Executive Summary

Illinois United for Youth

Pathways: A Strategic Plan for Children's Mental Health

Illinois United for Youth (IUY) is a System of Care (SOC) planning initiative resulting from an awarded Substance Abuse Mental Health Services Administration (SAMHSA) Statewide SOC Expansion Planning Grant. In response to receiving the SAMHSA award, IUY formed a collaborative partnership of public and private stakeholders with an investment in serving children and adolescents with serious emotional disturbance. Once formed, IUY adopted the primary objective of developing a comprehensive strategic plan to improve and expand the service delivery system for Illinois youth, focusing on community-based interventions that are fully rooted in the Systems of Care Philosophy.

The IUY Planning Initiative is grounded in transforming Illinois' continuum of services towards a model that can deliver intensive, community-based services to children and adolescents that often have co-occurring social/emotional, behavioral, developmental, learning, and/or physical health disabilities requiring multi-system involvement. The service delivery model must also embrace the cultural, linguistic, trauma-informed, socio-economic, and other needs of youth and families requiring services. Finally, the service delivery model must provide for a broad array of services that can be flexible and individually customized in design, to reduce the reliance on out-of-home placements.

Vision: To ensure the development of a broad array of culturally relevant and evidence-informed services to improve overall health, safety and welfare of youth experiencing a serious emotional disturbance within the State of Illinois.

Mission: To develop a comprehensive strategic plan for integrating the system of care philosophy into Illinois' behavioral health service delivery model for youth with serious emotional disturbances.

Values: Family Driven, Youth Guided, Community-Based, Strength-Based, Evidence-Based and Informed, Trauma Informed, Culturally and Linguistically Competent, Evidence Based Continuous Quality Improvement.

To achieve these ends, the IUY Project Team is committed to establishing a Systems of Care Philosophy across Illinois' behavioral healthcare delivery system; though it is understood that no single intervention or effort will result in the complete implementation of Systems of Care. In response, the IUY Project Team has identified multiple strategies that it believes will continue to push Illinois closer and closer to a full realization of a delivery system reflective of the SOC principles and values. It is with this desire to enact a statewide shift towards the adoption and integration of Systems of Care Principles across the service delivery systems for youth that the IUY Project Team has elected to identify multiple, purpose-driven strategies that constitute the conceptual foundation for the IUY "Pathways: Illinois Strategic Plan for Children's Mental Health.

In addition, while Illinois is currently experiencing a great deal of change in terms of regulatory environment and financial constraints, this is an opportunity to introduce Pathways as an alternative to the status quo. The federal implementation of the Affordable Care Act facilities movement towards integrated physical and behavioral healthcare, data-driven outcomes, and performance related financing options. At the state level, Medicaid Reform and the SMART Act set the tone for ensuring care coordination, performance-based contracting, and efficiency in state-funded healthcare spending. There were also two other planning processes occurring at the same time. This included the IDHS-DMH-Illinois Mental Health Services 5 Year Strategic Plan (Public Act 097-0438), and the Illinois Human Service Commission-Children's Behavioral Workgroup of the Rationalizing Human Services Committee.

Over the course of the planning year, data collection efforts focused on assessing (1) planning partners' knowledge and level of comfort implementing core System of Care principles; (2) planning partners' perceptions of their systems' readiness to change to implement core SOC principles; and, (3) provider, parent and youth perceptions of what is needed at the local and state level to support local SOC implementation. The IUY Stakeholders looked to the core strategies being utilized by other states using a Systems of Care Philosophy to impact positive outcomes in their children's mental health service delivery systems. This review led to the identification and adoption of 12 strategies, across all five of the SAMHSA Core Strategy Areas:

  1. Implementing Policy, Administrative, and Regulatory Changes
  2. Developing or Expanding Services and Supports Based on the System of Care Philosophy and Approach
  3. Creating or Improving Financing Strategies
  4. Providing Training, Technical Assistance and Coaching
  5. Generating Support

The specific strategies represent distinct pathways that the IUY team believes can leverage systems change or enhancement, seeking to meet the Project's vision, mission, and values while addressing identified needs. By utilizing the Pathways approach, Illinois hopes to establish a framework grounded in System of Care while allowing all funders and operating agencies to implement the change at manageable rates. By providing sufficient flexibility and space for change in increasingly challenging times, while clearly outlining positive directions forward for Children's Mental Health in Illinois, this approach holds great promise for achieving the overall success of the IUY Project Plan.

Pathway 1: Creating or assigning a viable, ongoing focal point of management and accountability at the state level (e.g., agency, office, staff) to support expansion of the SOC approach.

Pathway 2: Developing interagency structures (e.g., memoranda of understanding and interagency agreements) to set policy, guide, and support expansion of the SOC approach.

Pathway 3: Creating or expanding an individualized, wraparound approach to service delivery.

Pathway 4: Creating or expanding family-driven and youth-guided services and expanding family and youth involvement in the planning and delivery of their own services to improve outcomes to support expansion of the SOC approach.

Pathway 5: Developing and implementing strategies directed at reducing racial, ethnic, and geographic disparities in service delivery across child-serving systems to support expansion of the SOC approach, improving the cultural and linguistic competence of services.

Pathway 6: Increasing the Use of Medicaid to finance services by adding new services, changing existing service definitions, obtaining waivers, using EPSDT (spell out), using rehabilitation option, etc., to finance services and supports to support expansion of the SOC approach.

Pathway 7: Maximizing the use of federal system of care grants to finance infrastructure and/or services to support expansion of the SOC approach.

Pathway 8: Redeploying funds from higher cost to lower cost services.

Pathway 9: Creating ongoing training and technical assistance capacity.

Pathway 10: Establishing a strong youth and family partnership/connection to support and be involved in expansion of the SOC approach (e.g., through funding, involvement at the system and policy levels, contracting for training and services).

Pathway 11: Using data on the outcomes and cost avoidance across systems and services to promote expansion of the SOC approach.

Pathway 12: Cultivating partnerships with provider agency and organization leaders, managed care organizations, and other key leaders to support expansion of the SOC approach.

Pathways will naturally embrace the concepts central to both national and state healthcare reform efforts and provide Illinois with an opportunity to alter its service delivery model towards an efficient and effective community-based behavioral healthcare model, reducing the reliance upon costly out-of-home options such as residential or inpatient care. The diverse makeup of Illinois serves to underscore the need for flexibility and modular development of any strategic plan that can be consumed in whole, or part, by any system partner, funder, or invested stakeholder. The implementation success of Pathways will rely heavily on the ability to apply the strategic planning efforts to multiple locations within the state, each with varying degrees of need, resources, infrastructure, funding and other supports.