"Show-Me Kids", a federally funded system of care site in southwest Missouri is producing positive outcomes in their national and local evaluation. Highlights include:

• From intake to 12-months post-intake & from 6- months to 12-months post-intake youth reported statistically significant increases in interpersonal strength. (These finding are corroborated by their caregiver’s report.)
• Youth reported statistically significant decreases, in depression/anxiety from intake to 6-months post-intake and from intake to 12-months post-intake.
• From intake to 6-months post-intake youth reported significantly less arrests.
• Caregivers reported statistically significant increases in youths’ interpersonal, intrapersonal, and affective strengths, from intake to 12-months post-intake.
• For affective strength statistically significant gains were also found from intake to 6-months post-intake.
• Caregivers reported statistically significant increases in youths’ strengths related to school, from intake to 6-months post-intake and from intake to 12-months post-intake.
• Caregivers reported significantly less strain from intake to 6-months post intake and from intake to 12-months post-intake.

"Youth in Transitions", another federally funded system of care site located in St. Louis is also showing positive results in their evaluations:

• At 6-months post-intake, youth reported significantly less dysphoria.
• At 6-months post-intake, youth reported significantly less worrying, less preoccupation with social concerns, and less total anxiety.
• At 6 months post-intake, fewer youth were: 1) Questioned by the police 2) Arrested 3) Told to appear in court 4) Placed on probation
• At 6-months post-intake, caregivers reported that more youth were passing their classes.
• After receiving an average of 4.5 months of "Transitions" services, approximately half of the youth moved to less restrictive placements in the community.
• At 3 months (Time 1) and 6 months (Time 2) post-intake, youth, caregivers, and care mangers, reported high fidelity wraparound services.

"Partnership with Children & Families", a graduated federally funded system of care site in St. Charles achieved success as well:

• 69% of children remained in the home and community out of residential or psychiatric placement within 6 months.
• Living arrangements stabilized in 6 months as shown by a 16% decrease in youth living in multiple settings.
• Within 12 months strain on caregivers improved or remained stable in 91% of families.
• The cost was very reasonable at less than $1,000 per month when at the time of the evaluation residential treatment cost between $3 and $7 thousand per month and inpatient care cost nearly $9 thousand per month.
• 97.5% participated in goal oriented education.
• 86% attended all possible school days.
• 82.5% did not receive out of school suspension in a semester.
• Before the "Partnership" 42% had been arrested - but after 6 months in the program 89% and after 12 months 95% were free from law enforcement involvement.

"Circle of Hope" Missouri's 4th federally funded system of care site in St. Joseph came on line last October.

A brief report was recently completed on satisfaction of service provision from Missouri's three Federal system of care sites (St. Charles, Southwest Multi-County and St. Louis). At 6-months post-intake, both youth and caregivers reported being satisfied, to very satisfied with:

• Overall services;
• Cultural sensitivity of services; and
• Their involvement with service planning.

Custody Diversion Protocol-Latest Numbers

A number of years ago, national mental health and child welfare advocates began to voice concern over governmental policies across the country that inadvertently forced some families to relinquish custody of their children in order to receive needed mental health services. To address that problem, Missouri advocates, along with the Departments of Mental Health and Social Services, implemented the "diversion from state custody" protocol. The protocol became effective several years ago, and through March, 2008 there have been a total of 696 referrals to this protocol.

• Of those referrals, 648 youth (93%) were diverted from custody;
• Of those diverted, 387 (60%) were temporarily placed out of the home.

Missouri is one of the few states in the nation to address the custody issue with a multi-department systems resolution.

Comprehensive Community Mental Health Services Program for Children and Their Families

2005 Key Outcomes for Children and Families in Systems of Care Source: www.systemsofcare.samhsa.gov/news/datafactsheet.aspx

• Reduced costs due to fewer days in inpatient care. The average reduction in per-child inpatient hospital days from entry into services to 12 months translated into an average per-child cost savings of $2,776.85.
• Decreased utilization of inpatient facilities. The percentage of children who used inpatient facilities within the previous 6 months decreased 54 percent from entry into systems of care to 18 months after systems of care.
• Reduced arrest results in per-child cost savings. From entry into systems of care to 12 months after entry, the average reduction in number of arrests per child within the prior 6 months translated into an average per-child cost savings of $784.16.
• Mental health improvements sustained. Emotional and behavioral problems were reduced significantly or remained stable for nearly 90 percent of children after 18 months in systems of care.
• Suicide-related behaviors were significantly reduced. The percentage of children and youth who had deliberately harmed themselves or had attempted suicide decreased 32 percent after 12 months in systems of care.
• School attendance improved. The percentage of children with regular school attendance (i.e., 75 percent of the time or more) during the previous 6 months increased nearly 10 percent with 84 percent attending school regularly after 18 months in systems of care.
• School achievement improved. The percentage of children with a passing performance (i.e., C or better) during the previous 6 months increased 21 percent with 75 percent of children passing after 18 months in systems of care.
• Significant reductions in placements in juvenile detention and other secure facilities. Children and youth who were placed in juvenile detention or other secure facilities within the previous 6 months decreased 43 percent from entry into services to 18 months after entering systems of care.

Missouri's newest federally funded system of care site is making headway. The mission of Circle of Hope in St. Joe is to create a system of care that will enhance service delivery by integrating physical health and mental health within school settings.
After a year of planning, Circle of Hope has successfully:

• formed a family group
• hired staff
• organized community based committees
• completed a community needs mapping
• established family/community governance
• designed the service model
• implemented the evaluation
• developed a strategic plan
• and initiated a service pilot at a school

One of the goals in achieving the Circle of Hope mission is to implement wraparound service planning for each family within the system. Dr. John Vandenberg, leader of the National Wraparound Initiative, has begun working in St. Joe to help achieve that goal.

At the other end of the state, Youth in Transitions - St. Louis System of Care has paved the way for St. Joe and the rest of Missouri to begin moving towards wraparound services. Several years ago, again with the assistance of Dr. Vandenberg, St. Louis initiated a strategy to saturate the community mental health centers BJC-BH and Hopewell along with all partnering state agencies in the wraparound philosophy of service planning. Summary of the achievements to this point:

• all state agencies and interested parents have received High Fidelity 101 Wraparound Orientation
• a large number of staff and parents have received additional training
• BJC-BH and Hopewell each employ a Qualified Mental Health Professional who is "certified" by VroonVandenberg, LLP to train all interested partners to the level of coaching certification
• the e-learning tool for High Fidelity 101 has been obtained
• now hiring a trainer who has the highest level of certification by Vandenberg as a "trained trainer"

The outcome of these efforts gives Transitions four coaches, six facilitators and a trainer, all of whom are VroonVandenberg, LLP approved.

Transitions therefore has the capability of orienting, coaching and training the trainers throughout the state. Missouri's ultimate goal is that high fidelity wraparound will be used by all public agencies, with ongoing training by in-state certified trainers.