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Complex Case Planning for Children & Youth Under Age 21

The Department of Human Services (DHS) seeks to provide a comprehensive approach to serving children, youth, and young adults — birth to 21 years of age — through programs that focus on early intervention, long-term prevention, and services that support family stability, safety, community protection and the child/youth's healthy development and permanent connections. In order to meet the needs of children, youth, and families with complex issues and concerns, clear structures are necessary at the county, regional and state levels so that resources, expertise and collaboration can be maximized. 

A comprehensive and effective system of care recognizes that children and youth with social, emotional, behavioral, and/or physical health needs often require services from more than one child-serving system. Effective planning takes into account the strengths of the child and family, the multitude of needs, and engages the various human service agencies responsible for assisting the child and family.

What population is served?

Children, youth, and young adults:

    • With complex mental health, behavioral health, intellectual disability, and/or physical health needs; and
    • Who are being served by more than one child-served system (county children and youth, county juvenile probation, county mental health, county intellectual disabilities, or receiving medical assistance for a physical health diagnosis) and are in need of comprehensive, coordinated treatment.

From January 1, 2019 to October 31, 2019, there were 1,142 children and youth served in a residential treatment facility managed by Behavioral Health HealthChoices, and approximately 150 who had multiple referrals for placement denied or were placed in a non-bordering state.

The Office of Mental Health and Substance Abuse Services (OMHSAS) led a Continuum of Care initiative from 2007 to present which led to a 60 percent reduction in both in-state and out-of-state child residential treatment facility placements, as well as the development and support of evidence-based treatments in many counties. With a goal of placing adjudicated youth only when necessary, Pennsylvania reduced the use of congregate care over the last ten years by 62 percent in dependency placements and 60 percent in delinquency placements. This reduction has been accomplished by scrutinizing the placements of adjudicated youth to ensure their needs are met in the least restrictive setting. To continue reducing reliance on congregate care, a coordinated continuum of care is necessary to meet the needs of those with complex needs at the community level.


Bulletin and Process Planning Process

The complex case planning bulletin outlines three tiers to ensure coordinated service planning for children and youth under age 21 with complex needs. The tiers include a county level process, county/state joint process, and state process. 

The County Level Process

Each county agency has a local process for developing plans and delivering services based on the child/youth's needs identified. Counties have developed a cross-agency process to support children and youth when the needs identified require the expertise of multiple systems. Counties have also created ways to engage systems outside of the county human services system, including the education and physical health systems, in this cross-agency planning process. Counties continue to revise these local cross-agency planning processes as they strive to more efficiently serve children and youth with complex needs in the least restrictive, most appropriate setting.

    • Initiate Integrated Children’s Services and Planning Process
        • Development of an individualized and comprehensive case plan with all necessary services and systems coordinated.
    • County Complex Case Planning Team
        • Includes child’s/youth’s entire planning team, all involved agencies, and the child/youth and family in order to:
            • Define goals;
            • Develop service plan;
            • Develop necessary resources to implement the plan;
            • Evaluate the progress; and
            • Conduct ongoing/regular reviews beginning as soon as the child’s/youth’s needs are identified. 

The County/State Process

    • Individual or local agency refers the case to the appropriate DHS regional office if one of the following applies:
        • Resources were discussed and next steps cannot be identified
        • Services and/or placement options cannot be identified
        • The team, family, and child/youth cannot reach an agreement on services or placement options
        • Funding sources cannot be identified and/or resolved in a blended, braided or shared manner
    • The regional office will identify other regional offices that could assist with addressing identified challenges.
    • A planning meeting will be scheduled with the county complex case planning team and respective regional offices as soon as possible but no later than two weeks from the date of the referral.
    • A plan will be developed with the identification of resources and services necessary to address the challenges.

The State Level Process

At the state level, departments and agencies with programs serving children and youth collaborate on children’s issues.

A referral form has been developed (found in the column on right) and a resource account established for submission of referrals 
(
RA-PWCMPLXCASEREFS@pa.gov) if the child’s/youth’s particular situation meets at least one of the following:

        • The clinically appropriate solution requires support from multiple program offices/agencies or stakeholders at the county level who together cannot agree on a solution.
        • The funding solution comes from multiple sources, which may include external entities.
        • The case involves complexities that render it unresolvable through the established county or regional office process.
        • The child/youth is currently in an inappropriate placement due to an inability to identify or implement the least restrictive treatment option. 

    • The appropriate members will be identified with a program office lead responsible for the timely scheduling of a coordination meeting to discuss, strategize, and achieve resolution.
        • An internal meeting will be scheduled within two weeks of receipt of the referral.
        • A planning meeting will be scheduled within one week of the internal meeting.
    • The program office lead will provide a summary of the results of the meeting to all individuals invited to the meeting.
    • If a resolution was not able to be identified, follow-up meetings will be scheduled until an appropriate resolution is determined.
    • All referrals will be monitored within the department to ensure timely resolution as well as to track strengths, challenges, and potential gaps in service provision. The statewide aggregated trend data will be reviewed by a multi-system Steering Team to continually assess and improve service delivery for children and youth with complex behavioral health needs. 


Contact

Have feedback or questions? Please email RA-PWCMPLXCASEREFS@pa.gov.