Governance and System Management Track 1 – Early Developmental Stages

1. Governance and System ManagementTrack 1 – Early Developmental Stages • Vickie Miene • NE Iowa • vickie-miene@uiowa.edu • Bruce Strahl • TA Partnership • bstrahl@ffcmh.org • Michelle Zabel • University of Maryland • mzabel@psych.umaryland.edu • Lisa Conlan • Parent Support Network of Rhode Island • lisaconlan2@aol.com

2. Governance and System Management Lessons Learned from Iowa Vickie Miene

3. Building Governance StructureKeep the Principles Always Visible

4. Community Advisory Council & Planning Committee Family, Youth and Community Stakeholders State Level Resource Team of State Level Family Groups Public & Private Stakeholders Community Circle of CareOrganizational Chart Iowa Department of Human Services Gary Lippe, Project Director University of Iowa College of Public Health Thomas E. Vaughn Child Health Specialty Clinics Debra Waldron, M.D, MPH Director & Chief Medical Officer Center for Disabilities and Development Robert Bacon, Director, Iowa’s University Center for Excellence on Disabilities State Local Liaison Bill Bowden, Finance SAMHSA Funded Positions Pink: Fully Funded Positions Blue: 50% or Less Funded Positions White: Non-Funded Positions Principle Investigator and Technical Assistance Coordinator Vickie L. Miene, LMHC Psychiatrists at UIHC – Tele-health Don Van Dyke, M.D. Clinical Consultant Tara Levin psychologist Judy Stephenson, Human Resources Evaluation Associate Rob J. Fernandez Oelwein/Decorah Deborah Bahe, ARNP Dubuque/Clinton Mary Drury, ARNP Evaluation Manager Jennifer A. Cook Youth Coordinator Jill M. Kluesner Oelwein Nurse Care Coordinator Brenda Carradus Decorah Nurse Care Coordinator Sarah A. Wanless Dubuque Nurse Care Coordinator Shannon M. Hines Clinton Nurse Care Coordinator Sharon Kleppe Key Family Contact Gloria J. Klinefelter Data Collector Social Worker 1 Dawn Milius Social Worker I Carol Hagen Melanie K. Tietz Social Worker I Carol Lippe Social Worker I Amber Ohsann Data Collector Social Marketer tbh Data Collector Secretary II Arleen M. Wentworth Parent Coordinators Tamara K. Lauritzen Parent Coordinator Mary Kay Lynch Parent Coordinator Linda L. Van Natta Parent Coordinator Billi Mitchell Data Collector Cultural Competency Cord Harold Blatt Secretary II Glynis Varney Secretary II Nicole Johnson Secretary II Jenna Lanser Secretary II Julie Peck Outreach/Support Parent Consultant

5. Goal: Implement the mental health care component of the CMHI in Northeast Iowa. Child, family & community Population – C&Y ages 0-21 with behavioral & MH challenges -Strengths & needs drive service planning -Training & supports empower families -Services reflect & build on community context Child, family & community strategies -Family Team Process -Family-driven, youth guided services -Data informed planning & service delivery -Family support & empowerment Short & intermediate outcomes -Increased awareness of MH services & supports -Attainment of plan goals -More access, options, & continuity -Service gaps identified Long-term outcomes -Improved child & family functioning -fewer days hospitalized -better school performance Goal: Develop SOC infrastructure using a bottom up approach. Local, community & regional -Geography & distance -Socioeconomic status -Available service capacity -Cultural & historical traditions -Sense of community -Political will & collaboration -Social networks -Community diversity Local, community & regional -Expand service and support capacity -Communication & outreach -Develop youth & family capacity to inform local & regional service system development -Empowerment strategies Local, community & regional -Greater service and support capacity -More access, options, & continuity -Increased collaboration -Increased awareness of mental health options -Families, youth and community leaders are fully involved Point of entry characteristics -Service capacity -Administrative culture, rules, regulation, service hours, etc. -Differential access and services by agency, school or school district -Staff characteristics, education & training Point of entrystrategies -Navigation team & wraparound process -Data drive service provision -Timely access to services -Implement family advocate models -Ongoing staff training & development -Communication & outreach -Supports to ‘non’ MH system partners Point of entry outcomes -Full continuum available -Efficient, effective services -Enhanced service quality -Continuity of care assured -Increased staff competencies -Increased awareness among providers & families Long-term outcomes -Increased family satisfaction -Increased provider satisfaction System processes / procedures -Policy & regulation -Fiscal / Financial practices (reimbursement) -Cultural/social attitudes & understanding -Capacity for family and youth organization System strategies -Change rules & regulations -Data driven decisions & accountability -Increase family & youth Voice -Relationship building System level outcomes -Braided / blended funding -Increase system efficiency -Services are truly family & youth driven -Siloed systems will become a culture of collaboration -Increased sustainability

6. Building Local Systems of Care: Strategically Managing Complex Change 6 Human Service Collaborative. (1996). Building local systems of care: Strategically managing complex change. [Adapted from T. Knosler (1991), TASH Presentations]. Washington: DC.

7. Community Circle of CareCQI Process 10 County Planning Committee BDF Advisory Group CCC Staff Member Parent/youth Members Community Members HAWC Area Advisory Group CCC Staff Members Parent/Youth Members Community Members Dubuque Advisory Group CCC Staff Member Parent/youth Members Community Members Clinton/Jackson Advisory Group CCC Staff Member Parent/youth Members Community Members CCC All Staff Meetings Local Care Coordination Staff Team Meetings led by ARNP Team Meetings led by ARNP Local Care Coordination Staff Local Care Coordination Staff Local Care Coordination Staff Individual Family Team Meetings led by Care Coordinators Individual Family Team Meetings led by Care Coordinators Individual Family Team Meetings led by Care Coordinators Individual Family Team Meetings led by Care Coordinators

8. Governance and System ManagementTrack 1 – Early Developmental Stages Bruce Strahl Technical Assistance Partnership

9. SOC Governance is Different, it is more about • Creating opportunities for partnership and collaboration • Transformation • Connecting to state initiatives • Influencing policy • Building for sustainability • “Barrier busting” • Giving family and youth a voice • Modeling SOC values • Building a broad based community system and ensuring the understanding by all that the funding is for the children, families and youth

10. Critical Characteristics of SOC Governance Balanced-true sharing of responsibility, power and authority Inclusive-with significant and authentic decision making roles for all who desire a role Broad-many places available to be a part of decision making for family, youth state and community partners Defined-roles concise, clear and understandable Simple

11. Governance Characteristics (continued) Culturally and linguistically competent Clear communications flow and work flow and easily explainable to all stakeholders with diagram Efficient and effective Clear roles and procedures for decision making Responds quickly but also accommodates a more deliberate approach when needed

12. WG WG WG WG WG Broad Based Governance System Coordinating Committee Odd Number Group 11-13-17-19 PD, PI, Community Leaders, Lead Family, Family Member, Youth, Policy Makers, Lead Evaluator • Full Partnership • Facilitator • Agenda • 2 Framed Major Challenges • Work Group Meet • Work Group (Some) Report Progress • Agency Pitch – Networking OK • Role • Frame Major Strategic challenges to go to full partnership • Set agenda for full partnership meeting • Model SOC principles • Barrier busting • Conscience of SOC, Cultural competency, family inclusion, collaboration • Help the PD • Model Change • Do It 1st • High Standard of Care/Quality OK Memorandum of Agreement Send a Work Group Out Standing or Ad Hoc • Decisions • Broad SOC Community Strategy • Intake System • Social Marketing • Referrals to Community Services • Participation in Child & Family Teams • Family Involvement • Administrative Team • Grant Requirements • Grant Administration • Staffing • Budget • Quality STAKEHOLDERS MEETING EVERY OTHER MONTH

13. Avoiding Governance Pitfalls This is not a mental health project! It is a challenge for MH to not own it to the exclusion of others Make sure all the system development work is not done by SOC employees-partners must share equally in “building” and “carrying the load” Fiduciary agency is not the “lead agency”. The fiduciary agency should have no additional decision making beyond it’s assigned role in the governance system

14. Avoiding Governance Pitfalls Input is not involvement! Beware of: “we got their input, we will put it together”, “we will run it by them”, “they should feel engaged, they participated in a focus group” Avoid advisory groups For care teams, coordinators, wrap supervisors stationed in partner agencies, dual supervision takes extra time, communications and coordination

15. Governance and System ManagementTrack 1 – Early Developmental Stages Michelle Zabel University of Maryland

16. Regional Care Management Entities • A CME is a structure that serves as a “locus of accountability” for youth with complex needs and their families. • Provide Supports to Youth and Families: • Child Family Team Facilitation using Wraparound Service Delivery Model • Care Coordination using Standardized Assessment Tools • Care Monitoring and Review • Peer Support Partners

17. Regional Care Management Entities • Provide System Level Functions: • Information Management & Web-based Information System • Provider Network Recruitment and Management • Utilization Review of Service Use, Cost, and Effectiveness • Evaluation and Continuous Quality Improvement • Cross-System and Jurisdiction Financing • Populations to Be Served: • 1915(c) Psychiatric Residential Treatment Facilities (PRTF) Demonstration Project Medicaid Waiver • SAMHSA funded SOC grants – MD CARES and Rural CARES • Child Welfare’s Place Matters Group Home Diversion using Resource Coordinators • Other Out-of-Home Diversion using Care Coordination