MULTI-SYSTEM YOUTH (MSY) refers to children or young people with significant mental health, addiction and/or developmental delays who is involved or at risk of being involved with child protection and/or juvenile justice due to not being able to access the right services or supports to remain stable and in their own home. Multi-system youth have complex needs that cannot be met by a single system. In some cases, two or more systems are used to fill gaps in services offered single agencies or when the cost of providing services becomes prohibitive for a single agency.

Last summer, Senator Randy Gardner and Representative Sarah LaTourette co-chaired the Joint Legislative Committee on Multi-System Youth, a bipartisan committee of five senators and five representatives that was created to address the issues affecting multi-system youth. The 2016-2017 biennial budget bill[1] created this legislative committee to do the following:

• Identify the services currently provided to multi-system youths and the costs and outcomes of those services;
• Identify existing best practices to eliminate custody relinquishment as a means of gaining access to services for multi-system youths;
• Identify the best methods for person-centered care coordination related to behavioral health, developmental disabilities, juvenile justice, and employment;
• Identify a system of accountability to monitor the progress of multi-system youths in residential placement; and
• Recommend an equitable, adequate, sustainable funding and service delivery system to meet the needs of all multi-system youths.

2/3 of Youth in Custody of Ohio’s Public Children Services Agencies are NOT in custody due to abuse and neglect

Most states make efforts to coordinate services for youth across systems and agencies. In Ohio, the Family and Children First Council was created in 1993 to “cluster” together members of local child caring agencies. For more than two decades, Local Family and Children First Councils (FCFCs) have streamlined and coordinated existing services for families seeking assistance by considering the best and most appropriate care for a child with needs from two or agencies. In 2014, local FCFCs provided service coordination for 5,491 complex multi system youth, including 287 youth whose needs were so severe as to require specific types of residential and out of home treatment.

Extreme cases can result in parents relinquishing custody to gain access to services

While local support and collaboration have been successful in helping many children and their families, some youth served by multiple systems have needs so extreme that they cannot be supported through this method alone. When children have intensive needs that exhaust the resources of both the family and community, parents face a decision to relinquish custody to a child protection agency to access necessary services. Nationally, more than 12,700 children were relinquished into the custody of the state to gain access to mental health services. According to a recent policy brief on multi-system youth from the Public Children Services Association of Ohio, nearly one in three (30%) of multi-system youth in Ohio entered public children services agency via custody relinquishment. As the following chart from the PCSAO policy brief shows, custody relinquishment occurs for a large fraction of youth served by the juvenile justice, developmental disabilities, and behavioral health systems in Ohio.

Estimated 30% of multi-system youth in Ohio entered a
Public Children Services Agency via custody relinquishment

BUDGET REQUESTS RELATED TO THE JOINT LEGISLATIVE COMMITTEE ON MSY RECOMMENDATIONS REPORT

Senator Randy Gardner and Representative Sarah LaTourette are working to address a couple of the key recommendations of the Legislative Committee in Ohio’s SF7 18-19 budget.  A group of stakeholders are working with the Co-Chairs and other members of the Committee toward these budget goals:

CRISIS STABILIZATION FUND

The Ohio Department of Mental Health and Addiction Services (ODMHAS), in its capacity as the Governor’s Chair for the Ohio Family and Children First Cabinet Council, shall establish a Youth and Family Crisis Stabilization Fund to address the unmet and uninsured needs of Ohio’s MSY who are in crisis and unable to access appropriate levels of care and services. ODMHAS shall partner with key stakeholders to develop policies to ensure appropriate access and accountability for this new Youth and Family Crisis Stabilization Fund. It would be funded with an appropriation of $5 million per year in unspent TANF funding in SFY 2018 and 2019.

DATA

ODMHAS shall establish a unified strategy for data collection and sharing across child serving systems to identify resource utilization, service utilization patterns and gaps, and monitor outcomes.  This strategy should identify and track the availability of evidence-based services that are particularly important for MSY (a) both before and after Office of Health Transformation’s behavioral health redesign, and (b) both before and after transitioning community behavioral health services into Medicaid managed care.  The strategy shall be implemented no later than January 1, 2018, and shall include making de-identified data and analysis of the de-identified data publically available on a quarterly basis. The Department of Mental Health and Addiction Services shall provide an annual report on the data and its analysis to the Governor and the General Assembly beginning no later than December 31, 2018.