Child Mental Health
Vision and Mission Statement for Child-Adolescent Services Division (CASD):
Vision:
We envision a community that enhances the system of care philosophy and core values which are: person-centered, family driven, culturally responsible, and strength, and community based. (P.L. 25-141).
Mission:
To provide the highest standard of care and strengthen our island community by enhancing every person’s emotional and behavioral health through evidence-based practices that is person centered and culturally responsible.
CASD-I’Famagu’on-ta provide integrated, community-based outpatient services for children-adolescents who are high risk and those with serious emotional disturbances (SED) and their families. Services are to include care-coordination or wraparound, individual, group, and family counseling, training and support, home-based services, 24-hour crisis hotline via GBHWC hotline #647-8833/34. Transition-placement service, linkage and referral to other mental health related services in the community. Provide education and awareness outreach for early identification, prevention and intervention services.
Goals:
CASD through the creation of the I’Famagu’on-ta program in 2003 has adopted the System of Care philosophy and wraparound approach in its service planning, implementation and service delivery. This framework is built on the following Core Values and Guiding Principles: child-centered, youth guided and family driven, strengths and community based, and culturally competent. The System of Care Guiding Principles are: access to a comprehensive array of services, individualized services using a wraparound approach, services in the least restrictive environment, full family participation, integrated services, care coordination, early identification and intervention, smooth transitions, protection of the child’s rights, non-discrimination and cultural appropriateness. CASD/I Famagu’on-ta work in collaboration with public, private, faith based child-serving agencies, the family and natural support systems, organize in a coordinated network providing comprehensive array of mental health and related services for the treatment of children-adolescents who are high risk and those with severe emotional disturbances and their families.
The island’s organizational structure of its system of care is comprised of GBHWC (the single state agency of behavioral and wellness center), private and non-profit providers, as well as services provided by the military sector. In addition, GBHWC collaborates with public child-serving agencies such as Dept. of Education, Child Welfare, Dept. of Youth Affairs, Juvenile Probation Dept. and Dept. of Integrated Services for Individuals with Disabilities (DISID), as well as private and non-profit providers.
TOP PRIORITIES:
A. SYSTEMS OF CARE and WRAPAROUND APPROACH:
Goal: To continue to support, strengthen, expand, and sustain a System of Care for Guam’s children from birth to age 21 through community–agency partnership and family involvement at all levels for the prevention of out of home and off-island placement, providing array of mental health and related services allowing for the changing needs of the child and family through-out treatment, transitioning from youth to adult services, and providing supportive services to strengthen family life.
Objective: Develop collaborative partnership with families, agencies and community stakeholders to sustain a system of care for children, adolescents and their families.
The Expansion-Implementation Grant award (2011-2017) allows for Guam to develop the Expansion of System of Care Plan 2013, for the island children and youth from birth to age 21. This Plan is based on the following five Strategies and sub-strategies: Strategy One: Implementation of Regulatory Changes System-Wide Care Standards and Protocols. Strategy Two: Develop and Support a Home and Community-Based System of Care. Strategy Three: Attain Sustainable Funding. Strategy Four: Provide System of Care Training and Promote Workforce Development, and Five: Implement an Anti-Stigma Social Marketing Campaign.
I’Famagu’on-ta is Guam’s First System of Care (2003) created out of the Child Mental Health Initiative (CMHI), a Federal Government Cooperative Agreement administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Mental Health Services (CMHS) Child-Adolescent and Family Branch, with the Government of Guam administered by the Guam Behavioral Health and Wellness Center (GBHWC) and the Child-Adolescent Services Division (CASD) for the creation of a System of Care for Children-Adolescents with Severe Emotional Disturbances and their families.
The Child Mental Health Initiative, called for a radical system change in how social systems (such as the Department of Education, Department of Youth Affairs, Guam Behavioral Health and Wellness Center, Department of Public Health and Social Services, Superior Court of Guam Juvenile Probation, Juvenile Section of the Guam Police Department and the Department of Integrated Services for Individuals with Disabilities, work together to provide the mental health and related needs of children and families.
The Guam System of Care Council (GSOCC) was established by Public Law 25-141 in 2002 as the advisory board to the I’Famagu’on-ta. In 2012, the Governor’s Executive Committee for System of Care (GECSOC) was established by Executive Order, 2012-16. This committee is comprised of the Directors from the following agencies: Guam Behavioral Health and Wellness Center (GBHWC), Department of Public Health and Social Services (DPHSS), Department of Youth Affairs (DYA), Department of Integrated Services for people with Disabilities (DISID), Guam Department of Education (GDOE), Guam Judiciary, the Guam Police Department (GPD), and the Department of Administration (DOA).
It is our commitment as we collaborate with our community partners, families and all child-serving agencies that we work together in providing an array of services utilizing both traditional and natural supports that are community based, child and family centered and culturally appropriate. A Memorandum of Understanding have been developed and signed by all six child serving Agency’s Directors.
There are 11 array of mental health services mandated in the Cooperative Agreement that are either to be enhanced, if the services are existing, or to be developed, if they are not available. These array of services range from least restrictive where the child remains in the home and supportive mental health services are provided to prevent out of home placement, to a most restrictive service which would be an out of home placement. The following array in the order of least to most restrictive are as follows: Case-Management, Individualized Service Plan (Wrap-Around), Outpatient Counseling, and Consultation, Therapeutic Respite Care, Crisis Response Services, Therapeutic Day Treatment, Diagnostic and Evaluation (psychiatric, psychological and medication evaluation/consultation and management), Intensive Home-based Services, Therapeutic Foster Care, Therapeutic Group Home and Transition to Adult Services.
I Famagu’on-ta have served over 5,000 children and adolescents over the past 10 years. Each child or adolescent is assigned a Wrap coordinator (Care-Coordinator/Social Worker). I Famagu’on-ta currently has 9 Wrap Coordinators and a core support staff of 3 Key Family Contact/Coordinators (Family Partners), Youth Coordinator, and a Data Adm. Clerk, The three Family Partners represents the dominant ethnic and cultural group on Guam; Chamorro, Filipina and Chuukese. The Family Partners work as a team with the Wrap Coordinators and are valuable support for the families.
B. OUTPATIENT SERVICES:
Goal: To provide Outpatient Mental Health Services to children, adolescents and their families in the area of Intake and Emergency and Crisis Assessment and Intervention, Early Mental Health Screening and Identification, Public Education and Awareness, Counseling and Referral Services. Additionally, there are special projects to supplement the services and to enhance family life such as the Annual Christmas Cheer for Families and the Art of Healing project for Children and Adolescents, and other creative art activities and projects.
Objective: To support, empower and strengthen child and family ties by making these mental health services accessible to not only children/adolescents with severe and complex mental health needs and their families, but to all children and adolescents that may be at risk and in need of mental health services.
CASD-I Famagu’on-ta provide care coordination/wraparound, and counseling services to include children-adolescents who are admitted in the Crisis Stabilization Unit. Approximately 20% of the Social Worker’s and PSW/Counselor’s time is spent in the Unit whenever there is an admission. The Counselor and Social Worker provide assessment, attends family and treatment meetings with the Psychiatrist and other service providers, provide linkages with services in the community and provide after care services as needed. In situations where the child-adolescent is on medication regimen, the Social Worker/Care/Wrap Coordinator services attends and updates the psychiatrist on the child’s progress during the medication follow up appointments. Individual and family counseling are provided as needed and upon request.
CASD-I’Famagu’on-ta staff engages in community outreach and mental health public awareness and anti-stigma campaign through education and awareness displays at the Malls, public speaking presentations on a regular basis and especially during Mental Health Month in May and Children Mental Health Awareness Week. Crisis debriefings to individuals, families and groups affected by traumatic events, and outreach crisis counseling at time of major disaster through the Crisis Counseling Program (CCP) a program funded by FEMA and CMHS, are additional available services.
In Outpatient Services, CASD conducts Intake interviews and assessments using the assessment tools of the Child Adolescent Needs and Strengths (CANS) and the Child Adolescent Service Intensity Instrument (CASII). Most of the referrals come from the Department of Education, the juvenile justice and legal systems, as well as self-referrals from families themselves.
In the area of early identification, screening and intervention, CASD is providing primary care providers (Physicians, Child Care Providers, Head Start, and PEDS. etc.) consultation service to address mental health concerns as well as to connect families to mental health and related services. Additionally, CASD-I Famagu’on-ta is a member of the Guam Early Learning Council and partners with Project Karinu, the Early Childhood System of Care.
CASD Outpatient Services serve the general public, but mainly those from low income and indigent homes. Those with private medical insurance are encouraged to seek mental health services through their private providers, but a significant number of these families are receiving services from the GBHWC because they are unable to pay the co-payment or meet their deductible. Many of the children and youth that we provide therapeutic services also require medication treatment which is very costly. Fee schedule for services are being worked out and will soon be implemented.
Wrap Coordinators/ Social Workers and Counselors attend court hearings and IEPs on a regular basis with the schools as well as other functions relating to mental health issues with the child and family. Wrap Team meetings are held at various settings and locations accommodating the needs of the child and family. This work is flexible; strengthen based, child centered and family driven.
The ultimate goal of CASD-I’Famagu’on-ta is for the young person to have positive outcomes from the services provided and be a successful contributing member of our community.
IMPACT STATEMENT:
The services, which CASD provides shall in time reduce if not eliminate off-island placement for children-adolescents with severe emotional disturbances. It shall also reduce inpatient admission in any restrictive care facility. It shall reduce the number of admissions into the Department of Youth Affairs (DYA), Child Protective Services (CPS) as well as reduce the number of Juvenile Court Cases.
It shall instead increase the number of youth staying and completing high school and going on to higher education, both academic and vocational, and increase the number of independent and employed young adults. Overall, it shall increase the self-esteem and self-confidence of children-adolescents, produce happy and productive youth and keep families intact.
With all these improvements, it shall translate into savings of taxpayers’ funds and a mentally healthy community.
System of Care and Wraparound Work!
System of Care and Wraparound Work!
PDF Files
1. Case Presentation Form
1. Case Presentation Form
The island’s organizational structure of its system of care is comprised of GBHWC (the single state agency of behavioral and wellness center), private and non-profit providers, as well as services provided by the military sector. In addition, GBHWC collaborates with public child-serving agencies such as Dept. of Education, Child Welfare, Dept. of Youth Affairs, Juvenile Probation Dept. and Dept. of Integrated Services for Individuals with Disabilities (DISID), as well as private and non-profit providers.
