Primer Hands On-Child Welfare THE SKILL BUILDING CURRICULUM 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. 1 Process How system builders conduct themselves Structure What gets built (i.e., how functions are organized) Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. 2 Structure “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. 3 Example 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 happenstance • 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) Credibility Capacity Commitment Consistency Pires, S. (2005). The 5Cs of core leadership. Washington, DC: Human Service Collaborative. 10 Examples of Leadership Styles Charismatic Facilitative Managerial 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 possible • 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 evaluation) • 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 Initiatives ___ ___ --- 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 County Administrative 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 Partnerships Reinvestment of savings Community Providers and Natural Helping Networks 18 Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.