What can parents do when their teenage son threatens his siblings with a knife? Whom do they call for help? How about when their 11-year-old daughter disengages from her family, friends, and schoolwork, exhibiting signs of depression? Where do they turn?
In Burlington County, New Jersey, two state-contracted, private nonprofit agencies – Partners for Kids and Families and the Family Support Organization of Burlington County (FSO) – are working together through a unique collaborative model to help youth and families address behavioral health issues and create long-term plans to keep youth in their homes and communities. Partners for Kids and Families, one of New Jersey’s first care management organizations, has been providing comprehensive support for children and youth with complex behavioral health needs for over 10 years – and more recently, under the direction of the state, began serving children and youth with developmental disabilities or substance abuse issues. FSO is staffed by parents who have cared for a child or youth with behavioral health issues and who work directly with parents and/or caregivers. Together, these two organizations are partnering to deliver services via a care management entity (CME) approach, an innovative way to meet the needs of high-risk children and youth.
CME Basics and NJ Specifics
CMEs typically offer a set of core services, including: creation and facilitation of a child and family team (CFT); intensive care coordination using the wraparound approach; linkage to peer supports and crisis response/intervention; and referrals to natural supports and home and community-based services. CMEs are also responsible for data collection, reporting and managing utilization of services, and quality outcomes. New Jersey’s 15 CMEs are part of the Children’s System of Care (CSOC), a statewide delivery system designed for children and youth with complex behavioral health needs, developmental disabilities, and/or substance abuse issues. Each county in the state has a care management organization and FSO that collaborate to support families impacted by a child or youth’s behavioral health challenges. New Jersey prioritizes family involvement in its CME model, and the FSO plays an integral role in establishing and sustaining family engagement by providing peer support and connecting families to services.
Like most CMEs, Burlington County’s uses multiple funding streams to provide the full array of services. About 75 percent of Partners for Kids and Families’ budget comes from Medicaid and the remainder is covered by state contract funds. In New Jersey, children and families who are not eligible for Medicaid can access CME services through a state Medicaid “look-alike” plan – so no family is excluded based on income. State contract dollars fund the FSO.
From Referral to Transition: How Does the CME Approach Work?
Members of CHCS’ child health quality team recently visited Partners for Kids and Families, where executive director Michael Dallahan, FSO executive director Deborah Kennedy, and their colleagues walked through how the process works in Burlington County. Following is a high-level outline:
- Prior to Referral: In New Jersey, a statewide administrative services organization, called a contracted services administrator (CSA) is responsible for triaging the needs of families who connect with the CSOC. The CSA is staffed by clinicians who determine whether a family should be referred to their county’s care management organization or to other services. Families, child welfare and juvenile justice caseworkers, behavioral health clinicians, and others, can call the CSA to access services for youth and families.
- Referral to CME: Once a CSA clinician determines that a youth meets the necessary (moderate or high) level of care criteria, the youth is referred to Partners for Kids and Families and is assigned a care manager. The parent/caregiver is referred to the FSO and assigned a family support partner (all processed via the state’s electronic records system, CYBER).
- Initial Meeting: Within 72 hours of the referral, the care manager and family support partner meet with the youth and family members. During this initial meeting, families are oriented to the wraparound process, its 10 principles, and its underlying values. The care manager and family support partner begin identifying the youth’s and family’s strengths and needs and determine who should participate on the CFT. The CFT includes the youth and his/her caregiver(s), formal supports (e.g., therapist, child welfare case manager, probation officer), and natural supports (e.g., basketball coach, clergy, friend). Natural supports are key, but can be more challenging to identify. The family support partner is particularly critical in gaining the trust and buy-in of families.
- Crisis and Individualized Service Plan: Within seven days of the referral, the CFT works together to develop a crisis plan that outlines the youth and family’s definition of a crisis; risks or triggers; and strengths and available resources. Within 30 days, the CFT develops an individualized service plan (ISP), which outlines the youth and family’s vision, strengths, needs, and strategies for recovery. The ISP guides the work of the team and is updated at least every 90 days to reflect evolving needs.
- Ongoing Engagement: Following the initial 30-day engagement period, the care manager, family support partner, and other CFT members work with the youth and family to achieve the goals of the ISP and move toward transition out of the CME. A care manager must have at least three contacts per month with members of the CFT, with the frequency determined by the youth and family’s needs.
- Transition: The average length of involvement for a youth with the CME in Burlington County is between 6-18 months, depending on the level of need. Ideally, transition out of the CME occurs when the youth and his/her family have developed a sustainable plan and natural support network. Sometimes a family may move out of Burlington County or may opt out of CME services. Regardless of the circumstances for transition, Partners for Kids and Families provides the youth and family with information on how to access services in the future, including referrals if necessary. The FSO also offers ongoing support groups and trainings for parents and caregivers.
New Jersey is one of a number of states employing the CME model for children and youth with serious behavioral health needs. CHCS is working with three of these states – Georgia, Maryland, and Wyoming – in a quality improvement collaborative funded by the Centers for Medicare & Medicaid Services to implement or expand the CME approach. Though CMEs across the country share many common elements, there is no one way to implement this approach – each is tailored to the environments in which they operate and the children and families they serve. States and communities interested in exploring this approach can learn from the experiences of existing programs to determine what might work in their own local contexts.