# Presentation: 393248

## Alabama

- Department
- of
-  Mental Health/
- Mental Retardation

**Office on Disability April 27****th**** 2005 Summit: Addressing Barriers for Children with Co-Occurring Developmental Disabilities and Emotional/ substance Abuse Disorders**
**SAMHSA Rockville MD. **

## Mental Health systems don’t provide services that families need; they provide services that they get paid for.Quote: Parent Advocate/ Georgetown Training Institute, San Francisco CA. 

## DMH/MR Organization of Services

- Commissioner

- Division of Mental Illness
- Associate Commissioner

## 310 BoardsPublic Corporations established to contract with DMH/MR and provide Planning, Studies, and Services for a given area.

**Comprehensive 310 Board**
- Planning, Studying and Services for Mental Illness, Mental Retardation and Substance Abuse.
- May Contract one of these areas out.

**Specialty 310 Boards**
- Provides Planning, Studying, and Services for _one or more_ service areas

## Catchment Areas  Children/Adolescent Mental Health Services

- Geographical areas based 	on population
- Responsible for serving 	persons in that 	area with a few 	exceptions

## Comprehensive 310 Boards 

- There are 11 Comprehensive 310 Boards responsible for MI/MR/SA Services in their catchment areas.

## MR 310 Boards

- There are a total of 22 Specialty MR 310 Boards

## MR Regional Areas

-   Region 1
-   Region 2 West
-   Region 2 West
-   Region 3
-   Region 4

## DMH/MR Division of Services for Children

- MI Division (Seriously Emotionally Disturbed)
- 2 FTEs for SED Services
- MR Division (Intellectual disabilities)
- 1FTE (Early Intervention)
- Children’s Issues shared responsibility
- SA Division (Substance abuse/ dependency)
- No FTE dedicated to Adolescent Treatment Issues
- 2001 Office of Children’s Services
- 1FTE
- Cross divisional responsibility/ emphasis on Co-Occurring (SED/SA and SED/MR)

## Barriers to Access

- Fragmentation of services/ responsibility/ separate provider systems
- Historical funding challenges created service cultures of minimal responsibility
- Availability of services/ specialized services in rural settings
- Stigma/ sometimes providers don’t see past the ID symptoms for other needs
- Work force Issues
- Shortage of service workers/ capacity
- Training needs
- Service Culture shifts

## Barriers to Access Cont.

- Cross-certification of programs
- 	(Is it MR or MI? -sometimes tied to funding sources)
- Appropriateness of Services
- Services delivery orientation creates different expectations
- Cognitive capacity to participate in certain programs (IOP, In-home, residential)
- Services Structure (O.P. 1 or 2x per month may not be intense enough) More info needed on Best Practices/ especially with this target group
- Medication issues can be complicated
- Lack of community resources/Residential services may not be specialized/leads to unsuccessful completion of programs/ longer LOS

## Barriers to Eligibility

- State funds / most MR state funds support waiver services/ waivers not easily accessible
- Eligibility determined by what the professional determines as “primary issue”
- Collaboration between multiple systems not always reimbursed (case management)
- MR service system adult focused/ Waiting List

## Barriers to Eligibility cont.

- Some Mental Health services have been historically unavailable to youth with ID, especially intensive in-home and residential type services.
- Barriers to eligible services in school or community can lead in involvement with juvenile justice system

## 2000 Children’s Task Force: Recommendations to Alabama DMH/MR

- 37 stakeholders (child-serving agencies, parents & advocates) recommended:
- Priority given to children with multiple disabilities & other specialized treatment needs “Gap Kids”
**T**obacco Settlement/Children First funding  will not supplant current funding
**E**ntry into the DMH/MR service system should be a single point of contact

## Task Force further recommended:

- Pursue greater collaboration with other agencies to meet the needs children
- Priority given to community-based services
**C**onsolidate MH/MR children’s services into a single organizational unit reporting directly to the Commissioner.

## Promising Initiatives in Alabama for Children with ID and SED or SA needs

- Multiple Needs Child Legislation 1993
- 4 mandated agencies (Mental Health/ Child Welfare/ Juvenile justice and Education)
- Eligibility (need services of two or more agencies and at risk for out-of-home placement)
*Braided funding*
- Children’s Task Force of 2000  Enhancement and development of services for “Gap Kids”
- Establishment of Children’s Office/ Director with responsibilities for this population
- In-home teams
- Crisis evaluation/ respite

## Promising Initiatives cont.

- OUR Kids Initiative
- Collaboration with Mental Health/ Child Welfare/ and Juvenile Justice to jointly fund community services for youth whose needs cross agency jurisdiction
- Each service can serve children with ID and SED.
*Pooled Funding*
- Mental Health Juvenile Court Liaisons
- 22 community mental health clinicians/ youth involved with juvenile justice and have MH/ SA/ or MR needs
- Co-Occurring (MH/SA and Juvenile Justice) Pilot Project for screening/assessment of youth and referral to evidence-based interventions
*Pooled funding*

## Recommendations

- Follow the momentum generated by Co-Occurring (MH/SA) initiatives when creating new service paradigms and integrated models of care (State & Federal)
- 	*What is the primary diagnosis/issue,  may not be the best question for children.*
- Federal grant initiatives to highlight or target this population to build capacity as well as provide services/ systems need new competencies
- Advocate for federal incentives to have professionals enter front-line child serving mental health fields
- 	(i.e. student loan relief)

## Recommendations Cont.

- Identify and remove federal barriers to braiding and blending of funds within and between agencies.
- Increase training opportunities for multi-level issues (financing – best practices) that encompass this issue
- Increase Federal-State partnerships with Education and MH to work more collaboratively on school-based services
- Federal Medicaid cuts will have devastating effects on efforts to transform systems at the state level
- Identify Best practices for this population and  encourage reporting of data on Evidence-Based Practices that have significant differences with this population

- Steven P. Lafreniere M.S.
- Director
- Office of Children’s Services
- RSA Union Building
- 100 N. Union Street
- Montgomery, AL 36130-1410
- (334) 353-7110
- Steven.lafreniere@mh.alabama.gov