New Jersey runs the only statewide children’s mental health system in the country — and by James Parauda’s own admission, many of the people who could benefit from it have never heard of it.
Parauda is president of NJCMO, the association representing New Jersey’s 15 Care Management Organizations, and CEO of Tri County CMO, which covers Somerset, Hunterdon and Warren counties from its base in Branchburg. The CMOs contract with the state’s Children’s System of Care, part of the Department of Children and Families, to coordinate mental health, substance use and developmental disability services for kids and families — with a focus of keeping children in their homes and in their communmity.
The results are striking. Roughly 95% of the children involved with a CMO remain living at home, up from as low as 75% when the system launched 25 years ago. NJCMO now serves 33,000 kids a year statewide, with roughly 18,000 involved on any given day.
The system traces back to the late 1990s, when a group of parents raised alarms that children were falling through the cracks of New Jersey’s mental health system. Gov. Christine Todd Whitman’s administration responded by creating what eventually became the Children’s System of Care — a model other states have since studied and, in some cases, tried to copy.
Despite that track record, Parauda said, NJCMO remains largely unknown outside the families and professionals who work with it directly — a gap he’s hoping to close as the organization marks its 25th anniversary this fall.
Parauda spoke with BINJE about how the system works, where it falls short, and why he thinks Gov. Mikie Sherrill’s focus on youth mental health could be a turning point.
BINJE: For people who’ve never heard of NJCMO or the CMO system, what exactly do you do?
PARAUDA: We do wraparound services for youth and families. Instead of moving kids out of the home and saying, “Go fix my kid and bring them back,” we wrap services around the whole family, in the home. We look at the entire environment — home, school, social activities, medical and therapeutic needs — and figure out how to help these kids function within society. The youth is the identified client, but we take account of the whole family, because treating the child within that family unit is what makes the model work.
BINJE: Are you a government agency, or something else?
PARAUDA: There are 15 Care Management Organizations covering all 21 counties — I run Tri County, which covers Somerset, Hunterdon and Warren. Each CMO is an independent 501(c)(3) nonprofit with a direct contract with the Children’s System of Care (CSOC), which sits under the Department of Children and Families (DCF). CSOC is considered the mental health arm of the child welfare system, but it’s a separate entity within DCF. NJCMO is the association representing the collective interests of all 15 CMOs.
BINJE: How is that work funded?
PARAUDA: Mostly through Medicaid. Our direct contract with the Department of Children and Families is actually a very small piece — less than 5% of our funding. More than 95% comes from Medicaid reimbursement, at a rate of about $1,000 a month per child enrolled. We serve about 900 kids through TriCounty, so that’s roughly $900,000 a month in Medicaid funding supporting those families.
BINJE: OK, let’s talk specifics: What’s NJCMO’s model for actually working with a family, once they’re in the system?
PARAUDA: It’s a three-step process — we do it for you, we do it with you, then we help you do it on your own. Families stay with us for an average of 13 months. By the end, the goal is for caregivers to know their community’s resources well enough to manage on their own, though we’re always here if they need to come back.
BINJE: The kids. What is the typical age of the children you serve — and has that changed over time?
PARAUDA: Yes. Twenty-five years ago, our core population was 14- to 17-year-olds. That’s shifted younger, to 11- to 13-year-olds, though we’re contracted to serve kids from age 3 to 21. New Jersey has also made sure income isn’t a barrier — families can’t be turned away for making too much or too little, which isn’t the case in every state.
BINJE: Now, how do families actually find you?
PARAUDA: That’s one of the real challenges in our system. The state contracts with what’s called a Contracted System Administrator — currently PerformCare — which serves as the front door. If a family calls us directly, we still have to refer them to PerformCare’s 1-800 number (877-652-7624). Families usually hear about us through a school counselor, a probation officer, a psychiatric hospital or an emergency room. The challenge for families is there’s no well-known point of entry the way there is for something like the 988 crisis line.
BINJE: You’ve said NJCMO is “the best-kept secret in New Jersey.” Where’s the awareness gap?
PARAUDA: Honestly, it’s all of the above. We’ve done well building relationships in schools, through IEP teams and child study teams. But there are more than 500 school districts in New Jersey, and staff turnover means that knowledge doesn’t always stick. Legislators are a big piece too — Assemblywoman Katz told us she wished she’d known about the CMO system. We hear that a lot. The goal is for every child who qualifies to actually know we exist.
BINJE: Gov. Mikie Sherrill has made youth mental health a signature issue, and she’s a parent of teenagers herself. Could this be an awareness turning point? What do her statements and positions mean for NJCMO?
PARAUDA: It’s been significant. Having a governor who understands this firsthand changes the conversation. We’ve had direct communication with her office, including this spring, when we were advocating for a Medicaid reimbursement rate increase. There’s currently a bill in both the Assembly and Senate addressing that.
BINJE: OK. The money question. Or, is it the dream-scenario question? If the state gave NJCMO a significant funding increase tomorrow, where would it go?
PARAUDA: Workforce, without question. Our care managers come out of college making around $50,000 a year, which doesn’t go far with student debt today. The standard caseload ratio is supposed to be 15 families per care manager, but because it’s hard to recruit and retain staff, it’s often 18 or 19 — and right after the pandemic, some CMOs were over 20. You simply can’t give a child the same level of care at a caseload of 22 as you can at 15.
BINJE: Let’s wrap up here. NJCMO turns 25 this year. What’s planned?
PARAUDA: We’re holding a 25th anniversary event in Trenton on October 9th, inviting legislators and community partners. Acting DCF Commissioner Joseph Ribsam is expected to speak. We’re hoping to have between 500 and 1,000 people there — it’s a free, invitation-based awareness event, not a fundraiser.
For information about NJCMO, go to njcmo.org.
