Child Mental Health
Mission Statement for Child-Adolescent Services Division (CASD):
To provide integrated, community-based outpatient services for children-adolescents who are high risk and those with serious emotional disturbances (SED) and their families, services to include individual, group and family counseling, 24-hour crisis intervention, outreach, prevention and education, transitional placement services, provide support, linkage and referral for other mental health related services in the community. Provide outreach for early identification, intervention and prevention of out of home placement.
Goals:
CASD is committed to uphold the System of Care Core Values to be child-centered, family focused, strengths based, community based, and culturally competent and abide by the System of Care Guiding Principles to provide Access to a comprehensive array of services, Individualized services using a wraparound approach, Services in the least restrictive environment, Full family participation, Integrated Services, Care Coordination, Early Identification and Intervention, Smooth transitions, Protection of the child’s rights, non-discrimination and cultural appropriateness, and in collaboration with public, private and faith based child-serving agencies along with stakeholders shall provide a comprehensive array of mental health and related services organized into a coordinated network of a continuum of care for the treatment of children-adolescents who are high risk and those with severe emotional disturbances and their families.
TOP PRIORITIES:
A. SYSTEMS OF CARE:
Goal: To develop, implement and sustain a system of Care for Guam through community–agency partnership and family involvement at all levels for the prevention of out of home and off-island placement, providing array of mental health and related services following the needs of the child and family through out treatment, transitioning from youth to adult services and providing supportive services to strengthen family life.
Objective: Develop collaborative partnership with families, agencies and community stakeholders to sustain a system of care for children, adolescents and their families.
1. Project I Famagu’on-ta is Guam’s award from the Child Mental Health Initiative (CMHI), a Federal Government Cooperative Agreement administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Mental Health Services (CMHS) Child-Adolescent and Family Branch, with the Government of Guam administered by the Department of Mental Health and Substance Abuse (DMHSA) and the Child-Adolescent Services Division (CASD) for the creation of a System of Care for Children-Adolescents with Severe Emotional Disturbances and their families.
The CMHI Cooperative Agreement is a six year funding source from the period of October 2002 through September 2008. This fund is seed money to assist Guam in developing its System of Care for children-adolescents with severe emotional disturbances/complex mental health needs and their families. This funding requires a match both in-kind and cash match from Guam. For year one, the match was all in-kind contributions. The second year and thereafter, the Guam Legislature appropriated a Local Cash Match of $250,000.00 for the use of flexible funds to support the wraparound and for family support in the area of respite care vouchers, stipends and support services. The continuation of this $250,000 funding is critical for the duration of the Cooperative Agreement. We request that at the end of each fiscal year, that any remaining funds are carried over to the next fiscal year.
The Child Mental Health Initiative, is for a radical system change in how social systems (such as the Department of Education, Department of Youth Affairs, Department of Mental Health and Substance Abuse, Department of Public Health and Social Services, Superior Court of Guam Juvenile Probation and Department of Integrated Services for Individuals with mental illness), work together to provide the mental health needs of children and families. It is our commitment as we collaborate with our community partners, families and all child-serving agencies that we work together to provide an array of services both traditional and non-traditional mental health services that are community based, child and family centered and culturally appropriate. A Memorandum of Understanding have been developed and signed by all six child serving Agency’s Directors. The Guam Police Department, Juvenile Investigation Division, is a recent addition to this partnership.
There are 11 array of mental health services mandated in the Cooperative Agreement that are either to be enhanced, if the services are existing, or to be developed, if they are not available. These array of services range from least restrictive where the child remains in the home and supportive mental health services are provided to prevent out of home placement, to a most restrictive service which would be an out of home placement. The following array in the order of least to most restrictive are as follows: Case-Management, Individualized Service Plan (Wrap-Around), Outpatient Counseling, and Consultation, Therapeutic Respite Care, Crisis Response Services, Therapeutic Day Treatment, Diagnostic and Evaluation (psychiatric, psychological and medication evaluation/consultation and management), Intensive Home-based Services, Therapeutic Foster Care, Therapeutic Group Home and Transition to Adult Services. In addition to these mental health services, other related services are to be enhanced and made accessible to the child and family. Many of these services are to be contracted out or outsourced into the community for capacity building and sustainability. The Therapeutic Day Treatment, (Rays of Hope) and the Therapeutic Group Home (TGH) with a built in Respite Care have been outsourced to Latte Treatment Center, an outfit out of Shiloh, Texas. Other mental health and related services are being provided through partnership and memorandum of understanding (MOU) between child serving agencies. All these traditional, nontraditional services and natural support make up the system of care.
I Famagu’on-ta have served cumulatively 400 children and adolescents over the past 3 years. Each child or adolescent is assigned a Wrap coordinator (Care-Coordinator/Social Worker). I Famagu’on-ta currently has 9 Wrap Coordinators and a Core staff of 4, consisting of a Principal Investigator who also fills in the position of a Project Director and Clinical Director due to the vacancies of the two critical positions, a Key Family Contact/Coordinator, Youth Coordinator, and a part-time Technical Assistant, Cultural Competence and filling in also as a Social Marketing Manager. There are three Family Partners representing the ethnic and cultural group one of Chamorro, one Filipina and one Chuukese. The Family Partners compliments the work of the Wrap Coordinators, a vital team member and a close ally of the families. All the positions in I Famagu’on-ta, except for the Principal Investigator/Acting Project and Clinical Director, are 100 percent federally funded and are unclassified positions. In fiscal year 2006, DMHSA and the collaborative child serving agencies, families and stakeholders developed the Sustainability Plans for I Famagu’on-ta, Guam’s System of Care mirroring the intent of the local government to sustain I Famagu’on-ta as documented in Public Law____ with the re-establishment of the Guam System of Care Council.
The project staff participates regularly on technical assistance conference calls with the National Technical Assistance to stay abreast of mental health issues and concerns. The Clinical and Evaluation Components of the project provide the research on evidenced-based outcomes.
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B. COMMUNITY BASED, CONTINIUM OF CARE SERVICES:
Goal: To provide supportive, community-based mental health services to child/adolescent and family that are, child and family centered, culturally competent and provide a safety net continuum of care that is seamless.
Objective: Enrolled children and adolescents in the Project I Famagu’on-ta shall access these services through their Wrap plan. These services are to prevent out of home placement and if out of home placement is necessary, that it be on island, be temporary and short-term and have discharge planning initiated from the start. This service is to bring home children and adolescents that are in off-island placements.
1. Rays of Hope, is a community-based service offering Therapeutic Day Treatment consisting of education instructions and therapeutic intervention/behavioral management This home was made available through GHURA via HUD’s Community Development Block Grant. Although the home was purchased in 2002, it needed renovations to meet ADA, Fire and Public Works Occupancy requirements. Funding via GHURA were identified and made available prior to the renovation work. Rays of Hope started its operation in May 2004 providing partial Day Treatment services to children-adolescents who have been enrolled in Project I Famagu’on-ta. The services’ emphasis were on therapeutic behavioral management consisting of social skills building activities for the youth to improve their social interactions, develop leadership and behavioral management skills, and improve their self esteem and school performance. Rays of Hope was outsourced to Latte Treatment Center in July 2005 but continues to be under the oversight of the Child-Adolescent Division of the Department of Mental Health and Substance Abuse. This service is funded out of the Child Mental Health Initiative Cooperative Agreement.
2. Therapeutic Group Home, also known as Latte Treatment Center is a temporary home for up to 10 youth at any time who are not able to live at home with their parents for various reasons. This group home is a treatment center similar in concept to the Guma Manhoben. The initial residents of this home were youth who were returning from off-island residential treatment facilities which were paid out of the Residential Treatment Funds. The Group Home provides services and supports for youth who would otherwise be in DYA, other more restrictive placements or sent to off-island residential treatment facilities. Funding for this home was switched from federal to local funding beginning this fiscal year.
C. OUTPATIENT SERVICES:
Goal: To provide Outpatient Mental Health Services to children, adolescents and their families in the area of Intake and Emergency and Crisis Assessment and Intervention, Early Mental Health Screening and Identification, Public Education and Awareness, Counseling and Referral Services. Additionally, there are special projects to supplement the services and to strengthen family life such as the Annual Christmas Cheer for Families and the Art of Healing for Children and Adolescents.
Objective: To support, empower and strengthen child and family ties by making these mental health services accessible to not only children/adolescents with severe and complex mental health needs and their families, but to all children and adolescents that may be at risk and in need of mental health services.
CASD will continue providing Outpatient Services as listed above and to include providing case management/care coordination and counseling to children-adolescents who are admitted in the Child Inpatient Unit (CIU) for acute care. Approximately 25% of the Social Worker’s and PSW/Counselor’s time is spent in CIU whenever there is an admission. The Counselor and Social Worker provide assessment, attends family and treatment meetings with the Psychiatrist and other service providers, provide linkages with services in the community and provide after care services as needed. In situations where the child-adolescent receives only medication, the Social Worker continues to provide Case Management services and sits in during the medication follow up appointments. Individual and family counseling are provided as needed and upon request.
CASD staff engages the community in mental health awareness and stigma reduction campaign through education and awareness displays at the Malls, public speaking presentations, debriefings on traumatic events, Outreach Crisis Counseling at time of disaster through Project PRO a FEMA and CMHS funded project, and through its annual Christmas Cheer for families, and the Art Academy and Art of Healing, displays of children and adolescents art work. staff in coordination with Clinical Division staff provides crisis and emergency services such as debriefings to individuals, families and groups who have experienced or have been affected by traumatic events.
In Outpatient Services, CASD conducts Intake interviews and assessments. Many of the referrals are from the Department of Youth Affairs, Department of Education and Sanctuary for suicide assessments and for conduct behavior problems. Additionally, CASD gets a growing number of referrals for counseling from Healing Hearts because of sexual assault and abuse on minors.
In addressing the need for more outreach services to the underserved children and adolescents, CASD had conducted a pilot project school based mental health service at Southern High School, Agueda Johnston Middle School, Astumbo and PC Lujan Elementary Schools to students who can benefit from some mental health intervention. An evaluation of this pilot project at the end of the school year (2005-06) revealed this is a much needed service at all the piloted schools. Unfortunately due to significant loss of staff, CASD was unable to continue this service. In 2006-2007 I Famagu’on-ta staff however, conducted extensive outreach to over 25 schools to bring awareness to both faculty and parents (PTO) about children’s mental health and in particular about what I Famagu’on-ta, System of Care is about, information and referral and how to access its services.
In the area of early identification, screening and intervention, CASD is providing primary care providers (Physicians, Child Care Providers, Head Start, and PEDS. etc.) consultation service to address mental health concerns as well as to connect families to mental health and related services. Additionally, CASD is represented in organizations such “Tinituon” (the Beginning) for the zeoro-3 program and also with the Interagency Collaborting Council, (ICC).
CASD Outpatient Services serve the general public, but mainly those from low income and indigent homes. Those with private medical insurance are encouraged to seek mental health services through their private providers, but a significant number of these families are requesting services from the Department because they are unable to pay the co-payment or meet their deductible. These families therefore, are provided the mental health services through the Department. Many of the children and youth that we provide therapeutic services also require medication treatment which is very costly. For several years now, with the increasing shortage of Social Workers and PSW Counselors, CASD is experiencing tremendous challenges in being able to provide quality services to increasing number of children/adolescents and their families with severe and complex needs.
Currently, CASD local funded staff has significantly decreased over the past four years. The staff consists of an Administrator who oversees and manages the overall operation of the Division including the I Famagu’on-ta Cooperative, a Secretary, two Community Program Aides I, one Psychiatric Technician I and two Social Worker, one of which is finishing her Masters Degree in the States. The Supervisor position has been vacant and unfunded for many years now. This position must be filled to support the need for staff supervision. There are currently no funded Psychiatric Social Worker/Counselor positions either. Counseling services are contracted out to a limited number of Individual Marriage and Family Therapist (IMFT). A PSW Supervisor position is requested as well as a PSW I and II positions to support the need for more counseling services in the community. Additionally, more Social Worker/Care Coordinators need to be hired to provide case-management/Wrap-around with our child-adolescent population. In light of the fact that most of the care-management/Wrap Coordination services are being conducted by I Famagu’on-ta staff, our children and youth with complex mental health needs will be in dire straits if I Famagu’on-ta is not sustained and the wrap around services at the level it is operating ceases.
Wrap Coordinators/ Social Workers and Counselors attend court hearings and IEPs on a regular basis with the schools as well as other functions relating to mental health issues with the child and family. Wrap Team meetings are held in many settings accommodating the needs of the child and family. This work is flexible; strengthen based, child centered and family driven.
All CASD staff is service providers and are committed as in-kind contributions to the CMHI Cooperative Agreement, I Famagu’on-ta.
IMPACT STATEMENT:
The services, which CASD provides shall in time reduce if not eliminate off-island placement for children-adolescents with severe emotional disturbances. It shall also reduce inpatient admission in the Child Inpatient Unit, an acute care facility at DMHSA. It shall reduce the number of admissions into the Department of Youth Affairs (DYA), with Child Protective Services as well as the number of Juvenile Court Cases. It shall increase the number of youth staying and completing high school and going on to higher education, both academic and vocational, and increase the number of independent and employed youth. Overall, it shall increase the self-esteem of children-adolescents, produce happy and productive youth and keep families intact. Over time all these changes shall translate into savings of taxpayers’ funds and a mentally healthy community.
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