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Vorys Health Care Advisors

Multi-system youth: the need for additional and coordinated services

Posted in Behavioral Health, Care Coordination, Child protection, Medicaid, multi-system youth, Wrap-around

2/3/2017: Please see our latest post on multi-system youth at https://www.voryshcadvisors.com/2017/02/03/multi-system-youth-update/ 

“Multi-system” youth are children and adolescents served by multiple public systems, including state agencies providing both financing and direct services in the areas of:

  • Child protection,
  • Health care (often through Medicaid),
  • Juvenile justice,
  • Intellectual and developmental disabilities,
  • Behavioral health care (both mental health and addiction services),
  • Child care, and
  • Education.

Multi-system youth have complex needs that cannot be met by a single system. In some cases, two or more systems are used to fill gaps in services offered single agencies or when the cost of providing services becomes prohibitive for a single agency.

Most states make efforts to coordinate services for youth across systems and agencies. In Ohio, the Family and Children First Council was created in 1993 to “cluster” together members of local child caring agencies. For more than two decades, Local Family and Children First Councils (FCFCs) have streamlined and coordinated existing services for families seeking assistance by considering the best and most appropriate care for a child with needs from two or agencies. In 2014, local FCFCs provided service coordination for 5,491 youth, including 287 multi-system children who required specific types of residential and out of home treatment.

While local support and collaboration have been successful in helping many children and their families, some youth served by multiple systems have needs so extreme that they cannot be supported through this method alone. Often, when children have intensive needs that exhaust the resources of both the family and community, parents are forced to relinquish custody to a child protection agency to access necessary services. Nationally, more than 12,700 children were relinquished into the custody of the state to gain access to mental health services. According to a recent policy brief on multi-system youth from the Public Children Services Association of Ohio,  nearly one in three (30%) of multi-system youth in Ohio entered public children services agency via custody relinquishment. As the following chart from the PCSAO policy brief shows, custody relinquishment occurs for a large fraction of youth served by the juvenile justice, developmental disabilities, and behavioral health systems in Ohio.

PCSAO Survey - Multi-System Youth via Custody Relinquishment

In recognition of the issues affecting multi-system youth, Ohio’s most recent state budget created the Joint Legislative Committee on Multi-System Youth to:

  • Identify the services currently provided to multi-system youths and the costs and outcomes of those services;
  • Identify existing best practices to eliminate custody relinquishment as a means of gaining access to services for multi-system youths;
  • Identify the best methods for person-centered care coordination related to behavioral health, developmental disabilities, juvenile justice, and employment;
  • Identify a system of accountability to monitor the progress of multi-system youths in residential placement; and
  • Recommend an equitable, adequate, sustainable funding and service delivery system to meet the needs of all multi-system youths.

The Joint Committee held its first hearing on January 19, where it named Senator Randy Gardner its Chair and Representative Sarah LaTourette its Vice-Chair. The Committee’s second hearing, held February 16, 2016, featured a panel of young adults shared personal experience being involved with more than one state agency. The youth highlighted the need for additional services and supports for multi-system youth and their families, including for wrap-around services, peer-to-peer support, in-home support for parents, greater supports for adopted youth and their parents, and other measures to the state could implement to create a more cohesive experience for children who need services from multiple systems.

Mary Wachtel, Legislative Director at PCSAO, testified that, “the reality is that parents and families are still faced with very difficult decisions about how to get their children the help they need.  Some folks have to consider actually relinquishing custody in order to gain services for their children; others have to balance how to keep a child at home and keep other family members safe. And for too many families, they still are facing these decisions.”

Four young adults testified in a panel before the Committee. Rafael Weston, Rebecca McGovern and Braxton Devault gave testimony about their lives and experiences with systems of care that aim to address mental health, medication and addiction, human trafficking, and abuse. Overall, the youth shared messages that were personal and powerful as they talked about the following:

  • Feeling connected to peers with similar experiences reduced his feeling of isolation;
  • Having had help with parenting, which has helped to overcome challenges with addiction;
  • Positive experiences in a transitional age youth program for those between the ages of 18-22 provides basic independent living skills;
  • Youth advocacy as an important counterbalance to negative messages;
  • Caution that should be taken against overprescribing medications;
  • The experience of human trafficking;
  • Early education to avoid drug use is important; and
  • Ways in which  Youth M.O.V.E. (Motivating Others Through Voices Of Experience) can be helpful as to grow youth leadership and provide a powerful voice of experience.

The youth mentioned a number of ways they could have been better served, including:

  • Support specifically for adopted youth and their adoptive families when struggling with behavioral health issues;
  • Cohesive communicative services that connect between systems of care;
  • The creation of a wellness plan;
  • Preventing abuse through early intervention and in-home supports;
  • More support for parents to prevent removal from the home; and
  • Services offered closer to home so youth and their families can avoid traveling to other counties to access care.

The legislators asked probing and compassionate questions.  The youths’ own words best describe their experiences.

Weston shared his story of being the youngest of three boys to a single mother.  He said had problems with reading, but was also diagnosed with other behavioral issues and had a negative image of himself because adults would ask what was “wrong” with him. That negativity also played out when his mother couldn’t retain custody of him because she lacked financial resources, and he thought his mother gave him up for adoption. He also said that the residential facility he was in was like “another form of prison” with the possibility of having his possessions stolen or getting hurt.

McGovern, who was the victim of human trafficking, took issue with being returned to her adoptive parents that abused her and said adopted youth who have behavioral health needs would greatly benefit from additional supports.

A number of the panelists told members of the Committee about the benefits of wrap-around services. McGovern, who attends weekly meetings with a drug and alcohol counselor, said having a case manager and a psychiatrist on her team allowed her to focus specifically on addiction issues at group meetings. She said she also benefits from parenting help through the city’s Healthy Moms and Babes program. Weston said he would have benefited from a residential facility that would have created a wrap-around type of plan specifically for him.

The panelists also noted the importance of positive peer supports and mentors. Devault said Youth M.O.V.E. and another autism-oriented program allowed him to connect with peers who have had similar experiences, and Weston agreed Youth M.O.V.E. made him feel less isolated. Weston also said youth advocacy is important for high-risk children because they receive negative messages about themselves and giving them opportunities, to speak to lawmakers, for example, helps put positive labels on themselves.

“A lot of times I really just needed a positive, friendly role model so I didn’t feel so alone,” Devault said.  When questioned about an appropriate age for young people to start interacting with peers who have faced similar experiences, Weston said kids need to be engaged socially “as young as possible.”

Chair Gardner expressed hope that stakeholders could provide the Committee with metrics on the possible “unevenness” of state services across counties, especially for transition age youth.

In hearing from youth served by multiple systems, the Committee has already made great progress. We look forward to the Committee’s continued work as it begins to craft solutions that address the complex needs of children served by multiple systems, particularly those who are voluntarily relinquished into the custody of child protection to gain access to services.