policy

For this assignment, please choose one of the two case examples

Choose either the  Willie M. Program or the  Ventura County System of Care.  Both of these programs were created as a response to policy changes that were attempting to bring more comprehensive and systemic care to children with mental health diagnoses.

1. Briefly describe the program you chose. 

2. Then discuss at least  three  methods that program developers used to address treating children with SEDs in order to be compliant with the state guidelines.

3. In what ways would this program enhance protective factors OR alleviate risk factors for children with SEDs and their families?

Case example1:

The Willie M. Program

The Willie M. Program grew out of a class action lawsuit (Willie M. et al. v. James B. Hunt, Jr. et al., 1980)

filed against the State of North Carolina on behalf of children with serious emotional disorders (SED) and

aggressive behavior who were institutionalized because of inadequate community-based care. Seeing the

negotiations to settle the lawsuit as an opportunity to improve the service structure, administrators in the

North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

(MH/DD/SAS) created a comprehensive continuum of community-based care for high-risk and hard-tomanage

children and adolescents with SED.

To be represented and served under the class action suit, youths had to meet criteria as a class member: be

younger than 18 years old; have a serious emotional, mental, or neurological disorder; have a history of

violent or chronically aggressive behavior; have been placed in public custody, such as institutions, or be at

risk of such placement; or have been denied access to needed treatment or educational services. Although

many youths met the criteria, four youths were ultimately named as plaintiffs in the litigation. Willie M.,

the first of four plaintiffs, was an 11-year-old boy diagnosed as emotionally disturbed with unsocialized

aggression.

The North Carolina Department of Human Services avoided a trial by agreeing to the court’s complaints

and demands. Each member of the class was guaranteed individualized treatment in the least restrictive

setting possible. The treatment was to be based on the child’s needs rather than the availability of service

providers to provide a service or set of services. If needed services did not exist, such services were to be

created.

Leaders within the Division of MH/DD/SAS welcomed the challenge and advocated for the development

of local systems of care (SOCs) within which they could create and provide services to class members. The

Willie M. Program became among the first model SOCs in the country, serving as many as 1,500 severely

aggressive youth with SED a year; two thirds of them lived in specialized foster care or group homes. The

SOC required cooperative arrangements among the multiple agencies serving these youth. Court officers

monitored the interagency relationships, making sure that public education, child welfare, and juvenile

justice personnel worked in concert with the Division of MH/DD/SAS on behalf of these children.

Comprehensive case management, also called wraparound case management, was the primary tool used to

tailor services to the individual needs of members of the class action lawsuit. Each class member was

required to have an individual habilitation plan. Beginning in 1995, the individual habilitation plan was

based on an assessment process that reviewed both risk and protective factors.

An Assessment and Outcomes Instrument (AOI) was created to assess and to measure the progress of

children in the Willie M. Program. The instrument used a risk and protective factor perspective and

measured both fixed characteristics (i.e., factors that could not be changed through intervention, such as the

loss of a parent) and dynamic characteristics (i.e., factors that were malleable in treatment, such as school

performance). Risk factors included family-level characteristics (e.g., living in poverty; parental loss; parental

mental health and substance abuse problems, parental criminality, and large family size) and individual-level

characteristics (e.g., fetal substance exposure, neurologic or developmental disorders, poor mother-infant

attachment, difficult or shy early temperament, witness to violent acts, and history of physical and sexual

abuse, school failure, and delinquent behavior). Of the possible 30 risk factors assessed by the AOI, each of

the Willie M. class members had experienced an average of 13 risk factors—a number that far exceeds most

definitions of a high-risk youth (e.g., Rutter, 1979). Consistent with the literature on risk and conduct

disorders, most Willie M. class members with poor behavioral outcomes had histories of negative parent–

child interactions and poor academic performance. Better behavioral outcomes were predicted by protective

factors such as having good skills in areas such as problem solving, interpersonal relationships, and reading;

having social support networks available, including involvement with family members and prosocial peers;

and having a parent who was consistently employed (Vance, Bowen, Fernandez, & Thompson, 2002).

Each member’s individual rehabilitation plan specified interventions that were likely to result in positive

behavioral changes. Because most risk factors associated with Willie M. class members were fixed historical

experiences and family features that were not amenable to change, few options were available that would

reduce the impact of those risk factors on current behaviors. However, evaluations of the Willie M. Program

found that strengthening protective factors was directly associated with improved behavioral outcomes

(Bowen & Flora, 2002; Vance et al., 2002). Depending on individual needs, protective factors such as

reading skills, relationships with adults, social skills, positive beliefs and attitudes, and involvement in

community activities were strengthened through a variety of targeted interventions. In addition, parental

and caretaker positive discipline skills were strengthened. The protective factors that were found to be

strongly associated with behavioral improvement included increased levels of home and school social skills.

Interventions targeting these factors included teaching skills in anger management, empathy development,

and making and keeping friends (Bowen & Flora, 2002). Because of these positive behavioral changes,

youth served in the Willie M. Program attended school more often and had fewer arrests. Class member

and family satisfaction with services was high. As an individualized SOC was successfully developed, the

Willie M. class action lawsuit was resolved in 2000.

The Willie M. Program in North Carolina was both successful and expensive. The court demanded the

provision of needed services, regardless of cost. Many state legislators resented this open-checkbook

approach. As costs went up for class members’ services, appropriations to other parts of the mental health

system declined or were not increased accordingly. Once the class action lawsuit was resolved and its

mandates removed, funding for the Willie M. Program was reduced and realigned within the Division of

MH/DD/SAS.

Example2:

Ventura County System of Care

In 1985, the California State Legislature passed a landmark bill (AB 3920) authorizing a demonstration

program to integrate mental health services across a core group of service systems, including child welfare,

public education, and juvenile justice. The legislation provided for creation of a comprehensive, coordinated

system of care (SOC) and facilitated interagency cooperation by integrating numerous federal and state

statutes that addressed public mental health services for children and by amending various statutes and

regulations. Ventura County was selected as one of three demonstration sites under Assembly Bill 3920. As

part of the demonstration program, all child-serving agencies in Ventura County were required to engage in

interagency planning and to develop interagency protocols and agreements that emphasized providing

services to children in their homes or in the least-restrictive setting.

The Ventura County System of Care had five interdependent components as outlined in the enabling

legislation: (a) a clearly defined target population, (b) a systemwide goal to preserve family unity and locally

based treatment, (c) a commitment to developing collaborative programs of services and standards tailored

to individual needs of children and their families, (d) a continuum of service options and settings that cross

agency boundaries, and (e) a mechanism for system evaluation.

Client outcomes for the Ventura County System of Care reflected a cross-agency perspective. The

overarching goal was for children with serious emotional disturbances to remain or to be reunified with

their families, to attend and progress in public schools, and—as appropriate—to desist from problem

behavior such as delinquency and drug use. A cross-agency target population experiencing serious emotional

disturbance (SED) was identified, including populations within each agency that had been mandated for

services. The target population included emotionally or behaviorally disordered youth, such as (a) court

dependents whose histories included neglect, physical or sexual abuse, multiple foster home placements,

residential treatment, and psychiatric hospitalization; (b) court wards for whom the public sector had legal

responsibility because of delinquent behavior and who were at risk of out-of-home placement; (c) special

education pupils who required mental health services to benefit from their Individual Education Plans; and

(d) children who were not part of a formal agency other than mental health and who were at risk of out-ofhome

placement to state hospitals or residential treatment.

Mental health treatment was integrated into the service systems of the other major child-serving public

agencies. The county mental health department was given responsibility for serving the mental health needs

of the targeted children involved in the public school, child welfare, and juvenile justice systems. Mental

health staff located their services in places where targeted children lived and went to school, a step that

required reorganization of the Department of Mental Health. Most of the mental health staff was deployed

to agency and school settings to provide or supervise mental health services in those settings. Depending on

the needs of the agency, mental health staff provided consultation, assessments, case management,

counseling, day treatment, special day classes, in-home care, family therapy, enriched foster-home care

services, or crisis intervention.

The state legislation that created the demonstration project also facilitated the blending of categorical funds

so that each agency domain was enabled to determine the array of mental health services it needed. Specific

roles and relationships between agencies were delineated in interagency agreements and facilitated by a

number of interagency coordinating mechanisms. An interagency juvenile justice council became the policymaking

body of the county system. This policy-making body was created to serve as a vehicle for identifying

problems, developing interagency solutions, and working through agency conflicts. The council’s

permanent members included the county counselor, public defender, district attorney, sheriff, chief

administrative officer of the juvenile court, director of probation, a member of the board of supervisors, the

superintendent of schools, the director of the Department of Child Welfare, and the director of the

Department of Mental Health. Still in operation today, the council reviews all agency budgets and looks for

ways to mingle and coordinate funding streams.

The Ventura County demonstration project met the system-level performance outcomes required by the

statute. By integrating mental health services into each system, more children were served—especially

children from ethnic minority backgrounds—and fewer youth required placement in restrictive and costly

state hospitals or residential treatment centers. The project netted a substantial savings to the state. The

demonstration program was expanded to more counties in 1989. In 1992, the California State Legislature

enacted the Children’s Mental Health Services Act, which expanded the SOC model to all counties. In

2001, the legislature enacted a law requiring an agency-integrated SOC statewide (Stortz, 2003).

California can be a beacon for other states. Its formal adoption of SOC principles and policies in statute has

provided fiscal incentives for many local county collaborations. The state’s shift to the rehabilitative option

for federal Medicaid billing has allowed clinical staff to work outside of their offices and support field-based,

in-home, and wraparound service delivery models. A state match to the federal EPSDT (Early and Periodic

Screening, Detection, and Treatment) program has provided an important fiscal engine to expand and

sustain services and supports to children and youth 0 to 21 years old. Most recently, the California Mental

Health Services Act (Proposition 63), enacted in 2007, has provided additional and ongoing state funds to

further transform the mental health system in California with increased funding for mental health

promotion, prevention, and early intervention services to children and adolescents statewide (Hodges,

Ferreira, Israel, & Mazza, 2007).

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