Strategies for Achieving Sustainability Integrating Professional for Appalachian Children (IPAC)

1. Strategies for Achieving Sustainability Integrating Professional for Appalachian Children (IPAC) Jane Hamel-Lambert, MBA, PhD, President, IPAC Sherry Shamblin , Chair, Board of Directors, IPAC ORHP All Grantee Meeting, Washington, DC Peer to Peer Sustainability PanelAugust 2, 2010

2. Overview Integrating Professionals for Appalachian Children Seven Strategies for Achieving Sustainability Exemplar: Tri-County Mental Health & Counseling Services, Inc

3. Vertical network: participating agencies… child serving systems… mental health, medicine, speech language, audiology, nursing, schools, early intervention … and parents. • Legal Status: 501(c)3 • Governance Structure: Independent Board of Directors,15 person; bylaws (corporate regulations)

4. Vision & Mission IPAC’s vision is to ensure healthy development for all children. Mission: By leveraging our expertise and integrating our resources, IPAC will develop innovative, culturally-sensitive programs that address the critical and complex challenges impacting the health and mental health of our region’s children and families.

5. Rural, Appalachian, Southeast OH • Professional Shortages: HPSAs, MHPSAs, Dental • Medically Underserved Areas (MUAs) • High Poverty • High Unemployment • Low Educational Attainment

6. What was happening … OU Therapy Associates Grandma’s FP Physician Mom’s FP Physician Head Start Home Services GI Children’s Hospital GI Specialist Local Hosp OT Sensory Integration Local Hospital ER Endocrine Children’s Hospital Visual Tracking Therapy Public School ER Zanesville Auditory Processing Evaluation Redesigned Services OU Psych & Social Work Clinic UMA Pediatrics Family Navigator

7. IPAC’s Vision for Change Ensure healthy development for all kids by improving our community’s ability • to identify, • to refer, and • to provide comprehensive, coordinated care to young children with developmental and behavioral concerns.

8. Network Development “….to develop a formal networkwith the purpose of improving the coordination of health services in rural communities and strengtheningthe rural healthcare system as a whole.” • Office of Rural Health Policy http://ruralhealth.hrsa.gov

9. Balancing Strategy & Structure Strategy: Collaboration & Capacity Building • Interagency collaboration • Blend wisdom of “doers and directors” • Build balanced community-university partnership Structure: Non-Profit Organization • Bylaws, 501(c)(3) status, bank account • 15 member board of directors, organized around 7 constituency groups

10. Clinical Programs Achieve Vision Interagency Collaboration • Developmental Screening in Primary Care and Childcare Settings • Family Navigator Program • Local Interdisciplinary Assessment Team • Co-locating behavioral health providers in primary care

11. Two Sustainability Challenges Sustain the Programs Fiscal challenge: clinical services generate revenue Culture of collaboration (3 separately owned) Sustain the Network: “We are the keepers of our culture” building trust takes time building a network is a long-term commitment celebrate the successes share responsibility for challenges transparency regarding budgets, decisions prudent fiscal management

12. Grant Funding Net Planning ($85,000): Focused on deciding what being a network would mean, designed the infrastructure (board, bylaws, legal structure). What will the network will do? Network Development ($540,000): Two goals • Network self-sustaining • Incorporate, network policies, leadership, membership, dues structure, communications (internal & external stakeholders), collaboration skills • Build integrated health delivery system through interagency collaboration/programs Outreach Grant ($375,000): Programmatic agenda: ECMH consultation for preschools, plus workforce development trauma and autism trainings. SAMHSA Project LAUNCH (3.5 mil): • Programmatic agenda: Regional expansion and diversification of programs (i.e., health and wellness), workforce development • Network Agenda: board development, membership, functions, communication

13. Sustainability: Facets other than Funding • Partnership and Collaborative Capacity Development • Shared identity, logos… mugs, magnets, stationary • Shared clinical focus: young kids, interdisciplinary • Core values: Integration, Access, Collaboration • Stakeholders: doers/directors, univer/community • Incorporating brings substantial structure • You are an organization (not just a program) • Governed by a board of directors (power assigned) • Bylaws set expectations (attendance, who gets on the board/how you get on the board, etc)

14. Plan, plan, plan … “There are good ideas and then there are good ideas with a plan. The former often die on the vine, having nowhere to go. The latter create companies.” (www.hivelocitymedia.com, July 2010) Grants … work plans sets goals, objectives and activities on timeline… Create a Sustainability Plan…network committees to examine dues structure, board structure, revenue generating strategies, personnel needs. What are you operational expenses; how are you paying your bills. Identify consultants, go to management trainings, read.

15. IPAC Operational Snapshot Revenues: • Bank account opened with a donation • Dues structure… know why your charging what you do charge. We started at $500/yr, now $1000/yr… Annual Expenditures • Directors and Officers liability insurance (approx $1300 per year) • Server for website (approx $330 per year) • Filing taxes .. Donated services local CPA Slow Growth (board paces growth) • Contract for Coordinator, Interdisciplinary Assessment Team ($3180) • Personnel (?$15,000): part time employee (a) website, communications (b) professional develop programs for revenue • Employment: HR consultant paid through another grant; legal consultation costs loom • President is volunteer (no cost) but capacity is limited

16. Seven Strategies for Sustainability • Care about the emerging culture of your network (trust, transparency, respect, conflict management) • Strengthen organizational identify: shared vision/purpose, jointly agreeing on the problems to solve, then jointly designing solutions, anchors ownership and responsibility • Visual Representation of you Network: logos, website, stationary, newsletter. • Build capacity of network: leadership, management, strategic planning, fiscal/accounting, communications • Find ways to diversify revenue streams (grants, donations, dues, in kind services, revenue generating programs) • Fiscally prudent decision making… grow at a pace you can afford • Plan, plan, plan… know where you are, know where you want to go, and know how you intend to get there.. ……and celebrate the successes along the way!

17. Tri County Mental Health and Counseling Services, Inc • Sherry Shamblin, PCC-S

18. Exemplar Sherry Shamblin • From Network Participant to Network Leader • From Provider to Department Director Tri-County Mental Health • From Network Skeptic to Network Supporter • From Isolated Competitor to Collaborative Community Partner

19. Changing Agency Culture CEO: 2007 CEO: 2009 “Collaboration might be good for services, but its not good for business.” “Membership in IPAC has led to several direct benefits for our organization...valuable assistance in obtaining new funding to expand our early childhood services. The collaboration fostered within the IPAC network also helped us to establish a successful behavioral health/ primary care integration service delivery model… The Interdisciplinary Assessment Team… helpful resource for children served by our clinical staff, while the trainings sponsored by IPAC have increased the capacity of our staff to deliver standardized assessments to young children.”

20. Growth contributes to sustainability but growth is interconnected

21. leveraging the network to achieve sustainable organizational change Administration has changed attitudes about partnerships, about the potential of grants to support innovation, about services delivery. From a single early childhood mental health (ECMH) provider to a ECMH Department Expanded EMCH staff from 1 – 4 with grant funding; 5th funded through state EMCH dollars ECMH Director is on agency leadership team shaping direction of organization Expanded services offered: co-located behavioral health providers in primary care; ECMH in new settings, use of evidenced-based models, conducting developmental screenings

22. leveraging the network to achieve sustainable organizational change Emerging Community Based Participatory Research Committee Accessing national expertise through technology State and regional ECMH training including other mental health agencies Initiating and leading EMCH workforce development opportunities with Ohio University’s counseling department.

23. How each IPAC grant contributed Staying on track: expansion of childcare trainings, team building with other future network partners net plan: training, exposure to new ideas net dev.: training, skill development, leadership opportunities, expansion of childcare consultation, co-located services, iat access, increased trust/cohesion with network partners

24. How each grant contributed: Outreach: grant writing experience, introduction to cbpr, leadership development, ecmh school partnerships SAMHSA Project Launch : ecmh department, evidenced-based models, expansion of primary care ventures, opportunities to train/ develop regional workforce

25. Why We Needed IPAC & What We’ve Given IPAC Support OPPORTUNITY CAPACITY DEVELOPMENT

26. Contact information: Jane Hamel-Lambert, MBA, PhD Ohio University 740-593-2289 Hamel-lj@ohio.edu Sherry Shamblin, PCC-S Tri-County Mental Health and Counseling Services, Inc. 740-592-3091, x4631 sshamblin@tcmhcs.org Photo credit: Larry Hamel-Lambert at hamel-la@ohio.edu