S A F E C H I L D R E N , S TA B L E FA M I L I E S , S U P P O R T I V E C O M M U N I T I E S Ohios Multi-System Youth Initiative OACCA Fall Conference September 9, 2016 Angela Sausser, Executive Director PCSAO Multi-System Youth Definition A youth with significant mental health, addiction and/or developmental delays who is involved or at risk of being involved with child protection and/or juvenile justice. Whoare not accessing the right services or supports to remain stable and in their own home. Who...have a high risk of poor outcomes education, health, employment, criminality 2 Other Terms for Multi-System Youth

Cross-Over Youth High Intensity Needs Youth Youth with Complex Needs Dual Diagnosed/Dually Served Youth Youth with multi-systemic needs 3 Multi-System Youth Data Very limited as agencies information systems dont talk to each other Very limited state level data from several systems Special projects have been created to pull such data, but still limited 4 Multi-System Youth Data Findings from YYAT Medicaid Hot Spot Data (2013) OhioMHAS, 4/17/15 presentation 13% of all Medicaid youth between ages of 14-21 used

Medicaid MH services Youth in foster care account for 25-41% of expenditures within the Medicaid program despite representing less than 3% of all enrollees Most youth in the foster care system have been diagnosed with at least 1 chronic medical problem and as many as 25% have 3+ chronic health concerns. 5 Multi-System Youth Data Family and Children First Councils served the following with pooled funding in SFY 15: 5,491 children with multi-system needs with 32.9% being between 14-18 Identified having 13,456 needs (average 2.45 per child): 57% mental health 46% poverty 38% special education 22% developmental disability 18% unruly 12% child neglect 11% autism Source: OFCF SFY 15 FCSS Annual Report 6

Multi-System Youth in Juvenile Justice 467 youth in Juvenile Correctional Facilities and Alternative Placements, 50% have mental health needs 47% have special education needs 8.9% of youth adjudicated of a felony offense were committed to Department of Youth Services; the remaining are served in the community. Source: ODYS, SFY 2015 7 Multi-System Youth in BHJJ Programs Issues of the 3,495 Youth enrolled in BHJJ Programs Females Males Physically abused Sexually abused Run away Substance abuse, including alcohol and/or drugs Talked about committing suicide Attempted suicide Exposed to domestic violence or spousal abuse

Childs biological family been diagnosed with depression or shown signs of depression Childs biological family had a mental illness, other than depression Child lived in a household in which someone was convicted of a crime Childs biological family had a drinking or drug problem 18.7% 27.0% 58.9% 46.3% 49.5% 23.6% 41.7% 14.0% 7.4% 44.7% 54.1% 30.4% 9.4% 37.9%

68.1% 60.8% 48.3% 40.3% 38.8% 40.8% 61.8% 57.7% 8 Multi-System Youth in BHJJ Programs Most Common Axis 1 Diagnosis Females Males

Adjustment Disorder Alcohol-related Disorders Attention Deficit Hyperactivity Disorder Bipolar Disorder Cannabis-related Disorders Conduct Disorder Depressive Disorders Disruptive Behavior Disorder Mood Disorder Oppositional Defiant Disorder Post-traumatic Stress Disorder 6.6%* 13.4%** 25.8% 7.9%** 27.8% 11.2% 21.8%*** 5.6% 12.0%* 40.1% 9.5%*** 4.9%

9.3% 40.5%*** 5.6% 37.3%*** 22.1%*** 12.1% 6.6% 9.6% 39.9% 4.9% 9 Multi-System Youth in Child Protection While allegations of abuse and neglect account for 82% of screened-in reports, 6 in 10 children in agency custody are there for reasons other than abuse and neglect. Children In PCSA Custody Reports Screened-in Abuse and Neglect; 82.00% Child Behavioral Problem; 15.69%

Delinquency; 15.69% Abuse and Neglect; 39.22% Dependency; 29.41% Other; 18.00% 10 Multi-System Youth in Child Protection Nearly half (49%) in residential or group homes have a primary removal reason other than child abuse and neglect: Primary Removal Reasons for Youth in Residential Treatment Facilities Other Dependency Neglect Abuse Delinquency Child Behavioral Problem Unruly Status Offender

60% 50% 40% 24% 30% 20% 19% 10% 0% 0.09 0.07 6% 0.25 0.1 Source: ODJFS SACWIS data, 9/11/2014; 2,111 children in CRC or Group home on that day 11 Custody Relinquishment

30% of multi-system youth entered agency custody via custody relinquishment : Youth via Custody Relinquishment Multi-System Total Custody Relinquishment 250 200 150 100 50 0 JJ DD

MH/BH Source: PCSAO Survey of 40 PCSAs, June 2015 12 Multi-System Youth in Child Protection Casey Family Programs recently reviewed metro sized agencies performance & found: 40% of teens experience congregate care as their 1st placement in child protection care 13 A County Public Children Services Experience 14 Franklin County Children Services Nationally, there has been a major shift from the traditional abuse/neglect population child welfare agencies were designed to serve. Franklin County and many others in Ohio are above the National average for the rate of teens entering care for reasons other than abuse and neglect. 60

FCCS 20% points greater than National average % Percentage 50 40 30 20 10 0 FCCS National 52%* 32%* Kids Entering Custody Ages 11-17 FCCS

National *Average from 2012 2014 Source: Data Sources: Ohio SACWIS Data for Franklin County Children Services, and http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/afcars for National Data 15 Franklin County Children Services Youth initially placed in group placements, if moved to a second setting it is most likely to another group placement 63% of youth initially placed in group placement are moved to a second placement within the first month (within 30 days) Youth initially placed in a group placement are unlikely to experience a family-like setting if a placement change occurs Yet, 92% of youth initially placed with a kin or foster family will experience a family like setting in their second placement *Note: Group Placement is cumulative term to denote the following settings: shelter, group home, residential treatment, hospital settings. 16 Joint Legislative Committee on Multi-System Youth 17

Joint Legislative Committee on Multi-System Youth Held six hearings Worked closely with a large external Stakeholder group Testimony from families, youth, service providers, county agency leaders, State officials Primary focus on preventing the need for future relinquishment of custody in order to access treatment 18 Multi-System Youth Continuum of Care 19 Variability of Services Across the State Williams Lake Lucas Fulton

Geauga Cuyahoga Defiance Ashtabula Ottawa Sandusky Wood Henry Erie Trumbull Lorain Portage Paulding

Huron Seneca Putnam Medina Summit Mahoning Hancock Van Wert Wyandot Allen Ashland Crawford Richland

Wayne Stark Columbiana Hardin Mercer Marion Auglaize Shelby Darke Logan Union Morrow Knox Delaware

Champaign Guernsey Perry Pickaway Belmont Ross Washington Athens Vinton Highland Clermont Meigs Pike

Athe Brown Adams Scioto Jackson Gallia Lawrence Monroe Morgan Hocking Clinton Hamilton Noble Fairfield

Fayette Warren Harrison Madison Greene Butler Muskingum Franklin Jefferson Tuscarawas Licking Clark Montgomery Carroll

Coshocton Miami Preble Holmes HFWA GH IL CRC RPF CCCF IHBT MST MST-PSB FFT ICT MDFT OhioMHAS Private OhioMHAS Licensed DD Respite DYS Institutions

Special Institutions CCF Joint Legislative Committees Recommendations 1. Access to Peer Supports and Mentors for youth and families 2. Access to High Fidelity Wraparound 3. Improve data collection and sharing on multi-system youth 4. Modernize Family and Children First Councils 5. Create a state level safety net fund to offset uninsured/underinsured costs 6. Conduct an Independent Study on Residential Treatment in Ohio 7. Create an Oversight Committee to monitor the implementation of these 21 S A F E C H I L D R E N , S TA B L E FA M I L I E S , S U P P O R T I V E C O M M U N I T I E S Next Steps with Ohios MultiSystem Youth Initiative Connection with BH Re-Design Efforts

23 Next Steps for Non-BH Re-Design Efforts 1. OFCF Cabinet plans to make recommendations on addressing the variances between FCFCs. 2. Advocate for state level safety net funding to offset uninsured/underinsured costs 3. Advocate for funding to conduct an Independent Study on Residential Treatment in Ohio 4. Encourage the creation of an Oversight Committee to monitor the implementation 24 S A F E C H I L D R E N , S TA B L E FA M I L I E S , S U P P O R T I V E C O M M U N I T I E S Any Questions? Thank you! Contact Information: Angela Sausser, Executive Director (614) 224-5802

[email protected]

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