New Jersey is the nation's most densely populated state, containing the 10th largest population of children and youth in the country. In 2000, the state set out to transform its children's mental health system. This effort, which implemented services in January 2001, addressed a very broad population of children--those with serious emotional disturbances as well as those at risk. It included children eligible for public health insurance programs (Medicaid and Family Care--New Jersey's State Children's Health Insurance Program--have carved out behavioral health services from physical health care services and coordinated benefit packages) and children whose private insurance would not cover the services they needed. This system transformation was designed with the values and principles of the System of Care (Stroul and Friedman, 1986) as its operating framework. Its purpose is to ensure that children and families receive the services and supports they need, when and where they need them, so they can remain at home, in school and out of trouble. The state created new infrastructure components, services and supports, policies and procedures and has realigned existing ones. Now integrated with New Jersey's Child Welfare Reform Plan, this transformation effort operates under the Department of Children and Families.
(Like many states, New Jersey's Child Welfare Agency is under a court settlement necessitating numerous child welfare system reforms. New Jersey's Plan, "Child Welfare Reform Plan: A New Beginning" July 2004, includes children's behavioral health as a critical component requiring among other things the closure of the state's only children's psychiatric hospital.)
The development of the System of Care (SOC) grew out of a parent/professional endeavor that led to the award of a SAMHSA grant in Burlington County. The grant for the Burlington County project served as the springboard for developing a statewide SOC model. With the support of the governor, who allocated seed money and revamped the Medicaid State Plan for Children's Mental Health that would bring children's mental health services to the Medicaid platform, New Jersey proceeded.
Some key components of the New Jersey SOC include a wraparound care management entity that addresses the complex needs of multi-system-involved youth and a mobile response and stabilization component designed to provide face-to-face crisis intervention in the community within one hour. Other features include a family support organization designed to provide peer support for caregivers, and intensive in-community treatment provided by licensed clinicians in children's homes or other community settings. Each of these services is managed by the state but operated by local agencies at the county level.
Out-of-home residential treatment programs have also been dramatically changed since the reform began. New Jersey has moved away from institutional care and has developed many small community-based homes for youth that previously would have been "placed" in institutional residential treatment centers. In addition to the newly developed array of community services, a key component of managing the SOC is an Administrative Service Organization or Contracted Systems Administrator in New Jersey. It serves as the single point of entry and provides utilization management and standardized electronic records for the SOC.
Over the next five years the state seeded all communities/counties with the continuum of services. Over time both processes and practices have been refined and programs addressing specific needs were developed. Some addressed the specific needs of the juvenile justice system, medically fragile youth and youth with co-occurring developmental disabilities and mental health challenges. Today the SOC serves nearly 40,000 children and youth annually in New Jersey and has been successfully keeping youth at home, in school and out of trouble. …