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					    Primer Hands On-Child Welfare

                Module 3
Process and Structures in System Building
                       Developed by:
                       Sheila A. Pires
                  Human Service Collaborative
                      Washington, D.C.

                         In partnership with:
                         Katherine J. Lazear
      Research and Training Center for Children’s Mental Health
               University of South Florida, Tampa, FL
                             Lisa Conlan
         Federation of Families for Children’s Mental Health
                          Washington, D.C.
    How system builders conduct themselves

What gets built (i.e., how functions are organized)

     Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
   “Something Arranged in a
Definite Pattern of Organization”
   I. Distributes
       – Power
       – Responsibility
   II. Shapes and is shaped by
       – Values
   III. Affects
       – Practice and outcomes
       – Subjective experiences
         (i.e., how participants feel)
   Pires, S. (1995). Structure. Washington, DC: Human Service Collaborative.
     Goal: One service & support plan; one service manager

             Child Welfare                                                             Mental Health
             •Family Group Decision Making                                             •Individualized Wraparound Approach
             •CW Case Worker                                                           •Care manager

   Kinship    Subsidized    Permanent    Tutoring                                       Crisis           Treatment     In-Home
    Care       Adoption       Foster  Parent Support,                                  Services          Foster Care   Services
                               Care        etc.

 Juvenile Justice                                             Children in &
 •Screening & Assessment
 •Probation officer
                                                               at risk for
                                                              out-of-home                                Education
  Community Services
                                                              placements                                 •Child Study Team
                           MCO                                                                           •Teacher
                           •Prior Authorization
                           •Clinical Coordinator                                                    Alternative    EH Classroom
                                                                                                      School      Related Services
                     Out-patient          Primary         Med. Mngt.
                      services             Care

Result: Multiple service & support plans; multiple service manager
                            Pires, S. (2004). Primer Hands On. Human Service Collaborative: Washington, DC                  4
                               Wraparound Milwaukee
   CHILD WELFARE                      JUVENILE JUSTICE                      MEDICAID CAPITATION                       MENTAL HEALTH
  Funds thru Case Rate                 (Funds budgeted for                    (1557 per month                           •Crisis Billing
 (Budget for Institutional           Residential Treatment for                  per enrollee)                           •Block Grant
Care for CHIPS Children)                Delinquent Youth)                                                         •HMO Commercial Insurance

                    9.5M                     8.5M                                          10M                           2.0M

                                                     Wraparound Milwaukee
                                            Management Service Organization (MSO)
                                                                     $30M                                        Families United
      Per Participant Case Rate                                                                                    $300,000

                                                                                                                      Provider Network
                 Service                                   Child and Family Team                                      240 Providers
               Coordination                                                                                           85 Services

                                                        Plan of Services & Supports

   Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee Count Mental Health Division, Child and Adolescent   5
   Services Branch.
             Truisms About Structure

• Certain functions must be structured and not left to
• Structures need to be evaluated and modified if
  necessary over time
• New structures replace existing ones; some
  existing ones are worth keeping; some are more
  difficult to replace than others
• There are no perfect or “correct” structures

         Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.   6
     System of Care Functions Requiring Structure
• Planning                                                 • Human Resource Development/Staffing
• Decision Making/Policy Level                             • Staff Involvement, Support,
  Oversight                                                  Development
• System Management                                        • Orientation, Training of Key
• Service & Supports Array                                   Stakeholders
• Evidence-Based & Promising Practices                     • External & Internal Communication
• Outreach and Engagement                                  • Provider Network
• System Entry/Access                                      • Protecting Privacy
• Screening, Assessment, & Evaluation                      • Ensuring Rights
• Decision Making & Oversight at the                       • Transportation
  Service Delivery Level                                   • Financing
   – Services & Supports Planning                          • Purchasing/Contracting
   – Services & Supports Authorization                     • Provider Payment Rates
   – Service Monitoring & Review                           • Revenue Generation & Reinvestment
• Service Coordination                                     • Billing & Claims Processing
• Crisis Management at the Service                         • Information Management
  Delivery & Systems Levels                                • Quality Improvement
• Utilization Management                                   • Evaluation
• Family Involvement, Support, &                           • System Exit
  Development at all Levels                                • Technical Assistance & Consultation
• Youth Involvement, Support, &                            • Cultural & Linguisrtic Competence
  Development                                                                                                             7
                    Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative.
                Core Elements of an
         Effective System-Building Process
    The Importance of Leadership & Constituency Building
•    A core leadership group
•    Evolving leadership
•    Effective collaboration
•    Partnership with families and youth
•    Cultural and linguistic competence
•    Connection to neighborhood resources and natural helpers
•    Bottom-up and top-down approach
•    Effective communication
•    Conflict resolution, mediation, and team-building mechanisms
•    A positive attitude

              Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative.   8
                Core Elements of an
         Effective System-Building Process
             The Importance of Being Strategic
•   A strategic mindset
•   A shared vision based on common values and principles
•   A clear population focus
•   Shared outcomes
•   Community mapping—understanding strengths and needs
•   Understanding and changing traditional systems
•   Understanding of major financing streams
•   Connection to related reform initiatives
•   Clear goals, objectives, and benchmarks
•   Trigger mechanisms—being opportunistic
•   Opportunity for reflection
•   Adequate time
               Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative   9
                 The 5Cs of
               Core Leadership
Constituency (representativeness)

 Pires, S. (2005). The 5Cs of core leadership. Washington, DC: Human Service Collaborative.   10
  Examples of Leadership Styles




    Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.   11
  Partnership Involves

    • Team Building
    • Communication
    • Negotiations
    • Conflict Resolution
    • Leadership Development
    • Mutual Respect
    • Skill Building
    • Information Sharing

Pires, S. (1996). Partnership involves. Washington, DC: Human Service Collaborative.   12
                              Principles to Guide Collaboration
• Build, maintain trust so collaborative partners are able to share
  information perceptions, feedback and work as a cohesive team.
• Agree on core values that each partner can honor in spirit & practice.
• Focus on common goals that all will strive to achieve.
• Develop a common language so all partners can have a common
  understanding of terms (i.e., ―family involvement,‖ ―culturally
  competent services.‖
• Respect the knowledge and experience each person brings.
• Assume the best intentions of all partners.
• Recognize strengths, limitations, and needs; and identify ways to
  maximize participation of each partner.
• Honor all voices by respectfully listening to each partner and attending
  to the issues they raise.
• Share decision making, risk taking and accountability so that risks are
  taken as a team and the entire team is accountable for achieving the
  goals.                                                            13
   Stark, D. (1999). Collaboration basics: Strategies from six communities engaged in collaborative efforts among families, child welfare, and children’s
   mental health. Washington, DC: Georgetown Child Development Center, National Technical Assistance Center for Children’s Mental Health
           Challenges to Collaboration ―Barrier Busters‖
    CHALLENGE                                                        BARRIER BUSTERS
Language differences:                                                    • Cross training
Mental health jargon vs.                                           • Share each other’s turf
     court jargon                                                      • Share literature
Role definition: “Who’s                                        • Family driven/accountability
     in charge?”                                                • Team development training
 Mandated service vs.                                                   • Job shadowing
  requested services                                             • Communication channels
                                                                 • Share myths and realities
  Information sharing                                          • Set up a common data base
    among systems                                      • Share organizational charts/phone lists
                                                                      • Share paperwork
                                          • Promote flexibility in schedules to support attendance in meetings
 Addressing issues of                                              • Document safety plans
 child and community                                        • Develop protocol for high-risk kids
         safety                                         • Demonstrate adherence to court orders
                                                     • Maintain communication with District Attorneys
                                                                • Myths of “bricks and mortar”
Maintaining investment                            • Invest in relationships with partners in collaboration
  from stakeholders                                           • Share literature and workshops
                                                        • Track and provide meaningful outcomes
  Sharing value base                           • Infuse values into all meetings, training, and workshops
                                          • Share documentation and include parents in as many meetings as
                                                               • Strength-based cross training
                                                        • Develop QA measures based on values
 Adapted from Wraparound Milwaukee. (1998). Challenges to collaboration/“barrier busters.” Milwaukee, WI: Milwaukee County Mental Health   14
 Division, Child and Adolescent Services Branch.
           Catalyst/Trigger Mechanisms
• Legislative mandates (new or existing)
• Study findings (needs assessments, research, or
• Judicial decisions - Class action suits
• Charismatic/powerful leader
• Outside funding sources (federal, foundations)
• Funding changes
• Local ―scandals‖ and other tragedies
• Coverage of successes
• CFSR findings/Program Improvement Plans
     Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative   15
          Building Local Systems of Care:
      Strategically Managing Complex Change

Human Service Collaborative. (1996). Building local systems of care: Strategically managing complex change. [Adapted from T. Knosler (1991),   16
TASH Presentations]. Washington: DC.
Example: Cuyahoga County (Cleveland)
                               Cuyahoga Tapestry System of Care
                              Administrative Services Organization
                         Training and Coaching for Wraparound Fidelity

                                                System of Care                                             Family to Family
PEP Connections      PEP Tapestry                                                  SCY                       Community
      ___                ___                                                        ---                      Wraparound
   700 kids            240 kids                                                  60 kids                          ---
                                                   800 kids                                                   500 kids
  and families       and families                                              and families
                                                 and families                                                and families

                                                                              200 kids =
                     300 kids =                   300 kids =
                                                                            Help Me Grow
                    Child Welfare               Juvenile Justice
                                                                           (Birth to 3 years)

                  Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.       17
              Cuyahoga County (Cleveland)
                           System of Care Oversight Committee

      Services                                                                                       State
    Organization                                        FCFC $$
                                                        Fast/ABC $$             }
                                                                          Early Intervention and
                                                                           Family Preservation
                                                        Residential Treatment Center $$$$
                                                        Therapeutic Foster Care $$$
                                                        “Unruly”/shelter care $

Neighborhood Collaboratives &                                                  }
                                                        Tapestry $$ System of Care Grants
                                                        SCY $$
    Lead Provider Agency

                                                                   Reinvestment of savings

       Community Providers and Natural Helping Networks

                     Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.