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What Makes a System of Care Systematic?

What Makes a System of Care Systematic?. How Systematic Can a Mental Health System of Care Be?. Mental health is not FedEx. Mental health care is inherently messy. And – if the need for services overwhelms chronically under-staffed providers many of whom are not well prepared to serve children

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What Makes a System of Care Systematic?

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  1. What Makes a System of Care Systematic?

  2. How Systematic Can a Mental Health System of Care Be? • Mental health is not FedEx. • Mental health care is inherently messy. • And – if the need for services overwhelms chronically under-staffed providers many of whom are not well prepared to serve children • And - if budgets are inadequate and reimbursement rates punishingly low • And – if there is a deeply ingrained stigma preventing people from getting help for their children before their situations are falling apart • What can be realistically hoped for?

  3. I have never despaired … because I have never hoped. http://www.youtube.com/watch?v=9K30e9O3Nng

  4. Goals of the Session • Analyze a system of care’s vulnerability to three major threats: • Diffusion of responsibility; • Organizational inertia; and • Organizational entropy. • Identify ways of making a system of care robust.

  5. The Case of Jose • What system of care problems can be inferred from Jose’s case? • Assume you are the Director of Maternal, Child and Adolescent Health in the county serving Jose and his family.  You decide to call a meeting to address the problems Jose’s case highlighted.  Who would you invite? • Assume everyone is very interested in making sure there are no more Jose’s.  Despite everyone’s good intentions, what serious challenges will the county face in trying to avoid a similar scenario in the future?

  6. Quick Poll • Have you experienced cases like Jose’s? • Yes, just as bad • Yes, but not nearly as bad as Jose’s case • No

  7. Quick Poll • Have you ever participated in a system of care meeting with leaders trying to address a case like Jose’s? • Yes, it was fully attended • Yes, but we did not have everyone we needed at the table • No

  8. Quick Poll • If “yes” to the system of care meeting, how would you describe the outcome of that meeting? • We made real progress. Positive changes came of it. • Mixed success. There were some changes for the better but nothing really significant and enduring. • We tried but nothing really changed.

  9. Diffusion of Responsibility • Also know as the “bystander effect” • When an individual is part of a group, they do not feel responsible to act when something goes wrong. That same person, if alone, often will step in.

  10. System of Care and Diffusion of Responsibility • Where in a system of care might a diffusion of responsibility creates cracks through which children and families might fall? • Break it down by age group. • 0-3 • 4-5 • 6-12 • 13-18

  11. Organizational Intertia • An object at rest … An object in motion … • An organization that is being asked to change or initiate something new will experience organizational inertia. • In your plan which organizations are being asked to change? • How much inertia will the system of care encounter?

  12. Organizational Entropy • Entropy – the tendency for things to break down over time. • What in a system of care can break down over time? • Critical relationships – retirement, moves, promotions • Loss of institutional knowledge – retirement, etc. • Changes in support – funding, space, political will • ?

  13. What Can Be Done? Each community and each situation is unique but … • Build relationships across organizations Help organizations and individuals own the System of Care (use training events, convene the leaders) • Establish clear expectations Write things down Read the Checklist Manifesto • Provide feedback, especially early on

  14. What Can Be Done? 4. Celebrate success 5. Recognize individuals 6. Address breakdowns in a blame-free way 7. Help providers benefit from participation – high quality training, fewer no shows, effective referrals, timely information and feedback; better enrollment in programs 8. Position people on the front line to revise the system of care from their experience

  15. Final Thoughts • Common Ground • Everyone wants to have a really good system of care for children. • Relationships, Relationships, Relationships • Make time to get together with people and get to know their situation. And, let them know that you understand. • Challenge and Support • Go hard on the problem; go soft on the people

  16. Q & A

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