1 / 54

System of care..

System of care. Why should nz care?. KARIN ISHERWOOD Planning & Funding Capital Coast DHB Dr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development. ACKNOWLEDGEMENTS. Ms Sue Treanor Director The Werry Centre Mr Bruce Kamradt Director

arin
Download Presentation

System of care..

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. System of care.. Why should nz care? KARIN ISHERWOOD Planning & Funding Capital Coast DHBDr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development

  2. ACKNOWLEDGEMENTS Ms Sue Treanor Director The Werry Centre Mr Bruce Kamradt Director Milwaukee Wrap Around Programme

  3. WHAT WILL WE COVER  Introductions/Background/a Journey… System of Care Philosophy & Underpinnings Explanation & History Wrap Around Milwaukee The Concept of Technical Assistance Local Initiatives & Comparisons  Developing a System of Care in New Zealand

  4. THE WERRY CENTRE • Contracted by MOH & HWNZ • Sits within Auckland University School of Population Health, Tamaki Campus • Responsible for Workforce Development across Infant, Child & Youth Mental Health/AOD sectors nationally • 18 FTE, 5 based in South Island (Christchurch)

  5. OUR MAHI EXAMPLES • Development & Implementation of a Competency Framework (Real Skills Plus CAMHS) • Mentoring: Emergent Leadership Development • Family/Whanau Participation • Youth Participation • Student Placement Development: MHPP • CAPA/7HH

  6. OUR MAHI EXAMPLES • Training: SACS-BI, CBT, ASD, Eating Disorder • Well-Child • Regional Forums • Parenting Programme: Incredible Years • Sector Days • Family Therapy Development

  7. A JOURNEY.. • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use. • He is the oldest of 2 children, having a 9 year old sister Kelsy. • Josh lives with his mother &sister. His father has had no contact with the family since Josh was an infant. • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.

  8. A JOURNEY.. • Josh is seen for an assessment at the Youth Mental Health Service by Gill, a Pakeha Social Worker who feels Josh needs further investigation by the Psychiatrist for management of mood &substance use. • Contact with Josh is supplemented by contact with his mother &a teacher at his school. • The clinicians on the team believe that it will be important to involve Josh’s family & school in his care. • A meeting is set up at the Youth Service with all parties. Mother fails to attend. She is contacted by phone after the meeting & the outcome is shared with her..

  9. A JOURNEY.. • The clinicians continue to work with Josh attempting to involve all parties in his care through regular phone contact & further meetings at the service. • After several appointments where Josh has failed to attend & the school reports he has been truant, his mother is contacted who reports that Josh has ‘run away’. • A referral is made to CYF who eventually locate Josh & he is returned home. • Further attempts are made to re-engage Josh with the Youth service without success.

  10. A JOURNEY.. • The team contact his Social Worker at CYF &express their concern that until Josh is in a stable residence, contact with Josh is unlikely to be helpful. His file is closed.

  11. QUESTIONS.. • What do you think about this scenario? • Are there things that could have been done differently?

  12. IIMHL International Initiative for Mental Health Leadership • A A ‘Virtual’ Agency (began in 2003) • Improve mental health services • Recovery focussed, evidence based practice • Support innovative leadership • Facilitate connections between leaders • Government to Government Initiative • 7 member countries • NZ, USA, Canada, Scotland, Ireland, England, Australia • Yearly exchanges to promote shared innovative practice

  13. SYSTEM OF CARE SIMPLY PUT • A system of care is a range of • Services & Supports • Guided by a • Philosophy • Supported by an • Infrastructure

  14. SYSTEM OF CARE DEFINITION • Spectrum of effective, community based services & supports for children & youth with or at risk for mental health or other challenges & their families • Organised into a coordinated network • Builds meaningful partnerships with families & youth • Addresses cultural & linguistic needs • Function better at home, school, community & life

  15. SYSTEM OF CARE BACKGROUND • Developed in the USA, following report findings • Major framework for improving mental health &substance use delivery systems, services &outcomes for 25 years • Used to shape system reforms in states, communities, tribes & territories • Extensively researched & evaluated • Found to be effective in improving organisation &delivery of children’s mental health services

  16. SYSTEM OF CARE CORE VALUES • Family Driven &Youth Guided • Strengths & needs of child &family determine type M& mix of services &supports provided • Community Based • Supportive, adaptive infrastructure of structure, processes &relationships at the community level • Culturally &Linguistically Competent  Agencies, programs &services reflect cultural population, to aid access &utilisation of appropriate services

  17. SYSTEM OF CARE GUIDING PRINCIPLES • Access to a Broad Array of Effective Services • Traditional, non-traditional, formal &informal, natural • Each Child & Family is Different • Plans reflect uniqueness of each family • Services & Supports Least restrictive, most typical & developmentally appropriate

  18. SYSTEM OF CARE GUIDING PRINCIPLES • Youth & Families are Full Partners • Planning &delivery of services, policies &procedure that govern care in their community, state, territory, tribe & nation • Cross-System Collaboration • Linkages among child-serving systems for management, service coordination & integrated management of service delivery & costs • Provide Care Management  Services are coordinated, families can move through system as needed

  19. SYSTEM OF CARE GUIDING PRINCIPLES • Developmentally Appropriate Services & Supports Optimal social-emotional outcomes in home & community Facilitate transition of youth to adult system as needed • Incorporate Mental Health Promotion, Prevention & Early Identification & Intervention Improve long-term outcomes& mechanisms to identify problems at an earlier stage

  20. SYSTEM OF CARE GUIDING PRINCIPLES • Continuous Accountability Mechanisms Track, monitor &manage achievement of goals  Fidelity to system of care philosophy  Check quality, effectiveness &outcomes at system level, practice level &child &family level • Protect the Rights of Children & Families  Promote effective advocacy efforts

  21. SYSTEM OF CARE GUIDING PRINCIPLES • Services do not Discriminate • Be responsive &sensitive to differences of race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio economic status, geography, language, immigration status & other characteristics Keeping these principles in mind, let’s look at development

  22. SYSTEM OF CARE DEVELOPING THE SYSTEM • Underpins National Delivery of Child Mental Health • Newly developed services expected to adhere to principles • Use the System of Care Philosophy as a Guide  Not a model to be replicated  Arrays of services will depend on community  Consider particular needs, goals, priorities, populations

  23. SYSTEM OF CARE DEVELOPING THE SYSTEM • Adapt Approach Based on Changes • Political, administrative, fiscal, community context & data • Each community Creates Individual Process  plan, implement & evaluate

  24. SYSTEM OF CARE EACH PROGRAMME IS UNIQUE & DIFFERENT • One Program is Particularly Successful • Wraparound Milwaukee—Bruce Kamradt • 2009 Innovations in American Government Award, Harvard University’s Ash Institute

  25. SYSTEM OF CARE EACH PROGRAMME IS UNIQUE & DIFFERENT • Share the Knowledge, Spread Wealth  Educate State, communities &sectors  SAMHSA partnered with Georgetown University’s National Technical Assistance Centre for Children’s Mental Health  Developed a training package based on the success of WA  In September 2011, piloted the training with representatives from 7 states &3 countries

  26. WRAPAROUND MILWAUKEE QUICK HISTORY • Situation • Bruce Kamradt &colleagues aware of same kids cycling through child welfare, juvenile justice, MH • Each service was funded individually • Services were limited & fragmented • System reacted to crises • Removing kids was usual, lots of out of home care • Government was offering SOC grants  First pilot—25 Kid Project (17 out of 25 kids home in 90)

  27. Wraparound Milwaukee SYSTEM OF CARE IN ACTION!! • Care Management Entity • Responsible for day to day management of system of care  Can be done by any agency

  28. Wraparound Milwaukee • Ten Functions of CME • Assessment &enrolment of youth in CME • Mobile Crisis Services (can contract it out) • Care coordination (can contract it out) • Operation of Provider Network (array of services) • Fiscal management—(child welfare, juvenile justice, health) 6. Quality assurance, quality improvement 7. Information technology (built their own system) • Create mechanisms for family advocacy • Clinical &medical oversight • Training, staff development, public relations (developed their own curriculum) How does Wraparound Work?

  29. Wraparound Milwaukee FOUR PHASES OF WRAPAROUND

  30. Wraparound Milwaukee • PHASE 1: • PREPARATION/ • ENGAGEMENT & WELCOMING • Set the Tone for Collaborative Teamwork • Orient the family to the process • Begin initial crisis & safety planning • Listen & learn the family’s story • Explore strengths, needs, culture & vision • Identify & engage team & orient them to process • Arrange the first Child & Family Team Meeting • Create agenda for first meeting

  31. Wraparound Milwaukee • PHASE 2: • INITIAL PLAN DEVELOPMENT • Develop the Team, All Members are Heard & Valued • Determine ground rules • Distribute agenda • Document strengths of all members & the community • Develop an initial family vision to guide needs discussion • Identify & prioritise youth & family needs • Brainstorm & select strategies to meet needs • Review & finalise the initial crisis/safety plan • Assign roles & responsibilities • Schedule the next meetings

  32. Wraparound Milwaukee • PHASE 3: • Plan Implementation & Refinement • Continuous Review of Progress, Change Plan as Needed • The initial plan is implemented • Progress tracked by facilitator, discussed & reviewed • Success is evaluated & celebrated • New strategies are determined when necessary • The team builds cohesiveness, communication & trust • Facilitator addresses team member buy-in and family satisfaction • Updates are documented, logistics are addressed

  33. Wraparound Milwaukee • PHASE 4: • Plan Completion & Transition • Family Defines ‘Good Enough’ Transition to Informal & Natural Supports • Plans are made for transition out of formal Wraparound • Process & plan is modified to reflect ‘unwrapping’ • Team celebrates successes & work is documented • Transition portfolio is completed including • Important contacts • Past records • Follow-up plan for family

  34. Wraparound Milwaukee VALUES • One Family has One Plan • Build on strengths to meet needs • Families run their own plan • Best fit with culture &preferences • Community-based responsiveness • Increase parent choice &family independence • Care for children in context of families • Plans fail, families don’t • Hold people accountable • Unconditional approach • Never Give Up!

  35. Wraparound Milwaukee SERVICE STRUCTURES • Reflect Need, Rather than What is Funded • One electronic record, accessible to each service • Notes on time • Crisis teams have access to info after hours via computer • Contract people in, look for innovative people, not only clinicians • Each family gets 14 hours of direct service per month • Services purchased on fee for service basis • Consumers choose their own providers • Care coordination • Family advocacy

  36. Wraparound Milwaukee OUTCOMES • Does it Work, Can They Prove It? • Fewer kids in institutions or inpatient • Shorter stay when they do go in • 500 days of inpatient care compared to 5000 • 3,700 per month per child, compared to 8-9000 • School attendance increases • Academic achievement increases Is it as good as it sounds?

  37. Wraparound Milwaukee Miscellaneous Things that Stood Out • Care in context of family • If no family, then work on building a family • Family &youth partnerships—voice, choice &ownership • Care coordinators are key • 50% of plan should be informal services • Family advocacy is paramount

  38. Wraparound Milwaukee Family advocacy • Provided by Families United of Milwaukee • Build relationship with family • Support family to take active role in planning &decision making • Emphasiseimportance of voice, choice &ownership • Advocate with families in schools, courts, etc. • Coach families to partner with workers to effect change • Involved in Partnership Council • Welcoming families/Family Orientation • Training &coaching of providers • On quality committees, management team, review panels • Do whatever it takes!!!

  39. Wraparound Milwaukee CHALLENGES • According to a Panel of Service Partners • Engagement of families • Getting the right people at the table • Best practice among all systems—cross discipline • Meaningful sharing of information • Define each agencies roles &responsibilities • Education needs for young people • Different data management systems across agencies • Overlap of Wraparound Coordinator versus CYF Case Manager

  40. Wraparound Milwaukee CHALLENGES • Fairly Familiar • Drivers for NZ development of services • We know that children & families are central • Always working on improving the services we provide • Recognise that we are stronger when we work together

  41. The Concept of Technical Assistance Technical Assistance is the support offered to the System of Care to enable competence &confidence when partnering with infants, children &young people& their families/whanau, with mental health &/or AOD concerns

  42. Technical Assistance An Example • The Georgetown University Centre for Child &Youth Human Development • Partner with service-providers, government agencies, consumer &advocacy organisations& universities

  43. WHAT THEY DO • Continuing Education • Clinical Practicuum • Conferences • Workshops • Distance Learning • ‘Professional’ Preparation

  44. THEIR FOCUS System of Care Service Delivery Underpinned By: • Interdisciplinary strengths &evidence-based practice • Family Centred: Full partnership with families & youth • Community based • Culturally & linguistically competent • Effective Facilitative Leadership

  45. WHAT HAVE WE DEVELOPED?

  46. SYSTEM OF CARE NEW ZEALAND SYSTEMS New zealand systems • High & Complex Needs Funding • Individualised plan, multi-agency, buying services based on need • Strengthening Families • Child &family focused, family often guiding, multi agency • WhanauOra • Flexible, family at centre, navigator, service collectives • Plus Local Innovative Programs How would we develop our own System of Care?

  47. SYSTEM OF CARE NEW ZEALAND IMPLEMENTATION • Policy, Administrative, Regulatory Changes Needed • Cross-sector agreement to change delivery philosophy • Develop or Expand Services & Supports • Array of home &community, including CME • Creating or Improving Financial Strategies • Using existing funds creatively, useful doesn’t equal costly • Providing Training, Technical Assistance & Coaching • Sustainable, The Werry Centre &TePou, some DHBs • Generating Support • Families &youth, high level decision makers, providers etc

  48. SYSTEM OF CARE MULTIPLE LEVELS OF IMPLEMENTATION • Changes to State • Policies, financing, workforce development • Changes to Local System • Plan, implement, develop infrastructure, manage, evaluate • Changes to Service Delivery/Practice Level • Array of effective, evidence-informed treatments, services &supports to improve outcomes • Evaluation • Now consider this…

  49. Remember Josh?? • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use. • He is the oldest of 2 children, having a 9 year old sister Kelsy. • Josh lives with his mother & sister. His father has had no contact with the family since Josh was an infant. • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.

  50. Josh and his whānau are referred to Wrap Around New Zealand • The service partners with Josh, his whānau and all of the services and agencies that are currently involved to develop a goals-based plan for Josh and is whānau • With their Wrap-around New Zealand Service co-ordinator, Josh and his whānau consider all of the options of across-sectoral service delivery, and decide upon their preferences for service delivery

More Related