Executive Order 2023-04

WHEREAS, in response to nationwide youth mental health crisis, I, Governor JB Pritzker, launched the Children’s Behavioral Health Transformation Initiative (“Transformation Initiative”) in March 2022 to evaluate and redesign the delivery of behavioral health services for children and adolescents in Illinois. The Transformation Initiative builds upon the substantial progress made by Illinois agencies to ensure that every young person experiencing mental or behavioral health problems can access needed services. By identifying and addressing current barriers to delivering efficient and effective care, the Transformation Initiative produced a plan to offer families a set of streamlined, accessible, and responsive solutions; and,

WHEREAS, in Illinois, a mental health workforce shortage, an eroded continuum of care, misalignment in the geographic and clinical distribution of services, and, historically fragmented processes have presented challenges to Illinois in providing an adequate array of supports and placement; and,

WHEREAS, in Illinois, this has resulted in system stresses at many points in the service continuum to care for youth in need of high-end services, including in emergency rooms, in psychiatric inpatient wards, in shelters, and in family homes; and,

WHEREAS, this has contributed to parents relinquishing custody of some youth in an attempt to expedite residential placement and/or to secure payment for psychiatric services; and,

WHEREAS, the passage of the Custody Relinquishment Prevention Act (20 ILCS 540) underscored the need to halt the separation of children and parents in order to fund psychiatric care, and develop alternative strategies to support residential care and acute psychiatric services for youth with significant and complex needs; and,

WHEREAS, historically, in Illinois, four different State agencies (the Department of Children and Family Services, the Department of Healthcare and Family Services, the Department of Human Services, and the Department of Juvenile Justice) and the Illinois State Board of Education are tasked with aspects of care management for youth with behavioral health needs resulting in a complex system of services that can be difficult for youth and their families to access; and,

WHEREAS, there are numerous promising programs underway in Illinois that can be expanded, replicated, and coordinated to strengthen the continuum of care for youth with behavioral health needs and their families; and,

WHEREAS, to address these system challenges, the Transformation Initiative was tasked with building a coordinated, inter-agency approach to ensure that young people with significant behavioral health needs receive the community and residential services that they need to thrive while providing parents, guardians, and family members with transparency and clarity in the process; and,

WHEREAS, in its first year, the Transformation Initiative accomplished:

1. The formation of the Inter-agency Crisis Staffing group that promotes cross-agency collaboration and expedited services and placements for the highest need youth. The group has collaboratively staffed 121 cases, resolving 50 (41%) of these through January 30, 2023.
2. The development and pilot implementation of an Intake Portal for the Inter-agency Crisis Staffing Group to automate case assignment and make the service and placement process more efficient. The Intake Portal yields data that can be used to understand barriers, successes, needs, and outcomes.  
3. The development of collaborative strategies to identify challenges and service needs specific to young adults with developmental disabilities in the care of Department of Children and Family Services who must transition to adult services.
4. Data linkage and analysis across multiple data sources from the involved agencies to understand the overall needs of Illinois youth with significant behavioral health needs, existing gaps in service, and areas on which to focus in order to build capacity for placement and services.
5. A statewide survey of residential providers to develop an interactive map of residential capacity that can be used to understand staffing shortages, agency-specific and out-of-state demand, and occupancy.
6. A national review of best practices to identify approaches that can be implemented in Illinois to improve the Illinois behavioral health system for youth.
7. Engagement with private providers interested in developing new programs to identify needed resources and provide technical assistance.

WHEREAS, the Transformation Initiative delivered a Blueprint Report to the Governor’s Office on this day, February 24, 2023. The Blueprint Report recommends that the State:

1. Create a centralized resource for families seeking services for children with significant and complex needs. This will involve building a more robust Care Portal to allow families to access information and to seek help more easily.
2. Improve coordination of service delivery, ensuring more seamless transitions and the earlier detection of elevated risk.
3. Centralize oversight of residential beds to reduce duplication and enable the State to manage residential treatment resources more effectively.
4. Implement resource referral technology to enable families to more easily link to services in their communities.
5. Use regular data analytic review to inform capacity adjustments, translating data analysis into changes in capacity that can be implemented with agility.
6. Adjust rates, including standardizing rates for similar services across State agencies, to ensure that providers are compensated consistently and that youth can receive the services they need to thrive.
7. Expand eligibility and develop new service types to ensure that Illinois has a full continuum of care.
8. Partner with providers in a standard protocol to encourage consistent and transparent development of new programs to meet emerging needs.
9. Offer universal screening in education and pediatrics to ensure that mental and behavioral health problems are detected and addressed early.
10. Facilitate information sharing across agencies to improve seamlessness and timeliness of interventions, leveraging previous efforts to integrate data and overcome barriers.
11. Build workforce by using expanded credentialling to broaden the array of roles that are supported and incentivized.
12. Fortify community networks by investing in local communities and parent leadership.

NOW THEREFORE, I, JB Pritzker, Governor of Illinois, by virtue of the executive authority vested in me by Article V of the Constitution of the State of Illinois, do hereby order as follows:

1.  A Children’s Behavioral Health Transformation Initiative Chief (Chief) position is established. The Chief shall lead the State’s comprehensive, inter-agency effort to ensure that youth with significant and complex behavioral health needs receive appropriate community and residential services and that the State-supported system is transparent and easier for youth and their families to navigate. The Chief shall serve as a policymaker and spokesperson on children’s behavioral health, including coordinating the multi-agency effort through legislation, rules and budgets and communicating with the Illinois General Assembly, federal and local leaders on these critical issues.
2. The Chief, in coordination with the Department of Children and Family Services, Department of Healthcare and Family Services, Department of Human Services, Department of Juvenile Justice, and Department of Public Health, and the Illinois State Board of Education, shall:
   1. Develop a plan to address the recommendations in the Children’s Behavioral Health Transformation Initiative Blueprint Report to be delivered to the Governor and the General Assembly by October 1, 2023, that includes but is not limited to the implementation of the recommendations as well as the necessary policy, fiscal, training, communication, data analytic, and technological implications.
   2. Recommend policy, regulatory, and resource changes necessary to accomplish the goals and objectives laid out in the Blueprint Report.
   3. Convene providers, family members, medical professionals, advocates, and other stakeholders, as needed.
   4. Promote effective interagency collaboration and system integration to improve the behavioral health system for youth with significant needs.
3. Nothing in this Executive Order shall be construed to contravene any other federal or State law or regulation.  Nothing in this Executive Order shall affect or alter the existing statutory powers of any state agency or be construed as a reassignment or reorganization of any State agency. 
4. This Executive Order supersedes any contrary provision of any other prior Executive Order. 
5. If any part of this Executive Order or its application to any person or circumstance is found to be invalid by a court of competent jurisdiction, this invalidity does not affect any other provision or application of this Executive Order, which can be given effect without the invalid provision or application.  The provisions of this Executive Order are severable. 
6. This Executive Order shall take effect immediately upon filing with the Secretary of State.

                                                                                    _______________________

                                                                                      JB Pritzker, Governor

Issued by the Governor February 24, 2023

Filed with the Secretary of State February 24, 2023