THE SKILL BUILDING CURRICULUM Module 3 Process and Structures in System Building

1. Primer Hands On-Child Welfare THE SKILL BUILDING CURRICULUM Module 3 Process and Structures in System Building Developed by: Sheila A. Pires Human Service Collaborative Washington, D.C. In partnership with: Katherine J. Lazear Research and Training Center for Children’s Mental Health University of South Florida, Tampa, FL Lisa Conlan Federation of Families for Children’s Mental Health Washington, D.C.

2. Process How system builders conduct themselves Structure What gets built (i.e., how functions are organized) Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

3. Structure “Something Arranged in a Definite Pattern of Organization” • I. Distributes • Power • Responsibility • II. Shapes and is shaped by • Values • III. Affects • Practice and outcomes • Subjective experiences (i.e., how participants feel) Pires, S. (1995). Structure. Washington, DC: Human Service Collaborative.

4. Example Goal: One service & support plan; one service manager • Mental Health • Individualized Wraparound Approach • Care manager • Child Welfare • Family Group Decision Making • CW Case Worker Kinship Care Subsidized Adoption Permanent Foster Care Tutoring Parent Support, etc. Crisis Services Treatment Foster Care In-Home Services • Juvenile Justice • Screening & Assessment • Probation officer Children in & at risk for out-of-home placements • Education • Child Study Team • Teacher Community Services • MCO • Prior Authorization • Clinical Coordinator Alternative School EH Classroom Related Services Out-patient services Primary Care Med. Mngt. Result: Multiple service & support plans; multiple service manager Pires, S. (2004). Primer Hands On. Human Service Collaborative: Washington, DC

5. Wraparound Milwaukee CHILD WELFARE Funds thru Case Rate (Budget for Institutional Care for CHIPS Children) JUVENILE JUSTICE (Funds budgeted for Residential Treatment for Delinquent Youth) MEDICAID CAPITATION (1557 per month per enrollee) • MENTAL HEALTH • Crisis Billing • Block Grant • HMO Commercial Insurance 9.5M 8.5M 10M 2.0M Wraparound Milwaukee Management Service Organization (MSO) $30M Families United $300,000 Per Participant Case Rate Provider Network 240 Providers 85 Services Service Coordination Child and Family Team Plan of Services & Supports Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee Count Mental Health Division, Child and Adolescent Services Branch.

6. Truisms About Structure • Certain functions must be structured and not left to happenstance • Structures need to be evaluated and modified if necessary over time • New structures replace existing ones; some existing ones are worth keeping; some are more difficult to replace than others • There are no perfect or “correct” structures Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

7. System of Care Functions Requiring Structure • Planning • Decision Making/Policy Level Oversight • System Management • Service & Supports Array • Evidence-Based & Promising Practices • Outreach and Engagement • System Entry/Access • Screening, Assessment, & Evaluation • Decision Making & Oversight at the Service Delivery Level • Services & Supports Planning • Services & Supports Authorization • Service Monitoring & Review • Service Coordination • Crisis Management at the Service Delivery & Systems Levels • Utilization Management • Family Involvement, Support, & Development at all Levels • Youth Involvement, Support, & Development • Human Resource Development/Staffing • Staff Involvement, Support, Development • Orientation, Training of Key Stakeholders • External & Internal Communication • Provider Network • Protecting Privacy • Ensuring Rights • Transportation • Financing • Purchasing/Contracting • Provider Payment Rates • Revenue Generation & Reinvestment • Billing & Claims Processing • Information Management • Quality Improvement • Evaluation • System Exit • Technical Assistance & Consultation • Cultural & Linguisrtic Competence Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative.

8. Core Elements of an Effective System-Building Process The Importance of Leadership & Constituency Building • A core leadership group • Evolving leadership • Effective collaboration • Partnership with families and youth • Cultural and linguistic competence • Connection to neighborhood resources and natural helpers • Bottom-up and top-down approach • Effective communication • Conflict resolution, mediation, and team-building mechanisms • A positive attitude Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative.

9. Core Elements of an Effective System-Building Process The Importance of Being Strategic • A strategic mindset • A shared vision based on common values and principles • A clear population focus • Shared outcomes • Community mapping—understanding strengths and needs • Understanding and changing traditional systems • Understanding of major financing streams • Connection to related reform initiatives • Clear goals, objectives, and benchmarks • Trigger mechanisms—being opportunistic • Opportunity for reflection • Adequate time Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative

10. The 5Cs of Core Leadership Constituency (representativeness) Credibility Capacity Commitment Consistency Pires, S. (2005). The 5Cs of core leadership. Washington, DC: Human Service Collaborative.

11. Examples of Leadership Styles • Charismatic • Facilitative • Managerial Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

12. Partnership Involves • Team Building • Communication • Negotiations • Conflict Resolution • Leadership Development • Mutual Respect • Skill Building • Information Sharing Pires, S. (1996). Partnership involves. Washington, DC: Human Service Collaborative.

13. Principles to Guide Collaboration • Build, maintain trust so collaborative partners are able to share information perceptions, feedback and work as a cohesive team. • Agree on core values that each partner can honor in spirit & practice. • Focus on common goals that all will strive to achieve. • Develop a common language so all partners can have a common understanding of terms (i.e., “family involvement,” “culturally competent services.” • Respect the knowledge and experience each person brings. • Assume the best intentions of all partners. • Recognize strengths, limitations, and needs; and identify ways to maximize participation of each partner. • Honor all voices by respectfully listening to each partner and attending to the issues they raise. • Share decision making, risk taking and accountability so that risks are taken as a team and the entire team is accountable for achieving the goals. Stark, D. (1999). Collaboration basics: Strategies from six communities engaged in collaborative efforts among families, child welfare, and children’s mental health. Washington, DC: Georgetown Child Development Center, National Technical Assistance Center for Children’s Mental Health

14. Challenges to Collaboration “Barrier Busters” Adapted from Wraparound Milwaukee. (1998). Challenges to collaboration/“barrier busters.” Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch.

15. Catalyst/Trigger Mechanisms • Legislative mandates (new or existing) • Study findings (needs assessments, research, or evaluation) • Judicial decisions - Class action suits • Charismatic/powerful leader • Outside funding sources (federal, foundations) • Funding changes • Local “scandals” and other tragedies • Coverage of successes • CFSR findings/Program Improvement Plans Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative .

16. Building Local Systems of Care: Strategically Managing Complex Change Human Service Collaborative. (1996). Building local systems of care: Strategically managing complex change. [Adapted from T. Knosler (1991), TASH Presentations]. Washington: DC.

17. Example: Cuyahoga County (Cleveland) Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

18. Cuyahoga County (Cleveland) System of Care Oversight Committee County Administrative Services Organization FCFC $$ Fast/ABC $$ Residential Treatment Center $$$$ Therapeutic Foster Care $$$ “Unruly”/shelter care $ Tapestry $$ SCY $$ } State Early Intervention and Family Preservation } System of Care Grants Neighborhood Collaboratives & Lead Provider Agency Partnerships Reinvestment of savings Community Providers and Natural Helping Networks Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.