‘Systems of Care’ Help Address Juvenile Justice Mental Health Challenges

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Connecting state and local government leaders

In a recent NACo podcast, experts discuss how to bring together “all of those essential pieces that children with serious behavioral health needs and their families need in order to be successful in life.”

As some states redesign their Medicaid programs because of the Affordable Care Act, some county governments are considering adopting systems of care that more effectively deliver health services.

The community-based systems stress interagency cooperation, consist of many programs and services and require steady funding.

They’ve proven highly effective in meeting the mental health needs of youth in juvenile justice systems, at least 65 percent of which have one diagnosable issue and 20 percent serious emotional issues, according to the National Association of Counties.

“A system of care, first and foremost, is a set of values and principles that really provide an organizational framework for systems reform on behalf of children and families,” Denise Sulzbach, Technical Assistance Network for Children’s Behavioral Health deputy director, said in a recent NACo podcast.

“System of care is not a program. It’s not a single initiative. It’s pulling together all of those essential pieces that children with serious behavioral health needs and their families need in order to be successful in life.”

Effective systems of care are data-driven and aim to serve both children and their families in their homes or communities, rather than at a residential facility.

While less than 10 percent of children enrolled in Medicaid use behavioral health services, they account for 38 percent of its expenses, Sulzbach said, but systems of care can decrease the cost of care by 25 percent—a $40,000 savings per year per child.

“Knowing that one of the main pieces for us is trying to make sure that kids stay with their families and do not wind up in out-of-home care, a mobile urgent treatment team is there to help us to go out into the community . . . if there’s a crisis situation to make sure that we can stabilize the situation and not use places like in-patient care,” Mary Jo Meyers, deputy director of Wraparound Milwaukee, said in the podcast.

Milwaukee County, Wisconsin, implemented the Wraparound Milwaukee system of care about 20 years ago, which now serves around 1,100 families with children who’ve been in the juvenile justice system daily.

Care coordinators with six agencies work with the families to choose between 220 service providers, while an administrative arm oversees finances and quality assurance.

All costs are covered for the enrolled, 21 percent of which reoffended compared to 40 percent outside the system, Meyers said.

Clinical symptoms tend to decrease at higher rates and school attendance tends to improve among juveniles in systems of care, Sulzbach said.

The Just Care Family Network system of care in Shelby County, Tennessee, serves children that come from the state’s juvenile court or child welfare system but has linked mental health agencies, the school system and faith-based institutions into its network during its six years.

Systems of care can benefit any target group.

In March, Michigan received $5.5 million from the U.S. Department of Housing and Urban Development to put toward low-income adults with disabilities.

The money will be split cooperatively between the Michigan Department of Community Health and Michigan State Housing Development Authority, The State News reported, comprising a system of care.

West Virginia, similarly, received $1 million in federal funding to its Office of Maternal and Child Health Services to support system of care infrastructure benefitting women, infants, toddlers, families, and children with special needs, WVVA-TV reported.