How the CSOC Fulfills Its Mission
The CSOC maintains a planning structure regarding the direction of service, following a system of care plan for Children and Families, established through the DMH planning process, as a guide for system of care development.
- Manages a diverse continuum of programs that provide mental health care for children and families.
- Promotes the expansion of services through innovative projects, interagency agreements, blended funding, and grant proposals to support new programs.
- Collaborates with the other public agencies, particularly the Department of Health Services (DHS), the Department of Children and Family Services (DCFS), the Probation Department, the CountyOffice of Education (LACOE), and school districts (e.g., LAUSD).
- Promotes the development of county and statewide mental health policy and legislation to advance the well-being of children and families.
Whom the CSOC Serves
The CSOC serves children who have a DSM-IV Axis I diagnosis and have symptoms or behaviors that cause impairment in functioning that can be ameliorated with treatment.
The priority target population that the Short-Doyle/Medi-Cal community mental health providers serve are children with a DSM-IV Axis I diagnosis that have or will, without treatment, manifest in psychotic, suicidal or violent behavior, or long-term impairment of functioning in home, community, or school.
The CSOC Treatment Network
The CSOC provides mental health services through 20% directly-operated and 80% contracted service providers. The CSOC network links a range of programs, including long-term and acute psychiatric hospitals, outpatient clinics, specialized outpatient services, day treatment, case management, and outreach programs throughout the county.
Clients and Programs Related To Child Abuse and Neglect
This report presents the characteristics of child and adolescent clients who are victims of, or are at risk of child abuse and neglect and are receiving psychological services in relevant programs provided by DMH.
Among such programs are those that serve young children who are in or at risk of entering the child welfare system. These include: the Mental Health Services Act (MHSA) funded 0-5 Full Service Partnership(FSP) program, an intensive treatment program for children with mental health problems who are in or at risk of entering the child welfare system; DMH directly operated and DMH contract provider outpatient programs (including therapeutic preschools) serving children age 0-5 who are at risk of entering the child welfare system, as well as those already in foster care with mental health diagnoses - these include the DMH directly operated programs Ties for Families and Young Mothers and Well Babies. Additionally, selected DMH providers participate in First 5 LA’s Partnership for Families initiative, a program for children and families at risk for child welfare involvement. Collectively, these programs provide a continuum of screening, assessment and treatment, serving the mental health and developmental needs of children from birth to five years of age. They are a critical component of prevention and early intervention strategies that support more comprehensive infant and early childhood mental health systems of care.
The programs to be presented in greater detail in this report include those that provide psychological care for abused or neglected children and adolescents and their families.
In addition, the report covers other programs for children and adolescents who are at risk for abuse or neglect. The report will review the following programs: Katie A. programs (Screening, Assessment, Treatment, and Wraparound); Family Preservation; Family Reunification; Child Abuse Prevention Program; Juvenile Court Mental Health Services; Juvenile Halls; Dorothy Kirby Center; Challenger Memorial Youth Center and its associated Juvenile Justice Camps; D-Rate Assessment Unit; Level 14 Group Homes; and Community Treatment Facilities.
DMH Specialized Children and Youth Services Bureau Child Welfare Division
Katie A. v. Bontawas a class action lawsuit that challenges the long-standing practice of confining abused and neglected children with mental health problems in costly hospitals and large group homes, or placed them in foster homes without sufficient care rather than providing services that would enable them to stay in their homes and communities. Los AngelesCountyentered into a Settlement Agreement in May 2003 to develop and implement strategies to provide the plaintiff class with care and services consistent with good child welfare and mental health practice. On March 14, 2006, federal Judge A. Howard Matz issued an injunction requiring that the State of California screen members of the plaintiff class to identify children and youth who may need individualized mental health services, and provide them with the Wraparound services and therapeutic foster care when appropriate.
The Child Welfare Division of Los Angeles County DMH was created as part of the enhanced Specialized Foster Care (SFC) Mental Health Services Plan approved by the Board of Supervisors in October 2005. The division is a centralized DMH administrative structure to provide oversight and coordination of countywide activities related to providing mental health services for children and youth in the county’s child welfare system. The Division works closely with DCFS Administrators, the DMH Executive Management Team and Service Area District Chiefs, County Counsel, the Katie A. Advisory Panel and relevant county departments to bring the county system into compliance with the requirements of the 2003 Katie A, Settlement Agreement.
DMH SFC co-located staff are now working in all of the 19 DCFS Regional Offices and are a critical component of the Katie A. Strategic Plan. SFC staff improves access for children involved in the child welfare system andprovidesmental health screening, assessment and linkage with an appropriate level of treatment in the community. The DMH clinical staff provides an array of mental health services including: follow-up on the Mental Health Screening Tool (MHST); mental health assessment; brief treatment, crisis intervention, and linkage to an array of mental health service providers in the community. DMH staff also attends and participates in Team Decision-Making (TDM) meetings, and has an integral role in the Resource Management Process (RMP) that is applied in case planning.
The following is a summary of the countywide Katie A. settlement-related programs coordinated by the Child Welfare Division:
Related Mental Health Screeningand Assessment Programs
(1) Multidisciplinary Assessment Team (MAT)
MAT is a collaborative screening process offered through DCFS and DMH. All newly detained children and youth in the child welfare system receive a comprehensive assessment of their medical, dental, educational, caregiver and mental health needs through the MAT process. DMH service providers complete the MAT assessment within 30 – 45 days of receiving a referral and independent of the DCFS detention process. The DMH MAT provider conducts a standard Child and Adolescent Assessment and completes a MAT Summary of Findings Report, which is incorporated into the child’s Case Plan presented to the court. MAT staff then assists the case-carrying CSW in linking children and their families to needed services.
Countywide,3,731MAT assessments were completed in FY 10-11 compared with 3,417 in FY 09-10.
(2) Coordinated Services Action Team (CSAT)
The CSAT is an administrative network in each DCFS regional office that coordinates screening and assessment of: (a) newly detained, (b) newly opened and non-detained, and (c) existing DCFS cases. Every DCFS case is given a mental health screening by a Children’s Social Worker (CSW) using a brief checklist, the California Institute of Mental Health/Mental Health Screening Tool (CIMH/MHST). Those screening positive are referred for assessment and possible mental health services. CSAT provides a Linkage Specialist (SLS) to assist CSWs in identifying suitable service linkages, and also monitors effective service delivery. Implemented in May 2009, CSAT initiated a monthly Referral and Tracking System (RTS) Summary Data Report that tracks rates of screenings and referrals. CSAT is primarily a DCFS process. DMH participates in CSAT via SFC co-located staff, D-Rate units, and Wraparound liaisons.
The cumulative RTS summary for the last nine months of FY 10-11(October, 2010 to June, 2011),reports that: (1) for newly detained children, 2,469 mental health screenings were completed by 615 CSWs (average number of screenings = 4.0), the rate of screening was 97%, the rate for positive screens was 81%, and the number referred for mental health services was 1,946, which is a 98% referral rate. (2) For newly opened non-detained children, 7,035 screenings were completed by 935 CSWs (average number of screenings = 7.5), the rate of screening was 97%, the rate for positive screens was 68%, and the number referred for mental health services was 4,458, which is a 96% referral rate. (3) For existing open cases, 2,109 screenings were completed by 548 CSWs (average number of screenings = 3.8), the rate of screening was 94%, the rate for positive screens was 41%, and the number referred for mental health services was 812, which is a 97% referral rate. For these three groups of children, the average interval between referral for mental health services and providing a mental health service was 3.3 days.
(3) Medical Hubs
Six Medical Hub clinics are operated by the Los Angeles County Department of Health Services (DHS), providing mental health, forensic and medical screenings for children under the care of DCFS or at risk of entering the foster care system.
During FY 10-11, 70% of newly detained children received an Initial Medical Examination, including the CIMH/MHST mental health screening tool, at a Medical Hub clinic. Children and youth screening positive are reviewed for mental health assessment and linkage as needed.
Katie A. Treatment Programs
(1)Intensive In-Home Mental Health Services
(a)Comprehensive Children’s Services Program (CCSP)
The CCSP was developed by DMH in collaboration with DCFS to provide effective evidence-based therapy to children and youth in the child welfare system. The CCSP program provides 24/7 intensive case management for children ages 3-17, as well as access to one or more of the following evidence-based therapies that constitute the In-Home Mental Health Services (IIHMHS) program:
- Incredible Years (IY)
- Trauma Focused Cognitive Behavioral Therapy (TFCBT)
- Functional Family Therapy (FFT)
During FY 10-11, there were 609cases receiving the following CCSP interventions: 103 received IY, 391 received TFCBT, and 115 received FFT.
(b)Intensive Treatment Foster Care (ITFC)
The ITFC program seeks to reduce placement instability and provide an alternative to congregate care settings. ITFC places DCFS foster children in foster homes in which the child is typically the only foster youth and where they will have a treatment program individualized according to their needs. ITFC foster parents receive additional training hours and have access to 24/7 support. Children are placed after efforts are made to match them with appropriate foster parents. Mental health clinicians are trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which is provided if/when clinically appropriate. During FY 10-11, there were 48 ITFC placements.
(c)Multidimensional Treatment Foster Care (MTFC)
MTFC is an evidence-based form of treatment foster care which is now serving youth, ages 6-17, who have a parent or other identified caregiver, yet remain in out-of-home care because the caregiver is unable to manage the youth’s difficult behaviors. The goal of the Multidimensional Treatment Foster Care (MTFC) program is to decrease problem behaviors of the youth while simultaneously enhancing the parenting skills of the permanent caregiver. Treatment is typically short-term, averaging 6-12 months, and is provided in a specially trained foster home environment. Each MTFC home has only one foster child who is provided with their own bedroom. Foster parents attend specialized training and participate in weekly meetings. With the guidance and 24/7 support of the program supervisor, foster parents provide youth with close supervision while implementing a behavioral management system tailored to each child’s needs. A skills coach takes the youth into the community to practice their newly developing prosocial behaviors. Adolescent youth have an individual therapist who, along with the skills coach, works toward specific treatment goals as directed by the program supervisor. Meanwhile, the youth’s permanent caregiver attends weekly sessions with the family therapist. These sessions are coordinated by the program supervisor and are designed to promote positive interactions during visits with the youth in preparation for successful reunification. Psychiatric consultations are also provided, when needed. Rigorous scientific studies have determined that MTFC outcomes are significantly efficacious with regard to safety, permanency and the well-being of youth. During FY 10-11, 33 youth were placed in MTFC homes.
(2) Wraparound
Wraparound is an interagency collaborative supported by DCFS, DMH and the Probation Department. There are currently 34 Wraparoundagencies thatprovide multifaceted support, including mental health services. Tier I Wraparound is intended for children and youth who are currently placed or are at imminent risk of placement in a group home at a Rate Classification Level (RCL) 10 or above.
On May 1, 2009, Wraparound expanded its target population to include any child/youth with an open DCFS case (either voluntary or court), who qualifies for Early Periodic Screening Diagnostic and Treatment (EPSDT) and has an urgent and/or intensive mental health need which causes impairment at school, home and/or in the community. The latter program has been designated Tier II Wraparound.
The Tier I Wraparound program serves children ages 5-17.5 years of age who are under the jurisdiction of one or more County departments – DCFS, DMH or Probation and who are placed in, or at imminent risk of placement in a Rate Classification Level (RCL) 10-14 group home.
Children receiving Wraparound have multiple unmet needs for stability, continuity, emotional support, nurturing and permanence. These needs are evidenced by substantial difficulty functioning successfully at home, school, and community. Most are diagnosable within the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV). Many have had a history of psychiatric hospitalizations and one or more incarcerations in a juvenile facility or probation violations, and/or a prior history of multiple placements or emergency shelter care placements.
The DCFS, DMH, or Probation Liaison receive referrals for possible acceptance into Wraparound from their respective caseworker/referral source and conduct a preliminary review. Completed referrals are then submitted to the Interagency Screening Committee (ISC). The ISC “core” team is a collaborative comprised of Liaisons from DCFS, DMH, Probation and a DMH Parent Advocate. The ISC must screen referrals within seven days of receipt. If a child/youth is accepted at the ISC, the Wraparound provider makes telephone contact with the family within 48 hours and face-to-face contact within seven days.
In order to define, implement and review the specific services that need to be provided to meet the child/family’s needs, the Wraparound provider convenes a Child and Family Team (CFT) that meets weekly (or as needed) with each family. The CFT “does whatever it takes” to assist the family to meet agreed-upon goals that are developed by the team.
Tier I Wraparound Program
During FY 10-11, there were 1,752 children and youth enrolled in the Tier I Wraparound program with an average age of 14.8. Figures 1, 2, 3 and 4 describe their gender, age-category, race/ethnicity, and Agency of Primary Responsibility. For clients with an identified agency of primary responsibility, DCFS referred the largest proportion of the Tier I Wrap clients receiving mental health services while Probation referred the second largest proportion.
The DSM diagnoses for Tier I Wrap clients and reported substance use are displayed in Figures 5, 6 and 7. The most prevalent primary admission diagnoses were Adjustment/Conduct Disorder/ADHD, Major Depression, Bipolar Disorders and Anxiety Disorders.There were 165 clients (9.4%) with a primary or secondary diagnosis of Child Abuse and Neglect. Substance use was reported for few Tier II Wrap clients with the Dual Diagnosis substance use codes.
Tier II Wraparound Program
During FY 10-11, 2,446 children and youth were enrolled in the Tier II Wraparound program with an average age of 12.6. This is notably younger than the average age of 14.5 observed for Tier I Wraparound clients. Figures 8, 9, 10, and 11 describe their gender, age-category, race/ethnicity, and Agency of Primary Responsibility.
The DSM diagnoses of Tier II Wraparound clients and reported substance use are displayed in Figures 12, 13 and 14. The most common primary admission diagnoses were Adjustment/Conduct Disorder/ADHD, Anxiety Disorders, and Major Depression. Primary or Secondary diagnoses of Bipolar Disorders were 5.5% of Tier II diagnoses, a substantially smaller percentage than was observed for Tier I (16.3%). For Tier II There were 278 Tier II Wraparound clients (11.4%) with a primary or secondary diagnosis of Child Abuse and Neglect. Substance use was reported by means of the Dual Diagnosis substance use codes for few Tier II Wraparound clients. However, DCFS reports that 9.9% of all children enrolled in a Wraparound program had an active substance use issue in FY 10-11.