Transcript Building Effective Service Systems for Children and
Building Effective Service Systems for Children and Families
Presentation by:
Sheila A. Pires Human Service Collaborative Washington, DC
The President’s New Freedom Commission for Mental Health September 11, 2002 Chicago, Illinois
The Total Population of Children and Families Who Depend on Public Systems • Children and families eligible for Medicaid • Children and families eligible for the State Children’s Health Insurance Program (SCHIP) • Poor and uninsured children and families who do not qualify for Medicaid or SCHIP • Families who are not poor or uninsured but who exhaust their private insurance, often because they have a child with a serious disorder • Families who are not poor or uninsured and who may not yet have exhausted their private insurance but who need a particular type of service not available through their private insurer and only available from the public sector Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Examples of Sources of Behavioral Health Funding for Children and Families in the Public Sector
Medicaid
•Medicaid In-Patient •Medicaid Outpatient •Medical Rehabilitation Services •Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT)
Child Welfare
•CW General Revenue •CW Medicaid Match •IV-E (Foster Care and Adoption Assistance) •IV-B (Child Welfare Services) •Family Preservation/Family Support
Substance Abuse
•SA General Revenue •SA Medicaid Match •SA Block Grant
Juvenile Justice
•JJ General Revenue •JJ Medicaid Match •JJ Block Grant
Education
•ED General Revenue •ED Medicaid Match •ED Block Grant •Special Education •Part C, Early Interv.
Mental Health
•MH General Revenue •MH Medicaid Match •MH Block Grant
Other
•WAGES •Children’s Medical Services/Title V Maternal and Child Health •Mental Retardation/Development al Disabilities •Title XXI - State Children’s Health Insurance Program (SCHIP) •Vocational Rehabilitation •Local Funds Pires, S. (1995). Examples of sources of behavioral health funding for children & families in the public sector. Washington, D.C. Human Service Collaborative
Current Systems Problems
• Patterns of utilization • Cost • Administrative inefficiencies • Poor outcomes
Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Efficacy of Services
(Barbara Burns’ Research at Duke University) • Most evidence of efficacy: Intensive case management, in-home services, therapeutic foster care • Weaker evidence (because not much research done): Crisis services, respite, mentoring, family education and support • Least evidence (and lots of research): Inpatient, residential treatment, therapeutic group home Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Categorical vs. Non-Categorical System Reforms
Categorical System Reforms Mental Health Child Welfare Juvenile Justice Etc.
Non-Categorical Reforms
Shared Population Focus
Pires, S. (1996). Human Service Collaborative, Washington, D.C
Customizing Care for Children with Serious Emotional/Behavioral Disorders and Their Families Operational Characteristics • Collaboration across agencies at policy, management and service levels • Partnership with families • Cultural and linguistic competence • Blended, braided, or coordinated financing • Shared governance and liability across systems and with families • Shared outcomes across systems, reflecting community values • Organized pathway to services and supports • Interagency/family services planning and monitoring teams Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Customizing Care for Children with Serious Emotional/Behavioral Disorders and Their Families - Operational Characteristics (continued) • Single plan of care • One accountable care manager • Cross-agency coordination • Individualized services/supports “wrapped around” child and family • Home-and community-based alternatives • Broad, flexible array of services and supports • Integration of clinical treatment services and natural supports, linkage to community resources • Integration of evidence-based treatment approaches • Cross-agency management information systems Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Local Ownership State Commitment
Pires, S. (1996). Human Service Collaborative, Washington, D.C.
Financing Strategies to Support Improved Outcomes for Children
• First Principle: Program Drives Financing • Redeployment: Using the Money We Already Have – The cost of doing nothing – Shifting funds from “deep end” treatment to early intervention – Moving across fiscal years • Refinancing: Federal Claims Generating New Money by Increasing – The commitment to reinvest funds for families and children – Foster care and adoption assistance (Title IV-E) – Medicaid (Title XIX) Friedman, M. Center for the Study of Social Policy
Financing Strategies to Support Improved Outcomes for Children (continued) • Raising Other Revenue to Support Families and Children – Donations – Special taxes and taxing districts for children – Fees and third party collections including child support – Trust funds • Financing Structures which Support Service Goals – Seamless services: financial claiming invisible to families and children – Funding pools: Breaking the lock of agency ownership of funds – Flexible dollars: removing the barriers to meeting the unique needs of families – Incentives: Rewarding good practice Friedman, M. Center for the Study of Social Policy
Finance: the art of passing currency from hand to hand until it finally disappears.
n Robert W. Sarnoff, son of David Sarnoff and head of NBC