SYSTEM OF CARE 101: 8 Guiding Principles to Effective Community Care

1. SYSTEM OF CARE 101:8 Guiding Principles to Effective Community Care June 2013 West Virginia System of Care

2. Welcome, All Partners! Division of Child & Adolescent Behavioral Health Bureau for Children & Families

3. Your Training Team • Karie Martin, West Virginia System of Care • Tiffany Pittman, WV Bureau for Behavioral Health & Health Facilities • Jeanette Rowsey, West Virginia System of Care • Linda Watts, West Virginia System of Care

4. Learning Objectives • Become aware of behavioral health needs and services for West Virginia children and youth • Become familiar with West Virginia’s efforts • Learn how children and youth with serious emotional and behavioral disturbances and their families can be best served in the community • To learn specific principles, actions and practices that move toward improved service delivery

5. Level of Need • 20% of U.S. youth exhibit “complex problems” or mental health challenges • 10% have a serious emotional disorder • Only 2% of school age children are identified with serious emotional disorders. • Fewer than 1 in 4 students with significant emotional and behavioral needs receive “minimally adequate treatment” (Surgeon General’s Report, 2000)

6. Who are WV’s Children & Youth at Risk of Out-of-Home Care? OVERLAPPING POPULATIONS Children & Adolescents with: • Developmental Disabilities • Juvenile Proceedings • Substance Abuse • Abuse/Neglect • Trauma • Serious Emotional Disturbances

7. How many West Virginia children are not sleeping in their own beds tonight? • In May 2012: 261 children/youth in state custody at facilities out of state • In June 2012: 128 children youth in parents’ custody at facilities out of state • In May 2012: 820 children/youth at facilities in state • 2012: 301 average youth per month in DJS facilities 1,510

8. 1,510

10. A Partnership—NOT a Program or Agency YOU are the System of Care!

11. Our Mission The West Virginia System of Care is a public-private-consumer partnership dedicated to : Building and maintaining effective community based services and supports for children and youth with, or at-risk for behavioral health related challenges, and their families.

12. Systems of Care • Coordinated network • Community-basedservices and supports • Organized to meet the challenges of children and youth with serious behavioral health needs and their families • Families and youth work in partnership with public and private organizations • Services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. • A system of care helps children,youth and families function better at home, in school, in the community and throughout life. Gary Blau, Child, Adolescent and Family Branch, CMHS, SAMHSA

13. System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their Families Program Passamaquoddy Tribe, ME Maine (3 counties) King County, WA Maine (4 counties) New Hampshire (3 regions) Vermont 1 (statewide) Worcester County, MA Sault Ste. Marie Tribe, MI Vermont 2 (statewide) Blackfeet Tribe, MT Worcester, MA Clark County, WA Bismarck, Fargo, & Minot, ND Rhode Island 1 (statewide) Montana & Crow Nation Rhode Island 2 (statewide) Multnomah County, OR Albany County, NY Mid-Columbia Region (4 counties), OR Minnesota (4 counties) Monroe County, NY Rhode Island 3 (statewide) Wisconsin (6 counties) Sacred Child Project, ND Connecticut (statewide) Clackamas County, OR Southeastern Connecticut Ingham County, MI Erie County, NY Westchester County, NY Lane County, OR New York, NY Willmar, MN Idaho Oglalla Sioux Tribe, SD Detroit, MI Mott Haven, NY Kalamazoo County, MI Northern Arapaho Tribe, WY Burlington County, NJ Cuyahoga County, OH Yankton Sioux Tribe, SD Milwaukee, WI South Philadelphia, PA United Indian Health Service, CA Allegheny County 1, PA Chicago, IL McHenry County, IL Lake County, IN Allegheny County 2, PA Lyons, Riverside, & Proviso, IL Nebraska (22 counties) Wyoming (statewide) Beaver County, PA Southern Consortium & Stark County, OH Glenn County, CA Delaware (statewide) Butte County, CA Marion County, IN Montgomery County, MD Placer County, CA Baltimore, MD Lancaster County, NE Alexandria, VA Napa & Sonoma Counties, CA Denver area, CO Washington, DC Charleston, WV St. Louis, MO Rural Frontier, UT Northern Kentucky Sacramento County, CA Southeastern Kansas Contra Costa County, CA Edgecombe, Nash, & Pitt Counties, NC Eastern Kentucky St. Charles County, MO San Francisco, CA Colorado (4 counties) Urban Trails, Oakland, CA North Carolina (11 counties) Sedgwick County, KS Clark County, NV North Carolina (11 counties) Nashville, TN Monterey, CA Southwest Missouri Mecklenburg County, NC California 5 (Riverside, San Mateo, Santa Cruz, Solano, & Ventura Counties) Navajo Nation South Carolina (3 counties & Catawba Nation) Maury County, TN Oklahoma (5 counties) Mississippi River Delta area, AR Greenwood, SC Santa Barbara County, CA California Rural Indian Health Board, Inc., CA Birmingham, AL Charleston, SC Los Angeles County, CA Gwinnett & Rockdale Counties, GA Choctaw Nation, OK San Diego County, CA Las Cruces, NM Pima County, AZ Ft. Worth, TX Hinds County, MS El Paso County, TX Travis County, TX Hillsborough County, FL Harris County, TX Southeastern Louisiana West Palm Beach, FL Sarasota County, FL Broward County, FL Funded Communities Fairbanks Native Association, AK DateNumber Wai'anae & Leeward, HI 1993–1994 22 1997–1998 23 1999–2000 22 2002–2004 29 2005 25 Guam Yukon Kuskokwim Delta Region, AK Puerto Rico Honolulu, HI

14. Eight Guiding Principles • Family-Driven • Youth-Guided • Culturally & Linguistically Competent • Array of Community-Based Services • Best Practice in Service Delivery • Quality Assurance • Government Accountability • Interagency Collaboration

15. West Virginia Background

16. West Virginia Milestones • 1990s: • Statewide Family Network • Providers Collaborating at Regional & Local Levels • Regional SOC Grant/Demonstration (1999-2006) • 2000-2005: • Residential Placement Commission • WV Code Chapter 49-7-34 includes System of Care intent • State Policy Academies – Implementation Team • 2006-2010: • State Funding for Family Advocacy, Support & Training services • Statewide Establishment of Regional Clinical Review for Youth Out of State • State receives federal Technical Assistance to conduct Service Array assessment process • 2011-2013 • WV awarded Federal System of Care Expansion Grant

17. Current Priorities

18. Major Goals in West Virginia • Family Advocacy, Support & Training • Statewide Youth Coordinator • Circle of Parents support groups • Expanded School-Based Mental Health • Child & Adolescent Needs & Strengths Assessment • Professional Development • Increasing Access • Quality Improvement

19. WV System of Care Moving from fragmented to integrated approach

20. Moving SOC Principles Into Practice: WhyIt Matters • Individual agencies in U.S. are evaluating how closely their practices reflect the system of care philosophy. • Children who received services in systems embodying high levels of SOC principles evidenced significant reductions in symptoms and impairment SOURCE: University of South Florida, SOC Practice Review

21. Agency Culture: Family-Driven Care

22. Agency Culture: Family-Driven Care

23. Guiding Principles in Daily Practice: Self-Evaluation

24. Family-Driven Care “We make home visits to include parents and make appointments so they do not have to miss a day of work to participate in their child's services…We have a strong engagement policy that includes parents that staff are expected to follow…We have a family resource center in our main site staffed by a full time person who assists families with multiple non-therapeutic needs..Parent consumers serve on our board and advisory groups always.”

25. How is the principle of Family-Driven Care put into daily practice? • Parents/Caregivers I work with understand the content of the service plan • I recognize that the family’s participation in service planning and in the decision making process is impacted by their knowledge & understanding of the expectations of the agencies/programs/providers • I assist parents/caregivers in understanding and navigating their programs/agencies • Parents/Caregivers I work with actively participate in the service planning process (initial plan & updates) • Parents/Caregivers I work with influence the service planning process (initial plan & updates) • Parents/Caregivers I work with actively participate in services Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

26. Youth-Guided Care “Youth are active participants in the treatment planning process. They have a voice and are educated at the time of intake of their rights and responsibility in this role as well as all of their rights. (Our agency) conducts student councils and youth are active members of these student councils and are educated on their role. They are able to provide input into making their treatment process the best it can be, and can provide feedback into ways in which programming can improve.”

27. How is the principle of Youth-Guided Care put into daily practice? • Youth I work with understand the content of the service plan • I recognize that the youth’s participation in service planning and in the decision making process is impacted by their knowledge & understanding of the expectations of the agencies/programs/providers • I assist youth in understanding the agencies they represent • Youth I work with actively participate in the service planning process (initial plan & updates) • Youth I work with influence the service planning process (initial plan & updates) • Youth I work with actively participate in services Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

28. Cultural & Linguistic Competence “We are awarded federal and state grants which require that our agency and staff give culturally competent care. Staff are trained in cultural competence annually..our staff are trained in ethnographic interviewing so they know how to determine cultural forces important to their clients.”

29. How is the principle of Culturally Competent care put into daily practice? • I verbally communicate in the primary language of the child/family • I can provide written documentation regarding services/service planning is in the primary language of the child/family • I can provide services in a comfortable environment • I recognize that the child and family must be viewed within the context of their own cultural group and their neighborhood and community. • I know about the family’s concepts of health and family • I recognize that the family’s culture, values, beliefs and lifestyle influence the family’s decision-making process Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

30. How is the principle of Culturally Competent care put into daily practice? (CONTINUED) • I recognize that the child and family must be viewed within the context of their own cultural group and their neighborhood and community. • I am aware of my own cultural values, beliefs and lifestyles and how these influence the way I interact with the child and family. • I am aware of the dynamics inherent when working with families whose cultural values, beliefs and lifestyle may be different from or similar to my own. • I translate my awareness of the family’s values, beliefs and lifestyle into action • Services I provide are responsive to the child and family’s values, beliefs and lifestyle

31. Community Based Services & Supports “(Our agency) would like to be able to provide community based services, and to be held accountable to outcomes and be funded in a way the service could be provided to best meet the needs of the youth and families. We are willing to work with and partner with other organizations in order to meet service gaps.”

32. Formal & Informal • FORMAL SERVICE SYSTEMS: • Mental Health • Child Welfare • Education • Juvenile Justice • INFORMAL SUPPORTS & HELPERS: • Sports • Hobbies • Clubs • Extracurricular activities • Religious activities • Other community based activities

33. How is the principle of Community-Based care put into daily practice? • As soon as the child and family was referred, my agency clarified the child and family’s needs • As soon as the child and family was referred, my agency responded by offering the appropriate combination of services and supports in a timely manner • Services are scheduled at convenient times for the child and family • Services are provided within or close to the family’s home community Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

34. Best Practice in Service Delivery “All services at (our agency) must be an established best practice or model service, or a program with evidence of its likely effectiveness with our target populations.”

35. How is the principle of Best Practice service deliveryput into daily practice? • Families I work with have a primary service plan that is integrated across providers and agencies • A thorough assessment or inventory was conducted across life domains • The needs of the child and family have been identified and prioritized across a full range of life domains • The strengths of the child and family have been identified • Evidence-based treatments and services are used • All services and supports are trauma-informed Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

36. How is the principle of Best Practice service deliveryput into daily practice? (CONTINUED) • The service plan goals reflect needs of the child and family • The service plan goals incorporate the strengths of the child and family • The service planning and delivery acknowledges or considers the strengths of the child and family • The types of services/supports provided to the child & family reflect their needs and strengths • The Intensity of services/supports provided to the child & family reflect their needs and strengths Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

37. Life Domains In a thorough assessment information is gathered about the following issues: • Emotional • Behavioral • Medical • Physical • Intellectual • Educational • Social • Recreational • Vocational • Cultural • Spiritual • Financial • Legal • Familial • Residential • Safety • Self-Care • Drug/Alcohol Use System of Care Practice Review (SOCPR), University of South Florida

38. Trauma-Informed Principles • Recovery is possible • Healing happens in relationships (trustworthiness) • Understand trauma & its impact • Minimize re-traumatization • Ensure cultural competence • Promote safety, respect, acceptance • Support empowerment, choice & autonomy • Share power, governance, evaluation • Integrated Care System of Care Practice Review (SOCPR), University of South Florida

39. Evidence Based Practices

40. Quality Assurance “We collect an abundance of outcomes that assist us in determine effectiveness of services. (Our agency) is moving forward from outcomes to impact as we are becoming more interested in how our services are preparing youth and families to be successful long-term and how our services are assisting youth to become productive members of their communities, gain skills necessary for them to further education, graduate, gain work/career skills, be prepared to go to college, graduate college, become employed, become a self-sustaining member of their community etc.”

41. How is the principle of Quality Assurance put into daily practice? • I can demonstrate that the services and supports provided to the child and family have improved their situation • I can demonstrate that the services and supports provided to the child and family have appropriately met their needs Sources: WV System of Care Guidelines, System of Care Practice Review (SOCPR), University of South Florida

42. Government Accountability “(Our State Division) allows funding to follow the youth through the system.”

43. What does it look like when “Government Accountability” principle is put into practice? • I educate families about their rights and expectations regarding agency responsibilities, programs and providers • I assist the child and family in understanding and navigating the agencies they represent • Families I work with are provided with information about steps to assure they are getting what they need from their service providers, including steps for holding them accountable Sources: WV System of Care Guidelines; System of Care Practice Review (SOCPR), University of South Florida; “Requesting Accountability” by Phil Rabinowitz & Val Renault, University of Kansas Work Group for Community Health & Development (2013)

44. Holding Entities Accountable: Tools & Steps • Do homework – research. • Decide what kind of accountability you need. • Appeal directly to the entity. • Appeal to the appropriate regulatory agency. • Go public. • Institute direct action. • Advocate for official changes in laws or policy. • Initiate a lawsuit. Source: “Requesting Accountability” by Phil Rabinowitz & Val Renault, University of Kansas Work Group for Community Health & Development (2013)

45. Interagency Collaboration “We have shared resources with many other community partners including local boards of education and local schools.”

46. What does it look like when “Interagency Collaboration” principle is put into practice? • There is ongoing two-way communication among and between all team members, including formal service providers, informal helpers (if desired by the family), and family members including the child • There is a smooth, seamless process to link the child and family with additional services, if necessary • There is one person who successfully coordinates the planning and delivery of services and supports Sources: WV System of Care Guidelines; System of Care Practice Review (SOCPR), University of South Florida

47. Moving SOC Principles Into Practice: WhyIt Matters • Individual agencies in U.S. are evaluating how closely their practices reflect the system of care philosophy. • Children who received services in systems embodying high levels of SOC principles evidenced significant reductions in symptoms and impairment one year after entry into services, while children in systems embodying low levels of SOC principles did not. SOURCE: University of South Florida, SOC Practice Review

48. Eight Guiding Principles • Family-Driven • Youth-Guided • Culturally & Linguistically Competent • Array of Community-Based Services • Best Practice in Service Delivery • Quality Assurance • Government Accountability • Interagency Collaboration

49. What does it look like when SOC principles are put to work? • Recognize two principles where your practice is strongest • Consider one principle to work on • Share strengths & strategies • Gather new tools • Commit to action

50. System Strengths & Areas for Growth