Last Updated:
06/05/2007

Westchester and Nation Celebrate Systems of Care with Celebration
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As part of National Summit Day to recognize Systems of Care on 5/4, a System of Care celebration was held at the Mt. Vernon Community Network, hosted by Mt. Vernon High School.  Mt. Vernon Network was honored for over 25 years of Network and Community Development.  Dr. Jennifer Schaffer, Commissioner Dept. of Community Mental Health presented a Proclamation to the City of Mt. Vernon and Mt Vernon Network from Westchester County Executive Andrew Spano.  The Mount Vernon School District was also honored for hosting the Community Network for the past several years.  Superintendent Brenda Smith and High School Principal Dr. Larry Ashley accepted the Proclamation.
 

Westchester County CCSI Facilitates Five Regional Trainings
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Westchester County Department of Community Mental Health Wraparound Training Team facilitated 5 Regional Trainings sponsored by New York State Coordinated Children's Services Initiative.  The trainings were held throughout the months of April, May and June and includes 5, 2-day trainings in Lake Placid, Kingston, Batavia, Syracuse and Long Island.  Over 500 service providers and family/youth support workers attended the training sessions.  The primary focus of the trainings were on the Coordinated Children's Services Initiative (CCSI), systems of care development and the wraparound approach. 

Westchester County Department of Community Mental Health Annual Meeting,
Tuesday, May 17, 2005 at the Westchester County Center.
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Honorable Andrew J. Spano, Westchester County Executive and Dr. Jennifer Schaffer Commissioner Department of Community Mental Health provided a welcome and introduction to the meeting.  The keynote speaker, Larke Huang, Ph.D., Technical Assistance Partnership, Advisor President's New Freed Commission, Member presented on the "The President's New Freedom Commission as a Foundation for Change Across Systems.

Download the PowerPoint Presentation (you MUST have powerpoint already installed to view).  [RIGHT-CLICK] ... [SAVE TARGET AS] and download it to the hard drive before playing.  NOTE: The file is almost 5BM in size.  Download times will depend on internet connection speed as well as speed of computer

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Surgeon General Releases a National Action Agenda on
Children's Mental Health
HHS NEWS
U.S. Department of Health and Human Services
Press Release January 3, 2001
 

Washington, DC – David Satcher, MD, PhD, Assistant Secretary for Health and Surgeon General, released a National Action Agenda for Children's Mental Health, which outlines goals and strategies to improve the services for children and adolescents with mental health problems and their families.  According to the report, the nation is facing a public crisis in mental health for children and adolescents.

In the United States, 1 in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment.  Yet, in any given year, it is estimated that fewer than 1 in 5 of these children receives needed treatment.  The long-term consequences of untreated childhood disorders are costly, in both human and fiscal terms

"This report provides a blueprint for change," said Dr. Satcher, "and presents an overarching vision aimed at fostering social and emotional health in children.  The burden of suffering by children with mental health needs and their families has created a health crisis in this country.  Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by the very institutions and systems that were created to take care of them."

The National Action Agenda identifies eight goals and multiple action steps, which include promoting public awareness of children's mental health issues, reducing stigma associated with mental illness, and improving the assessment and recognition of mental health needs in children.

"We must educate all persons who are involved in the care of children on how to identify early indicators for potential mental health problems.  This begins with families.  We need to help families understand that these problems are real, that they often can be prevented, and that effective treatments are available," said Satcher.  "We also need to better educate frontline providers – teachers, health care workers, school counselors and coaches, faith-based workers, and clinicians of all disciplines- to recognize mental health issues.  Finally, we need to train health are providers in scientifically-proved, state-of-the-art approaches of assessment, treatment, and prevention."

The Surgeon General's action steps encourage the wide adoption of science-based prevention and treatment services, as well as continued research.  According to the report, bridging the gap between research and practice is not the only step.  Connecting research and practice to policy is critical to ensuring access to quality mental health care for children and their families. 

The report calls for an increase in the coordination of mental health care services for families with mental health needs.  At present, there exists no primary mental health care system for children.  Despite the existence of mental health programs in many communities, the nation lacks a basic mental health care infrastructure.  Mental health treatments and services are fragmented across many institutions, raging from schools to primary care to child welfare and often the juvenile justice system.  Moreover, disparities in access exist across racial, ethnic, and socioeconomic groups.

"The multiple systems for mental health care can be very difficult to navigate for many families, " said Dr. Satcher.  "In reality, services are often just not available.  The agenda in this report presents an unparalleled opportunity to make a difference in the quality of life for all of America's children, " said Dr. Satcher.  "It will take the efforts of all of us at the Federal, State, and local level to implement the action steps outlined in this agenda.  I am confident that we will succeed."

The National Action Agenda reflects the culmination in a series of activities over the past year, including the Surgeon General's Conference on Children's Mental Health in September 2000.  The report includes proceedings from this conference and synthesizes recommendations from three major Federal agencies – the Department of Health and Human Services, the Department of Education, and the Department of Justice – and a broad section of mental health stakeholders – youth and family members, professional organizations and associations, advocacy groups, faith-based practitioners, clinicians, educators, health care providers, and members of the scientific community and the health care industry. 

The National Action Agenda on Children's Mental Health is available on the Surgeon General's website at www.surgeongeneral.gov/cmh/ .  Print copies of the report are available through the National Institute of Mental Health, Office of Communications and Public Liaison, at (301) 443-4512.
 

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N.Y. lags in effort to reform treatment system
By JORGE FITZ-GIBBON
THE JOURNAL NEWS
(Original publication: December 12, 2002)

For the original print, please visit: http://www.nyjournalnews.com/rtc/1part3.htm
For additional articles on RTC, and the Journal New's Piece called "Throwawya kids" visit: http://www.nyjournalnews.com/rtc/index1.htm

New York state has failed to repair a fractured system of care for troubled children that relies on costly institutions while neglecting promising alternatives, an investigation by The Journal News has determined.

Other states — including New Jersey and Connecticut — have set out to change the way they serve emotionally disturbed children by focusing on community-based programs without bureaucratic barriers, a widely embraced approach pioneered in Milwaukee.

But New York policy-makers have been either unable or unwilling to confront deep-rooted problems in the state's child welfare and mental health systems, although the most

successful community-based alternative — known as "Wraparound Milwaukee" — has proved that many high-risk children can be better served at half the cost in their own homes or communities.

So far, New York institutions seem reluctant to relinquish their lucrative stake in the system.

"The most expensive kind of care is institutional care, and it's usually the poorest kind of care," said Marcia Lowry, a civil liberties lawyer whose landmark 1973 lawsuit led to

reforms in the New York City foster care system. "There's no cost saving to sticking kids into bad institutions, aside from the impact on children, which is of course very damaging. "There is not sufficient political will to change it. The city could do it. The state could do it. They haven't," Lowry said.

New York officials argue that it is ultimately the counties' task to care for troubled children. Yet, a fragmented state funding and oversight system limits what counties can do. Children and their families are forced to rely on multiple government agencies, each overseeing a portion of the services a child needs. Families routinely shuttle from office to office, duplicating paperwork just to patch together the necessary services. The most effective approaches are relegated to "pilot program" status and are confined to individual counties, towns or agencies.

Still, there has been no far-reaching initiative from lawmakers, nor a mandate from Gov. George Pataki to do more. Instead, New York relies on privately run, publicly funded  institutions — former orphanages and children's hospitals that have evolved into catch-all facilities known as residential treatment centers or RTCs. The Journal News found wide-ranging flaws in RTC care, including insufficient mental health services, inadequate oversight and an over reliance on psychotropic medications to control unruly children.

Because of their proximity to New York City, Westchester, Rockland and Putnam counties have the state's highest concentration of these institutions, with 13 campuses housing more than 2,000 children. A varied population of youngsters — from juvenile delinquents to mentally ill children — are clustered in the centers at a cost that can exceed $100,000 per year for a single child.

It is a burden that ultimately falls on the taxpayers: RTCs are a $200 million-a-year industry in Westchester, Rockland and Putnam. Westchester spends an additional $3 million a year to send 50 children out of state for treatment. In all, 420 New York children were treated out-of-state last year at a cost of $36.8 million.

And it is a national problem. In October, a report of the President's New Freedom Commission on Mental Health said the country's mental health systems were "in shambles," particularly for troubled children.

"The 'mental health maze' is more complex and more inadequate for children," the report said. "The service system in many communities is more fragmented for children than for adults, with even more uncoordinated funding streams and differing eligibility requirements."

Changing the system
Wisconsin's Wraparound Milwaukee program has become the model for states seeking to reform their child welfare systems. It calls for therapists, clinicians, tutors and social workers to work in the home, with all the services "wrapped" around the child and family. Youngsters without viable homes remain in their communities in therapeutic foster homes, which house small groups of children in the care of specially trained foster parents. The homes exist in New York but are underused.

New Jersey's system overhaul began in 1999 with a mandate from then-Gov. Christie Whitman. The state was spending nearly all of its child welfare funding on residential care, with limited results. New Jersey decided to create the Children's System of

Care Initiative, which became the first attempt to implement Wraparound Milwaukee statewide.

The initiative calls for the creation of local managed-care agencies — a total of 15, with smaller counties combining services — through which all of the funding and resources are funneled directly to children in their own homes or community-based facilities. New Jersey has created six of the local agencies, with a seventh — for Hudson County — now being added.

Julie Caliwan, director of the New Jersey initiative, said one of the goals is to reduce use of psychiatric drugs, a common concern in institutional care. But there is no definitive

evidence that wraparound systems have a significant impact on medication use.

As it is, the push in New Jersey is not to phase out RTCs so much as to redefine their purpose. New Jersey has far fewer children in out-of-home placement — 2,035 children, 887 of those in RTCs, compared with about 40,000 out of home and 5,000 in RTCs in New York.

Reducing the use of institutions or simply shortening the amount of time a child spends there can radically cut cost. The number of institutionalized Milwaukee children has dropped from 385 to 40, while the cost to taxpayers for each child was cut in half.

"Once you get past the initial break-in period, you're going to get tremendous cost benefit from it," said Harry Shallcross, a consultant who has worked with 38 states and helped New Jersey create its wraparound plan. "You're going to both keep kids at home, and you're going to do it for a lot less money than it costs to go into residential care."

Wraparound has drawn interest from other parts of the nation, including Pennsylvania and Massachusetts. Connecticut's KidCare proposal will use a wraparound approach. The first step in Connecticut's plan — a mobile crisis team — kept 88 percent of children it served out of institutions between July and September.

Pilot programs
The concept has not been entirely lost on New York. Kids Oneida, a wraparound pilot program in upstate Oneida County, handles 110 troubled children at a time, most of them

classified as high-risk. About 40 percent of the children are referred by Family Court or institutions. Yet, nearly two-thirds are able to remain in the community.

Of the one-third that end up in residential facilities, most stay there for three to six months before returning to their homes — compared with the 16-month median stay in a

Westchester RTC. Nonetheless, the long-term impact of Kids Oneida is still uncertain. In four years, the program has not significantly reduced the number of children who are

institutionalized in Oneida County, although officials there maintain that it has kept the number from increasing.

RTC administrators resisted the program when it began four years ago, said Mike Daly, executive director of Kids Oneida. Some expressed concern about the welfare of the children, although, he said, many seemed worried about losing income or becoming irrelevant.

"If your business is selling bread, and someone is around the corner who can sell it cheaper, that's a threat to you," Daly said. "But now I see the RTCs working hard with us."

Westchester County has a grass-roots version of wraparound, known as Networks. The process brings together teams of social workers, educators and government agencies to help families with emotionally disturbed children who are at risk of being institutionalized. It is one of a number of county measures that reduced the number of Westchester children in institutions by 31.4 percent between 1994 and 1998.

Rockland also has a Networks program. But neither county has the critical pool of funding that is essential to wraparound. Without it, families have to apply to separate agencies for services. Many families fall through the cracks because they don't fit into any one program.

Myra Alfreds, director of children's mental health services at the Westchester County Department of Community Mental Health, would like to bring wraparound here. She visited Milwaukee in September. For now, only pilot programs are in the works. "We have lots of examples of doing little things," Alfreds said. "We have a system in our communities where families have access to a range of services, but we don't have any financing strategy that puts the money together. And of course, that's very hard in New York state."

One pilot program will partner Westchester County with Children's Village in Dobbs Ferry, the nation's largest RTC, and target five to eight institutionalized youngsters. It

differs from the Milwaukee model in one key way: The services would not be run by a separate managed-care agency as wraparound dictates, but rather by Children's Village, which oversees the very type of institution that wraparound seeks to eclipse — an RTC.

For state officials, wraparound is still an experiment. "Wraparound Milwaukee is an emerging national model that we're interested in," said Bill Van Slyke, a spokesman for the state Office of Children and Family Services, or OCFS, which oversees the child welfare system. "We'll be watching it very closely to determine whether this is something that may be possible and right for New York state."

Asked why the Westchester program would not serve more children, Van Slyke referred questions to county officials. "Since social services in New York are administered locally, we don't by fiat tell local districts what approaches to take," he said.

When asked the same question, Nancy Travers, Westchester's deputy social services commissioner, deferred to the state — an indication of the uncertain accountability that plagues the child welfare system.

Barriers and bureaucracy
Pooling funding and resources within the state's bureaucratic child-care system remains the most difficult hurdle for widespread reform. Oneida County had to obtain several state waivers to get Kids Oneida up and running.

"It's been very hard to move the child welfare system in this state," said Lowry, the civil liberties lawyer. "The reason we continue to provide services this way is because that's what we've always done. It also has to do with the fact that there is real estate involved here. There are beds. It is easier when there are facilities to simply put a child in an existing facility rather than doing the hard work of developing new programs."

The barriers begin in Albany, where a variety of state agencies oversees the care of troubled children. OCFS, the Office of Mental Health, the Department of Health, the Office of Mental Retardation and Developmental Disabilities, and the Department of Education, among others, can all play a role in a single child's life.

The Office of Mental Health, or OMH, relies heavily on Medicaid funds to treat children in psychiatric hospitals and a state-run system of institutions called residential treatment facilities, or RTFs.

OCFS oversees juvenile justice and child welfare services, and empowers counties to contract with private child-care agencies that operate RTCs.

There also are multiple paths into the institutions. A single RTC can have children referred by OCFS, a local school district, the county Department of Probation or parents.

"You need to have a single integrating structure which pulls together those elements of the child's life and helps the child and family to develop a coherent plan, and to follow through on that plan," said Michael Friedman, policy consultant for the Mental Health Associations of Westchester and of New York City.

Magnifying the problem is New York City, with one of the largest foster care populations in the country. More than three-fourths of the children in RTCs in Westchester, Rockland and Putnam are placed by the New York City Administration for Children's Services.

'Turf issues'
The position of most child-care agencies and RTC directors is that their institutions serve a vital function in the treatment of children with diagnosed emotional and mental health disorders.

"They need to be in a place with many child-care workers," said Jerry Dohrenwend, assistant executive director of Abbott House in Irvington. "A lot of kids need the supervision of an RTC."

Most local RTCs are run by agencies that already provide other services, including community- based programs. RTC administrators generally support the wraparound concept, but walk a blurry line: They are quick to add that it would not help most of the children their industry thrives on treating. Children's Village Executive Director Nan Dale, one of the state's most influential RTC officials, criticized wraparound

during a 90-minute interview with The Journal News Editorial Board last month. Dale said most children in institutions have no homes to return to and could pose a danger to the community.

But in a written statement released this month, she said wraparound "has a lot of strengths" and "can work for many children."

"I caution, however, any rush to import something on a broad scale to New York, which is a larger and far more complex system," the statement added. "We need an array of service options, and the flexibility to use whatever fits best for the child and family in need."

Critics charge that the private agencies that run the RTC system are simply protecting their industry. Wraparound strips RTCs of much of the decision making and removes their direct control over the purse strings.

"One of the reasons (wraparound) hasn't caught on more rapidly is that it changes the status quo for providers," said Robert Friedman, head of the University of South Florida Department of Child and Family Studies. "These centers are influential. They have their own boards of directors who have direct access to legislators and county commissioners. If their money is being cut, it's guaranteed they're going to speak up."

There have long been calls for a change. Reports critical of child welfare and mental health from decades ago still ring true.

"The word 'fragmented' is a much used adjective when government services to children are discussed," said a 1987 report by the state Senate Committee on Mental Hygiene, whose chairman was Sen. Nicholas Spano, R-Yonkers. "There has been no consistent, well-developed attempt to identify a comprehensive set of needs of children, and to provide a central structure for ensuring that the needs of children are met."

This year, a report by the state Senate Committee on Investigations and Government Operations, also presided over by Spano, took the system to task again after an attack on a counselor at the Pleasantville Cottage School.

"There are turf issues in terms of different agencies; there are different levels of government, different agencies within different levels of government," Spano said. "It's a hodgepodge."

An internal document from the state OCFS obtained by The Journal News said that thousands of children are not receiving the mental health care they need. If the system is not reformed, the state could find itself in violation of federal law by treating children in institutions unnecessarily, the document said.

The report's recommendations have twice been submitted to lawmakers in Albany but have yet to spark serious discussion. In October, the state Assembly Committee on Health, Mental Retardation and Developmental Disabilities released another report, this one taking issue with the care of mentally ill adults and children. The committee's chairman, Martin Luster, D-Ithaca, said looming budget shortages are no excuse for inaction.

"You can get the law in place," Luster said. "You can get the programs in place. You can do the thinking and the planning and the structuring, then provide the money as times change. But even these preliminary steps are not being taken."

Needless suffering
The crisis in child mental health care is not unique to New York. In 1984, the federal government laid out a set of principles for states and counties to follow. The Child and Adolescent Service System Program, or CASSP, continues to provide guidelines for improved mental health care.

But CASSP has done only so much. In a report on the 2000 national conference on children's mental health, the Surgeon General criticized the quality of care available to children. "Growing numbers of children," the report said, "are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by those very institutions which were explicitly created to take care of them."

The problems have failed to draw enough attention from Albany to improve the system statewide. Pataki declined numerous requests by The Journal News to be interviewed. A series of questions on the issue were submitted to the governor's office on Nov. 19. The office responded with a written statement this month that defended Pataki's record.

Pataki said the state has "achieved considerable success in improving New York's child welfare system" and that his office is reviewing ways to improve the "quality and variety of services provided."

An aide to the governor would not elaborate.

"We have made significant progress, but success in child welfare, like all human services, is difficult to demonstrate or appreciate while even one child or one family suffers," the statement said.

New York has taken some action in the past decade, launching a number of well-meaning but limited initiatives. In the early 1990s, the state approved the Community Mental Health Reinvestment Act, which used savings from a reduction in state hospital beds to fund community-based programs starting in 1994. Lobbying efforts ultimately set aside some 25 percent of the money for youngsters.

The act was allowed to expire last year, however. A new reinvestment bill has been passed by both the Assembly and the Senate but has not been signed by Pataki.

The governor proposed two years ago to raise an estimated $64 million by closing several adult psychiatric hospitals and merging others with child psychiatric hospitals — including Rockland Children's Psychiatric Center. The money was to fund community-based initiatives, but opposition stalled the plan. Any savings have been absorbed into the general fund.

In 1998, the state also tried to overhaul the child welfare system by creating OCFS. The agency merged the Department of Social Services and juvenile justice Division for Youth. Not included in the new agency was the Office of Mental Health, a decision that many call an oversight, given the needs of the children in OCFS care. Since Medicaid dollars are meant for clinical and mental health care, OCFS is now hard-pressed to draw sufficient federal money to provide those services.

"When you look at it, I think it's an omission," said Spano, the Yonkers state senator. "There either has to be at least a coordination of services or possibly a combining of the agencies. It's impossible to identify a kid who's in an RTC system who has not had, at one point in their residency, some psychiatric episode for need of psychiatric intervention."

This year, the Legislature did approve the Child Welfare

Financing Plan, a Pataki proposal that supports preventive services and aftercare. The plan, which was worked into the 2002-03 budget, calls for the state to match up to 65 percent of local spending.

OMH has also expanded two programs to serve troubled youth at home when they are at risk of being institutionalized. The Home and Community Based Waiver, which pays for individualized services, grew from 300 to 600 children over the past three years. Family Based Treatment, a program which houses children with specially trained caretakers, grew from 365 to 490 slots.

But while there have been occasional pieces of legislation in recent years — including a proposed bill of rights for youngsters in the child welfare system — and innovative pilot programs, there has yet to be comprehensive reform.

The Coordinated Children's Services Initiative, or CCSI, for instance, offers startup money for programs that promote inter-agency cooperation. Begun in 1994 by OCFS and OMH, it has been used in 56 counties, including Westchester. But CCSI, with a $660,000 budget, has been used sporadically and remains the exception rather than the rule.

"You're basically kind of inviting people to be more collaborative," said Shallcross, the New Jersey consultant. "But you're not really providing any really new structure or accountability to operating a new structure."

'Nobody's job'
RTCs have to be willing to adopt a different role, stabilizing children rather than providing long-term care, said Michael Friedman, the mental health consultant.

Programs like Kids Oneida are in place to provide effective models, said Martin Irwin, a Syracuse consultant on mental health issues. Like Networks, one Onondaga County program — The Family Support Center at the Elmcrest Children's Center — has been able to surround at-risk children and their families with services to prevent them from entering the foster care system. The idea is to intervene, work with families and return the children to their homes in three to four weeks. "The entry to foster care, I think, needs to be different," Irwin said. "It's a disaster. It doesn't do anything to get you home quickly."

Despite a federal mandate that children be placed in the least restrictive setting — and the majority of New York foster-care children are not institutionalized — thousands are still in RTCs statewide. The motivation to change that remains uncertain.

"We have the capacity in New York state to develop a system of care for kids with serious emotional disturbances," said Gail Nayowith, executive director of the advocacy group Citizen's Committee for Children. "The services are here. The talent is here. The research institutions are here. The training institutions are here.

"But it's nobody's job, and that's the problem," Nayowith added. "Until it's somebody's job, it's not going to get done."

Send e-mail to Jorge Fitz-Gibbon

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COORDINATED CHILDREN'S SERVICES INITIATIVE
GOVERNOR PATAKI SIGNED LEGISLATION

Text of Nov. 20 NYS Office of Children & Family Services press release.

ALBANY -- New York State Council on Children and Families (CCF) Executive Director Alana Sweeny today announced the establishment of a preventive, community-based initiative to help better serve vulnerable children with multiple needs and reduce the number of children placed in out-of-home residential care.

Governor George E. Pataki recently signed legislation to formally recognize the Coordinated Children's Services Initiative (CCSI), a collaborative effort between state, local and community-based agencies to improve services for children with emotional and behavioral disorders by using innovative methods to meet their individual needs. Since Governor Pataki took office in 1995, the number of children in foster care has decreased by 36 percent.

While CCSI provides a structure for interagency planning and service delivery, it is a process based on a set of principles rather than a program.  It is not mandated, but allows counties and schools the option of participating.  The law:

• Establishes a three tier interagency structure to assure that services are comprehensive and coordinated.
• Establishes key principles of operation.
• Requires parent participation at all levels of the system.
• Provides for the blending of funds across systems and the flexible use of funds to meet the unique needs of each family.
• Requires evaluation and outcome standards.
• Requires a state level report of CCSI's effectiveness and recommended modifications of statewide policies, regulations and strategies to the Governor, legislature and Board of Regents.

This legislation is yet another example of Governor Pataki's commitment to helping New York's vulnerable children and families grow stronger and healthier together," said Executive Director Sweeny. "By coordinating state, county and community resources, we can continue to reduce the number of children in foster care by providing the most appropriate home- and community-based preventive services for their families."

The new law establishes CCSI as a means to help reduce the number of out-of-home placements by helping at-risk children with multiple needs through cooperative interagency planning and integrated service delivery, while providing individualized care with family involvement. The initiative seeks to decrease residential placements in the child welfare, mental health, education and juvenile justice systems by providing families with community-based resources to meet the needs of their child while helping to eliminate the duplication of services. The legislation also provides counties and school districts with the ability to combine or otherwise use available federal and state funding in a more flexible manner.

New York State CCSI Director Tyler Spangenberg said, "The new CCSI law demonstrates New York State's commitment to developing an individualized, family-driven, culturally competent system of care to support children and their families. The CCSI structure and processes allow stakeholders at all levels to work together to continuously improve their services so that children can remain at home with their own families and in their communities."

Currently, CCSI membership consists of 56 counties and eight state agencies: CCF; Division of Probation and Correctional Alternatives; the offices of Children and Family Services, Alcoholism and Substance Abuse Services, Mental Health, and Mental Retardation and Developmental Disabilities; and the departments of Education and Health. Family representatives are equal participants with the agencies at both the state and local levels. The legislation signed by Governor Pataki formalizes these partnerships.

In addition to establishing CCSI this year, Governor Pataki also signed into law his Child Welfare Financing Plan. The plan provides uncapped funding for a full array of preventive and support services for vulnerable children and families and gives local governments more flexibility to provide better preventive services that help reduce out-of-home placements of children into foster care and juvenile justice facilities. The Child Welfare Financing Plan will, for the first time in New York State, also provide enriched funding to aftercare and independent living services that help support youth after they leave foster care.

Additionally, the Governor's Child Welfare Financing Plan creates a foster care block grant to help decrease the amount of time children spend in out-of-home placement and enables counties to reinvest savings from foster care reductions into innovative prevention strategies to reduce the number of out-of-home placements.

Family Ties Dinner of Champions
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(Myra Alfreds)

(Karen Fredericks (left), Former Director, Family Ties and
Carol Hardesty (right) Current Director of Family Ties)

The Family Ties Annual benefit dinner, "Champions of Children" was held November 10, 2004.  A special presentation was made to Myra Alfreds, DCMH Director of Children's Mental Health Services, in honor of her dedication to the growth and development of Family Ties, her work promoting and expanding the Network Model, and her work on behalf of children in Westchester County.  The dinner was very well attended.

Juvenile Justice Focus of DCMH Fall Forum
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The Mental Health Fall Forum, held at the County Center on Oct. 19, featured Joyce Burrell, Sr. Juvenile Justice Advisor for the Technical Assistance Partnership for Child and Family Mental Health.  Her presentation focused on the system of care for Juvenile Justice Youth and was well attended.  In addition to the large group presentation in the morning, Ms. Burrell met with a small group of juvenile justice agencies and children's mental health staff in the afternoon and she visited Non-Secure Detention the following day, where discussions focused on how to incorporate direct family involvement and more strength-based, system of care work.

Conference Focusing on Residential Services Held at County Center
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On December 1, 2004 Westchester County Single Point of Entry and Single Point of Return Committees sponsored a conference titled: Transitional Planning For Youth In Residential Care "Residential & Community: Partners In A System Of Care".  . The conference was supported by Coordinated Children's Services Initiative (CCSI) grant. 

Dr. Jennifer Schaffer, Commissioner of DCMH and Mrs. Nancy Travers, First Deputy Commissioner DSS welcomed the 165 residential providers, community agencies, school districts, county administrators and parents and youth in the audience. Keynote speakers Dr. Martin Leichtman (Private Consultant, Kansas) and Mr. Raymond Schimmer (Executive Director Parsons Child and Family Center) presented on the chaining model of residential services. The audience was treated to a very special panel of Youth Forum members and Family Ties parents who experienced residential placement. The afternoon included two workshops titled: Meeting New Challenges" Integrating Residential Treatment within a System of Care" and Effective Planning For Transition Back to the Community - Single Point of Return Process.

The conference was sponsored by Westchester County Single Point of Entry (SPOE) and Single Point of Return (SPOR) committees.  Both committees are part of Westchester's System of Care structure that help to support children and families. 

Single Point of Entry (SPOE)

In 1996, Westchester County created a Single Point of Entry (SPOE) committee for children where a strong recommendation for Residential Treatment had been made.  SPOE is a cross-system approach to residential placement, consisting of county level decision makers/gatekeepers of residential services. This group meets for the purpose of identifying children and adolescents at a very high level of risk.  The group reviews all community options for developing a plan of care that may avert placement, with an emphasis on non-traditional approaches.  When placement is unavoidable, the group's focus is to determine the most appropriate, least restrictive, and briefest treatment that is also clinically appropriate.  Cross-systems support is utilized to maintain the placement and facilitate return to the home community.  The committee has experienced success in finding other options to placement and, in turn, has educated the systems on alternative services and approaches to out-of-home care.  Outcomes are reviewed the following month.  It is intended that the SPOE initiative will be of assistance in determining that all appropriate community based resources and services are explored prior to the implementation of a placement of a Westchester County youngster into residential care.

Single Point of Return (SPOR)

Single Point of Return (SPOR):  Created in 1999, SPOR is a Cross System Approach to create a Single Point of Return process for youngsters returning to the community from residential care (both RTC and RTF level of care).  SPOR is co-chaired by the Department of Social Services Manager for Residential Services and Department of Community Mental Health.  Core members of the committee include a special advocate from Family Court, Family Ties of Westchester (Family Support) and Youth Forum (Peer Support), Student Advocacy, Westchester County Youth Bureau and DSS/RTC aftercare programs (Children's Village and Urban League) and, most recently, local school districts.  Children/Adolescents are presented to this committee two to three months prior to a youth's return from out of home residential care to ensure there is coordination between the placement agency and the family and community to develop an appropriate service plan prior to a child's return to the community.  The committee assists in the development of individualized service plans for families by providing a cross-systems perspective and sharing of resources. Outcomes are reviewed the following month.  SPOR helps to reinforce the values and principles of Westchester County's System of Care. 

For additional information on Single Point of Entry/Return or the conference please contact Michael Orth, DCMH at  (914) 995-5225.

Respite Program Celebrates Annual Holiday Party
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On December 4, Respite held its ninth annual Holiday Party at Andrus for families in the System of Care.  Over 325 people attended, including adults and children.  Besides the Respite Staff, other volunteers included Family Ties staff and families, Children's Mental Health Case Management staff, Youth Forum members and DCMH Children's Staff. The families had a wonderful time!

Vocational Wraparound Initiative Kicks-Off at Southern Westchester BOCES
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An exciting new initiative started this fall at the Southern Westchester BOCES Rye Lake High School program.  The Rye Lake BOCES Vocational Wraparound Initiative is a partnership between Westchester County Department of Community Mental Health – Children's Mental Health Services, Family Services of Westchester, Family Ties of Westchester and Southern Westchester BOCES.  Funding is provided by New York State VESID and New York State Office of Mental Health.  The program will use the Vocational Wraparound Model developed by DCMH and its Network.  The program design is student centered and include the following enhancements to the TSP/Rye Lake HS program: the addition of a Vocational Wraparound Coordinator to the TSP/Rye Lake HS staff; addition of a Family Support Specialist; a vocational component for each participating student based upon ability, skills and aptitudes; collaboration with community-based providers to meet individual student needs; each student will receive a strength-based assessment and learning style assessment and individualized wraparound plan to support each student's vocational goals.  Students, who are currently enrolled in the TSP/Rye Lake HS program, have been selected for the initiative and represent several school districts throughout Westchester County.

Westchester Community Network Initiatives
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Through Westchester Community Network planning process, sub-committees for a number of initiatives have identified the need for knowledge, training and support in the areas of Juvenile Fire Setting ; dually diagnosed Mentally Retarded/Developmentally Delayed-Seriously Emotionally Disturbed children (MR/DD-SED); safety planning for sexually aggressive youth; parents with psychiatric disabilities; and increased opportunities for Respite.

• In April, 2004, a two-day training on Juvenile Fire Setters was sponsored by the Westchester Community Network. Sixty people, representing the fire and police departments, the Yonkers' School District, the Department of Social Services, mental health professionals and family support advocates attended the training. The presenters, recognized as experts in the field, were from Rochester, New York. They included Fred Rion, MSW, Juvenile Fire Prevention Coordinator with the Monroe County, N.Y. Fire Bureau; Paul Schwartzman, M.A., D.A.P.A. who spoke on intervention and treatment issues with Juvenile Fire-setters; Brent Ewell, CSW and David Frenzel, CSW who presented on the commonalities of Juvenile Sex Offenders and Juvenile Fire-setters.  Besides covering topics on intervention and treatment strategies, they also addressed community development and awareness building.
• In Winter 2004, a four-session training on "Multiple Challenges: Working with MR/DD – SED Children and Their Families " was presented by staff from Children's Mental Health, MR/DD, and Family Ties to participants from both the mental health and MR/DD systems.  Following the training, the first Peer Supervision Group for service providers and family support staff working with children and adolescents who are MR/DD-SED was held in April, 2004. The group is meeting monthly through August 2004, bringing together people who face the challenges of providing sound and effective interventions with children and adolescents with dual diagnoses and their families. This is another means of sharing both successes as well as brain-storming the many challenges faced in this work.  In August, a review of lessons learned and next steps is planned.
• Specialized training for case managers working with children with sexually inappropriate behaviors or a history of sexual abus e, has been provided with the assistance of the Juvenile Sexual Offender/Sexually Aggressive Youth Planning Committee to case managers in an effort to sustain the Safety Net program as a broad based service after the expiration of the SAMHSA grant
• A new initiative involves a work group consisting of Family, DSS, Adult and Children's Mental Health representatives whose goal is to identify the needs of parents with psychiatric disabilities . The initial work will be with parents living in the Yonkers community, the largest community in Westchester.  The work group is meeting with mental health providers and parent consumers to identify parents interested in participating in a focus group "What Helps, What Harms."  Interest in forming a support group will also be explored.  This issue has emerged as a growing priority nationwide.  In an effort to develop a knowledge base and identify what effective services exist and what are needed, a very comprehensive report: "Critical Issues for Parents with Mental Illness and their Families" by the Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, July 30^th , 2001 was prepared for SAMHSA. It provides an extensive "state of the issue". A summary of the report can be found at: www.mentalhealth.org/publications/allpubs/KEN-01-0109/default.asp
• An active county-wide planning group on Respite development was undertaken this year. Respite has been identified by families as one of the most important services they and their children receive. One if it's outcomes was the development and implementation of a two-part training "Train the Trainer" for summer camp staff from programs throughout Westchester county. The training was facilitated by staff from the Family Service of Westchester Camp Success program and a member of the Department of Community Mental Health training team. The focus was on specific techniques and strategies for summer camp personnel working with children and adolescents exhibiting challenging emotional and social behaviors. The goal of the training was to enable more adolescents and children to successfully participate in community-based programs during the summer months
• The Westchester County Single Point of Return, chaired by DCMH and DSS, its committee members and nine selected school district Pupil Personnel Directors met on May 11th to develop a plan to better coordinate efforts between County departments, residential providers, and school districts to ensure a smooth transition for youth returning to the community from out of home placement.  In addition, Project Connections, a pilot program grant funded by N.Y. State CCSI, focuses on utilizing wraparound planning by selected residential treatment centers, also with the goal of facilitating successful, smooth transitions back to the community.

For additional information regarding Westchester Community Network initiatives and training please contact Basia Kinglake at (914) 995-6377.

 

Westchester Recipient of New CCSI Grant
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Westchester County is proud to announce a new NY State Coordinated Children's Services Initiative grant award called PROJECT CONNECTIONS.  PROJECT CONNECTIONS is being initiated by Westchester County Single Point of Entry and Return Committees.  PROJECT CONNECTIONS proposes to pioneer an initiative that would support residential programs in joining the System of Care.  The initiative emphasizes an effort to engage residential programs as partners in a larger continuum of service provision, instead of operating separately from the service community.   Historically, residential programs have not been included in system of care development and as part of a continuum of services in the community.  Often, children with complex, intense needs are placed into care and that placement is viewed as an isolated solution.  At some point these children are returned back to their community; however, strong connections have not been maintained and developed with the community service system while they were in care.

PROJECT CONNECTIONS believes in the benefit of residential treatment, not, however, as an isolated solution, but as one of many steps a child may take in having their needs met effectively.  PROJECT CONNECTIONS appreciates that the children

served by this initiative may, at different times, need the structure, safety and therapeutic support of residential treatment.  PROJECT CONNECTIONS also knows that those same children will eventually be returned to their communities and suggests that to continue, build and develop on-going contact with their community and supports will help to facilitate better, more successful discharge transitions.  Single Point of Entry will continue to focus on its core goal of attempting to avert placement through utilization of community supports.  PROJECT CONNECTIONS will focus on children where residential treatment has already been deemed appropriate and necessary.  Overall, a wraparound approach that is family and needs-driven will be utilized. PROJECT CONNECTIONS will help to create a bridge between the community and the residential programs with the ultimate goal of:

1. incorporating residential treatment providers into the system of care;
2. using a needs-driven approach, in order to identify clear purposes and goals of a placement out-of-home;
3. reducing length of stay for youth in residential levels of care by utilizing a Tier I/wraparound approach while they are in care;
4. preventing children from returning to out-of-home care by utilization of wraparound/support circle approach for each child returning to the community.

Guidelines are now being developed for counties and schools on these basic requirements.  Initial guidelines focus on the blending and flexible use of funds, coordinated planning, confidentiality, strength-based plans driven by child and family needs, and outcome measurement.  For more information about PROJECT CONNECTIONS or CCSI please contact Michael Orth (DCMH) at 914-995-5225.

System of Care Celebration
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Westchester County Department of Community Mental Health and Family Ties of Westchester held a System of Care Celebration at the Westchester County Center on June 16^th and 17^th , 2003.  Over 350 service providers and family members from Massachusetts, Delaware, Connecticut, Rochester, Syracuse and Westchester attended the two-day conference.  The conference was a celebration of Westchester County's Children's System of Care.  Westchester has been at the forefront of System of Care development for the past several years.  The two-day celebration included plenary sessions, workshops, parent/youth expression and talent and thirteen afternoon workshops.  Participants also browsed through the bookstore, enjoyed Youth Forum and Respite art display and collected educational and system of care information.

Westchester County Executive Honorable Andrew J. Spano and Westchester County Department of Community Mental Health Commissioner Dr. Jennifer Schaffer welcomed all to the conference.  The morning was followed by a "System of Care Journey" presentation from Myra Alfreds, Director of Children's Mental Health Services Westchester County Department of Community Mental Health and Carol Hardesty, Executive Director of Family Ties of Westchester.  Then it was the parents and youth turn to show their stuff.  A Family Ties parent brought the house-down by signing a moving song followed by several Youth Forum and Respite youth reading their poetry. 

Day two included a plenary session featuring Dr. Christina Hoven, PI who provided a mid-point three-year report on outcomes and evaluation.  The second plenary session for the morning featured Vivian Jackson Cultural Competency.  Vivian's presentation was followed by a panel presentation that included Youth Forum and Family Ties members.

The workshops for the two-days included:

• Westchester's System of Care efforts regarding Juvenile Fire-Setting P
• Respite in a System of Care
• Education in a System of Care/PBIS (Positive Behavioral Interventions and Supports)
• Transitional Services
• Cultural Competency in a System of Care
• Linkages – Juvenile Justice Model
• Differential Child Protective Services
• Wraparound Approach
• Westchester's System of Care efforts regarding Juvenile Sexual Offenders/Reactive Youth
• Secondary Trauma
• Community Development Approaches: Network and Communities That Care
• Planning in a System of Care for children/youth with mental health and mental retardation/developmental disabilities
• Transitional planning from Residential Out-of-Home Placement to the Community

All of the workshops were co-facilitate by a parent and/or youth member.  For additional information regarding the conference please contact Michael Orth, Westchester County Department of Community Mental Health at (914) 995-5225.

PBIS Expands Both Throughout New York State and Westchester County
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NY State PBIS Effort

The New York State Education Department, New York State Office of Mental Health and Families Together in New York State Inc. have joined efforts and resources in a collaborative effort to support schools interested in facilitation positive systems change by adopting a Positive Behavioral Interventions and Supports (PBIS) approach to supporting all students in all settings.  This support has included the provision of training and technical assistance at the building, local, regional and state levels, while coordinating all efforts at all levels to build capacity and sustainability.

PBIS is a research validated effective practice that can bring about positive school-wide systems change.  PBIS research demonstrates the necessity of strong administrative support in order for PBIS to be effective about this change in any school buildings.  Interested schools are required to sign a commitment agreement that demonstrates their commitment to the initiative.  The commitment expectations include that PBIS will become one of the top three school improvement goals for 2-3 years and will therefore receive major attention and focus a the building level; the building-based administrators will identify and organize PBIS Leadership Team that is representative of school staff and will have as full participant, at least one non-staff family members; and the building-based administrators will provide active leadership and support for overall PBIS implementation and for the building-based PBIS Leadership Team; and agree to randomly selected School-wide Evaluation Tool (SET) to evaluate PBIS implementation at the building level which provides NYS with local, regional and statewide data.

Participating schools in Westchester County (Cohort 1 ) – started 2002 include:
Peekskill City School District:

• Hillcrest School
• Peekskill Middle School
• Woodside School

Interested Cohort 3 schools will be identified and begin the training in the Fall, 2004.

What is PBIS?

PBIS (Positive Behavioral Interventions and Supports) is a systems approach to preventing and responding to school and classroom discipline problems.  PBIS develops school-wide systems that support staff to teach and promote positive behavior in all students.  By reducing behavioral problems, PBIS creates and maintains safe learning environments where teachers can teach and students can learn. 

PBIS addresses:

• High rates of problem behavior that interfere with learning
• Ineffective and inefficient disciplinary practices
• Lack of supports for staff to address problem behavior
• Lack of general and specialized behavior intervention