Policy & Practice | Summer 2023

effective, and aligned with best prac tices. The CAT program provides a conflict-free assessment to all children and youth in the state with more intense service needs to determine whether they need residential treatment and, if so, the appropriate service setting to meet their needs. In addition, the CAT program works with multiple state agencies within the System of Care, including child protection, juvenile justice, courts, and community providers, as well as care management entities, local school districts, hospitals, and substance use disorder providers. The program uses the Child and Adolescent Needs and Strengths (CANS) 4 instrument to help determine the required level of services and protective factors and set treatment goals. Comprehensive Assessment forTreatment (CAT) Services Program By identifying the clinical needs and strengths of the youth and pro viding a “conflict-free assessment” process, the program aims to provide a comprehensive report and recom mendation, which helps to guide the child and family team. The program starts with referrals from the NH Department of Health and Human Services’ Division of Children, Youth, and Families (DCYF), Bureau for Children’s Behavioral Health (BCBH) or the department’s contractors. When a child requires services beyond what is currently offered in the com munity and a different level of care is indicated, Care Management Entities (CME), DCYF, and other designated service providers within the Children’s System of Care work together to determine the necessity of residential treatment and create a personalized recommendation for the child’s care. The assessment process involves close collaboration with the child, parent or guardian, referral source, and related partners in the child’s life. The assessor employs the evidence based CANS instrument and clinical questions to recommend the appro priate level of care and identify goals and protective factors. The consistent longitudinal data generated by this method is analyzed by Maximus, the state’s private-sector assessment

1. The process for the CAT program begins with Maximus staff receiving a referral via secure email. 2. Maximus reviews the referral and contacts the referral source for additional information when necessary. 3. The referral is then assigned to an assessor who reaches out to the referral source and the child’s treatment or support team to schedule interviews. 4. The assessor conducts all interviews, completes the CANS assessment, and submits the assessment to a quality reviewer. 5. Licensed clinicians review the assessment and the Determination and Recommendation Report, and when a Psychiatric Residential Treatment Facility (PRTF) is recommended, a physician will also review the determination. 6. Maximus disseminates the Determination and Recommendation Report to the required participants. From referral to the dissemination of the Determination and Recommendation Report, the process has been streamlined to approximately 14 days for Expedited Referrals—cases where the referred child or youth is currently in a detention setting, psychiatrically hospitalized, or already admitted to a qualified residential treatment facility. The process is completed in less than 30 days for other cases. n Coordination with agencies within the System of Care to deliver consistent services across program areas n Conflict-free, independent assessors employing proven instruments and methodologies n Data-driven, evidence-based analytics informs continuous improvement A New Approach: Comprehensive Statewide Design Referral Process

CAT Program Performance— Delivering Better Outcomes for Children A core objective of the CAT program and New Hampshire’s System of Care redesign is to provide the right level of services in the most appropriate setting. In the first year of operation, the CAT program has recorded a sig nificant reduction in the number of children referred to the highest level of care by utilizing all available commu nity resources and guiding youth to the most appropriate setting for care. A second core objective is to accommodate referrals from the com munity—from a parent, teacher, or community therapist—rather than solely from the courts. Promisingly, more than 20 percent of referrals in the first year came from the community, ensuring these children could access vital services without requiring court intervention or DCYF involvement. A third core objective of this redesign is to shorten the time a child may spend in higher levels of care, such as

provider, and the department, to identify areas for continuous enhance ment of services to meet the needs of the population being assessed. The CAT assessment also includes a module on caregiver needs and strengths, which helps identify areas where the child’s family may require additional support. Moreover, the CAT program provides data analysis and tools to help identify trends in the needs of both the child and family, such as substance abuse and disor dered eating, as well as informs the state on where there may need to be additional programming or supports developed within the System of Care. “The CAT program is unique in its design and implementation,” said Christa Ballew, Vice President for Clinical Services at Maximus. “They did the hard work to break down silos between agencies and stakeholders and then aligned services across multiple program areas—ensuring that all children in the state can access conflict free assessments to determine their behavioral health needs no matter how families reach out for help.”

See CAT Program on page 49

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Summer 2023 Policy & Practice