Transcript Document

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.
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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.
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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.
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Example
Goal: One service & support plan; one service manager
Mental Health
Child Welfare
•Individualized Wraparound Approach
•Care manager
•Family Group Decision Making
•CW Case Worker
Kinship
Care
Subsidized
Adoption
Permanent
Tutoring
Foster
Parent Support,
Care
etc.
Juvenile Justice
Children in &
at risk for
out-of-home
placements
•Screening & Assessment
•Probation officer
Community Services
MCO
•Prior Authorization
•Clinical Coordinator
Out-patient
services
Crisis
Services
Primary
Care
Treatment
Foster Care
In-Home
Services
Education
•Child Study Team
•Teacher
Alternative
School
EH Classroom
Related Services
Med. Mngt.
Result: Multiple service & support plans; multiple service manager
Pires, S. (2004). Primer Hands On. Human Service Collaborative: Washington, DC
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Wraparound Milwaukee
CHILD WELFARE
Funds thru Case Rate
(Budget for Institutional
Care for CHIPS Children)
JUVENILE JUSTICE
(Funds budgeted for
Residential Treatment for
Delinquent Youth)
9.5M
MEDICAID CAPITATION
(1557 per month
per enrollee)
8.5M
10M
MENTAL HEALTH
•Crisis Billing
•Block Grant
•HMO Commercial Insurance
2.0M
Wraparound Milwaukee
Management Service Organization (MSO)
$30M
Per Participant Case Rate
Service
Coordination
Child and Family Team
Families United
$300,000
Provider Network
240 Providers
85 Services
Plan of Services & Supports
Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee Count Mental Health Division, Child and Adolescent
Services Branch.
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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.
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System of Care Functions Requiring Structure
• Planning
• Decision Making/Policy Level
Oversight
• System Management
• Service & Supports Array
• Evidence-Based & Promising Practices
• Outreach and Engagement
• System Entry/Access
• Screening, Assessment, & Evaluation
• Decision Making & Oversight at the
Service Delivery Level
– Services & Supports Planning
– Services & Supports Authorization
– Service Monitoring & Review
• Service Coordination
• Crisis Management at the Service
Delivery & Systems Levels
• Utilization Management
• Family Involvement, Support, &
Development at all Levels
• Youth Involvement, Support, &
Development
• Human Resource Development/Staffing
• Staff Involvement, Support,
Development
• Orientation, Training of Key
Stakeholders
• External & Internal Communication
• Provider Network
• Protecting Privacy
• Ensuring Rights
• Transportation
• Financing
• Purchasing/Contracting
• Provider Payment Rates
• Revenue Generation & Reinvestment
• Billing & Claims Processing
• Information Management
• Quality Improvement
• Evaluation
• System Exit
• Technical Assistance & Consultation
• Cultural & Linguisrtic Competence
Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative.
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Core Elements of an
Effective System-Building Process
The Importance of Leadership & Constituency Building
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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.
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Core Elements of an
Effective System-Building Process
The Importance of Being Strategic
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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
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The 5Cs of
Core Leadership
Constituency (representativeness)
Credibility
Capacity
Commitment
Consistency
Pires, S. (2005). The 5Cs of core leadership. Washington, DC: Human Service Collaborative.
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Examples of Leadership Styles
Charismatic
Facilitative
Managerial
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
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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.
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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.
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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
Language differences:
Mental health jargon vs.
court jargon
Role definition: “Who’s
in charge?”
Mandated service vs.
requested services
Information sharing
among systems
Addressing issues of
child and community
safety
Maintaining investment
from stakeholders
Sharing value base
BARRIER BUSTERS
• Cross training
• Share each other’s turf
• Share literature
• Family driven/accountability
• Team development training
• Job shadowing
• Communication channels
• Share myths and realities
• Set up a common data base
• Share organizational charts/phone lists
• Share paperwork
• Promote flexibility in schedules to support attendance in meetings
• Document safety plans
• Develop protocol for high-risk kids
• Demonstrate adherence to court orders
• Maintain communication with District Attorneys
• Myths of “bricks and mortar”
• Invest in relationships with partners in collaboration
• Share literature and workshops
• Track and provide meaningful outcomes
• 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
Division, Child and Adolescent Services Branch.
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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
.
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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),
TASH Presentations]. Washington: DC.
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Example: Cuyahoga County (Cleveland)
Cuyahoga Tapestry System of Care
Administrative Services Organization
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Training and Coaching for Wraparound Fidelity
PEP Connections
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700 kids
and families
PEP Tapestry
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240 kids
and families
System of Care
Initiatives
--800 kids
and families
SCY
--60 kids
and families
300 kids =
Child Welfare
300 kids =
Juvenile Justice
200 kids =
Help Me Grow
(Birth to 3 years)
Family to Family
Community
Wraparound
--500 kids
and families
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.
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Cuyahoga County (Cleveland)
System of Care Oversight Committee
County
Administrative
Services
Organization
}
Neighborhood Collaboratives &
Lead Provider Agency
Partnerships
State
FCFC $$
Early Intervention and
Fast/ABC $$
Family Preservation
Residential Treatment Center $$$$
Therapeutic Foster Care $$$
“Unruly”/shelter care $
Tapestry $$ System of Care Grants
SCY $$
}
Reinvestment of savings
Community Providers and Natural Helping Networks
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.
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