Mental Health Family Case Management (MHFCM) - Allegheny County Department of Human Services (ACDHS) seeks to enhance and expand its Mental Health/Child Welfare Community of Practice System of Care (CoPSOC) to improve access, coordination and quality of mental health (MH) services for children, youth and families. The geographic catchment area for this project is Allegheny County (AC) in Southwestern PA. The population of focus will be families and their children/youth ages birth to 21 years who are at risk for or experiencing Serious Emotional Disturbances (SED) or Serious Mental Illness (SMI) and are 1) involved with child welfare (CW) or with both CW and Juvenile Justice (JJ), or 2) enrolled in participating schools with two or more family members at risk for or experiencing SED/SMI; CW/JJ involvement is not a requirement. In FY 2022-23, 5,074 children and youth in AC were active with CW. This cohort was 37% White and 63% People of Color (POC)—predominantly Black (60%)—and approximately 50% male and 50% female (legal sex). They ranged in age from under 1 (499 or 9.8% of the total) to 21+ (3 or 0.1%). Numbers of CW-involved children and youth remained fairly steady each year between ages 5 through 17 (between 200-300 or 5%-6%). The racial profile changed slightly in the cohort of 1455 active with both CW and MH (41% White and 56% Black). As might be expected, the numbers of dually involved children and youth increased with age, peaking at age 14 at 9% and not significantly decreasing until the ages of 18 and older. In AC, 60,755 distinct individuals (18,581 of whom were individuals under the age of 21) were active with publicly funded MH services in FY 2022-23. Of those, 2,985 (5%) individuals of any age were also active with the CW system; 1,455 (8%) of those individuals were children who were dually active with the MH and CW systems. Among youth aged 12-17 being removed from the home during 2018-2023, 57% had MH service activity in the year prior to placement; those aged 12-17 with any mental health services in the year prior to removal were placed in family settings at a rate that is 26 percentage points lower (58% vs. 84%) than youth in the same age grouping without recent MH services. Youth who are concurrently active with CW and JJ in AC also have high MH service utilization. Of the 219 crossover youth in FY 2022-23, most (92%) received MH services at some point in their lives. This project will also serve youth and families from outside the CW/JJ systems who will be referred from school districts (SDs) in low-income communities where upstream structural forces and persistent racial disparities have had an adverse effect on social determinants of health. In FY 2022-23 the student population in Sto-Rox SD, for example, was 71% POC/66% Black. Black students were overrepresented in the MH (57%), CW (69%) and JJ (86%) systems. In Pittsburgh Public SD, a statistically smaller (50%) but numerically larger Black student population was similarly overrepresented in MH (58% active) and CW (75% active), and particularly in JJ (85% active). Families that are active with CW frequently have complex needs and are involved with multiple systems, including MH. In FY 2022-23, 2,167 families were active with CW. Of these families, 1,585 (73%) had at least one family member receiving MH services in the same FY and/or in the two prior FYs. Forty percent (40%) had two or more individuals receiving MH services in the same FY; 58% had two or more individuals with MH services in the same FY and/or in the two prior FYs. The CoP SOC proposes to serve at least 240 participants over the entire project: 60 in each of the 4 years through MH Family Case Management (MHFCM). Objectives include: MHFCM involved individuals will have been referred to at least one evidence-based MH support or service; all MHFCMs will be trained in trauma-informed care; cross-system best practices; and MHFCM will be sustained through Medicaid.
