The evolution of Care Management Organizations (CMOs) and FACT, in particular, reflects the changing attitudes and beliefs about what makes children into successful adults, and how best to help those kids who have fallen behind because of intellectual, developmental, emotional or behavioral challenges.
Sadly, children with developmental or intellectual disabilities may only receive help in school and, even then, only in specialized, self-contained classrooms. There just aren’t many services to help these children, and their families, learn the skills to help them be more independent in their homes. Then the CMOs took on the role of care management from NJ’s Division of Developmental Disabilities and a fresh approach was begun.
Several years ago, many believed that inadequate nurturing and support from parents caused children to rebel. Then there was a long stretch when removing a child from their home to “fix” them and provide guidance and discipline was the answer. New residential treatment centers appeared everywhere and massive amounts of medication were prescribed to tame the behaviors of children suffering with emotional challenges.
But now, research on trauma has taken us in a different direction. While we all realize that frightening and violent experiences can leave a damaging imprint on the brains of children, we also now know that with consistent exposure to positive, supportive, and loving actions their young minds can be helped to rebalance and flourish. In fact, we believe that many ‘negative’ and ‘acting out’ behaviors can be effectively reversed through a carefully coordinated, family inclusive model of care that reinforces and rewards positive behavior.
In some respects, it is the simplest, least intrusive, and least expensive approach of all that often has the greatest positive impact on our youth in the long run.
As FACT embarks on its path towards the Nurtured Heart Approach, we are learning that both parents and children can improve their prospects without blaming, without out-of-home care, and even without medication. This is the bright future that we are now embracing.
To address the seemingly epidemic rise of families with children dealing with autism and other intellectual and developmental disabilities, FACT has expanded its specialized services and care management to not only assume the growing caseload formerly handled by the NJ Division of Developmental Disabilities, but to do so in a way that seeks to improve the quality of life for families in Union County.Read 2016 Executive Message
Intensive-In-Home (IIH) services are two specialized care programs intended to complement pre-existing services in schools or outpatient clinics. Rehabilitation services are restorative, short-term efforts aimed at stabilizing behaviors and lessening the need for hospitalization or out of home living arrangements. Habilitation services are longer-term, functional supports to improve a child's adaptive skills, self-help and social interactions. FACT's model now includes these IIH services to help advance a child's success at home, in school and within their community.
In 2016, we also served 77 youth whose hometowns are outside Union County. These youth are their own guardians and are in Out of Home Treatment outside Union County or are open to DCP&P office in Union County.
Sixteen year-old Jessica remembers a time when her life was anything but peaceful. Battling the intense challenges of autism while living in a chaotic home with her single mother and several step-siblings, Jessica struggled desperately with feeling confused, overwhelmed, misunderstood and, sadly, unloved much of the time.
Unfortunately, crisis after crisis at home quickly became too much for her mother to handle and routinely resulted in visits by the local police. She refused to go to school, take her medication or comply with any of the household rules. Things culminated in an incident that landed Jessica in a hospital and totally decimated any sense of security and stability in her life.
In 2016, FACT took over local care management for kids with intellectual and developmental disabilities from New Jersey's state agency. Jessica was assigned a FACT Care Manager who quickly convened a Child & Family team including her mother and several staff members from the hospital that treated her. All of the clinicians and team members agreed that Jessica needed out of home treatment to help her readjust to a more comfortable routine that offered the structure and therapeutic support that she needed.
|2016 Enrolled Youth Referral Sources|
|Mobile Response & Stabilization Services||230||36.3%|
|County Crisis Intervention Services||80||12.6%|
|Self (incl. recommendation of school / FS&E)||72||11.4%|
|Division of Child Protection & Permanency||71||11.2%|
|Mental Health Providers||43||6.8%|
|14 Day Plan||38||6.1%|
|Inter-County CMO Transfer||27||4.3%|
|Juvenile Justice Commission||23||3.6%|
|Partial Hospital Programs||21||3.3%|
|Children's System of Care||12||1.9%|
While a friendly, predictable routine and stable surroundings helped, things were obviously new, different and unfamiliar which hampered her progress at first. However, with prompting and assistance, Jessica quickly regained her interest in school and soon began visiting her home on weekends without incident. So, things were definitely improving.
No sooner did Jessica arrive home then her mother was abruptly evicted, resulting in Jessica being forced to stay with multiple friends and relatives for days at a time. The sudden elimination of a stable home, combined with losing the structure that had helped her recover much of her independence, Jessica was left emotionally devastated. The constant shuffling between make-shift homes often left her disheveled, dirty and without any food to eat. Her school finally contacted DCP&P, whose investigation resulted in her immediate placement in a resource home.
|2016 Out of Home Treatment Admissions|
|Residential Treatment Center||114||44.4%|
|Psychiatric Community Home||25||9.7%|
|Intensive Residential Treatment||10||3.9%|
|Emergency Diagnostic Residential Units||5||1.9%|
|Out of State Residential Treatment||4||1.6%|
|Special Skills Home||2||0.8%|
|Detox - Substance Use||1||0.4%|
|Detention Alternative Program||1||0.4%|
For Jessica, her new resource Mom was just what the doctor ordered. As soon as she moved into the house, she gained back not only the much-needed stability, structure and focus for her daily routine, but something else she needed much more -- love, compassion and understanding. Her FACT team expanded to include DCP&P and her resource Mom and together they decided Jessica could benefit greatly from Intensive-In-Home (IIH) services to help her continue her progress. She still loves her mother, but is happier and more independent in her new home. There's still a long road ahead but Jessica's future now looks peaceful and bright.
|Unrestricted||Temporarily Restricted||2016 Total||Unrestricted||Temporarily Restricted||2015 Total|
|Support & Revenue|
|Contract revenue prior year||-||-||-||-||48,429||48,429|
|Net assets released from restrictions due to satisfaction of time and purpose restrictions||855,587||-855,587||-||819,500||-819,500||-|
|Total Support & Revenue||5,045,748||261,331||5,307,079||4,564,005||370,837||4,934,842|
|Management and general||730,442||-||730,442||667,418||-||667,418|
|Change in Net Assets||-7,008||261,331||254,323||13,855||370,837||384,692|
|Net Assets - Beginning of Year||190,014||611,061||781,075||156,159||240,224||396,383|
|Net Assets - End of Year||$||163,006||$||872,392||$||1,035,398||$||170,014||$||611,061||$||781,075|
|Property and equipment - net||364,191||209,498|
|Liabilities & Net Assets|
|Accounts payable and accrued expenses||$||383,421||$||391,940|
|Total Net Assets||1,035,398||781,075|
|Total Liabilities & Net Assets||$||1,418,819||$||1,173,015|