Transcript Outcome Accountability for Prevention Programs

CBCAP/PSSF Joint Session:
System of Care Collaboration
Julie Collins, LCSW
Steve Preister, MSW, Ph.D.
March 11th, 2008
FRIENDS National Resource Center for Community Based Child Abuse Prevention
A Service of the Children’s Bureau
What we will cover
• What System of Care
is?
• Why focus on it?
• What this might mean
in your work?
• Discussion
So What is System of Care?
• There is often confusion about what
System of Care is
• This term is used in many different ways
• Is often used to refer to a continuum of
services that a community provider has
• Might be used to refer to the services
that the different child and family system
might have
Definition of System of Care
A system of care incorporates a broad, flexible
array of services and supports for a defined
population(s) that is organized into a
coordinated network, integrates service planning
and service coordination and management
across multiple levels, is culturally and
linguistically competent, builds meaningful
partnerships with families and youth at service
delivery, management, and policy levels, and
has supportive management and policy
infrastructure.
Pires, S. (2006). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Organizational Framework
System of care is, first and foremost, a
set of values and principles that
provides an organizing framework for
systems reform on behalf of children,
youth and families.
Stroul, B.( 2002). Issue brief-Systems of care: A framework for system reform in children’s mental health.
Washington, D.C.: Georgetown University Child Development Center
Values and Principles of SOC
• Comprehensive array of services and supports
• Individualized services and supports guided by an
individualized services and supports plan
• Least restrictive environment that is most appropriate
• Families, surrogate families and youth full
participants in all aspects of the planning and delivery
of services and supports
• Integrated services and supports
Continued …
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.)
Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental
Health. Reprinted by permission.
Values and Principles of SOC
• Services and supports coordination and management
accountability across multiple systems
• Early identification and intervention
• Smooth transitions
• Rights protected, and effective advocacy efforts
promoted
• Receive services without regard to race, religion,
national origin, gender, sexual orientation, physical
disability, or other characteristics and services and
supports should be sensitive and responsive to
cultural and linguistic differences and special needs
Adapted from Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev.
ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's
Mental Health. Reprinted by permission.
Core Values of System of Care
• Child Youth and Family – Centered
• Community Based
• Culturally and linguistically
Competent
Adapted from Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe
emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center,
National Technical Assistance Center for Children's Mental Health. Reprinted by permission
Operational Characteristics of SOC
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Collaboration across agencies
Partnership with families/youth
Cultural & linguistic competence
Blended, braided, or coordinated financing
Shared governance across systems & with families
and youth
Shared outcomes across systems
Organized pathway to services & supports
Child and family teams
Single plan of services and supports
continued…..
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Operational Characteristics of SOC
• Staff, providers, and families trained and mentored in a common
practice model
• One accountable service manager
• Cross-agency service coordination
• Individualized services & supports "wrapped around" child &
family
• Home- & community-based alternatives
• Broad, flexible array of services & supports for children &
families
• Integration of formal services & natural supports, and linkage to
community resources
• Integration of evidence-based and promising practices
• Data-driven focus on Continuous Quality Improvement (CQI)
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Cross Cutting Characteristics
• Cultural and linguistic competence, that is, processes
and structures that support capacity to function
effectively in cross-cultural situations;
• Meaningful partnership with families and youth, including
family and youth organizations, in system building
processes and structural decision making, design, and
implementation;
• A cross-agency perspective, that is, processes and
structures that operate in a non-categorical fashion.
• State, local and tribal partnership and shared
commitment.
Pires, S. (2002).Building systems of care: A primer. Washington D.C.: Human Service Collaborative.
System of Care Activities
• SAMSHA funded
– Focused on population of children who have a Serious Emotional
Disturbance – multi system involved
– Focused on younger children
• ACF Funded
– Infrastructure for SOC for child welfare population
– Cover different child welfare populations
• Federal Early Childhood Comprehensive Systems (ECCS)
Initiative
• SOC – created by state/community/other agencies to target
specific population
Locations of Systems of Care
ACF System of Care Sites
• Partnering4Permanency - Contra Costa County, CA
• Jefferson County Systems of Care - Jefferson County, CO
• The Community Taking Responsibility for Assisting in
Developing Life and Empowerment (CRADLE) - BedfordStuyvesant, Brooklyn, NY
• Family Centered Systems of Care - State of Kansas
• Caring Communities Demonstration Project -Clark County, NV
• Improving Child Welfare Outcomes through Systems of
Care - State of North Carolina
• Improving Permanency Outcomes Project (IPOP) - State of
Oregon
• Locally Organized Systems of Care for Children in
Pennsylvania - State of Pennsylvania
• Medicine Moon Initiative (MMI) to Improve Tribal Child
Welfare Outcomes Through Systems of Care - Tribal Sites in
North Dakota
Adapted from presentation by Ruth Heitsman, Co-Chair, Family Advisory Council, Kansas Family Centered Systems of
Care and Nicole Broussard and . National TA and Evaluation Center for Systems of Care
Why talk about SOC?
• Help with system change/reform efforts
• Framework for collaboration organized
around an identified population
• Integrated systems
• Improved outcomes for children and
families
• Development of a practice model
• Increased family and youth involvement
Why talk about SOC?
• Values and Principles = Practice Model
• Structure and Framework = Integrated
Systems
Adapted from System of Care Discussion presentation by Jan McCarthy, Steve Preister, Kris Sahonchik
Common Ground
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SOC Guiding Principles
Family and youth
involvement
Home, school, communitybased child & family
centered services
Strengths-based,
individualized care
Cultural & linguistic
competence
Interagency collaboration
Accountability
CFSR Practice Principles
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Family-centered practice
Strengthen and empower
families to protect and nurture
their children
Community-based practice
Support the needs of children
within the context of their
families and communities
Individualizing services
Tailor interventions to meet
specific needs of children &
families served
Strengthening parental capacity
Promote parent strengths &
self-esteem by emphasizing
service provider partnerships
Adapted from presentation by Ruth Heitsman, Co-Chair, Family Advisory Council, Kansas
Family Centered Systems of Care and Nicole Broussard and . National TA and Evaluation
Center for Systems of Care
Principles of Family Support Practices
• Staff & families work together in relationships
based on equality and respect.
• Staff enhances families’ capacity to support
the growth and development of all family
members.
• Families are resources to their own members,
other families, programs, and communities.
• Programs affirm and strengthen families’
cultural, racial, and linguistic identities.
continued…
Family Support America. (2001). Principles of Family Support Practice in Guidelines for Family Support Practice (2nd ed.). Chicago, IL.
Principles of Family Support Practices
• Programs are embedded in their communities and
contribute to the community building.
• Programs advocate with families for services and
systems that are fair, responsive, and accountable to
the families served.
• Practitioners work with families to mobilize formal and
informal resources to support family development.
• Programs are flexible & responsive to emerging
family & community issues.
• Principles of family support are modeled in all
program activities.
Family Support America. (2001). Principles of Family Support Practice in Guidelines for Family Support Practice (2nd ed.). Chicago, IL.
Principles of Family Support Practices
• Programs are embedded in their communities and
contribute to the community building.
• Programs advocate with families for services and
systems that are fair, responsive, and accountable to
the families served.
• Practitioners work with families to mobilize formal and
informal resources to support family development.
• Programs are flexible & responsive to emerging
family & community issues.
• Principles of family support are modeled in all
program activities.
Family Support America. (2001). Principles of Family Support Practice in Guidelines for Family Support Practice (2nd ed.). Chicago, IL.
Youth Development Principles
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Child and Youth Centered
Community Based
Comprehensive
Collaborative
Egalitarian
Empowering
Inclusive
Visible, Accessible, and Engaging
Flexible
Culturally Sensitive
Family Focused
Affirming
Adapted from Primers Hands On – Child Welfare Module 2, Sheila Pires, Washington, DC Human Services Collaborative
Youth Development Principles
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Embrace total youth involvement
Create a healthy and safe environment
Promote healthy relationships
Create community partnerships
Realize interdependence takes time
Value individual strengths
Build feedback and self-assessment
Learn by doing
Adapted from Primers Hands On – Child Welfare Module 2, Sheila Pires, Washington, DC Human Services Collaborative
Resonance between CFSR & SOC Outcomes
Child & Family Services
Review
System of Care
Children are protected from abuse and
neglect.
Build safety plans into service/support
plans.
Children are safely maintained in their
homes whenever possible and appropriate.
Prevent out-of-home placements, keep
families intact.
Children have permanency and stability in
their living arrangements.
Minimize disruption in children’s lives and
promote continuity and smooth transitions.
The continuity of family relationships and
connections is preserved for children.
Core value - family focus
Families have enhances capacity to care for
their families’ needs.
Strengthen the resiliency of both families
and youth and enhance natural helping
networks.
Children receive appropriate services to
meet their educational needs.
Focus on all life domains, including
education.
Children receive adequate services to meet
their physical and mental health needs
Holistic approach, broad array of services
and supports.
Fundamental Challenge to Building a SOC
No one system controls everything.
Every system controls something.
Pires, S. (2004). Human Service Collaborative. Washington, D.C.
Characteristics of SOC as Systems Reform Initiatives
FROM
• Fragmented service delivery
• Categorical programs/funding
• Limited services
• Reactive, crisis-oriented
• Focus on out-of-home placements
• Children out-of-home
• Centralized authority
• Creation of “dependency” continued………
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative
Characteristics of SOC as Systems Reform Initiatives
TO
• Coordinated service delivery
• Blended resources
• Comprehensive services/supports array
• Focus on prevention/early intervention
• Individualized services & supports in least
restrictive, normalized environments
• Children within families
• Community-based ownership
• Creation of “self-help”
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative
Child Welfare Population Issues
• All children involved with the child welfare system
• Demographic - e.g., infants, transition-age youth
• Intensity of System Involvement - e.g., out of home
placement, multi-system, length of stay
• At Risk: e.g., Children at home at risk of out of home
placement? Children in permanent placements at risk of
disruption ? (e.g., subsidized adoption, kinship care,
permanent foster care)
• Level of Severity e.g., Children with serious
emotional/behavioral disorders, serious physical health
problems, developmental disabilities, co-occurring
Pires, S (2004.) Human Service Collaborative. Washington, D.C.
System Change Focuses On:
• Policy Level (e.g., financing; regs; rates)
• Management Level (e.g., data; Quality
Improvement; Human Resource
Development; system organization)
• Frontline Practice Level (e.g., assessment;
services and supports planning; service
coordination; services and supports
provision)
• Community Level (e.g., partnership with
families, youth, natural helpers; community
buy-in)
Pires, S. (2006). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Benefits of Systems of Care
SAMHSA grants for Children with Serious
Emotional Disturbance
• Reduced self-harmful and suicide-related
behaviors.
• Reduced emotional and behavioral problems
• Reduced arrests resulted in per-child cost
savings.
• Improved economic status of caregivers.
continued ……
Adapted from SAMHSA Fact Sheet, Comprehensive Community Mental Health Services Program for Children and Their Families: 2006 Key Outcomes for
Children and Families in Systems of Care
Benefits of Systems of Care
• The education sector was the highestreferring child-serving sector to
systems of care.
• School performance improved
significantly.
• Suspensions and expulsions
decreased. School attendance
improved significantly.
• Decreased school mobility.
Adapted from SAMHSA Fact Sheet, Comprehensive Community Mental Health Services Program for Children and Their Families: 2006 Key
Outcomes for Children and Families in Systems of Care
Benefits of Systems of Care
SAMHSA Early childhood grants
Benefits of Systems of Care
Child Welfare
Resources
• Primer Hands On – Child Welfare System
of Care Curriculum
• Improving Child Welfare Outcomes
Through Systems of Care : Building the
Infrastructure, a Guide for Communities.
• Improving Child Welfare Outcomes
Through Systems of Care. Systems of
Care: Guide for Strategic Planning.
Resources
• National Resource Center for Organizational
Improvement - www.nrcoi.org
• National TA and Evaluation Center for Child
Welfare Systems of Care Grantees http://www.childwelfare.gov/systemwide/services
/soc
• National TA Center for Children’s Mental Health
at Georgetown University http://gucchd.georgetown.edu/programs/ta_cent
er
• Child Welfare Information Gateway –
www.childwelfare.gov
• TA Partnership for Children and Family Mental
Health - http://www.tapartnership.org/