Final Report:

1. Final Report: Implementation of Family Representation on County Interagency Oversight Groups to Support HB1451 Prepared for The Family Voice and Choice Subcommittee of the Colorado Federation for Children’s Mental Health The Collaborative Management Program of the Colorado Department of Human Services May, 2010

2. Presenters and Agenda Background Joe Russell Key Results Tiffany Johnson Recommendations Tiffany Johnson & Joe Russell Team supervisor and discussant: Donna Heretick, Ph.D. Argosy University Denver Program Evaluation Team (AUDPET)

3. Background • HB1451 passed the legislature in 2004 becoming law in July 2005. It was designed to including the family voice at the county policy making level regarding services that directly affect individuals and families. • Responsibility for implementing HB1451 was delegated to Health and Human Services, under the direction of Norm Kirsch. • The state incentivized county participation by providing funding through fees collected from divorce proceedings.

4. Background • Fall, 2008: AUDPET asked by The Family Voice and Choice Subcommittee of the Colorado Federation for Children’s Mental Health and The Collaborative Management Program of the Colorado Department of Human Services to plan and implement research into family involvement process. • Identify the factors and processes which support or impede meaningful integration of family involvement for county Interagency Organization Groups (IOG’s) and Collaborative Management (HB1451) processes, as exemplified by authentic involvement and equal voting membership of family representatives within the IOG for governance and policy making.

5. The Family Voice and Choice Subcommittee of the Colorado Federation for Children’s Mental Health and The Collaborative Management Program of the Colorado Department of Human Services agreed to: • Provide funding for AUDPET members expenses for hotel, food, phone, copying, and office supplies related to focus groups and individual interviews • Determine which county IOGs would participate. • County HB1451 Coordinators and IOGs identified stakeholder groups and arranged focus group meetings.

6. November 2008: Family Voice and Choice Subcommittee identified four categories and representative counties for comparison of mechanisms and progress. One county from each category volunteered to participate in focus groups. • “Good Family Involvement” (Stable family representation on county IOG): El Paso County • “Family Representation with Challenges” (Family representation on county IOG with some challenges along the way)*: Jefferson County • “Sporadic Family Involvement” (Some progress toward family representation on county IOG): Pueblo County • “Newly Emerging Family Involvement” (Preparing for family representation on county IOG): Garfield County. (* Designation revised, April, 2010)

7. Protocol Completed to Date • Phase I: (September to December 2008) AUDPET and Family Involvement Collaborative Management groups planned and developed MOUs with participating counties. • Phase II (January, 2009 to February, 2010) AUDPET worked with county HB1451 coordinators and IOGs to identify key stakeholder groups and areas of information gathering, and to schedule focus group meetings.

8. Key Areas of Questions Across Counties and Groups

9. Focus groups were conducted with members of the IOG and representatives of key stakeholder groups from each county: • El Paso County: April, 2009 • Pueblo and Garfield Counties: January, 2010 • Jefferson County: IOG, December, 2009; other stakeholder groups, February, 2010 Reports were submitted to each county for initial review within one month of completion of interviews

10. Reports with Recommendations March-April, 2010: Reports prepared by AUDPET - Individual County Reports: Prepared for individual participating counties' IOGs* - Integrative report summarizing four counties' findings* *All reports also filed with the Family Voice and Choice Subcommittee of the Colorado Federation for Children’s Mental Health and The Collaborative Management Program of the Colorado Department of Human Services

11. General Findings • Commitment • All four counties have a history of and commitment to a systems of care approach to services. This has provided the foundation for their choice to become involved with HB1451 initiatives and development of the IOG.  • Philosophy of Family Involvement • Each county had a family involvement philosophy initiated before HB1451 legislation incentivized the initiative. HB1451 legislation provided a vehicle for greater emphasis and concentration of their effort.   • Active Initiative • Each county has spent a considerable amount of time developing the family voice initiative, sharing ideas with other counties, while honoring their communities uniqueness and needs. The process of refinement continues in each county. • Leadership with passion • All four counties have individuals in key leadership roles and providers in the field who bring passion, experience, and genuine interest in helping families.

12. Core difference • The counties differ primarily in the degree to which families are viewed and integrated as keyresources for family care, from entry into services to policy-making levels. • El Paso – High fidelity wraparound systems of care • Jefferson –Philosophy plus some mechanisms in place (need expansion and integration) • Garfield - Philosophy with planned mechanisms (Comprehensive Community Family Assessment Model) • Pueblo - Philosophy still in development; mechanisms for family representation not yet identified/ implemented

13. Key Observations • Successful inclusion of meaningful family voice on the IOG appears to be enhanced where thelarger system of care involves family advocates as resource at all levels, from entry into the system through policy-making boards. • There is general interest in family involvement and voice when providers and families become aware of this possibility. However, often these groups are not aware of the possibilities or processes for implementation.

14. General Recommendations • More community education for all stakeholder groups regarding the philosophy and implementation of family voice - This is an ongoing need to support paradigm shift regarding family involvement. • Expanded Resources for County IOGs • Expand opportunities for communication and consultation among counties (beyond the Collaborative Management State Steering Committee) in order to share their experiences, lessons, and resources. • Tool kits to help counties in earlier stages of implementation of the IOG and family voice. • Continue funding mechanisms to sustain the progress and efforts made by the counties.

15. General Recommendations (Cont.) • Systematic Training and Mentoring Resources for Developing Family Voice Practices. • Supportive training and mentoring for IOGs, HB1451 coordinators, and providers for inclusion of family voice. • Supportive training and mentoring for family members who may be identified as candidates for various roles as family advocates and representatives to the IOG. Note: The Colorado Federation of Families for Children's Mental Health has a history of serving in this capacity and would be a prime resource for serving this function. • Ongoing Systems for Feedback and Evaluation - Processes for systematic feedback from members of all stakeholder groups (families, providers, community members, etc.) to identify successes, challenges, and opportunities for meeting family needs

16. County Summaries • El Paso - “Good Family Involvement” • Principal Finding - The Wraparound Model provides opportunities for family voice and empowerment from the time a family enters the system as a recipient of services, to the ability to support other families as a Family Support Partner on a care team, to other advocacy roles, including membership on the IOG. • Recommendations - Develop more focused mechanisms to identify and train family representatives (e.g., from those who serve as Family Support Partners or are active in other family advocacy activities) towards roles on the IOG

17. County Summaries • Jefferson – Family Representation with Challenges • Finding - Jefferson County has made a solid commitment to following the Systems of Care model, which has broadened perspectives on how to serve families better and include families in all services. • Recommendation - More communication about HB1451 should flow through all service groups involved with providing services to families.

18. County Summaries • Garfield – Newly Emerging Family Involvement • Finding - The Comprehensive Community Family Assessment Model provides opportunities for family voice from the time a family enters the system as a recipient of services, including membership on the IOG. • Recommendation -  Expand training for IOG members and ISST groups of all stakeholders in the Comprehensive Community Family Assessment model and incorporation of the family voice.

19. County Summaries • Pueblo – Sporadic Family Involvement • Finding - In Pueblo County, family representation has been initiated on the IOG through selecting a person with experience working with the Pueblo school system as a family advocate. However, he has since moved on to become HB1451 Coordinator. There is no family representative on the IOG at this time, although a process is being developed to identify candidates. • Recommendation - Beginning with the IOG, expand training and consultation to members of all stakeholder groups in the family voice philosophy and related practices.