CRCG – Community Resource Coordination Groups: local interagency groups, comprised of public and private providers come together to develop individual services plans for children/youth who have intensive needs that can best be met through interagency coordination and cooperation – unfunded mandate – sustained

Study compared diagnosed mental health problems of children with capacity of public/private providers

• Estimated that only 20% of Bexar County children with significant mental disorders received care, the second lowest level in the state.
• Of children who were dependent upon public systems – Only 13% received the treatment they needed. (most are Hispanic or African American, have maxed out insurance and resources on kids needs).

Texas Federation supported the development of the Bexar County Federation of Families and provided funding for Chapter leader and family partner to attend the National Federation Conference in DC.

Texas Federation of Families for Children’s Mental Health – since 1993 – SAMHSA Statewide Family network –  inform, mentor and advocate regarding IDEA, SOC, and Wraparound models to increase family and youth knowledge and participation at all levels of decision-making –provided ongoing  informed support to the Children’s Mental Health director  sustained

Attendance at Policy Academy – First System of Care Grant Application- not awarded

Bexar County Judges Children’s Diversion Initiative – Parallel to Adult Jail Diversion  – Divert children with MH issues from JP, CPS and School alternative education placements to appropriate MH services. JP, School and CPS subcommittees met monthly with stakeholders to address access to mental health services, each system’s barriers to access,  stigma reduction, cross system coordination  – School committee not sustained,  JP committee sustained, CPS committee became HB 1232 /Bexar CARES

Medical Director’s Roundtable for Children – created to parallel similar adult focused group to address access to crisis services, reduce inappropriate ER use, available child MH hospital beds, training, workforce and universal forms – not sustained

Military Family Run Organization, “Family Strong”, was developed and housed at CHCS but as the families were transferred and deployed, the family involvement eroded.  CHCS Youth were actors in the” Impact of Deployment on Youth” video sponsored by the American Academy of Pediatrics

Children and Youth Behavioral Health Needs Assessment conducted by CHCS part of the on-going compilation of a Bexar County Strategic Plan for Children’s Mental Health.

I. The criticality of points of intersection. Highest risk populations have the highest problem incidence

• As many as 45,000 BC children/youth are involved with multiple public systems (law enforcement, schools, local MH authority, child welfare) and private providers (counseling, pre-school, diversion)
• Providers who do not share information or jointly plan and integrate services.
• Scattered, fragmented services hinder early identification, access and continuity of care
• No overarching structure, no organized support for information sharing or service coordination.

II. Many options were identified but no path forward was determined. The study did not find the expected lack of resources.

• Coordination and access issues were far greater problems.
• Caregivers felt inadequately prepared to sort through a myriad of providers and modalities.
• Families and youth did not demonstrate that they were informed partners

III. A well-constructed system of care should prioritize preparing parents and caregivers to be their children’s natural case managers, including being active partners in treatment decisions and service planning.

• Training
• Peer support
• Active role in the governance of the system of care

Second SOC Application – not awarded

Youth Move  – Local chapter:  Youth (consumers) participate at local state and national MH meetings conference and awareness events, Legislative advocacy training, participation/advocacy in legislative sessions,   youth led awareness efforts – state SOC videos, annual Children Mental Health Awareness day, Guadapalooza, Photo Voice at MH focused venues, partners with state level SOC – sustained

YES Waiver – to present – HHSC DSHS Medicaid waiver – community based services for children with SED, ages 3 to 18, at risk for institutional care and relinquishment – sustained

Children’s Crisis Intervention Training: Parallel to Adult focused CIT – School police and other law enforcement training to respond to child/youth mental health crisis and divert to care – sustained

Texas Federation of Families provides scholarships to staff, youth and families to attend  National System of Care, National Federation of Families,  National Wraparound, and National School Based Mental Health conferences to promote and strengthen the knowledge base around evidence based practices.

Texas House Bill 1232 –  Bexar CARES Behavioral Health Pilot with CPS point of entry.  sustained

Texas Integrated Funding Initiative (TIFI) – small amount of funding to create awareness of system of care  and wraparound process,  cultural competency, stigma reduction, family/youth driven care , grant staff provided SOC and WA  info to diverse stakeholders – city, county, providers, families.

Community Supports for Wraparound Inventory: NWI Independent evaluation with Bexar CARES

• Bexar CARES score, 86.9 out of 168, was on par with the national average and showed a system at the midpoint of implementation of a “system of care”. (Number of respondents was small compared to other communities and few families responded. Those doing the work would say that progress and strengths are not as far along as survey results imply.)
• General local strengths: collaborative action, access improvements, and accountability and sustainability; specific achievement was cited in the areas of family voice, adoption of shared mission, principals and outcomes, cultural and linguistic responsiveness, and peer support.

Texas House Bill 35 – Continued HB 1232 for an additional two years.

Expanded HB 1232 BH pilot to include one school district.  sustained

• Regularly scheduled Family Team Meetings assess problems, recommend interventions, coordinate care from all sources and monitor progress over time.
• High level of cultural competence resulting from training and staff with skills and lived experience
• Family Partners were employed peer navigators, family educators, mentors; keeping families connected to and engaged in services.
• A total of 67 families and 163 children ages 1-18 participated.
• Demonstrated return on investment from Bexar CARES ranged from $6,000 to $8,000 per family.

Texas Senate Bill 294- Continued the Behavior Health Pilot for an additional 10 years.  sustained

Pilot expanded to all Family Based Service units in Bexar County.

• Implemented a series of psycho educational groups for immediate referral
• Skills groups initiated for children and youth referred to program

Bexar County was identified as a development sight for the Texas System of Care Expansion planning grant.  This SAMHSA grant was to help develop leadership for SOC, Governance structure, community plan, training, collaboration, social media and support evaluation measures.

Bexar County was identified as a performance sight for the Texas System of Care Expansion Implementation grant.  This SAMHSA grant help continue the development of the above areas identified in the planning grant period

Current  Data, Proposed Objectives and Outcomes

Applying national prevalence rates to the local population shows that 80,000 Bexar County children age 0-17 suffer from one or more mental, emotional or behavioral disorders. A review of local service capacity indicates only 20% of the children who need treatment receive it.

Objectives in proposed 2014-16 Bexar CARES Strategic Plan

1. Ensure Bexar CARES is family and youth guided at all levels. Strategies: increase family preparation for and representation in CQI processes and project staff hiring panels, create family roles in staff training activities, train family members to be community advocates, create a career ladder for family members wishing to enter the behavioral health workforce.
2. Improve service delivery and family access and follow through. Strategies: create an organized pathway to and through a coordinated model featuring clustered services, key early intercept points, and ample peer supports; increase participation by military families; increase use of evidence based practices, new therapy modalities; correct resource disparities with the introduction of respite and crisis services. 
3. Improve system organization and coordination. Strategies: strengthen governance structure; create continuous feedback loops for stakeholders and families; continuously monitor and guard cultural relevance; increase utilization of system of care resources by schools; strengthen data gathering and dissemination to inform decision-making; engage new funders to ensure sustainability.
4. Increase awareness of and resources for children’s mental health needs. Strategies: train families to become advocates for their children at the policy and legislative levels; improve social marketing strategies to expand public knowledge of children’s mental health needs and the potential for recovery.

The 2014-16 objectives were developed by the participants for their capacity to stimulate one or more of the following critical outcomes:

1. Early identification and problem resolution to support recovery.
2. Reduction in crisis episodes and/or hospitalizations.
3. Increased school attendance days and improved academic performance.
4. Improvement in family functioning and satisfaction.
5. Increased caregiver empowerment.
6. Reduction in per child cost of service to enable service provision to more children.
7. A culturally competent system of care.
8. A sustainable system of care.

The City of San Antonio was awarded SAMHSA SOC Expansion Grant for Bexar CARES to continue.

1. Early childhood focus for ages 3-8 working with Pre-kinder and Head start and elementary schools.
2. Services/Supports provided to 250 children per year through services and referral linkage to partnering agencies.
3. Ensure Bexar CARES is family and youth guided in management, services and advocacy.
4. Recruit and train up to 20 family members to mentor caregivers and stakeholders on behavioral health wellness within the constructs of system of care.
5. Improve service depth and accessibility by developing formal linkages with community providers including 8 non-profits serving the target population.
6. Strengthen organizational and collaborative structures of the governance board and stakeholder groups.
7. Increase awareness of community commitment to children’s mental health and stigma reduction.