On February 12, 2024, the Pennsylvania Department of Human Services (DHS) released recommendations from its Blueprint Workgroup, an interdisciplinary group comprised of representation from state and local governments, health care, education, service providers, managed care, and family advocates. The workgroup sought to evaluate challenges children and youth with complex, co-occurring physical and behavioral health care needs and their families experience like accessing care and services that adapt to a youth’s changing circumstances and needs, lessening the likelihood of child welfare system involvement, reducing trauma experienced by instability, prioritizing emotional well-being, and supporting family- and youth-driven care and choice.
One in six children have a diagnosed behavioral or developmental disorder, and rates of depression and anxiety are growing among children and young adults. Youth with co-occurring physical health, behavioral health, and/or intellectual disability or autism-related needs are considered complex cases because they require close coordination between multiple care and service providers in order to ensure the child and their family are receiving comprehensive supports and services that meet their unique and evolving needs.
Care coordination for these cases involve multiple county and state-level entities that coordinate health care, education, and disability services, and, at times, the child and their family may be involved with child welfare, foster care, and justice systems. Children and youth with complex needs are also more likely to have experienced abuse, neglect, and trauma, disruptions to their education, communications challenges, and a complex diagnostic history causing delayed or incorrect services. These circumstances create opportunities for confusion and lack of communication that can affect care.
Children and youth with complex needs deserve access to the care and supports they need without barriers, delays, or risks of new or additional trauma, and their families and guardians deserve support as they navigate systems of care for their child. The Blueprint Workgroup was established to help guide systems of care towards a renewed focus on youth and family engagement, respect for individual choice, support for the caring workforce, better collaboration and integrated planning between systems that serve youth with complex needs, and timely, accessible, and coordinated service delivery for youth that is responsive to their evolving needs.
Recommendations from the workgroup include:
-Prioritizing prevention through early identification of needs, accurate and timely diagnosis, and prompt service intervention;
-Improving information sharing and resource navigation among child-serving systems of care;
-Developing clear and strong guidance to inform multi-system case planning and management that prioritizes family engagement, evidence-based practices, peer supports between families, streamlining processes for families, and avoids trauma or re-traumatization that can occur when a case information has to be presented by the youth or their family repeatedly;
-Supporting a qualified, dedicated workforce, assessing payment models, and increasing efficiencies for people working in this system where appropriate;
-Conducting a system needs and gaps analysis across child-serving systems to determine opportunities for improvement and establishing multidisciplinary care coordination teams where needed; and,
-Building further understanding of trauma and embed trauma-informed care and principles across systems that serve and interact with children and youth with complex needs and their families.
Moving forward, DHS and Blueprint Workgroup members will begin work to determine work necessary to implement recommendations and identify barriers to implementation at the state and local level. The recommendations outlined in the workgroup’s report are a first step to strengthen supports for children and youth with complex needs and their families. Pennsylvania was also recently selected as one of eight states participating in a children’s behavioral health policy collaborative organized by Health Management Associates, the National Association of State Mental Health Program Directors, the National Association of Medicaid Directors, the Child Welfare League, and the American Public Human Services Association. The convening will build on this work by helping better align multi-system work to support youth with behavioral health needs.
To learn more about the Blueprint Workgroup and DHS’ work to support children and youth with complex needs, visit https://www.dhs.pa.gov/Services/Children/Pages/Complex-Case-Planning.aspx.