the CANS in SF: Process, Progress, Promise

1. the CANS in SF:Process, Progress, Promise April 19, 2010 Nathaniel Israel, PhD SFDPH CBHS CYF-SOC

2. Thank-Yous.. • San Francisco’s Children, Youth, and Families • Sai-Ling Chan-Sew, Director CYF-SOC • Community Programs Administration • John Lyons • Clinicians, Case Managers, and Program Directors

3. Presentation: Pro, Con, Process • Morning: High Energy • First Talk: High Expectations • Our Way Through: • Values of CANS • Collaboration: Audience Participation • Outcome Focus: Objectives in Bold

4. Starting Point: Get Out! • 22 Programs • 3 Advocacy Groups • 2 Themes: • Programs • Complex Needs of Children, Youth, Families, Communities • Provider History with Community • Provider Confidence in Effectiveness of Practice

5. Families • People in Systems aren’t listening to us • If they are, they’re not changing anything • Aren’t investing in us • Humanistic theory: don’t achieve our potential because something is in the way • Here it’s the systems that pay our paychecks: it’s us • Resources are there but they’re not being used effectively to help us

6. Empowering Narratives • Stories likely not new • Never been collected in a way that would allow us to: • Be forced to honor them and • Find concrete “next steps” to take to act in new ways that would better help families

7. Framework for Change • Value: • Put families and children first ; serve them effectively • Tool: • the __ __ __ __ • Process: • Become “communication rich” in actions that matter most for children, youth and families

8. Initial Implementation • Can we move from fights and frustrations to rational system that puts families first in policy and progress? • FCMH: • Long wait times for assessment • Under-serving FC population • Concern that treatment not matched to need

9. FCMH Implementation • Lessons learned: • Meaningful goals can be accomplished • Wait time reduced by 2/3rds • Confidence that treatment matched to needs • Cross-system communication can become understandable and rational • Requires persistent focus on outcome • Everyone involved has to have access to information about the outcome that matters • Progress facilitated by weekly review of progress, and problem solving to make more progress

10. Systemwide Implementation • If you can do something on a small scale, then you can do it on a large scale, right? • What could the possible barriers be?

11. Barriers • System changes: • Move to HER • Antiquated system did not support any entry of CANS • Had to switch to interim online system • Funding cuts • Scaling Issues: • Massive increase in scale with no attendant staffing increase (1 program to 61 programs)

12. Uneven Pace of Implementation • Early Adopters • Take it and run! • Hesitant Prove-its • Wait-and-See • Kick the CANS • ….and hope it dies.

13. Parallel Processes • Clear need for both Technical and Social Implementation / Learning Process • Chose local web-based app design firm (AJWI) • Began communication process to identify and answer implementation issues, identify system issues, and learn form successes

14. Social Process Multi-Level Training and Communication: • Certification • SuperUswer Certification • Applying CANS to practice (Treatment Planning, Identification of Outcome patterns) • SuperUser Calls • Manuals: SUPSM, Tx Planning, EBC • Policy Development (transfer, aging up) • Using CANS to be explicit about treatment goals, learn from each other

15. Technical Process Instant, Multi-Level Feedback from CANS: • Instant Feedback for Treatment Planning • Instant visual of client needs / strengths • Evidence based, client based Clinical Formulation • Cross-time comparison of client progress • Cross-clinician data for supervision • Program-Level Clinical Formulation

16. Goal • Utilize processes people are already familiar with to make sense of and act on these new sources of child, youth and family information

17. Client –Level Formulation / Progress

18. Program-Level Clinical Formulation

19. Program-Level Clin. Form. (2)

20. Program Clinical Formulation

21. But the learning and acting can’t stop there…

22. System-Level Profile

23. System-Level Profile

24. Cross-Agency Progress

25. Progress in SF: Process • Value: • Put families and children first ; serve them effectively • Tool: • the __ __ __ __ • Process: • Become “communication rich” in actions that matter most for children, youth and families

26. Progress In SF: Present • Now we have identified what are the most pressing needs of our children, youth, and families • We have identified the environments in which we must collaborate for success • We have a way to identify who we need to learn more from to promote effective practices for our children youth and families

27. Progress in SF: Next Steps • Full circle with families: CANS education for treatment empowerment • ‘Digging in’ to practices that are promising for families • Combining knowledge of EBTs and effective local practices to provide the care with the greatest chance of success for families

28. Thank you! • Contact info: nathaniel.israel@sfdph.org • Complete your attendance sheet and Evaluation sheet for CEUs / CMEs!