Cuyahoga Tapestry System of Care

1. Cuyahoga Tapestry System of Care Weaving Solutions with Children and their Families

2. Introduction…………………..3 What makes Tapestry different?...............................6 Family Voice & Choice……..7 Wraparound………………...9 Focus on Strengths………….11 Braided Funding…………....13 What does this mean for a family?................................15 What does this mean for a provider?............................17 Who is the Cuyahoga Tapestry System of Care?...................19 Partners…………………….20 Table of Organization…….22 Workers…………………….23 Families……………………..24 Why did Cuyahoga County need a new business model for serving families?...................27 How did this new way of doing business for and with families develop?.................30 Timeline…………………….31 Training & Coaching……...33 Goals……………………….34 How do we know it’s working?.............................36 Contact Information……….42 Table of Contents

3. When a family enters the Cuyahoga Tapestry System of Care, they have heard the phrase “We can help” more times than they can count, and they are frustrated. • The children or youth in the family feel that they have never found a “fit” with the services offered to them, or that those services were not enough. • The parents or caregivers in the family have been missing work because of the behavioral problems of their child, and they know that bad news is on the other end when someone from their child’s school calls.

4. The difference for a family entering the Cuyahoga Tapestry System of Care is that it has been designed to serve multiple needs within a single family. • The system of care is for the family who has a child at risk for or already involved with multiple child-serving systems or services, like Juvenile Court, the Department of Child and Family Services, alcohol and other drug counseling, and mental health.

5. The Cuyahoga Tapestry System of Care is: • Family-driven • Youth-guided • Community-based • Team-based • Strengths-based • Focused on empowering families and helping them learn the skills to sustain their health and wellness

6. What else makes Tapestry different?

7. “Family Voice and Choice” makes it different!

8. Tapestry is family-driven, which means that not only do parents and caregivers take an active role in shaping their care, they also participate in governance of the entire system of care. • Parent Advocates support families who are currently enrolled. • A Parent Advisory Council and Youth Advisory Council guides decisions within the system. • Parents and caregivers sit on every decision-making committee.

9. The “Wraparound” process makes it different!

10. Wraparound: A full-service approach to helping families! Instead of making a child fit into a “standard” service plan, a team of supporters helps the family develop a unique plan to “wrap” around them and keep them safe and at home. • A wraparound planning process brings people together from different parts of the whole family’s life and is: • Based on the strengths of the family and neighborhood • Something that a family “does,” not something that they are “given” • A team effort, with the child, family, professionals, community and neighborhood supports working together toward a common goal • A process that respects families, with teams that are sensitive and responsive to your family’s culture, language and community

11. A focus on strengths makes it different!

12. Tapestry focuses on strengths – not just in families, but within provider agencies and neighborhood centers as well! • This initiative brings together all the best efforts of the settlement house tradition, community-based care for families, and established mental health, child welfare, and juvenile justice provider agencies with the schools and churches. • It is a “whole life” approach to serving families!

13. Braided funding makes it different!

14. Tapestry braids formal Medicaid billable mental health services with informal supports. • This lets dollars follow the child, instead of the old way of doing business that meant communities paid for potentially repetitive services. • Tapestry gives families access to an astonishingly thorough network of no-cost or low-cost services.

15. What does that mean for a family? • Families aren’t forced to travel from agency to agency for the diverse range of services they need • Families stay where they are comfortable, in their home and in their neighborhood • Families connect with a Parent Advocate, who knows the system and their neighborhood • Families stay together!

16. Parents are at the center of the wraparound team that meets to develop the plan to address the needs of their family. • Every wraparound plan that is developed is unique to that family. • The wraparound planning process occurs in the neighborhood where the family lives. • The funding for that wraparound plan is drawn from several sources and blended together. • The goal of the plan is to keep the family together or reunify the family. • The services that the family receives are from their own neighborhood as well as from established agencies.

17. What does that mean for a provider? • Providers get to do what they do best based on their strengths, resources, and history—they fill a specific and necessary role on the family team.

18. Wraparound Specialists and Care Managers who coordinate care for family teams use a web-based case-management, service authorization and invoicing system called Synthesis, allowing supervisors to track services, family visits and other quality-assurance points, and creating a fee-for-service model where dollars follow the child. • In addition to serving more families through self-referral, the system of care now has enrollment specialists placed within the county’s Department of Children and Family Services and Juvenile Court. • Wraparound Training that helps people understand the principles of family-driven, strengths-based, neighborhood care has been opened to all partners and parents and caregivers within the system of care. • Tapestry is a leading system of care community in the nation with performance outcomes in the highest category for areas such as System Level Outcomes, Child/Family Outcomes, Satisfaction with Services, Family and Youth Involvement, and Cultural and Linguistic Competency.

19. Who is the Cuyahoga Tapestry System of Care?

20. Who are the Tapestry partners? • Parents, Caregivers & Youth • Parent & Youth Advisory Councils • Parent Advocates • Neighborhood Collaboratives Neighborhood “collabs” are associations of organizations that develop and promote resources for families. Each is unique, but in combination they are a partnership of faith-based groups, health care providers, schools, recreation facilities (e.g., YMCA), block clubs, mental health and substance abuse providers, social service providers, settlement houses, non-profits, etc. For a full list of current neighborhood collaboratives and provider agency partners, visit our online Who’s Who of Agencies.

21. Partners continued • County Funders • Board of County Commissioners • Department of Children & Family Services • Community Mental Health Board • Alcohol & Drug Addiction Services Board • Juvenile Court • Board of Mental Retardation & Developmental Disabilities

23. Who are the Tapestry workers? • 157 Wraparound Facilitators • 28 Supervisors • 14 Resources Specialists • 11 Parent Advocates • Serving approximately 2,500 families through a High Fidelity Wraparound process

24. Who are the Tapestry families? • Families that are eligible for enrollment in the Cuyahoga Tapestry System of Care have a child who is: • A resident of Cuyahoga County and within the neighborhood collaborative areas. • Under eighteen (18) years of age at time of referral. • Diagnosis of serious emotional disturbance (per the DSM IV criteria). • Have major impairments in several life domains. • Has, or is at risk for, involvement in more than one public child-serving system.[1] • May have had psychiatric hospitalization(s) over the past year. • Will require multiple sources of support to address problems across life domains (including intensive community psychiatric supportive treatment, coordinated care and case management). [1] Includes the Schools/Special Education, Department of Children and Family Services, Juvenile Court, Board of Mental Retardation/Developmental Disabilities, and the Alcohol and Drug Board.

25. Cleveland OverviewPoverty • In 2005, Cleveland, the county’s largest city, had the highest poverty rate among America’s big cities with nearly a third of its people (32.4%) living in poverty, including 47.6% of children under eighteen and 53.3% of children under age five. (U.S. Census Bureau, 2006)

26. Tapestry OverviewPoverty • Nearly 80% of the families enrolled in Tapestry are at or below poverty level. They are among the most economically challenged families in the most economically depressed city in the country.

27. Why did Cuyahoga County need a new business model for serving families?

28. Current partners within the system of care have long histories in Cuyahoga County—and saw a need to integrate their efforts to serve the families with the most complicated and numerous needs.

29. Tapestry marries clinical expertise with neighborhood know-how • Families benefit because they can receive the best services the county offers within their homes and neighborhoods—no trips downtown to get what they need

30. How did this new way of doing business for and with families develop?

31. Tapestry Timeline October 2005 Parent Advocate Activity Form is created February 2006 Expectations set at 2.5 billable hours per day January 2005 First Tapestry Enrollment March 2005 Training and Coaching begin Robert Wood Johnson Foundation Children’s Mental Health October 2003 Granted SAMHSA 1800’s 1994 2003 2004 2005: January March June October 2006: January February March Neighborhood Settlement Houses • January - June 2004 • Committees created • Contracts with Neighborhood Collaboratives and PEP June 2005 National Wraparound Initiative is applied locally January 2006 PEP has 13 of 16 care managers staffed March 2006 Care Manager floater position created Casey Family To Family Implemented at Children & Family Services

32. Tapestry Timeline continued January 2007 Synthesis imported from WAM & New Governor in Ohio April-May 2007 Work with fiscal architecture for SOC & Develop fiscal position paper for new administration at state level August 2006 CQI released & PEP introduces Incentive Program Nov. 2006 15 Care Managers staffed, but 06 turnover is 50% June 2006 Group Supervision begins 2006: April June July August September November December 2007: January April May April 2006 Intake Coordinator position created July 2006 PEP CEO shadows CMs Sept. 2006 $9-10 million added to SOC for 600 new kids & RFP process for new $ Dec. 2006 Monthly Program Fidelity & Individual Staff Activity Report released & Care Coordination Contracts completed April 2007 600 new SOC families

33. Child Welfare Funded Components Components Funded by CCCMHB Components Funded by SAMHSA & Braided Funds Components Funded by SAMHSA & AODBCC New Jointly Funded Components Managed by the Neighborhood Collaboratives Operated by Justice Affairs & Catholic Charities Based in four Partnerships Located Across community Managed by PEP “Original” 10 Collaboratives 30 Wrap Specialists 10 Resource Specialists 10 System of Care Supervisors 250 Families at each site 2500 families annually DCFS = 3.3 MM SAMHSA = 1.1 MM “New” 4 Collaboratives 8 Wrap Specialists 4 Resource Specialists 4 System of Care Supervisors 150 Families at each site 600 families annually DCFS = 920,000 Care Coordination Partnerships 80 Facilitators 8 Supervisors 300 DCFS 300 Court 200 HMG Serving 800 Families HHS = 6.0 MM DCFS = 3.0 MM ABC dollars from MHB and AOD = 300,000 Connections 20 Care Managers 2 Supervisors 1 Parent Liaison Serving 300 Families MHB = 2.82 MM DCFS = 248,905 JC = 92,779 MRDD = 40,000 Other = 1,400 Tapestry 16 Care Managers (PEP employed, Housed in Settlements) 2 Supervisors 10 Parent Advocates (Hired in Collaboratives) Serving 240 Families SAMHSA = 1.4 MM MHB = 600,000 SCY Services for Community Youth Screening and service through Detention Implementing ICT Integrated Co-occurring Treatment Serving 60 Families SAMHSA = 800,000 Training and Coaching Component

34. Goals of the System of Care Initiative • Increased capacity of the systems to work with children, youth and their families; • Increased access of systems to provide effective services for children, youth and their families; • Improved child and family outcomes such as improvements in child wellbeing, increased stability in living arrangements, and increased school attendance;

35. Goals of the System of Care Initiativecontinued • Develop a new business model together for county funders, provider agencies, and neighborhood collaboratives with families. Performance outcomes will be clear in this partnership; • Maximize county and state resources as a critical component of the plan; • Develop a collaborative workforce and improve our clinical technology in working with families in their neighborhoods.

36. How do we know that this new way of doing business is working?

37. Data from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which provides the grants that launch systems of care, indicate that systems of care save taxpayers money. • On average, wraparound care saves child welfare systems $7,965 per child in residential placement costs over the course of a month, and saves juvenile justice systems between $800 - $3,000 per child within the same time frame. • Cuyahoga County’s local data indicate that children thrive in this type of care: • Clinical outcomes improve or stabilize for 89% of youth with behavioral and emotional problems • 91% of children and youth with a history of suicide attempts or suicide ideation improve or stabilize • Other indicators, like school performance, stability at home, employment, show that systems of care work!

38. OutcomeMeasures Tapestry is data-driven, and has refined its definition of success with 9 specific outcome measures: • Children are with their families in the community • Children have increased rates of attendance at school • Children have improved performance in school • Children show improvement in Ohio Scales Scores (or other nationally recognized assessment instruments) For example … Our outcomes show that youth go from a moderate level of functioning impairment and problem severity to mild levels.

39. Outcome Measurescontinued 5. Family assessments indicate improved family functioning 6. Reduced length of stay in psychiatric settings 7. Reduced length of stay in residential settings 8. Reduced recidivism in referrals to Juvenile Court 9. Reduced recidivism and reduced penetration in Child Welfare

40. Parents who have experienced Tapestry become champions for systems of care!

41. A mother’s words: “I believe that the Tapestry program is so rare due to the fact that they try to empower and teach you and the rest of the family, and the child dealing with all the problems, instead of the normal programs where they promise you that they are going to fix your child. The children are not broken. They can’t be fixed, but all can learn to handle the things that are placed in front of you.”

42. 216-443-60621400 West 25th Street, 4th FloorCleveland, Ohio 44113www.CuyahogaTapestry.org