Supporting Youth and Families with Complex Behavioral Health Needs


North Carolina:

The North Carolina Department of Health and Human Services (NCDHHS) convened a multi-sector workgroup whose goal is to bridge and align previous and ongoing transformations aimed at strengthening the state’s ability to meet the needs of children experiencing or at imminent risk of harm and their families.

The state developed a Coordinated Action Plan to address the issue of children with complex behavioral health needs:

  • NCDHHS and its partners focused on underlying challenges in the state’s child protection system and identified the need for a unified effort across child and family servicing system partners:
  • Found youth were routinely staying in Division of Social Services (DSS) offices, emergency departments of hospitals and health centers, or hotels.
  • Identified opportunities for collaboration such as: Family First Prevention Services Act (FFPSA) implementation, regionalization of county social service agencies, and implementation of a practice model and development of a specialized Medicaid managed care plan for youth in foster care.
  • Current strategies include strengthening care coordination for children in foster care with Medicaid dollars, launching pilot MORES mobile crisis teams with philanthropic funds, and limited expansion of high-fidelity wrap-around services with the Governor Task Force Special State Fund.


In 2019, the Department of Medicaid established Ohio’s Next Generation Medicaid Program to shift the Department’s focus on the individual and away from the business of managed care.

Currently, Ohio offers lower intensity services and out-of-home services for youth with complex behavioral health needs, with a plan to expand intensive in-community services, including intensive care coordination, in-home therapies, and crisis intervention.

OhioRISE, a specialized managed care program for youth with complex behavioral health and multi-system needs, includes:

  • A specialized managed care plan;
  • Shared governance across multiple agencies to improve cross-system outcomes;
  • Coordinated and integrated care and services across local entities, school providers, health plans, and families; and
  • Prevention of custody relinquishment for vulnerable families through the use of a 1915(b) services waiver.

Within the OhioRISE ecosystem, multiple stakeholders work together to ensure the success of the plan, including—

  • Aetna (the statewide provider for the plan),
  • Medicaid Managed Care Organizations,
  • the Department of Medicaid,
  • the OhioRISE Advisory Council,
  • Network of Care Management Entities, and
  • the Child and Adolescent Behavioral Health Center of Excellence.


North Carolina

  • Sharon Bell, Child Behavioral Health Manager, Division of Child and Family Well-Being with the North Carolina Department of Health & Human Services
  • Lisa Cauley, Senior Director of Human Services for the North Carolina Division of Social Services


  • Marisa Wisel, Deputy Director, Ohio Department of Medicaid
  • Kara Wente, Director of Governor DeWine’s Children’s Initiative

Key Takeaways

  • System gaps are most apparent for youth who get bounced between disparate state services due to individual needs and available interventions
  • Assessing overall needs is a challenge from the start—for the individual and for larger population and system needs
  • Multiagency collaboration efforts to streamline processes and effectively triage is critical to supporting communication and efficient planning between agencies to serve these families and support a workforce and provider network that is equipped to handle multi-system needs
  • Widespread challenges across states include:
    • Lack of providers, beds, and available placements
    • Establishing eligibility for services
    • Families and providers that are ill-equipped to safely treat and care for complex needs

Questions To Consider As Next Steps

  • Which stakeholders’ involvement is essential to identifying improvements to cross-system outcomes for youth with complex behavioral health needs and their families, including specific agencies, legislators, and private sector representatives?
  • How can we best engage providers to address gaps that cross agency needs, especially for youth with complex, co-occurring, or multi-system needs?

Additional Resources