Mental Health Services and Policy Program
The mission of the Mental Health Services & Policy Program (MHSPP) is to provide research, evaluation, outcomes management, technical assistance and training that helps improve the lives of individuals and families that receive publicly funded mental health services.
Director: Neil Jordan, PhD
Associate Director: Eugene Griffin, PhD, JD
PROJECTS & PARTNERS
Illinois Department of Children & Family Services (DCFS) (PI: Dana Weiner, PhD)
MHSPP and DCFS have enjoyed nearly a decade-long partnership focused on addressing the needs of children and families through training, evaluation, and technical assistance. Relying upon the Total Clinical Outcomes Management model, MHSPP has helped the Department to implement decision support strategies as well as approaches to measuring outcomes that are strengths-based, consensus-driven, and contextually sensitive. Current MHSPP/DCFS projects include ongoing evaluation of the Integrated Assessment, System of Care, Specialized Foster Care and Child and Youth Investment Team programs, as well as web-based monitoring of residential placements. More recently, as data have accumulated on longitudinal trajectories of progress over time, our data analyses address questions by looking across these programs for patterns and changes. Other innovative work includes the Statewide Provider Database and geomapping websites, providing easy access to geographically organized information on community resources, performance based contracting in residential treatment, and consultation on the development of aftercare programming for youth returning from stays in the juvenile justice system.
The Integrated Assessment (IA) program provides comprehensive assessment for all youth that enter state custody. The IA includes an administration of the Child and Adolescent Needs and Strengths instrument (CANS), which assesses child behavioral and emotional needs, risk behaviors, life domain functioning, trauma experiences, traumatic stress symptoms, acculturation, child strengths, and caregiver needs and strengths. MHSPP provides DCFS with ongoing analysis of these data. The IA CANS serves as the baseline for all future assessments.
Following the IA, caseworkers complete a CANS assessment every six months to coincide with the Child & Family Team meetings that occur quarterly. This caseworker CANS provides regular checks on progress and emerging needs and strengths. When placement changes are indicated, a CAYIT is convened to arrive at a consensus around the best placement option for the youth. The Child and Youth Investment Team (CAYIT) Program is used for determining and planning appropriate out-of-home care for youth who may need a higher level of supervision or services than the current placement provides. The CAYIT process includes a CANS assessment to provide decision support for level of care decisions. MHSPP provides DCFS with ongoing analysis of the impact and outcomes of the CAYIT process.
For those children and youth placed in congregate care settings, MHSPP provides evaluation and technical assistance to DCFS for their residential treatment and group home programs. The DCFS Residential Provider Monitoring Unit (RPMU) provides quality assurance to DCFS by monitoring issues that may be occurring at the agencies, observing interactions between staff and youth, and investigating safety issues. MHSPP provides DCFS with ongoing analysis of RPMU data. MHSPP is also collaborating with DCFS, the University of Illinois-Chicago, and the Chapin Hall Center for Children to refine the performance-based contracting system DCFS implemented for residential treatment and group home providers during 2008.
Other programs, including System of Care and Specialized Foster Care, are designed to provide intensive services and skills to stabilize foster care placements. The System of Care (SOC) Program is a placement stabilization program for wards of the State whose foster placements are in jeopardy of a disruption. SOC provides intensive therapeutic services within a wraparound model, including individual, family, and group therapy, mentoring, tutoring, support groups for foster parents, case management, school management, and advocacy. SOC serves children that are in traditional and relative foster homes. A CANS assessment is done when youth first begin services, every six months, and at termination. MHSPP provides DCFS with ongoing analyses of placement stability and the impact of SOC services on symptoms and length of placement.
The Specialized Foster Care (SPEC) program serves DCFS wards with special emotional, behavioral and medical needs. These children are placed in special foster homes where foster parents are expected to provide a higher level of support and assistance to the child to meet his or her needs than would be expected in a traditional foster home. SPEC caseworkers assess these youth using the CANS upon program entry, every six months, and at program discharge. This information is then used to produce reports for DCFS and the SPEC agencies to assist them in learning about the SPEC population and in providing effective services to these children. MHSPP recently began analyzing SPEC data for DCFS, and future analyses will identify how SPEC participants differ from the general DCFS child population, mental health service needs, and how to improve child outcomes during their time in SPEC.
The CANS is also used among Intact Family Services workers who provide stabilization services to children and youth remaining with their biological families. These families may have varied needs for services, and ongoing CANS analysis can help to inform practice and administrative staff about the needs of this population and their functioning while in the Intact program.
The Statewide Provider Database is a searchable catalogue of outpatient services located in communities across Illinois. The tool is updated regularly and accessible by DCFS staff as well as community collaborators and other family-serving systems. A team of MHSPP graduate students and staff manage the data, conduct interviews with community providers, and provide training and technical assistance to child welfare staff using the tool. A companion geomapping site provides maps designed to address policy questions about gap analysis, availability of community resources, and epidemiology of clinical needs. These tools are increasingly utilized to inform contracting at the agency level and to better understand and address gaps in resources.
MHSPP also supports the IDCFS Trauma model by providing consultation and leadership to the Statewide Learning Collaboratives. The Learning Collaborative structure was built to assist with the implementation and adoption of the Illinois Trauma Informed Practice Model under the leadership of Dr. Cassandra Kisiel. MHSPP Learning Collaborative activities include comprehensive CANS training and certification for service providers statewide, and provider training for developing strength-based service/treatment plans using CANS data. MHSPP staff also manages, support, and provide remediation for users around the United States seeking CANS certification through the CANS training web site.
MHSPP has continued to provide technical assistance for the Screening, Assessment and Support Services (SASS) program. SASS is a statewide child mental health crisis program overseen by DCFS, the Illinois Department of Healthcare and Family Services (HFS) and the Illinois Department of Human Services (DHS). Children who are having a mental health crisis and are publicly funded (or have no health insurance) qualify for 90 days of mental health assessment along with any services which are deemed appropriate to manage the crisis (including inpatient hospitalization and community stabilization services).
In addition to these programs, MHSPP staff have provided data analysis and consultation to assist in planning for the integration of service provision to youth in the child welfare and juvenile justice systems. To this end MHSPP provides support for the use of the CANS tool in Juvenile Justice as well as empirically based cost modeling estimates for reductions in recidivism and aftercare planning.
Mental Health Juvenile Justice Initiative (PI: Gene Griffin, JD, PhD)
The Illinois Department of Human Services’ Division of Mental Health directs the Mental Health Juvenile Justice (MHJJ) Initiative, a program that funds local mental health providers in every county that has a juvenile detention center to provide liaisons to the court in order to: (1) identify those youth in the juvenile justice system who have a major mental illness, (2) develop a community-based treatment plan for those youth and (3) establish the necessary community support for that youth and family. MHSPP has evaluated the program since its inception in 2000 and has been able to demonstrate that mentally ill youth can be identified in the juvenile justice system and that, when treated in the community, their clinical condition improves, their school attendance increases and their re-arrest rate declines.
Illinois Childhood Trauma Coalition (PI: Gene Griffin, JD, PhD)
Dr. Griffin serves as the Clinical Director of ICTC, whose members represent over 50 public and private organizations in Illinois. The goal of this Coalition is to take a public health approach to the evolving understanding of the nature and impact of childhood trauma and to expedite the integration of this wisdom into public awareness and the array of systems that serve children and families in Illinois. Current projects include research on a possible developmental trauma diagnosis for DSM-V and training various groups on brain development and child trauma.
McHenry County Family CARE Evaluation (PI: Mary Spooner, PhD)
McHenry County Family CARE initiative is jointly funded by the Illinois Department of Human Services’ Division of Mental Health, the Center for Mental Health Services within the U.S. Substance and Mental Health Services Administration (SAMHSA), and the Mental Health Board of McHenry County. This 6-year, $9.5 million grant provides funding to redesign and transform the local mental health services delivery system for youth (up to age 21) with serious emotional disturbances that reside in McHenry County. Eligible youth include children and adolescents referred by a school, court, or community agency with a history of 12 months of treatment in a community setting or 2 psychiatric hospitalizations within 12 months. MHSPP is evaluating this system of care improvement project. Evaluation activities include data collection for a national SAMHSA longitudinal study and analyses of local data. Findings from the longitudinal study will inform future pilot projects to improve the effectiveness of systems of care nationally. At the local level, evaluation findings will be used by McHenry County policymakers to develop and implement culturally competent services that improve the well-being of children and families. Policymakers, for example, may use evaluation outcomes to change service eligibility policies, determine optimal staffing levels, and expand treatment resources for children and families.
Evaluation of the Chaddock Trauma Initiative (PI: Cassandra Kisiel, PhD)
The Chaddock Trauma Initiative of West Central Illinois is a 4-year, SAMHSA-funded project through the National Child Traumatic Stress Network (NCTSN) to promote the mental health and well-being of under-served children and adolescents and their families suffering from traumatic stress who reside in the rural tri-state area (Illinois, Iowa, Missouri) surrounding Quincy, Illinois. The primary goals of this initiative include: (1) infusing the tri-state area with specialized evidence-based interventions including Child-Parent Psychotherapy (CPP), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Behavioral Intervention for Trauma in Schools (CBITS), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), (2) training parents and child-serving professionals to implement trauma-informed services, and (3) further developing best practice models of trauma-related services through collaboration and coordination with local, state, and national organizations. MHSPP is designing, overseeing, and implementing the outcomes and process evaluation for this initiative. Specific evaluation elements include developing, refining and implementing evaluation surveys; overseeing the tracking, collection and management of assessment tools and protocols, in conjunction with the NCSTN; and analysis, report writing, consultation and quality improvement efforts.
Evaluation of Florida’s Medicaid IV-E Waiver for Child Welfare (PI: Neil Jordan, PhD)
Dr. Jordan has been collaborating with colleagues at the Florida Mental Health Institute at University of South Florida to evaluate the efficiency, effectiveness, and cost-effectiveness of child welfare services and practices after the implementation of a Medicaid IV-E waiver in Florida’s child welfare system. This 5 ½ year study is funded by the Florida Department of Children & Families.
Effect of Chronic Illness Complexity on Evidence-Based Depression Treatment (PI: Neil Jordan, PhD)
Diseases are often described and studied in isolation of other disease states, yet many individuals have multiple chronic conditions occurring together (MCC). Defined as having at least 3 chronic conditions, MCC is highly prevalent among veterans and elderly Americans. Persons with MCC have a higher risk for avoidable hospitalizations and preventable complications while hospitalized. Depression is one of the most common co-occurring illnesses in those with MCC. Most patients with depression are initially treated in primary care, and collaborative care models for depression have been shown to improve care processes and outcomes for depression patients treated in primary care. The value of depression disease management models for patients with MCC is less clear. Dr. Jordan and colleagues from the Hines VA Center for Management of Complex Chronic Care have been funded by the Agency for Healthcare Research & Quality to develop a schema to help prioritize which depression patients most need depression care management. This project aims to identify commonly co-existing clusters of depression and MCC for which high quality depression care is less likely to occur. Prioritizing these illness clusters for the development of multiple disease care management programs may provide opportunities to improve quality and outcomes of care for these complex patients.
The Center for Child Trauma Assessment and Service Planning of the National Child Traumatic Stress Network (PI: Cassandra Kisiel, PhD, Gene Griffin, JD, PhD, and Tracy Fehrenbach, PhD)
The Center for Child Trauma Assessment and Service Planning (CCTASP) at Northwestern University Medical School is a University-based Treatment Services and Adaptation Center of the National Child Traumatic Stress Network (NCTSN). Our Center is focused on the development and dissemination of assessment approaches and the application of evidence-based trauma intervention approaches for various providers within public sector service settings. Our efforts are targeted for children and adolescents with complex trauma and for providers who serve these youth within child welfare, mental health, juvenile justice and educational settings. CCTASP works both within Illinois and across several other states and NCTSN centers. The Center specializes in assessment, treatment planning, and the use of data-driven approaches to service delivery. The Center emphasizes the use the Child and Adolescent Needs and Strengths (CANS) – a trauma-focused comprehensive assessment, treatment, service planning, and outcomes evaluation tool – in conjunction with other data collection strategies. CCTASP also highlights a statewide provider database as a tool for translating CANS data into trauma-informed and strengths-based service planning. The assessment-based approach can be used to develop trauma-informed treatment-planning guidelines to assist practitioners with critical decision-making, matching treatments with specific populations, sequencing treatments based on identified needs and strengths, and determining whether treatment plans are effective.
MacArthur Foundation, Models for Change (Gene Griffin, JD, PhD)
Illinois participates in the MacArthur Foundation, Models for Change, juvenile justice programs. As part of the workforce development group, Dr. Griffin and others from Illinois helped to develop a curriculum for juvenile justice line staff. The curriculum focuses on an understanding of adolescent development, mental health, and trauma issues. These concepts are then applied to working with youth and families involved in the juvenile justice system. Dr. Griffin is involved in training juvenile justice staff in Illinois and in training trainers on this curriculum in other states.
Evaluation of Youth Network Council’s Trauma Informed Youth Services Initiative (PI: Tracy Fehrenbach, PhD)
With funding from the National Child Traumatic Stress Initiative (NCTSI) of the Substance Abuse and Mental Health Services Administration (SAMHSA), Youth Network Council has established a Trauma Informed Youth Services Initiative. The overarching goal of the initiative is to incorporate trauma-informed practices and policies into community-based youth serving agencies in Illinois to improve outcomes for young people who are experiencing traumatic stress. MHSPP is directing the design, oversight and implementation of the local outcome evaluation for this initiative. Broadly, the evaluation will assess the impact of implementing trauma-informed services with underserved youth in urban, suburban, and rural settings in Illinois by focusing on a wide range of indicators including youth’s behavioral and mental health needs and strengths, trauma-related symptoms and risk behaviors including delinquent behaviors that lead to legal sanctions. This 3-year project will end on September 30, 2012.
Long-Term Effect of End-of-Life Care among Spouses Who Dealt with Death at Home (PI: YongJoo Rhee, DrPH)
Dr. Rhee received a grant from Northwestern’s Department of Psychiatry and Behavioral Sciences to study spouses who provide end-of-life (EOL) care for their dying family members. These spouses frequently experience severe depressive symptoms as part of the bereavement process. However, little is known about the long-term impact of EOL care on psychological and physical health among spouses who deal with the most intense burden of the caregiving process at home. The findings can be used to help develop effective targeted support services for spouses who provide EOL care at home, including after the EOL care period ends.
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Chicago Public Schools (PI: Gene Griffin, JD, PhD)
MHSPP worked with Chicago Public Schools as they prepared to meet federal requirements for Response to Interventions, a paradigm for diagnosing attention deficit/hyperactivity disorder and learning disabilities. Initiatives included the development of a three tiered approach to dealing with behavioral health issues, including trauma, as part of a general education program. MHSPP, along with experts from Children’s Memorial Hospital, consulted on evidence-based assessment and intervention programs.
MHSPP Faculty:
Elizabeth Durkin, PhD (on leave)
Tracy Fehrenbach, PhD
Debra Ferguson, PhD
Gene Griffin, JD, PhD (Associate Director)
Neil Jordan, PhD (Director)
Chris Kelsey, MS
Cassie Kiesiel, PhD
John Lyons, PhD (adjunct)
Zoran Martinovich, PhD
Gary McClelland, PhD
YongJoo Rhee, DrPH
Mary Spooner, PhD
Dana Weiner, PhD