in~home therapy, alcohol and drug assessment and treatment for parents, mental health services, respite care, transportation, and connection to community services.xi This is a five year waiver totaling $10,000,000 with $2,000,000 designated annuain to provide flexible funding for reunifying families. Domestic Violence Services Grants to locai domestic violence service providers to assist victims of domestic violence. Services are provided to adults and children. $5,572,769 Special Needs Adoption Services provided include training to pre-adoptive homes, case management, and adoption studies"It for children with special needs for whom it is difficult to find an adoptive home. $4,148,700 Adoption Assistance To be eligible,-a child must have one of the following special needs: .be 10 yea rs or isthe only factor in determining eligibility; a member of a- sibling group of Qt more youth; at. more moderate to intense needs physicai, mental skills, functioning in a setting, behavioral and emotional needs or risk behaviors; or ra.ce._which of a child due to a lack of appropriate placement option General Purpose Revenue $47,929,100 Title $45,339,600 $93,258,700 Adoption Resource Centers Provides information on the adoptive process to prospective adoptive parents, birth parents, adoptive families, professionals, and the general public.?IV $33 8,000 i i Post Adoption Resource Centers Seven agencies provide education, support and services to adoptive families; provide an understanding of issues facingadoptive families among human service providers, schools and. medical care providers-and collaborate toaddressthe needs of adoptive "families. Title Sup part 2 each center receives between $70,000 and 500,000 Kinship Care (2014-15 Budgeted) Supports children who reside outside of the home with a relative rather than placing the child in foster care or other out?of?home placements. Federal TAN FXVI $20,340,400 Boys and Girls Clubs Represents 25;distinct. Boys. a.-nd..Girls. Clubs. with 42 program .sitesth rough outthe state. The objectives are to improve the social, academic and employment skills of low- income at riskyouth. Skills?Mastery and Resistance Training (SMART) curricula focuses on helping youth develop healthy attitudes and responsible behaviors that lead to $2,200,000 .3 Fag Wisconsin Office of Children?s Mental Health: Department of Children 8; Families Financial Table abstinence from sexual involvement and substance abuse; positive relationships free of violence and abuse, and overall health. Families eligible forfree and reduced lunch program may participate in a full range of services. TANF Child Abuse and Neglect Prevention Board (2014 - 15) CANPB supports services to prevent child abuse and neglect through partnerships and investments. The Board administers the Children?s Trust Fund (CTF) and is required to solicit and accept contributions, grants, gifts and bequests for CTF.WEI General Purpose Revenue $997,900 _'Title ll of the Child Abuse Prevention and Treatment Act (CAPTA) Federal Funding (FED) $636,300 Program Revenue comes from the sale of duplicate birth certificates, services such as state mailings, special computer services, training programs, printed materials and publications.__ $1,361,800 Segregated Funding (SEG) $15,000 Matching funds are also provided for the sexual abuse prevention campaign, the family resource center grants and the community? based family resource and support program grants $3,011,000 Child Advocacy Centers (CACs) Provide comprehensive services to child victims and their families by coordinating services from law enforcement and criminal justice agencies, child protective services, victim advocacy agencies, and health care providers. The Department oflustice provides 14 annual grants to CACs in 14 General Purpose Revenue Funding for the CAC grants is provided from Justice Information System Surcharge revenue. The $21.50 surcharge is assessed with a court fee for certain court procedures. 5 $2,388,100 $3,645,800 FED $823,900 $6,857,800 Child Care and Development Funds The federal child care and development block grant provides a combination of discretionary and entitlement funds for child care services for low~income families and to improve the quality and supply of child care for all families.? FY 2014 Federal CCDF (Discretionary, Mandatory and Matching) $89,857,446 Federal TANF Transfer to CCDF $62,899,870 $269,206,722 5% Wisconsin Office of Children?s Mental Health: Department of Children Families Financial Table 4 Direct Federal TANF spending on Child-Care - $100,000,000 State CCDF Maintenance of Effort Funds $16,449,406 Austin, Sam and Gentry, John, Community Aids/Chiio?ren and Fomiiy Aids, Informational Paper 47, Wisconsin Legislative Fiscal Bureau, January, 2015 p. 6 Gentry, John, Child Welfare Services in Wisconsin, Informational Paper 50, Wisconsin Legislative Fiscal Bureau, January, 2015 p. 26 Ibid p. 26 - 29 Ibid p. 29 Ibid p. 31 Ibid p.30 Ibid p. 44 ibid p. 44 Ibid p. 45 Ibid p. 45 4 Ibid p. 15 ?1 Ibid p. 18 ?m Ide p. 20 Ibid p. 21 Ibid p. 21 Gentry, John 0., Wisconsin Works and Other Economic Support Programs, Informational Paper 44, Wisconsin Legislative Fiscal Bureau, January 2015, p. 43 Ibid p. 40 Michael, Crime Victim and Witness Services, Informational Paper 60, Wisconsin Legislative Fiscal Bureau, January, 2015 P. 10 Gentry, John 0., Wisconsin Works and Other Economic Support Programs, Informational Paper 44, Wisconsin Legislative Fiscal Bureau, January, 2015 p. 77 SIP-age Appendix 03b: DOC Financial Table Wisconsin Office of Children?s Mental Health: Department of Corrections Financial Table Funding Title Purpose Amount Juvenile Justice System Total Amount $152,300,000 5 Secured Facilities The Division ofJuvenile Corrections (DJC) Operates two juvenile correctionai facilities one for males (Lincoln Hills) and one for females (Copper Lake).i $30,012,300 M'e'n'dota Juvenile Treatment: DHS operates a 29?bed, secured mental health 5-068 .- .- . .- General Purpose Revenue $1,365,500 . $2,772,800 $4,138,300 Lincoln Hills School - average daily population (2013 14): 221 $21,556,900 $4,317,100 County Community Youth and Family Aids 0 .- Provides counties with an annual allocation of state and federal funds that may be used to pay forjuvenile delinquency?related services, including out? of~home placements and non?residential, community?based services. Counties may supplement their expenditures with funding from other sources including community aids, other state aids to counties, county tax revenues, and special grant monies. $91,039,500 $88,600,000 Program Revenue: Federal funds received by the and transferred to DOC for out-of?home care for eiigible juveniles $2,449,200 to ho 0 {Qt "-A-bus Tre at nt rogra ms $1,333,400 Serious Juvenile Offenders State-funded, Average daily population (2013 14): I $14,500,000 Juvenile Corrective Sanctions Program of not $4,200,000 Grow Academy A male residential treatment program located in Dane County with an agricultural science?based curriculum and a capacity of 12. Average daily .1 Wisconsin Office of Children?s Mental Health: Department of Corrections Financial Table aeag population for June - December-of 2014: 10.iv Community Intervention Program EarlyinterVEntion services for first?time'juvenile offenders and for I I community?based interventions for seriously chroniCjuvenile offenders.V $3,700,000 Youth Diversion Program Gang diversion programming from General Purpose Revenue, Program Utility Aid Revenue and Federal Fundina? .. .. . .. State-tax revenues used with county discretion.?m $33,900,000 State tax revenues used with county discretion. $122,700,000 County and Municipal Aid Grants Through the Department of Justice Provide-d via the-Juvenile Justice Delinquency Prevention Act. Approximately 75% of these formula grants are distributed to local governments forjuvenile prevention, early intervention, and other services. 3" $639,300 Division ofJuvenile Corrections (2014 15) The state directly funds certain administrative costs.ix $2,300,000 Child Advocacy Centers Comprehensive; services forE child-victim's their families including coordinationwithflaw enforcement, criminal justice agencies, child protective service's, victim advocacy/?agencies, and health care providers" $238,000 Carmichael, Christina D., Juveniie Justice and Youth Aids Program, Informational Paper 56, Wisconsin Legislative Fiscal Bureau, January, 2015, p. 20. '5 ibid, p. 19 ibid, p. 25 i" bid,p.19 Ibid, p.33 "1 lbid, p.33 lbid, p. 33 ibid, p.33 ibid, p.34 Michaei, Crime Victim and Witness Services, Wisconsin Legislative Fiscal Bureau, January 2015. ZIPage Appendix C?3c: DHS Financial Table ?aeag Wisconsin Office of Children?s Mental Health: Department of Health Services (DHS) Financial Table Funding Title Description Amount Total Basic County Allocation $169,951,600 (2014 15) . .. General Purpose Revenue $138,665,200 $20,031,800 i (TANF): The state may $11,254,600 use up to 10% of this allocation for purposes consistent with the requirements of the 5586. ?1 Substance Abuse Block $27,005,484 Grant (SABG) {20% $9,735,700 - - 53:451089 Wi Department of Children and Families $3,158,000 $1,575,000 Bureau of Milwaukee Child Welfare (20% Prevention) $1,583,000 llPage Wisconsin Office of Children?s Mental Health: Department of Health Services Financial Table :ofj-Hea-?Ith; $2,144,700 WI Department of Corrections $1,349,200 i uve'nile' {Cortect-ions - _2 $23 5,700 Female Halfway House $352,200 Native American Halfway House $152,400 $202i600 Juvenile Justice Substance Abuse Screening and other grants $1,621,600 .. $2,082,916 Other treatment initiatives $3,456,279 Mental Health Block Grant $7,379,800 (FFY 2013 - 14) Community Aids Allocation: Funds support a wide range of human services $2,513,400 'lnitiativesfri? 'h'e'fui-ndin'g'ffo' :92 51.826500 Consumer and-Family Supports-Funds are distributed through grants for $1,015,800 mental health consumer and family supports Wisconsin Family Ties Peer-ran organizations . $710,000 Transformation Activities: Funding for a wide range of activities with a focus $530,800 on increasing access to services and developing evidence~based practices [m ill Wisconsin Office of Children?s Mental Health: Department of Health Services Financial Table SEE $494,000 .. Training and Technical Assistance: training of mental health professionals $160,000 $75,000 System Change Grants: Funding supports the initial phase of mental health $54,300 recovery?oriented system changes, prevention and early intervention strategies, and meaningful consumer and family involvement Coordinated Services Designed for children who are involved in multiple systems of care $4,426,500 Teams (CST) mental health, substance abuse, child welfare, juvenile justice, special education, or developmental disabilities). Additionally, DHS supports county and tribal CST Initiatives for children who satisfy the following:Vii have a severe emotional disorder; are at~risk of placement outside the home; are in an institution and are not receiving coordinated, community?based services; or are in an institution, but would be able to return to community placement or their homes if services were provided. General Purpose Revenue 52,500,000 Mental Health Block Grant 5 1,826,500 $100,000 Comprehensive Community $16,701,900 Services (CCS) .. hil. a. tee .. General Purpose Revenue $10,202,000 2,,dead . $0490900 Child Provides consultation and education to primary care clinicians on children?s $2,000,000 Consultation Program mental health needs; serves children and youth in Milwaukee County and in 15 counties in northern Wisconsin, including Ashland, Bayfield, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor, Vilas, and Wood.ix 3 Pag'e Wisconsin Office of Children?s Mental Health: Department of Health Services Financial Table General $500,000 Kuny Foundation I $1,500,000- Family Support Program (FSP) .--D nln'ua'l-Iylto '_-cou nties; - iil'd'le??ic?t'h5s?ve'r? {drama-h .- .- arg?matlb'nai "impair {ants and -avarnag-servant and-33m ob _:ty as agem'e'nt 're; $4,909,300 Birth to 3 Program (2013) Serves children under 3 years of age Who have developmental delays and disabilities)? .. .. $15,880,876 State and Federal Funds $11,273,513 Medicaid $2,808,128 Parental Cost Share $336,369 :lnsurance $255,384 Other $323,536 $30,877,806 Title ;f_or_..Chi_ldren and Youth - $1,213,525 Austin, Sam, and Gentry, John, Community Aids/Children and Family Aids, Informational Paper 47, Wisconsin Legislative Fiscal Bureau, January, 2015 p. 3. f: ibid,p.3 lbid,p.3 bid,p.3 ?1 Community Mental Health and Substance Abuse Prevention and Treatment Block Grant reporting from Dyck, Jon, Servicesfor Persons with Mental informational Paper 49, Wisconsin Legislative Fiscal Bureau, January 2015, p. 9-11 lloidp.11~12 f1? lbid, p.6 lbid, p. 12 xi Mabrey, Stephanie, Services for Persons with Developmental Disabilities, Information Paper 48, Wisconsin Legislative Fiscal Bureau, January 2015, p. 14 Austin, Sam, and Gentry, John, Community Aids/Children and Aids, informational Paper 47, Wisconsin Legislative Fiscal Bureau, January, 2015 p.4 4 on rt: Appendix C~3dz Financial Table Vang ?Z?tg Wisconsin Office of Children?s Mental Health: Department of Public Instruction Financial Table Funding Title Purpose Amount Grants to Local Educational $208,521,570 Agencies (LEAs) Elementary and Secondary Education Act (ESEA) Title I School Improvement $6,899,804 Programs ?Title 1 State Agency Program- $627,345 Migrant Title State Agency Program - Federally Neglected and Delinquent funds are provided to assist at?risk, neglected, $1,380,282 Neglected delinquent, and incarcerated youth so that they may have the same opportunities as S?Ill Homeless Children and Youth $933,644 Education Special Education Special education is provided by school districts, $368,939,100 cooperative arrangements with other districts, cooperative educational service agencies (CESAs), and County Children with Disabilities Education bBards (CCDEBS). The state reimburses a portion of the costs for educating and transporting pupils enrolled in special education, including school age parent programs.V High?Cost Special Education $3,500,000 Aid Supplemental Special ar: 1) $1,750,000 Education Aid revenue limit authority below the statewide average; 2) special education expenditures as a percentage of total district expenditures above 16%; and 3] membership is less than 2,000 pupils. A district may receive either supplemental special education aid or high costs special education aid in a given year, but not both.Vii Per Pupil Aid $126,975,000 Student Achievement Guarantee in Education (SAG E) Th year grants to school districts where at least 50% of at least one school?s population is made up of low-income pupils. School districts must do the following in each SAGE school: 1) Reduce each class size to 18 pupils for every one teacher, or 30 pupils to two teachers in the applicable grades; 2) Keep the school open every day for extended hours and collaborate with community organizations to make educational and recreational opportunities as well as community and social services available in the school to all district residents; 3) Provide a rigorous academic curriculum designed to improve academic achievement; and 4) Create staff development and accountability programs that provide training for new staff members, encourage employee collaboration, and require professional development plans and performance evaluations. 425 schools in 305 districts participated with approximately $109, 184,500 SAGE Debt Service $2,027 pai ible st $133,700 Pupil Transportation School districts required by state law to furnish transportation services to public and private school pupils enrolled in regular education programs, including summer school, are eligible to receive categorical aid.? $23,703,600 High-Cost Transportation Aid $5,000,000 Sparsity Aid in the prior year of less than 725 pupils; 2) Population density of less than ten pupils per square mile of the district?s area; and 3) At least 20% ofschool district membership Created for school districts meeting the following criteria: 1) School district membership- $13,453,300 qualifies for free or reduced-priced lunch. 133 districts participated in 2014 - Wisconsin Office of Children?s Mental Health: Department of Public Instruction Financial Table meg mam?am Bilingual-Bicultural Aid $8,589,800 Tuition Payments $8,242,900 Head Start Supplement $6,264,100 Educator Effectiveness Grants Provide reimbursements to participating schools districts for expenses associated with $5,746,000 system development, training, software, support, resources, and ongoing refinement, or for those districts using an approved alternative evaluation process, to fund development and implementation of the equivalent process. Districts receive a School Lunch $4,218,100 County Children with cally independent CCDEBs receive state aid if they fu nd the local share of their 34,0670300 Disabilities Boards Career and Technical $3,000,000 Education Incentive Grants School Breakfast Funding is used to provide a per meal reimbursement of $0.15 for each breakfast $2,510,500 Peer Review and Mentoring $1,606,700 3 Page Wisconsin Office of Children?s Mental Health: Department of Public Instruction Financial Table Four?Year-Old Kindergarten Two year grants to implement new four-year-old kindergarten programs. Eight school $1,350,000 districts participated in 20 School Day Milk $617,100 . .. . es. .m-biu'r'sa'ble . available: Aid for Transportation Open A child with disabilities requiring transportation under his or her individual education $434,200 Enrollment plan and aid for families who cannot afford the cost of transportation for pupils enrolled in classes at other educational institutionsm" Aid for Cooperative . . .. . $260,600 Educational Service Agencies Gifted and Talented Aid is provided annually as a grant program to provide gifted and talented pupils with $37,200 services and activities not ordinarily provided in a regular school program.W Suppiemental Aid 35 'eet? a sch? oi'd'st'r'ict'T $100,000 - I . Aid for Transportation Allows any 11th or 12th grade public school student to enrol] in one or more $17,400 Youth Options nonsectarian courses at a postsecondary institution for high school or postsecondary credit. Funding for transportation for parents unable to afford the Science, Technology, rants - $250,000 Engineering and Math (STEM) mathematical education projects led.? grants Alcohol and Other Drug Provides block grants to address the problem of alcohol and other drug abuse among $1,284,700 Abuse (AODA) Program schooi-aged children. Program revenue from the penalty assessment surcharge funds Revenue Funded these grants. 52 school districts and 4 CESAs in 2013 14.m ov Dpi.wi.gov/migrant lbid, p.19 ibid, p. 20 Kava, Russ and Pugh, Christa, State Aid to School Districts, informational Paper 24, Wisconsin Legislative Fiscal Bureau, January 2015, p. 18 Wisconsin Office of Children?s Mental Health: Department of Public Instruction Financial Table ig?tg Ibid, p. 20 lbid, p. 22 ibid, p. 22 Ibid, p. 23 lbId, p- 23 Ibid, p. 23 Ibid, p.25 lbid, p. 25 lbid, p. 26 ibid, p. 25 m" ibid, p. 25 Ibid, p. 20 tbid, p. 27 Ibid, p. 27 ??55 lbid, p. 27 m? ibid, p. 28 m" Ibid, P. 28 led, p. 29 m" lbid, p. 29 m? ibid, p.30 p_ 30 p. 30 Ibid, p. 28 Appendix C-3e: Discretionary Grants Financial Table Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table SAM HSA Grant Awardsi Amount City Program Period Description Dryhootch $100,000/yr Milwaukee 09/14 09/17 Provide peer support to veterans and their families Appleton School District $100,000/yr Appleton 09/14 - 09/16 Certify 30 Youth Mental Health First Aid instructors; train 1,200 aduits Lac Du Flambeau Band of $290,078 Lac du 09/14 ~09/17 Expand substance abuse treatment capacity in Tribal Healing to Wellness Chippewa Flambeau Courts and Juvenile Drug Courts Neenah .loint School District $100,000/yr Neenah 09/14 09/16 Focus on 1218 year olds using adults trained in Youth Mental Health First Aid United Community Center, $524,000/yr Milwaukee 09/14 09/17 Provide trauma-informed, gender~responsive, culturally competent Inc services within a family?centered treatment model for 126 Milwaukee County pregnant and post?partum women (primarily Hispanic) with substance uses disorders. Partnership with Sixteenth Street Community Health Center Milwaukee Public Schools $100,000/yr Milwaukee 09/14 09/16 Train 410 residents ofthe city of Milwaukee in Youth Mental Health First Aid including staff from Milwaukee Public Schools, Milw. Police Dept, Rogers Behavioral Health System, Boys and Girls Club, United Neighborhood Centers increasing the capacity of the community to detect and respond to mental health issues among school?aged youth. Fond du Lac School District $100,000/yr Fond du Lac 09/14 - 09/16 Certify 8 trainers in Youth Mental Health First Aid,- build on existing Mentai Health Services Steering Committee Wisconsin Family Ties $100,000/yr Madison 09/15 - 09/16 Develop statewide peer network for recovery and resiliency Wisconsin Family Ties $70,000/yr Madison 07/13 0 06/16 Enhance the capacity and capability of families to drive the transformation of the chiidren?s mental health system of Wisconsin County of Barron $125,000/yr Barron 09/09 09/19 Prevent and reduce youth substance use Red Cliff Band of Lake $399,998/yr Bayfield 09/14 - 09/17 Provide system of care Maamawi (Together) Red Cliff Circles of Care Superior Chippewa Program Edgerton Hospital and Health $125,000/yr Edgerton 09/09 09/19 Prevent and reduce youth substance use Services Northeastern WI Area Health $125,000/yr Manitowoc 09/14 09/19 Prevent and reduce youth substance use Ed Center llPage Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table Menominee of WI Indian $195,859/yr Keshena 09/14 09/19 Prevent youth suicide Tribal Council Marshfield Clinic Research $125,000/yr Marshfield 09/14 09/19 Prevent and reduce youth substance use Foundation Winnebago Co Health Dept. $125,000/yr Oshkosh 09/14 09/19 Prevent and reduce youth substance use University of WI Claire $101,185/yr Claire 09/14 -09/17 Prevent suicide (Hope Inspires); provide info on mental health promotion and suicide prevention resources, class and speakers City of Janesville $125,000/yr Janesville 09/15 09/18 Train 1.6% ofthe adult population in Mental Health First Aid Wisconsin Dept. of Health $1,037,360/yr Madison 09/14 09/19 Target youth and young adults aged 16 25 who are at risk for, or Services Project experiencing mental health problems in Jefferson and Outagamie Counties Wisconsin Dept. of Public $1,950,000/yr Madison 09/14~09/19 1) Make schools safer; 2) Improve school climates;3) Increase capacity to Instruction - Project Aware identify warning signs of mental health problems among children and make appropriate referrals to mental health care; and 4) Increase capacity of the state and local education agencies to connect children and youth with behavioral health issues with needed services Wisconsin Dept. of Public $2,214,000/yr Madison 09/13 09/17 Create infrastructure to improve social and emotional skilis, enhance a instruction Safe positive sense of self, increase family, school and community Schools/Healthy Students connections, address behavioral and mental health needs, and create a safe and violence free school environment West Allis - Milwaukee $125,000/yr West Allis 09/09 09/19 Prevent and reduce youth substance use Berlin Area School District $100,000/yr Berlin 09/14 09/16 Certify 8 Youth Mental Health First Aid trainers; train 250 adults to recognize the signs and of mental health problems; connect children with services School Dist of McFarland $95,256/yr McFarland 09/14 09/16 Provide Mental Health First Aid and Youth Mental Health First Aid in 6 local educational agencies; train 8 additional trainers for a total of 16; use a communities-train~communities approach Arbor Place, Inc. $125,000/yr Menominee 09/15 09/18 Train 400 aduits on Mental Health First Aid Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table 2015 e'f?wirr?i?? eczema/3 Partnerships Outreach Community Health $116,587/yr Milwaukee 09/15 n~ 09/18 Train 30 instructors to provide Mental Health First Aid training to at least Centers 5,625 other adults who engage with transition?aged youth Wauwatosa School District $125,000/yr Wauwatosa 09/15 09/18 Certify 12 trainers in Youth Mental Health First Aid and conduct 18 workshops over three years training a minimum of 360 adults who regularly interact with youth in the community Assistant Secretary for $1,299,680/yr Madison 09/11 ?9/16 COntinued research and evaluation of important social policy issues Planning and Evaluation I associated with the nature, causes, correlates and effects of income Poverty Research Center dynamics, poverty, individual and family functioning, and child well- being. Campus Suicide 5102,000/yr Madison 08/12 -07/15 Implement campus/community Suicide Prevention Partnership Council; implement evidence~based practices to reach out to high risk populations Statewide Family Network $70,000/yr Madison 07/13 06/16 Transform children?s mental health system; children to 18 and young Grants adults to age 26 Statewide Peer Network for $100,000/yr Madison 09/14 a 09/15 Strengthen the voices of mental health consumers Recovery 8: Resiliency Grants Amount City Program Period Description Office of Adoiescent- Health Pregnancy Assistance Fund $1,500,000/yr Madison 2013 2016 improve education, economic, health, and social outcomes for school- Stote of Wisconsin aged parents and their children. Ten grants to school districts with 25 targeted high schools. . - Amount City Program Period Description Office of Family Assistanceii Health Marriage and $2,000,000 Milwaukee 10/15 9/20 Encourage fathers to be present in their children?s lives Responsible Fatherhood Grants/ New Pathways for Fathers and Families .. Amount City Program Period Description Early Head Start? Child Care $1,400,000 Ladysmith Enhance and support early learning settings; provide new, full-day comprehensive services that meet the needs of working families and BIPage Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table aneg indionheod Community Action Agency prepare chiidren for the transition into preschool Early Head Start? Child Care $1,000,000 Madison Enhance and support early learning settings; provide new, full~day Partnerships comprehensive services that meet the needs of working families and Dune Cty Parent Council, inc. prepare children for the transition into preschool Early Head Start- Child Care $1,200,000 Milwaukee Enhance and support early learning settings; provide new, ful ~day Partnerships comprehensive services that meet the needs of working families and Acelero, inc. prepare children for the transition into preschool Early Head Start- Chiid Care $4,800,000 Milwaukee Enhance and support early learning settings; provide new, fulluday Partnerships comprehensive services that meet the needs of working families and Next Door Foundation prepare children for the transition into preschool Native Languages $272,057/yr Bayfield 2014-2017 Add Ojibwe language immersion to the Red Cliff Early Childhood Center?s Preservation and Head Start program and into the Kindergarten classroom at the Bayfield Maintenance School to provide a foundation for language preservation and Red Cliff Bond oftoke revitalization for current and future families within the Red Cliff Superior community State Personal Responsibility $932,700 Madison 2015 Educate young people on abstinence and contraception to prevent Education Program (PREP) pregnancy and sexually transmitted infections, including Title State Abstinence $711,597 Madison 2015 Educate youth on abstinence, provide mentoring and counseling Grant targeting youth in the foster ca re system and who are homeless HRSA Maternal Child Health? Amount City Program Period Description Early Childhood $140,000/yr Madison 08/13 7/16 Connect early childhood systems and concurrent trauma and toxic stress Comprehensive Systems initiatives to enhance skills of all early childhood system providers who Grant touch the lives of very young children and their families; support evidence-based trauma interventions in 3 pilot communities Eliminating Disparities in $750,000/yr Lac du 07/01 3/19 Address infant mortality rates of Wisconsin Native Americans by Perinatal Health Flambeau increasing access to ca re through collaboration with tribal and non-tribal Great Lakes inter-Tribal health ca re systems Council, inc. Wisconsin Pediatric Medical $300,000/yr Madison 09/14 08/17 Provide children and youth with special health ca re needs with 4 Page Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table aoag .7551 Home integrated ca re through family centered medical homes Management Grants Wisconsin Maternal Child $803,569/yr Madison 07/1989 Provide education in leadership, clinical practice, research, public health Health Lead Program 6/2016 systems and policy to interdisciplinary MCH trainees Amount" City Program Period: Description? Bringing Evidence Based $5,242,866 Madison 10/15 09/19 Identify proven practices teachers can use to narrow gaps in student Practices to Practitioners in opportunity and achievement levels across all racial and ethnic Wisconsin backgrounds, and family income levels Race to the Top Early $34,052,084 Madison 1/13 12/16 Focus on improving young children?s early learning and programming Learning Challenge School Climate $231,489 Berlin 2014 2018 Connect children, youth and families to appropriate services and Transformation Grants supports; improve conditions for learning and behavioral outcomes for Berlin Area Schools school?aged youths; and increase awareness of and the ability to respond to mental health issues among school?aged youthsVi School Climate $660,354/yr Appleton 2014 2018 Connect children, youth and families to appropriate services and Transformation Grants supports; improve conditions for learning and behavioral outcomes for Appleton Areor Schools school?aged youths; and increase awareness of and the ability to respond to mental health issues among school~aged youths School Climate $747,030/yr Wausau 2014 2018 Connect children, youth and families to appropriate services and Transformation Grants supports; improve conditions for learning and behavioral outcomes for Wausau School District school?aged youths; and increase awareness of and the ability to respond to mental health issues among school-aged youths School Climate $578,521/yr Madison 2014 - 2018 Support Positive Behavioral intervention and Supports, develop a Transformation Grants school?based mental health training, and enhance supports for social State of Wisconsin - and emotional development in 50 school?community teams selected over two yearsVii Project Prevent Grants $459,586/yr Milvvaukee 2014 - 2018 implement the Resilient Kids? program to build capacity in both knowledge and resilience in children, families, community and staff that will lead to decreased School Emergency $472,509 Madison 2014 2015 Expand the capacity to assist school districts in developing and implementing high-quality school emergency operations plansix SlPa'ge Wisconsin Office of Children?s Mental Health: Discretionary Grants Financial Table meg State of Wisconsin National Institute of Justicex Amount City Program Period Description Wisconsin School Violence and Bullying Prevention Study State of Wisconsin $858,187 Madison 2015 2018 Examine the impact of Positive Behavioral Interventions and Supports in combination with a comprehensive buliying prevention program in middie schools vi Ebid IX Appendix C~3fz Tribal Family Services Financial Table Wisconsin Of?ce of Children?s Mental Health: Tribal Family Services? Financial Table Program Description Amount Total Amount Family Services Program Jointly administered by Department of Health Services and the Department of $1,990,579 (FSP) Children and Families. Tribes may use funds from both departments to support tribal staff who provide integrated services to. families.i General Purpose Revenue 51,271,879 Title iv-B sub?part 2 $408,700 Federal Community Services Block Grant $310,000 Funding can be used for domestic abuse, child welfare, self-sufficiency, teen parenting, childcare Funding must be used for: 1) Adolescent pregnancy prevention and parenting skills; 2) child respite care; 3) permanency for children in out-of?home care; 4] family preservation and support services; 5) empowerment for low-income individuals, families and communities to overcome the effects of poverty; 6) domestic abuse intervention, prevention, and education; 7) improve family functioning. i . Tribal Language Revitalization Grants - PR Funded $222,300 I These grants are funded from tribal gaming program revenue transferred from i i i i Austin, Sam and Gentry, John, Community Aids/Children and Famin Aids, Wisconsin Legislative Fiscal Bureau, January 2015, p. 7 Kava, Russ and Pugh, Christa, State Aid to School Districts, informational Paper 24, Wisconsin Legislative Fiscal Bureau, Januaryr 2015, p. 29. Appendix C-4: Recommendations Children?s Mental Health Collective Impact Stakeholders? Identify Activities to Promote Socially and Emotionally Healthy Children and Families The Children?s Mental Health Collective impact (CIVIHCI) stakeholders believe that children should grow up in safe, nurturing, and supportive homes within thriving communities where they are surrounded by positive relationships with peers and caring adults. Additionally, the group believes that children need to play and learn and to have a sense of meaning and purpose in their lives. Physical well?being is also needed as engaging in regular physical activity and receiving adequate nutrition further builds a healthy foundation.1 Unfortunately, these expectations are often thwarted by the experiences of trauma, maltreatment and other adverse childhood experiences. For these reasons, the CMHCI stakeholders are in the process of identifying concrete ways to improve the lives of Wisconsin families by promoting strategies that will decrease toxic stress, promote resilience, and ensure access to support and services for children and families in need. The following ideas are under development but serve as a starting point. In 2016, CM HCI stakeholders will continue refine the activities listed below, further populate the list, and enhance and add measurable outcomes. Decrease Toxic Stress Exposure to toxic stress or Adverse Childhood Experiences (ACES) can have profound and lasting consequences on a child?s physical and mental health.2 In addition to experiences listed on the ACE survey,3 the stakeholders recognize the impact of experiences outside this list such as poverty, racism, and community violence. For this reason, the stakeholders believe that addressing the following factors will improve the social and emotional well~being of Wisconsin?s children by reducing their exposure to toxic stress: I Reduce unemployment and create job opportunities that raise families out of poverty 0 Reduce homelessness Create safe housing options - Reduce community and gun violence 0 Reduce child abuse and neglect 0 Reduce racism 0 Eliminate children?s exposure to toxic substances such as lead Measurements: s/ Percent reduction of unemployment x/ Percent reduction of the number of families with children eight years old and under living in poverty Percent reduction of homeless families Percent reduction in violent crimes Percent reduction in gun violence Percent reduction of substantiated child abuse and neglect reports \sxs 1 Robert Wood Johnson Foundation (2014). Are the Children Well? A Model and Recommendations for Promoting the Mental Wellness of the Nation?s Young People. Prepared by Child Trends. 2 National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. Updated Edition. Retrieved from rva rd.edu. 3 Learn more about the ACE survey by visiting this website: llPage Percent reduction in racial disparities across ali child and famiiy-serving systems i/ Percent reduction in children?s exposure to lead Promote Resilience While toxic stress can have negative effects on children?s development, protective factors can increase children?s resilience. Providing support to parents is one of the best ways to enhance a child?s resilience and subsequently the child?s iife outcomes.4 Research also shows that a child?s community can affect his or her mental and physical health;5 thus, the importance of ensuring that all adults are able to model healthy behaviors and coping skills. The CMHCI identified the following resilience-building activities: Policy 9 Apply Wisconsin?s 2013 Senate Joint Resolution 595 to all policy related to children and families Provide paid family ieave through em ployee-paid payroll taxes as is done in California, New Jersey, and Rhode Island7 Limit ciassroom sizes Require parent involvement and leadership in all state agencies? policy development reiated to children and families Measurements: Percent of bills with a Joint Resolution 59 analysis performed by the Legislative Reference Bureau Percent of empioyers who provide paid time off w/ Percent of schools that prioritize small classroom size Percent increase of parent participation in policy deveiopment at each of the famiiy?serving state agencies Prevention and Early Intervention Screen for parentai depression during pediatric visits, during meetings with county nurse programs, and at Special Supplemental Nutrition Program for Women, infants, and Children (WIC) sites Mandate strength-based social and emotionai development screenings as part 'of pediatric visits Increase access to high-quality child care and early childhood education, particulariy for low-income families Provide children and with access to healthy foods and opportunities for exercise Provide mindfulness-based stress reduction techniques in early education, schools and the workplace Offer pregnant mothers and expectant fathers ACE surveys and educational materials regarding the impact of toxic stress and the importance of resilience Support public health campaigns focused on ACE awareness, resilience and developing social and emotionai well-being inciuding how to increase child and family protective factors Measurements: . Percent increase of parents who receive an annual depression screen 4 Emde, R., and Robinson, J. Guiding principles for a theory of early intervention: A perspective. In Handbook of early childhood intervention. 2nd ed. JP Schonkoff and SJ. Meisels, eds. 5 Selected bibliographies available through the CDC Healthy Places webpage 6 2 Page Percent increase in the number of screens that use strength-based language Percent increase in the number of screenings for children?s social and emotional development Percent increase in referrals to community supports and services as follow up to screening Percent of children living below 180% of the poverty line in 3 or more star settings Percent of schools and workplaces implementing mindfulness-based techniques Percent of parents receiving ACE information during pediatric visits Training, Consultation and Support Provide information and ongoing training (Continuing Education Credits when appropriate) on brain development, the impact of trauma and the importance of healthy social and emotional development to every professional who touches the life of a child Create trauma~informed care (TIC) professional agency accreditation and rating system infuse TIC, ACE information, and information related to social and emotional development into grade school, middle school and high school education curriculum Provide Crisis Intervention Training (CIT) to law enforcement, emergency responders, and correctional staff I Measurements: Percent of providers and legislators who receive training Percent of agencies and/or professionals with TIC accreditation Number of child serving agencies involved in TIC transformation Percent of law enforcement, emergency responders, and correctional staff trained in CIT Provide Access to the Right Services and Supports at the Right Time Rounding out the focus on reducing toxic stress and increasing resilience is the need to provide effective services and support to children and families with mental health issues. Wisconsin is building a more responsive, comprehensive service array for children with mental health needs which includes the creation of the Child Consultation Program, expansion of Coordinated Services Teams Initiatives and Comprehensive Community Services, development of a regional consortium to create a model for delivering mental health services in rural areas and expansion of in-home counseling services for children as well as the certification of Parent Peer Specialists. CMHCI recommendations in this domain include the following: County Services Provide a ?no?wrong?door approach? to families seeking county services Ensure that people in every county have access to the same array of mental health services including evidence?based practices Provide parents and caregivers engaged in public services the option of working with Parent Peer Specialists Provide planned respite for children and families as a diversion from residential and inpatient hospitalizations Measurements: Percent increase of providers who have integrated medical and behavioral health care Percent of counties that offer established service array Percent of services that include Parent Peer Speciaiists in their service array Percent increase of planned respite for families to reduce hospitalizations, and to provide gradual re?entry from the hospital back into community Require private insurers to provide mental health coverage on par with physical health coverage8 Provide all chiidren with medical homes to promote the integration of physical and behavioral health Expand the Child Consultation Program Provide competitive Medicaid reimbursement Redesign the Medicaid Prior Authorization process to maximize efficiency and eliminate unnecessary red tape Resource Allocation, Deveiopment, Monitoring and Technical Assistance Create blended funding strategy across state agencies to support child ren?s social and emotional development Shift resources from deep-end services hospitalizations and residential care) to improving prevention and early intervention Commit resources to data integration across all chiid and family~serving systems Monitor and coach counties to ensure that all Coordinated Service Teams operate with fidelity Require programs receiving public funding to report child and family outcomes Create and maintain a website of mental health clinicians trained in evidence-based practices Design a children?s mental health consultation infrastructure to be accessed by all child and family- serving systems Measurements: Number of funders participating in coilective impact and/or blended funding strategies Percent of generai state revenue and county dollars invested in early intervention or prevention Percent reduction of youth hospitalizations Percent of money used for expanding crisis services Percent reduction at Winnebago Mental Health Institute (WMHI) Percent increase of counties/regions signing memoranda of understandings linking Coordinated Services Teams initiatives and Comprehensive Community Services to ensure consistency of care, particularly related to children?s crisis plans Number of state and county contracts that include language outlining that reimbursement wili be based on reporting outcomes and demonstrating progress Percent increase in the sites receiving mental health consultation, training and coaching 8 See National Conference of State Legislatures for more information mandatesaspx 4 Page Appendix 05: Missouri Model for Trauma-informed Care Implementation The Missouri Model: A Developmental Framework for Trauma?informed The implementation of a trauma?informed approach is an ongoing organizational change process. A ?traumadnformed approach? is not a program model that can be implemented and then simply monitored by a fidelity checklist. Rather, it is a profound paradigm shift in knowledge, perspective, attitudes and skills that continues to deepen and unfold over time. Some leaders in the field are beginning to talk about a "continuum" of implementation, where organizations move through stages. The continuum begins with becoming trauma aware and moves to trauma sensitive to responsive to being fully trauma?informed. Purpose: To ensure that agencies do no harm; to assess the implementation of basic principle of trauma~informed approaches in various organizational settings; to develop a common language and framework for discussion; and to help increase the effectiveness of services, wherever and whatever they are, by increasing awareness of trauma. Application: To a very wide range of settings, including but not limited to behavioral health services. Use: a Not for formal evaluation or certification, but for informational purposes a To help anyone who is interested (clients, advocates, other agencies, etc.) determine whether a particular agency or setting is meeting basic criteria for integration of trauma principles 0 To help agencies identify where they are on the continuum and where they want to be. Organizations can choose the appropriate place on the continuum based on their needs and setting. This document was developed by a group of Missouri organizations, MO State Trauma Roundtable, that have been active champions in addressing the impact of trauma and working towards becoming trauma?informed organizations. They represent a variety of organizations that serve children, youth, families and adults in a variety of settings including healthcare, inpatient substance use disorder, and community based mental health Services. Anyone is free to use this document but would appreciate notification of such to ats .carter dmhmo. ov. The recommended citation when used is Missouri Model: A Developmental Fromeworkfor Trauma?informed, M0 Dept. ofl?vlentol Health and Partners {2014). fl) 1[Pag Trauma Aware Definition Processes Indicators Resources Key Task: Leadership understands Most staff: Websites: Awareness and that knowledge about 1) increase in National Child Traumatic Stress Network attitudes trauma could potentially understanding the Trauma aware organizations have become aware of how prevalent trauma is and have begun to consider that it might impact their clientele and staff. enhance their ability to fulfill their mission and begins to seek out additional information on the prevalence of trauma for the population served. Awareness training is offered (including definitions, causes, prevalence, impact, values and terminology of trauma-informed care.) People are made aware of how and where to find additional information, and are supported in further learning. The organization explores what this new information might mean for them and what next steps may need to be taken. concept oftrauma 2) Increase in understanding of how the impact of trauma can change the way they see (and interact with) others. The impact of trauma is referenced in informal conversations among staff. National Center on Domestic Violence, Trauma and Mental Heaith (trauma-aware) Anna National Center for PTSD, U.S Department of Veterans Affairs Resource Center on Violence Towards Women ACE Study Documents: TIP 57: Trauma-informed Care in Behavioral Health Services? Chapter 2 Trauma Awareness. 483.6. df SAM HSA concept pa per (trau ma?aware) 4884.9df Paul Tough. The Poverty Clinic. The New Yorker, March 21, 2011. Trauma Sensitive Definition Processes Indicators Resources Key Task: Values ofa trauma? The organization Websites: Knowledge, informed approach are values and prioritizes application, and skill development Trauma sensitive organizations have begun to: 1) explore the principles of trauma- informed care (safety, choice, collaboration, trustworthiness and empowerment) within their environment and daily work; 2) buiid consensus around the principles; 3) consider the implications of adop?ngthe principles within the organization; and 4) prepare for change. processed with staff. Through a self? assessment process, the organization identifies existing resources and barriers to change as well as practices that are consistent or inconsistent with trauma?informed care. Leadership prepares the organization for change and leads a process of reflection to determine readiness for change. The organization begins to identify internai trauma champions and finds ways to hire people who refiect in their attitudes and behavior alignment with the trauma-informed principles. the trauma lens; a shift in perspective happens. Trauma is identified in the mission statement or other policy documents. Trauma training for ali staff is institutionalized, including within new staff orientation. Basic information on trauma is available and visible to both clients and staff, through posters, flyers, handouts, Web sites, etc. Direct care workers begin to seek out opportunities to learn new trauma Management recognizes and National Center on Trauma?informed Care Child Trauma Academy http://chiidtraumaprg/ International Society for Traumatic Stress Studies Toolkits and Videos: Healing Neen (DVD) Failot and Harris Organization Self Assessment Tool Risking Connection organizationai assessment Assessment. df institute for Health and Recovery insidepdf Documents: TIP 57: Trauma?informed Care in Behavioral Health Services, 2014. Ann Jennings and Ruth Ralph. In Their Own Words, 2007. A Long Journey Home: A Guide for Creating Trauma?Informed Services for Mothers and Children Experiencing Homelessness 3 Page The organization examines its commitment to consumer involvement and what next steps could be taken. The organization begins to review tools and processes for universal screening of trauma. The organization begins to identify potential resources for trauma specific treatment. responds to compassion fatigue and vicarious trauma in staff. Traumawsensitive schools 4 on ll) Trauma Responsive De?nition Processes Indicators Resources Key Task: Change Planning and taking action. and integration Begin integration of principies into staff behaviors and practices. Trauma responsive organizations have begun to change Begin integration of their principles into staff organizational supports: culture to 0 Addressing staff highlight the role trauma oftrauma. At Self-care levels ofthe Supervision models organization, staff . Staff deveiopment begins rethinking the routines and infrastructure of the organization. Staff performance evaluations Begin integration of principles into organizational structures: Environmental review Record?keeping revised Policies and procedures re? examined Self?help and peer advocacy incorporated Staff applies new knowledge about trauma to their specific work. Language is introduced throughout the I organization that supports safety, choice, collaboration, trustworthiness and empowerment. The organization has policies that support addressing staff?s initial and secondary trauma. All clients are screened for trauma and/or a "universal precautions? approach is used. People with iived experience are engaged to play meaningful roles throughout the agency (empioyees, board members, volunteers, etc.) Website: National Child Traumatic Stress Network Documents: TIP 57: Trauma~informed Care in Behavioral Health Services 4816.pdf Healing the Hurt Rich et al (men of color) Trauma Stewardship: An Everyday Guide to Caring for Self While Ca ring for Others, van Dernoot, Lipsky 8: Burk, Engaging Women In Trauma?informed Peer Support: A Guidebook PeerEngagementGuide Coior UP FRONT Assaulted Staff Action Program forvvictimssof-vioience/ Training: Child Welfare Trauma Tooikit SIPage Changes to environments are made. Trauma-specific assessment and treatment models are available for those who need them {either directly or through a referral process). Organization has a ready response for crisis management that reflects trauma- informed values. toolkit?2008 Juvenile Detention Trauma Toolkit ?Think Trauma? Educators? Toolkit CTSN assets/pdfs/Child Trauma Toolki Final. df Partnering with Youth and Families Toolkit assets/pdfs/Pathwavs ver ?nishe First Aid pdf/pfa/PFA 2ndEditionwithapnendices.pdf The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic, Lanius, Vermetten Pain (Eds) Best Practices websites: Veterans Administration database indexasp NREPP (trauma) California Evidenced Based Clearinghouse for Child Welfare 6 P?ase Trauma?Informed Definition Processes Indicators Resources Key Task: Measuring Leadership Websites: Leadership impact on including hiring National Child Traumatic Stress Network clients of new leaders Trauma? demonstrates a informed Revision of commitment to National Technical Assistance Center for Children?s Mental Health organizations policies and trauma have made procedures informed values Anna Institute video ? mportant Souls trauma? (safety, choice, responsive Implementation coiiaboration, practices the organizational norm. The trauma model has become so accepted and so thoroughly embedded that it no longer depends on a few leaders. The organization works with other partners to strengthen collaboration of the agency?s model/values is measured for fidelity to a trauma? informed modei and appropriate corrective actions ta ken. Practice patterns of staff Program assessments Interventions to address the impact of secondary trauma on staff is monitored trustworthiness and empowerment). All staff is skilled in using trauma- informed practices, whether they work directly with clients or with other staff. All aspects of the organization have been reviewed and revised to reflect a trauma approach. People outside Children, vioience and trauma video Men and boys as sexual abuse survivors Documents: 57: Trauma~informed Care in Behavioral Health Trauma?informed Supervision Guide Institute for Heaith and Recovery How Schools Can Help Students Recover from Traumatic Experiences Rand Gulf State Poiicy Institute TR413pdf Helping Traumatized Children Learn #Massachusetts Advocates for Children in Association with Harvard Law School Toolkits: Traumawinformed Organizational Tooikit for Homeless Nationai Center on Family Homeiessness 7 Page around being trauma? informed. Focus on reduction of stigma of tmuma Human resource policies support hiring staff with knowiedge and expertise in trauma The organization and staff become advocates and champions of trauma within their community Advocacy at a macro level with payers and policy-makers for systemic changes that support trauma? informed approaches the agency (from the Board to the community) understand the organization?s mission to be trauma-related. People from other agencies and from the community routinely turn to the organization for expertise and leadership in trauma- informed care. The organization uses data to inform decision making at all ievels. A variety of sustainable training is promoted and made accessible to staff, including at new Working with Partners: Trauma-informed community building manual Collective Impact impact Creating Culture: Promising Practices of Successfui Movement Networks Prevention institute Cross Sector Collaboration Disaster Preparedness and Response: disaster TA center Public Health Emergency US. Department of Health and Human Services Office, Disaster Response for Homeless Individuals and Families: A Trauma-informed Approach informedpdf 00 PU 01.: i staff orientation? Ongoing coaching and consultation is available to staff onwsite and in real time. The business model including fiscal structures works to meet the need to address trauma. 9 U. on 1? Appendix CA6: TIC and EBP County and Tribal Activity Table Wisconsin Of?ce of Children?s Mental Health (OCMH) Trauma-Informed Care (TIC) and Evidence-Based Practices (EBP) Summary Document, 2015 The OCMH created the following table in response to requests for information made by several stakeholder groups. These results-originated from a Select Survey that was first posted on the Wisconsin Listserv in October 2015. The four question survey was re?issu ed directly to county human service directors and tribal leaders by the Wisconsin County Association Human Service Association, the Department of Health Services Tribal Affairs Office, and the OCMH. The first column represents the counties or tribes responses to the question: "Does your human services department have any organized, structured trauma? informed care culture change efforts underway?? The second column identifies the method chosen to facilitate the transformation. The third column is a response to the following question: ?Is there a concerted effort to train your area mental health/substance use providers in an evidence?based thera py?? The fourth column documents the EBPs being used. The final column identifies the county or tribe as well as the source of their responses. Finally, a key to the acronyms is located at the end of the document. TIC Which approach to TIC culture change are you EBPs Which evidence?based approaches are you using? County or Tribe using? - No No Ashland (SM) NR Bad River No No Bayfield (SM) No Yes MFT Buffalo (SM) No Yes TF-CBT - Burnett (LS) No Yes CPP, MST, FFT Calumet (LS) No No Chippewa (SM) NR Clark No Yes Crawford (SM) No Yes TF-CBT, EMDR, CBITS, MST, CPP, Target Dane County (SM) 0' r4 No Yes TF-CBT, MDFT, FAST Dodge (SM) s?l No No Douglas (SM) rxi No No . Dunn (SM) rd No Yes TREM Claire (SM) :15 No No Florence (SM) tr) as No Plan to coordinate a three county training No ForestdOneida?Vilas (SM) No Yes TF-CBT, CPP, CBITS Forest Potawatomi (LS) r; No Yes Green (SM) oci No No Green Lake (L5) WI :5 No Yes EMDR Iron (SM) 1 Page 21. No Yes EMDR Jackson (LS) 22. No No Juneau (LS) 23. No CST is offering TIC training No Kewaunee (SM) 24. NR Lac Court ?re?ies 25. NR Lac {3e Fiambeau 26. No Plan to use our own approach No Lincoln (SM) 27. No No Manitowoc (SM) 28. No No Marathon (SM) 29. NR Marinette 30. No No Marquette (SM) 31. No Yes TF-CBT Monroe (SM) 32. No Yes TF-CBT, CPP, MST Oconto (SM) 33. No No Oneida County 34. NR Oneida Tribe 35. No Pians to use Waupaca, SaintA and consultants Yes DBT Ozaukee (SM) 36. No Yes TF-CBT, EMDR, MST (contracted) Pepin (SM) 37. No No Pierce (LS) 38. No Yes TF-CBT Portage (SM) 39. NO No Starting process of identifying providers Price (SM) 40. NR Red Cliff 41. No Yes CBITS, MFT Rusk (SM) 42. No No Sawyer(SM) 43. NR Sokaogon 44. NR St. Croix 45. No Applying for WTP Yes DBT, MST, CPP St. Croix (SM) 46. No Yes Stockbridge-Munsee (LS) 47. No Yes Taylor (LS) 48. No No Trempealeau (SM) 49. No Yes FAST Vernon (SM) 50. No Working on our environment/practice Yes Washburn (SM) 53.. No Yes Motivational Interviewing Washington (LS) 52. No Applying for WTP TF-CBT, CPP, MST Waushara (SM) 53. Yes Consultant Yes TF-CBT, CPP, FSAT Adams (LS) 2 Page 54. Yes Our own approach Yes BT Barron (SM) 55. Yes HHS, United Way, UWGB and community partners No Brown (SM) 56. Yes Our own approach No Columbia (LS) 57. Yes Consultant, own approach Yes TF-CBT, Door (SM) 58. Yes Sanctuary Model Yes BT Fond du Lac (SM) 59. Yes WTP Yes TF-CBT Grant (SM) 60. Yes Our own approach Yes TF-CBT Ho?Chunk Nation (LS) 61, Yes WIP our own Yes Iowa (SM) 62. Yes Yes TF-CBT, Seeking Safety, Coping Cat, DBT, FFT, incredible Years Jefferson (LS) 63. Yes WlP-ourown Yes Kenosha (SM) 64. Yes SaintA Yes CPP La Crosse (LS) 65. Yes Our own approach Yes Lafayette (SM) 66. Yes Our own approach No Langlade (SM) 67. Yes SaintA, Fostering Futures, Safe Schools/Healthy Students, ACE interface Yes Menominee Nation and Menominee (SM) 68. Yes SaintA Yes EMDR, MST, FFT, DBT, PCIT, CBT Milwaukee (SM) 69. Yes WTP and our own approach Yes DBT, FFT Outagamie (LS) 70. Yes Our own approach Yes TF-CBT, EM DR, MFT Polk (SM) 71. Yes SaintA Yes Racine (LS) 72. Yes Consultant No Richland (LS) 73. Yes WTP Yes EM DR, FFT Rock (LS) 74. Yes Our own approach Yes FFT Sauk (SM) 75. Yes Consultant No Shawano (LS) 76. Yes TBD. ACE interface and additional consultation Yes EMDR, DBT, TF-CBT in planning Sheboygan (SM) 77. Yes Our own approach Yes CPP, FFT Walworth (SM) 78. Yes Saint A?s No Waukesha (LS) 79. Yes Our own approach Yes CPP Waupaca (LS) 80. Yes Yes TF-CBT, MST, FAST, FFT Winnebago (LS) 81. Yes Our own approach No Wood (LS) Response LS:lnfo from Listserve Slenfo from Survey Monkey 3]Page 1. 2. l. Counties that did not respond: Clark Marinette Tribes that did not respond: Bad River Band of Lake Superior Chippewa Lac Court Oreiiles Band of Lake Superior Chippewa Lac De Flambeau Band of Lake Superior Chippewa Oneida Nation of WI Red Cliff Band of Lake Superior Chippewa Sokaogon Chippewa Community St. Croix Chippewa indians of WI Acronyms related to approaches ACE Interface: Fostering Futures: Child Traumatic Stress Network SaintA=7 essential ingredients Trauma Project (sponsored by the Dept. of Child and Family Services and informed by september 9 2014 meeting 10 15 a 4 12 east/sepOQpresentation trauma proiect Acronyms related to EPBs Cognitive Behavioral Therapy CPP=Child Parent Family Therapy TREMzTrauma Recovery and Empowerment Model FASTzFamilies and Schools Together Movement Desensitization Reprocessing CBITS=Cognitive Behavioral Intervention for Trauma in the Schools Descriptions can be found at: DBT=Dialectical Behavioral Therapy MST:Multisystemic Therapy FFT=Family Functional Therapy PCIT=Parent Child Interaction Therapy CC: Coping Cat Appendix CH7: System Collaboration Table E?t? Wisconsin Office of Children?s Mental Health: System Collaborations The following table represents a point?in?time (November 2015) list of state agencies collaborative activities focused on improving the lives of children and families. The colors represent the activities designation within a public health conceptual framework;1 specifically, green represents a universal approach, peach represents a secondary approach and lavender represents a tertiary approach. The state agency acronyms are as foiiows: Abuse and Prevention Board DCF=Department of Children and Families DHS=Department of Health Services DOC=Department of Corrections of Public instruction DWD:Department of Workforce Development OCM H=Office of Children?s Mental Health WEDC=Wisconsin Economic Development Corporation. Project/Initiative Description Brighter Futures Prevent and reduce violence, substance use, child abuse and neglect, and adolescent pregnancies Counties include: Barron, Dane, Kenosha, Outagamie, Portage, Kenosha, Washington, Red Cliff Band of Lake Superior Chippewa Lead: DCF (DHS) Ongoing Connections Count 0 Connect vulnerable families (with children aged 0-5) to resources; connections made through the assistance of a trusted community Lead DCF (Fostering member Futures? Policy Advisory Council) 2016?2017 Family Foundations Home 0 Provide support to families from pregnancy to 8 years old with focus on Visiting parenting, school readiness, heaith and preventing child abuse and neglect Lead: DCF (CANPB, DHS, OCMH) Ongoing A Pubiic Health Approach to Children?s Mental Health: A Conceptual Framework mentalhealthyermownt. ov sites files resources DMH-Pubiic Heaitn A Wr?oMaMchSurnma . df LEW map/W. 1 WI Office of Children?s Mental Health 1 W. Wilson Street, Room 656 s> Madison, Wl 608?266~2771 Wisconsin Office of Children?s Mental Health: System Collaborations :aots Governor?s Early Childhood Advisory Council (ECAC) Leads: DCF and DPI (DHC, DOC, OCIVIH) 9 Ensure that all children and families in Wisconsin have access to quality early childhood programs and services Ongoing Leading Together Lead: DHS (DCF, DPI, OCMH) a Support family leadership within state and county level policy, program, and quaiity improvement activities initiatives Ongoing Mobilizing Action for Resilient Communities Lead: OCMH a Educate three Wisconsin workplaces on the impact of adverse childhood experiences followed up with opportunity to learn and practice mindfulness 2015-2017 Project AWARE (Advancing Wellness and Resilience Education) Lead: DPI Enhance school safety and climate, and the coordination and integration of mentai and behaviorai health services 0 Train thousands of people in Youth Mental Health First Aid Three school districts: Adams-Friendship, Ashland, and Milwaukee 2014-2019 Safe Schools Healthy Students Lead: DPI (DCF, DHS, DOC, OCMH) 0 Promote early childhood social and emotional learning and deveiopment Promote mental, emotional, and behavioral heaith - Link families, schools and communities - Preventing behavioral health problems including substance use Create safe and violent-free schools Three communities: Beloit, Menominee Nation, Racine 2013-2017 Race to the Top Lead: DCF (DHS, DPI, OCMH) Reinforce You ngStar 0 Strengthen family engagement 9 Create early childhood longitudinal data system 2013?2016 WI Office of Children?s Mentai Health s? 1 W. Wilson Street, Room 656 Madison, WE <5 608~266~2771 Wisconsin Office of Children?s Mental Health: System Collaborations School Climate Transformation Lead: 9 Support for Positive Behavioral intervention System (FEES) 0 Develop a school-based mental health framework and needs assessment a Enhance supports for social and emotional development Fifty school and community teams 2014-2019 . School Safety Research Lead: 0 Study the impact of PBES plus bullying prevention in middle schools 2015-2017 3 i '5 WE Office of Children?s Mental Health 4? 1 W. Wilson Street, Room 656 ?r Madison, WE 608-266-2771 'r 5 mm Wisconsin Office of Children?s Mental Health: System Collaborations -. . -- - Six'c'o- u'nt'ie?s Kendshagaatih?, Washington; and- 'Leadst'DHSia-hd'DCFeducation-and awareness of evidence-basednone; 3' "pharmac?eutiCal interventions. - canam:marshal 1' i 5 'io'e'velb'pl sage-'- il?d??pth sari5193153ef=z??i?tlkv?ufh? p?yi?h'bt'kdhici Lead: Collective impact Increase access to effective - - -- OCMH -. Adj-uv?hjl Health? 'Lea'di a: OCMH) a WI Office of Children?s Mental Health 1 W. Wilson Street, Room 656 Madison, WE 608?266?2771 n' rife; rl.??n we etect . . . m? WW Sim Ei'giES. .10. use; ?g :a duh-s Landfi .anie ndi-?ock untiesiandra afouri Dim. nty. he yg insist-tin WI Office of Children?s Mentai Health 1 W. Wiison Street, Room 656 Madison, WI 608?266?2771 Wisconsin Office of Children?s Mental Health: System Collaborations Response-.1. I. I I. I'L?ad: I Youth E'miergencyg; --. High-"rates of? 5 'P'rcjv'i?de?f?e'tdrh m'e'ri 'r'es'pOnse arid reduce -- . 3' 20152201 - 3 Projects of interest that are not based 0n state agency collabm?ation "J'u'v?ni?i'ni'ti'al'lz'r'nonths after-reunification; - - - '3 ?ongdm'g I: a El WE Office of Chiidren?s Mental Health 1 W. Wilson Street, Room 656 Madison, WI 608?266-2771 Wisconsin Office of Children's Mental Health: System Collaborations Lin_e.._i FProvide seiryiiclesus'i-ng staff-TraumaSensitive Schools 3 e_ an infernal Sohool ooaoh in 27 schools January 2016; I - Se__co_nd.c_0h_or_t_ 2016?2019 . W1 Of?ce of Children?s Mental Health 1 W. Wilson Street, Room 656 Madison, WI 608?266-2771 Appendix D-1: Emergency Detention FAQ Wisconsin Office of Children?s Mental Health: ED FAQS FREQUENTLY ASKED QUESTIONS ABOUT EMERGENCY DETENTIONS Wisconsin laws give law enforcement, with county approval, the authority to place children and adolescents in a hospital when there is a need to protect the young person from harming themselves or others; this is called an ?emergency detention? and is commonly referred to as an In Wisconsin, these involuntary hospitalizations are on the rise.l The Office of Children?s Mental Health is examining data related to this alarming trend. in the meantime, we hope to answer some commonly asked questions related to involuntarily hospitalizing a young person. FAQ Can't the hospital fix the child? Parents and/or professionals who request an ED may believe that the hospital will be an effective way to address a child?s mental health or behavioral issues. In reality, many of these children are released back home within just a few-days.2 Even when the child has a treatable condition, the hospital is best equipped to offer short-term crisis stabilization, not long-term interventions. it is up to the parents, educators, social workers, and other community-based support people to examine what might be going on in a child?s life that corresponds to the alarming behavior and subsequently to help the child and family develop a plan to address the child?s needs in the community over the long-term. FAQ Don?t we need to ED this child to get him/her access to mental health services? Wisconsin faces a shortage of mental health providers. Many families spend months or even years on waiting lists trying to access services. As a result, some people believe that the only way to gain access to mental health professionals is to have the child hospitalized. While hospitalization does result in a mental health assessment, it does not guarantee access to ongoing services. In fact, an analysis of children on Medicaid in 2013 shows that only hallc of the young people received any mental health outpatient services following an ED. Even when children did receive follow-up therapy, most of the time they only received one or two sessions.3 The exact reasons for this are unclear, but it is important for those working with a child to know that an ED is not a guarantee that serviceswill be accessed. County human services can provide information about the types and extent of services available in the community. FAQ Isn?t this a way to get him/her to take medications? Hospital?based can prescribe medications. However, just because a youth is in a hospital under an ED does not mean that the detained young person can be forced to take medication,- this 1 Office of Children?s Mental Health analysis of admission data from Winnebago Mental Health Institute shows that EDs have become a much larger proportion of youth admissions in the last decade. 2 Based on WMHI admission/discharge data from 2003-2013, 2013 Medicaid records, and 2013 data from the Department of Health Services, Division of Mental Health and Substance Abuse Services 3 Based on an analysis of 2013 Medicaid records and 2013 data. at; 3 int tit . . Wisconsin Office of Children?s Mental Health: ED FAQs requires an additionai legal step which, according to data from the Department of Health Services? Winnebago Mental Health institute, almost never happens for children and adolescents. FAQ Won?t the hospitai at least provide structure and routine in the midst of chaos? hospitals provide structure and routine, which is something that might otherwise be missing from the life of a child in crisis. However, many hospital stays are too short for the youth to develop a new routine and subsequently sustain these benefits once out ofthe hospital. Even when stays are longer, the routine established is not generally one that can be easily repiicated back in the community. For that reason, it makes more sense for those working with the child to try to build routine into the community setting. During high levels of family stress, structure and routine, though very heipful, are often hard to achieve. There may be other ways to temporariiy remove a child from a stressful or chaotic home environment to ailow for deuescalation, such as staying with other relatives or friends or using respite services where available. FAQ if 5: When a young person starts talking about suicide or self-harm, don?t we need to move him/her to a locked facility for 24/7 monitoring? Suicide is a real risk, and everyone around a child is right to want to keep him safe. At the same time, many children and adolescents who express an intention to harm themselves feel overwhelmed and lack the language or communication skills to ask for heip. When a child or adolescent expresses a desire to harm him or herself, it is important to take appropriate steps. These may include putting the child in contact with someone who knows how to question, persuade and refer calling the or arranging a thorough, face-to-face suicide assessment by a qualified mental health provider. Starting a conversation can help determine the best way to approach the situation to both keep the young person safe, and to reduce the short and long-term negative consequences related to having a child/famin go through the ED process. FAQ Isn?t it better than nothing? When a child is in crisis, it?s understandable to consider a hospitai stay as a solution. However, there are clear downsides to submitting a child or adolescent traumatic experience. Children and adolescents are often taken to the hospital in the back of a poiice car, often in handcuffs. They are taken to a facility often hours away from their home, family and friends, and made to stay with people they don?t know. They may see other children who are in severe distress. If they are inappropriately placed, the treatment experience could be brief and positive outcomes may be minimai. Once they return home, children and adoiescents may feel the stigma of being the subject of an emergency detention. The whole process is stressful for the child and family, time consuming for those involved, and very expensive. Unless there is a well-founded concern of serious impairment to the chiid based on a professional assessment, emergency detention and hospitalization may actually be detrimental to the child and family. Wisconsin Office of Children?s Mental Health: ED FAQS What else can I do? When a youth is in crisis and adults feel like they have few other options, it may seem that an ED is the only choice available. However, hospitals, crisis workers, parents and schools report that many approaches do work. Here are some options: 6 De?escalate: Oftentimes what appears to be an enduring crisis is a short~lived burst of intense emotion. By taking a few simple steps, adults can often assist the young person to SUCcessfully move through the emotions. These steps might involve bringing in people the child is close to a grandpa rent, favorite teacher), silently being present, speaking calmly to the child and listening to the anger or fear without argument orjudgment, modeling breathing techniques, taking the child for a waik to get out of an enclosed space, gently leaving the child alone to work through the emotions, etc. a Look for the least restrictive option: EDs are the most restrictive and heavy?handed response to a crisis. If there is any way that a child can safeiy stay at his own home or at the home of a friend or family member a diversion), this should be the first option. This may involve ongoing contact with crisis workers or other supports. If those options are not feasible, some areas have non~ hospital crisis intervention or stabilization sites where youth can stay for a few hours or a few days. Voiuntary hospitalizations are the next Option, followed by EDs. - Plan ahead: All adults working with a child or adolescent can help determine what situations trigger intense emotions and how such situations can be avoided or handled more successfully in the future. Many community resources are trained to do such planning. Comprehensive Community Services (CCS), Coordinated Services Teams (CST) Initiatives, Positive Behavioral Intervention and Supports Tier 3 folks, and Crisis Intervention workers are ail trained to help develop an effective ?planned response?. These services can be accessed through your county and/or schools. 0 Use your primary care physician: Primary care physicians can prescribe appropriate medications, or consult with to do so. Oftentimes what appears to be a medical or mental health issue is rooted in a traumatic or chailenging situation in a child?s life, so conversations about medication should ideally include questions about what else might be affecting the chiid. 0 Get support for the whole famiiy: Crisis workers frequently report that when they are called to deal with a child, what they find is that thei'whole family is experiencing distress. They see a pattern of youth going to the hospital only to return to the same home environment that sparked the crisis in the first place. Consider whetherthe parents might benefit from mental health or substance abuse treatment, peer support, parenting information, or even just time away. Parents who feel supported in their own lives have more resources to help stabilize their child. Appendix CEDCS Summary Wisconsin Office of Children?s Mental Health: Reducing Youth Emergency Detentions gag 3 EMERGENCY DETENTION AND CRISIS STABILIZATION CROSS AGENCY WORKG ROUP SUMMARY OVERVIEW: The cross agency work group was formed in response to an increase in the number of youth being sent to Winnebago Mental Health Institute (WMHI). County, state agency, provider, and parent representatives were concerned about this trend and set out to address it. The initial workgroup was facilitated by the Department of Health Services-Division of Mental Health and Substance Abuse Services (DHS-DMHSAS) from September to October of 2014 ending with the short term goal of developing a residential crisis stabilization services for children that would reflect progress made in the adult system crisis stabilization sites established as Community Based Residential Facilities and Adult Family Homes). This group also recommended promoting linkages between crisis services/crisis planning to Coordinated Services Teams and Comprehensive Community Services programming to ensure crisis plans for children and families are accessible among service systems. Longer term goais included the following: (1) Develop a youth crisis assessment and de?escalation training protocol for counties and crisis intervention partners, law enforcement, and school systems; (2) Expand coverage to include the home as a crisis stabilization site for hospital diversion funded by Medicaid; and (3) Investigate potential to be a resource for crisis services. In January of 2015, the Office of Chiidren?s Mental Health agreed to facilitate the workgroup?s continued meetings in order to better understand the problem and establish further recommendations. The information below is based on meeting activities and available information from both formal analyses of hospital discharge data) and from stakeholder observations. DESCRIPTION OF THE PROBLEM: Although the initial focus of the group was on the high census at WMHI, additional information was needed to put the numbers in context. For instance, an analysis of youth admissions from both state facilities, WM HI and Mendota Mental Health Institute (MMHI), indicates that the number of youth admissions has not increased significantly, but the close re of MMHI youth beds shifted the entire youth population to WMHI. When this observation was made to stakeholders, they posited that the closure of MMHI youth beds did not fully capture the problem. Thus, more discussion and analysis resulted in an increased understanding about the trends at WMHI. Additional issues and information included the following: in Wisconsin has high rates of youth hospitalizations and these have increased in recent years even as other youth medical hospitalizations have declined. 0 Many of the hospitalizations are involuntary. Though it is not possible to determine the exact number of Emergency Detentions, counties reported 1,066 youth (18 and under) were Emergency Detained in 2014. The actual number is likely higher due to inconsistent county reporting. 0 hospitalizations are expensive and are the primary Medicaid expenditure for youth using mental health services. 0 Many hospitalizations can be avoided: The data indicate that oniy a fraction of youth admissions at WMHI result in a civil commitment, settlement agreement, or post-probable cau?se confinement. The majority of youth legal issues are dropped before that point. Additionally, Medicaid data indicates that only half of youth who were known to have been Emergency Detained had any outpatient therapy in the calendar year of their detainment. It was also noted that youth with developmental disabilities are Emergency Detained for behaviors that, with the right training, could likely be addressed in less restrictive settings. p. 1 October 10, 2015 Wisconsin Office of Children?s Mental Health: Reducing Youth Emergency Detentions Egg PROBLEM ANALYSIS: Although we may be unabie to identify all the factors that contribute to Wisconsin?s high rates of youth hospitalizations and EDs, the workgroup collectiveiy identified many facets of the problem as described below. 9 Strain on families: In Wisconsin, as well as the rest of the nation, we have seen an erosion of the middle class and an increase in the number of children living at or near the poverty line. Various health and human service sectors have noted this increased strain. The Department of Children and Families reports increases in the number of children being removedfrom the home and coming in contact with the Child Protective System. A variety of stakeholders report increases in adult and youth substance abuse. Anecdotally, educators report that children are expressing more problem behaviors. a Strain on mental health services: Wisconsin has a pronounced lack ofmental health providers. A report by Mental Health America placed Wisconsin 42? in the nation in the number of providers, and a report by Kaiser Family Foundation ranked Wisconsin last in terms of the ability to meet mental heaith needs; this I creates chalienges in meeting chiidren?s needs for mental heaith screening, assessment, and outpatient treatment. Counties report that their workforces are over-extended and that their staff lacks the support they need to meet the service demand. Providers report that Wisconsin?s Medicaid (MA) has low reimbursement rates for mental health services. in addition, MA reimbursement is not available for certain categories of preventative treatment respite care for families in crisis). More positively, there is some indication that youth detentions have decreased in recent years which may, in part, be due to a growing recognition that mental health issues are at the core of many delinquent behaviors. Though a positive shift in youth treatment, this may place additional strain on the mental health system. 0 Strain on crisis services: in a recent Department of Health Services? (DHS) county crisis services? survey (July 2015), the majority of counties pointed to under-staffing and high employee turnover as problems. This erodes the levei of stability and expertise in crisis services; it also may lead to other practices that make Emergency Detentions more likely, such as: Reliance on law enforcement: in the crisis services? survey referenced above, many counties noted that they rely heavily on law enforcement to respond to crises and make determinations about the appropriate course of action, especially after hours. While law enforcement may have an important role to play in the crisis system, this over?reliance could inadvertently promote the use of primariiy iaw enforcement related options. Lack of time to attend to the crisis: Best practice with youth in crisis dictates that enough time be allotted for a crisis worker to assess the situation, de-escalate, and work with the famiiy to stabilize the youth. In the DHS survey, approximately half ofthe respondents said that they used face-to-face assessments most ofthe time. Some counties noted that they were more likely to use mobiie crisis services when youth were involved. Some rural counties noted that whiie they are able to offer mobile services, in practice the travel time is a challenge with limited staff. Successful counties indicated that youth are most successful when the crisis response can be holistic and family?centered, and, when appropriate, lead to ongoing services. Lack of less restrictive options: The majority of counties surveyed expressed concern over the lack of youth hospital diversion or options. While most counties said that they try to divert individuals from hospitalization whenever possible, they noted that the lack of options makes this particularly difficult. Workgroup members and the counties reported that they are experiencing increased strain on the foster care system making it harder to use foster care licensed facilities for short- p. 2 October 10, 2015 Wisconsin Office of Children?s Mental Health: Reducing Youth Emergency Detentions Egg 3% term mental health stabilization. The number of residential care centers has also declined in recent years. Data from the Wisconsin Hospital Association Annual Surveys shows that the number of beds has declined. in addition, counties report that many of the beds that have closed were youth beds and that some hospitals have adopted new policies which make it increasingly difficult to admit a youth on a voluntary basis. Instead, more hospitals reportedly require an ED for admission. Stakeholder knowledge and beliefs: Many counties expressed the need for more training for their staff in order to more effectively assess and de-escalate crises. in the DHS survey, many counties indicated that they were only willing to see consumers in a secure environment hospital emergency room or police station), and/or that they require that police accompany crisis workers in non~secu re environments. While it is imperative to protect crisis workers? safety, there may be ways to provide crisis services in less restrictive and potentially triggering conditions. Even when a crisis staff person determines assesses that a situation can be safely handled outside of an Emergency Detention, counties report that sometimes other stakeholders take a highly cautious approach and default to the side of an Emergency Detention if there is any perception of risk. This has been mentioned with regard to law enforcement, corporate counsel, and hospital staff. EXAMPLES OF COUNTY SOLUTIONS: Counties have been creative and proactive in seeking solutions. Below are some examples cited by the work group. 0 Some counties are focusing resources on early identification, identifying youth at risk of crisis and targeting services to meet their needs. 0 Police training focused on serving youth. 0 At least one county will meet youth/family at the Emergency Room andfollow~up with 15 to 20 hours offace to face services a week. While another county provides an in?home treatment model that includes longer term treatment (more than 90 days). 0 Several northern counties stabilize youth in a non?hospital setting within 24 hours but have very limited capacity. Others report usingfoster and group homes. While others are considering a ?flexible use? model to provide an "hotel model? stabilization ?the parent stays with the child in a stable setting. 0 Ten counties contract with a network to help serve and place youth. They offer planned respite for families out of general state revenue or county funds to be used as a diversion to hospitalization, as a step down coming out of hospital back into community, and as a planned response to address a need prior to crisis. This network also provides training and technical assistance for counties dealing with youth in crisis. They attribute much of their crisis diversion to face-to-face assessment which they also use to de?escalate the situation. If they feel a hospitalization is not necessary but services are needed, they can place the child in a stabilization site, which could be a foster home, group home, or treatment foster home, all of which are licensed by DCF and must have specialized DHS 34 training. NEXT STEPS: The group created three workgroups focused on improving crisis response. These include: 0 Best practices: This group will collect and disseminate information on the best practices occurring I nationally and within Wisconsin, both directly in the crisis system and in work with stakeholders hospitals, law enforcement, schools]. The information will serve as a standing resource for counties. 0 Training: The Wisconsin County Human Services Association will lead an effort to help define a standard set of crisis training materials statewide. 0 New options for placement: This group will design and pilot a regional group home that can be used in lieu of hospitalization for the purposes of crisis stabilization. p. 3 October 10, 2015 Appendix D-3: CE DCS Recommendations EMERGENCY DETENTION AND CRISIS WORKGROUP: RECOMMENDATIONS TABLE Coordin ation Build and maintain reiationships with schools and private insurers. Encourage MOUs with schools and health systems to identify and connect at?risk youth to services. County representatives noted that many crisis cases Were unknown to them because they came from private providers/insurers. Coordinate internal efforts to free up staff resources. Encourage county use of or simiiar quality improvement process to improve internal process (ex: Jefferson, Rock). Promote and maintain linkages betWeen tribal crisis and mental health services and county crisis and mental health services. Coordinate regional or statewide efforts to maximize use of resources. investigate what functions can be effectively regionalized or even handled at the state level. Ex: call centers, centralized bed coordination system. Promote and maintain linkages between crisis services and Coordinated Service Teams and Comprehensive Services programming. Strong collaboration wiil ensure that crisis plans are available to every member of the youth/families' support team. Meet with hospital associations/hospital administrators to address the perception that hospitals have adopted new policies which make it increasingly difficult to admit a youth on a voiuntary basis. Traini n8 Introduce information about the Adverse Childhood Experience Study and trauma-informed care to anyone who touches the life of a child. Provide simple sensory de?escalation strategies and information I about Wellness Recovery Action Plans (WRAP) plans for providers, youth and families. Crisis intervention Team trainings for law enforcement. This specialized training provides officers with information about mentai health issues, reduces risks of injuries to consumers and officers, enhances working relationships with mental health providers, increases family involvement and reduces the need for more costly services. Provide stakeholders with information about the CST approach and CCS service array and approaches to suicide prevention. Estabiish training protocol for crisis staff, school liason officers, school staff, corporation councii and other stakehoiders. The training would focus on crisis assessments, de~escaiation techniques, deveioping crisis plans, working with special populations deveiopmental disabilities, dementia patients), trauma informed care and cultural competency, working effectively with partners, identifying and addressing vicarious trauma and burnout. Provide law makers, county supervisors, local leaders and businesses with information related to the cost savings in investing in early intervention Versus youth crisis services and hospitalizations. Train stakeholders law enforcement, corporation council, schools, hospital staff) understand potential liability concerns so that EDs are not seen as a necessary default option. in addition to concerns over legai liabilities, crisis workers express safety concerns over meeting youth in the home or community and limit contact to hospitals and police station. Training directed at reducing these concerns may increase successful crisis contact and planning. Retain workforce by providing training and support related to vicarious trauma through the development of Wellness Recovery Action Pians (WRAP) and reflective supervision. Train service administrators on billing Medicaid for crisis intervention, stabilization, and related services. Access incorporate Specialized support into service array. Monitor the development of certification for Pa rent Peer Speciaiists and incorporate onto support tea ms. Occupational Therapists are often able to provide sensory strategies to be used for de?escaiation. Estabiish out-of?home stabilization options (23-hours and/or motel model with parents on site) as well as in-home crisis stabilization services. Explore potential for using Residential Treatment Facilities. Review MA reimbursement rates and prior authorization practices for mental health screenings, assessments, and treatments with special attention to in-home, famiiy~centered approaches. Partner with hospitais to access voluntary youth beds. Plan respite using GPR or otherfunding source. Explore greater use of foster care options, group homes, family resource centers and Peer Run Respites, where avaiiable and applicable to age group. Provide mobile crisis services to better meet youth and families rwhere they are at'. August 28, 2015 Appendix Crisis Response Continuum From the Wisconsin Office of Children?s Mental Health, June 2015 Voluntary hospitalization Residential stabilization . options 5 days if 5 Group Home or Treatment c: _j a Foster Home CLTS as a model for blended Funding em :22? 2 .. with parents 0 staying overnight ("hotel model?) 5.. a mm: q, a Non-Residential stabilization .2 6 site (up to 24 hours) - ?Designated use (NCHC) OR a) ?F exible Use (Central WI) U) .2 Emergency Room Crisis Response .2 (Dane) 5- In-home Crisis Stabilization (CCF in Dane; Rock Co.) '5 Walk?in Crisis Center 3 (assessment, de?escalation, planning. e.g. Brown)County) On-site crisis response (at school or home: assessment, de? escalation, planning. Law enforcement trained in Youth CIT.) Planned Respite Sauk, Dodge, Adams) Early ID, prevention, planning (schools, outpatient therapists, trauma?informed communities) Crisis Prevention