Governor Jindal said, “This Coordinated System of Care will better support our young people who are either already in – or at risk of being in - out-of-home placement or our juvenile justice system. This is an evidence-based approach to provide services through social services, juvenile justice, health and education programs to Louisiana’s at-risk youth – which will include 1,200 young people in the first six months of implementation and 2,400 young people in the first full year. The initial targeted-population includes 1,200 youth currently in residential treatment facilities, secure care facilities, psychiatric hospitals, addiction facilities, alternative schools, detentions, developmental disabilities facilities, and homeless children. Another 42,000 children with behavioral health needs in the state will be able to benefit from enhanced coordinated care through this system.
“The Coordinated System of Care will have three specific goals, including reducing out-of-home placements of youth with significant behavioral health challenges, better using state resources and federal funding for services supporting at-risk youth, and improving outcomes for at-risk youth.
“The bottom line in this Coordinated System of Care is that we must join forces here on the state level – where many agencies are just blocks apart – to serve our most at-risk young people all across Louisiana. If we are going to serve our people well and be good stewards of taxpayer dollars, we absolutely must take a targeted approach to helping the most “at risk” young people in communities all around our state.”
Mark Thomas, Executive Director of Mental Health America of Louisiana said, “Right now, a child with behavioral health issues could be in the education system and then end up in juvenile justice or foster care systems. However, with the CSoC, the child can be treated without moving from one system to the other, hopefully preventing the child from slipping through a revolving door of unconnected treatment.”
John Gianfortre, a family counselor from Shreveport said, “One of the most important things for a provider is collaboration across the board. If the families, care providers and state agencies are all on the same page regarding a child’s care, the possibility of a positive result can only increase.”
Director of Litigation and Systems of Advocacy at the Advocacy Center Nell Hahn said, “We need the kinds of services that can keep children in family homes and communities. We hope that this system will do that. The measure of success will be how many children leave the expensive congregate care settings that we rely on now, and how successful they are in staying at home with families, finishing school, and going on to become productive citizens.”
Jefferson Parish Juvenile Court Judge Nancy Amato Konrad said, “In my experience inside the juvenile justice system, many times the children with mental issues who come before me are often involved in multiple public systems, like child welfare and special education. The best way to keep a child from appearing in juvenile court again and again is to provide services designed to integrate all the treatments offered by the disparate agencies and the juvenile justice system.”
Sheila Pires, a partner in the Washington, D.C. based Human Service Collaborative said, “I applaud Louisiana for taking this step toward revolutionizing the way children with mental health issues are treated. States across the country are spending enormous amounts of money on ineffective services, instead of working with providers, families, natural helping networks in communities and the youths themselves to develop individualized services and supports that make sense and around which there is evidence. Louisiana’s Coordinated System of Care can be a model for the rest of the country.”
DHH Secretary Bruce D. Greenstein said, “Too often families struggle to navigate a complicated and broken system that stretches across multiple agencies and offices. Much like our efforts to reform the state’s Medicaid program, this joint commitment will ensure that our most at-risk children are cared for in a coordinated system that improves outcomes and enables us to reach more families. By using Medicaid to more effectively leverage the dollars we spend, we can make sure that our investment in our children, our future, yields the highest possible return.”
DCFS Secretary Ruth Johnson said, “Ultimately, our goal is to ensure the best and most effective services for each child entering the system. With this initiative, services can be tailored to the needs of the child to make the most of available resources and expertise among all the agencies in the system. Our top priorities are to keep children safe and to provide at-risk children with the care they need so that they can have opportunities to move toward self-sufficiency in adulthood – the coordinated system of care aims to do this.”
State Superintendent of Education Paul Pastorek said, “For educators, the Coordinated System of Care is about focusing our efforts on supporting students in the most appropriate and beneficial way to meet their individual needs. This collaboration will allow educators and support agencies to do a better job of meeting both the emotional and academic development needs of children with behavioral disorders -- without compromising either.”
Deputy Secretary of OJJ Dr. Mary Livers said, “Once CSOC is implemented, the state of Louisiana will see long term benefits because fewer youth are anticipated to become involved with the juvenile justice system, as youth and their families will receive services within their communities, according to their individual needs.”
Governor Jindal also shared the story of a parent who navigated services for her child through many state agencies and now sees the benefit of the close coordination that will be provided through this new system. The parent asked not to be named in order to protect the identity of her child.
She said, “Before the CSoC was created, getting help for my child also meant moving my child out of my home and under the charge of a state agency, whether that was juvenile detention, hospitalization or institutionalization. We parents call that locking our kids up, and parents out. Our child is not a bad child. Yet, we had to choose between keeping our family together and getting our child help. Even though we had to make that tough decision more than once, we lived in fear that we would be considered bad parents and our child would never return home. The result is that we always waited until things were so out of control in our home that we had no choice but to allow agencies to take control of our child.”
This same parent said that with the CSoC, services like respite and crisis stabilization will allow her family to keep their child at home, with family and friends and in a regular school while on the path to recovery.
FIRST GOAL: Reduce out-of-home placements of youth with significant behavioral health challenges.
Governor Jindal said, “We want to do a better job of providing tools to keep kids healthy, educated and safe – in their own homes – wherever we can. In order to better serve this population of at-risk children, we worked closely with youth advocates, judges, local officials and especially parents – to develop this System and identify what services are needed to care for kids already in out-of-home facilities and those who are at risk of entering them.
“Beginning last January, over four dozen stakeholders attended an initial planning session and a wide scope of collaboration continued through countless stakeholder meetings, focus groups, and regional meetings throughout the last 14 months.The System developed by all these stakeholders we are announcing today will replace current fragmented programs across four state agencies with a one-stop shop for child service workers to access the Coordinated System of Care.
“From local wraparound services to specific support plans, this System is fundamentally designed to encourage young people in this at-risk population to remain at home and a part of their community, instead of diverting further away from their home and deeper into the state’s justice system, which is too often the result of how the disjointed agencies operate today.”
To refer youth into the Coordinated System of Care, educators may identify children who are receiving special education services and have behavioral health issues as eligible for the Coordinated System of Care services. In OJJ, the 3,000 youth under the agency’s direct supervision or in non-secure placements can be assessed to determine eligibility and potential services available under the new Coordinated System. DCFS will assess children in foster care and in residential facilities or at risk of out-of-home placement.DHH will also assess children in behavioral health treatment and those at risk of in-patient hospitalization.
All young people eligible for the Coordinated System of Care through these entry points will be referred by the Management Organization over the system to a “local wraparound agency.” Services within a wraparound agency will include around-the-clock behavioral health screenings, crisis stabilization, educational parent support and training, independent living and skills building, short-term care and peer support.
Once the system is accessed by a young person, they are immediately eligible for community-based programs – that will no longer be fragmented across multiple state agencies. The local wraparound agency works with a licensed mental health professional to develop an assessment of the youth’s needs, and establishes a “Child and Family Team” to care for them.
Next, an “Individual Care Plan” is developed with input from the child’s family and community partners like teachers, clergy, church leaders, coaches or other community organizations to ensure the needs of the individual child are met. The Child and Family Team is involved as the Individual Care Plan is executed with intensive case management until the youth is ready to be transitioned out of the Coordinated System of Care.
Additionally, a Family Support Organization will support the family and provide peer support to those participating in the System. Research indicates when a child’s family or support system is engaged, rehabilitation efforts are much more successful.
SECOND GOAL: The system is focused on reducing the state's cost of providing services by better-leveraging Medicaid and other funding sources, while also increasing service efficiency and reducing duplication across agencies.
Governor Jindal said, “It is critical that we make smart use of the hard-earned taxpayer money we are entrusted with. We must wisely invest dollars where they will produce the best services for our people.To that end, the System establishes a single payer for behavioral health services, which will maximize state dollars by ensuring no duplicative payments are made across payment systems.
“It is very important to point out that one of the key benefits of this Coordinated System of Care is that it improves services for at-risk children while leveraging $65.8 million in existing state general fund to draw down a total of $101 million in additional Medicaid dollars, providing the state with estimated total state savings of $16.3 million through fiscal year 2013.
In order to better coordinate services to draw down more Medicaid dollars, a state plan amendment must be submitted for additional behavioral health services for all those in this target population. The waiver application will seek to serve between 1,200 to 2,400 young people in the first year.
THIRD GOAL: The final focus of this Coordinated System of Care is to increase the overall outcomes of the children it serves.
Governor Jindal said, “We must increase wellness and education outcomes for all the youth targeted by this coordination of care. A 2008 study found that participation in ‘systems of care’ resulted in youth seeing meaningful improvements in school performance and attendance, and fewer contacts with law enforcement. The results of this study are also common sense. We need to individualize care for at-risk children and administer all state services – across agencies – with a laser-like focus on improving their overall health, wellbeing, and education. There is no reason for any child – especially children who we know are ‘at risk’ – to be served through four different agency silos with little to no coordination.”
The implementation of the Coordinated System of Care will occur in stages over the next several months. The implementation of this System will be phased in by region.
In addition to establishing this System and its goals, the executive order also formalizes a multi-departmental governance board to direct the System.
- Board members will include Secretaries from DHH, DCFS, OJJ, and DOE, a representative from the Governor’s office or his designee, two family representatives, a youth advocate representative and a non-voting youth member.
- The Board will be responsible for System planning and implementation, setting standards, oversight, financing decisions, and monitoring outcomes including quality and cost of services.
- The Governing Board will also enter into a memorandum of understanding with DHH to define the role of the Office of Behavioral Health as the implementing agency. This office will serve as the implementing agency because it is responsible for compliance with CMS-approved state Medicaid plan amendment and waivers.