# Presentation: 756404

*** ***
***Supporting Transitions for District of Columbia Foster Youth with Emotional Disturbances***

## National Statistics

- 20% of youth suffer from an emotional or behavior-based disturbance
- 1 in 10 youths has severe emotionally based disturbances that can lead to significant impairment
- 40–85% of foster youth are diagnosed with an emotional or behavior-based disturbance

## District of Columbia Statistics

- 3,000 youths are wards of the District of Columbia (DC)
- 1,500 youths ages 12–21 will grow up in foster care
- 1,200 youths are enrolled in Department of Mental Health services
- 100–150 youths age out per year

## Living Arrangements

| Placement of DC Foster Youth, Ages 16–21
May 2005 |  |
| --- | --- |
| Foster Home | 50%  |
| Independent Living Program | 24% |
| Group Home | 11% |
| Other | 16% |

## EPSDT Portals Project

**What is EPSDT?**

- Early Periodic Screening Diagnosis and Treatment:
- Medicaid’s comprehensive and preventative child health program for individuals under age 21
- Includes periodic screening, vision, dental, and hearing services
- Defined by law as a part of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) legislation

***EPSDT Portals Project***

## 
Funding Source:

	The CMS Real Choice Systems Change (RCSC) Effort Program Initiative funded two applicants $500,000 over a 3-year time frame, ending September 29, 2007.

**Funding Source:**
- 	The CMS Real Choice Systems Change (RCSC) Effort Program Initiative funded two applicants $500,000 over a 3-year time frame, ending September 29, 2007.

***Centers for Medicare & Medicaid Services (CMS)***

## CMS Initiative Intent 

    Assist States in addressing the needs of children with disabilities by building systems infrastructure to improve community long-term support systems, with a focus on patient choices of living environment, providers, and types of services and ensuring quality of services.

-     Assist States in addressing the needs of children with disabilities by building systems infrastructure to improve community long-term support systems, with a focus on patient choices of living environment, providers, and types of services and ensuring quality of services.

***Purpose and Intent***

## Purpose and Intent

**DMH, MAA, and CFSA Initiative Intent:**
-      Ensure that “aging-out” foster youth, starting at 15 years of age, with emotionally based disorders will transition into adult supports and services smoothly and appropriately.
-     Focus on the youth’s choice of living environment, provider of service, and quality care.

## Project Partners

***Project Partners***

- DC Child Family Services Agency
- DC Department of Health- Medical Assistance Administration
- DC Metropolitan Foster and Adoptive Parent Association
- DC Foster and Adoptive Parent Advocacy Center

## Children’s National Medical Center: DC Kids Program: Foster Care Advisory Board

Marshall Heights Community Development Organization, Inc.

Foundations for Home and Community: First Home Care

National Association for Former Foster Care Children of America, Inc.

- Marshall Heights Community Development Organization, Inc.
- Foundations for Home and Community: First Home Care
- National Association for Former Foster Care Children of America, Inc.

***Project Partners***

##  Project Goals 

- Examine and refine current methods for identifying EPSDT children in foster care who are in need of mental health services
- Examine and refine current regulations, policies, and programs offering mental health assessments and supports to EPSDT-eligible foster care children in order to identify gaps and eliminate duplicative services

## 3.	Establish clear policies and programmatic mechanisms to support young adults with significant mental health problems who must transition into the adult mental health system of care

4.	Identify and integrate mechanisms within DMH and CFSA under a continuous quality improvement approach

- 4.	Identify and integrate mechanisms within DMH and CFSA under a continuous quality improvement approach

***Project Goals**** *

## Core Transition Elements

**Program and Services**
- Effective team formation and functioning
- Transparency among and within agencies that serve youth
- Effective and efficient quality assurance/ quality improvement systems

## Core Transition Elements

**Program and Services**
- Reliable networks for foster youth and foster parents
- Linkage to age-appropriate and least restrictive housing options
- Linkage to agencies/programs that train for job readiness/life skill development

## Core Transition Elements

**Fiscal**
** **
- Financial incentives for providers to develop specific services for transitional services
- Provide clarity to Mental Health Rehabilitation Services (MHRS) funded under Medicaid

## Policy

Develop a pilot to determine feasibility of proposed comprehensive services

Strengthen systems’ infrastructure, including operational policies and enhanced information collection and sharing

- Develop a pilot to determine feasibility of proposed comprehensive services
- Strengthen systems’ infrastructure, including operational policies and enhanced information collection and sharing

***Core Transition Elements***

## Quality

Strengthen capacity of providers, administrators, families, and youth

Develop training materials
Mental health provider manuals
Child Family Services Agencies manuals
Foster youth manuals
Foster parents manuals

Conduct competency-based training and followup

- Strengthen capacity of providers, administrators, families, and youth
- Develop training materials
- Mental health provider manuals
- Child Family Services Agencies manuals
- Foster youth manuals
- Foster parents manuals
- Conduct competency-based training and followup

***Core Transition Elements***

## Project Accomplishments

- .

***Project Accomplishments***

- Established EPSDT portals workgroup
- Improved inter- and intra-agency lines of communication
- Incorporated a direct services pilot project
- Intra-agency transitional youth pilot study

## Project Accomplishments

- Strengthened DMH current programs
- Supported Employment
- Supported Housing
- Finalized district-wide cooperative agreement

## Project Challenges

- Delay in project staffing
- Short-term difficulty sustaining foster youth involvement
- 2005 Medicaid Deficit Reduction Act

## Moving Forward...

| Continue to build connections at local, district-wide, and Federal levels | Determine best funding mechanisms for DC population |
| --- | --- |
| Conduct focus groups
Foster youth and families | Enhance quality improvement/ quality assurance structure |

## Making a Difference

**WHAT**

**WHEN**

**NEEDS**

**SERVICES**

**FUNDING**

**WHERE**

**WHO**

**HOW**

**WHY**

**PRACTICES**

**POLICIES**

##     Youth focused! Strength based! Youth centered!