Governance and System Management Track 2 Sheila A. Pires

Governance and System ManagementTrack 2

Sheila A. Pires Human Service Collaborative

sapires@aol.com

Rob AbramsMultnomah County, Oregon

rabrams@mail.mesd.k12.or.us

Carol HardestyWestchester County, New York

chh2@westchestergov.com

Matt WojackIngham County, Michigan

wojack@ceicmh.org

2

Example: Evolving Governance Structure

Pires, S. (1996). Evolving governance structure. Washington, DC: Human Service Collaborative.

Policy Level Local Governing Board Agency Directors Family Advocacy Organizational Representative

Illustration 1.2A

Operational Level DMH Director

“Bring the Children Home”SOC Supervisor and Staff

“Bring the Children Home”Case Managers

Families ServedOther Agency Workers

Illustration 1.2B BRING THE CHILDREN HOME STATE LEGISLATION

COUNTY EXECUTIVE

Local Governing Board Agency DirectorsFamily/Youth Reps.DMH Director

Providers Forum

SOC Team Leader

“Bring the Children Home”Interagency Care Management Team

“Bring the Children Home”Care Managers

Families/Youth ServedOther Agency Workers

3

Pires, S. (1996). Contracted system management structure. Washington, DC: Human Service Collaborative.

Example of Governance/Management Structure

State Funding Pool

Local Allocation

County Alliance

Case Rate for each enrolled child

Provider ProviderProvider

Financer/Payers

Purchaser

Care Management Entity – Lead Non Profit•Organize and manage provider network•Staff and manage child and family team process• Intensive care management •Utilization management•Quality assurance•Outcomes management /monitoring•Management Information System (tracks children, services, dollars)

State Interagency

Body

Natural Supports Natural Supports

4

New Jersey - Contracted Management Structure

CHILD

Screening with Uniform Protocols

Child Welfare

Juvenile Justice/Court

SchoolReferral

Community Agencies

Family & Self

Other

Contracted Systems Administrator CSA

•Registration•Screening for self-referrals•Tracking•Assessment of level of care needed•Care coordination•Authorization of services

Community Agencies•Uncomplicated care•Service authorized•Service delivered

Care Management Organization•Complex multi-system involved children•Individualized plan developed•Full plan of care authorized

Family Support OrganizationFamily to Family Support

Adapted from NJ System of Care

Youth Support Organizations

5

Wraparound Milwaukee - Lead Public Agency Management Structure

Child WelfareFunds thru Case Rate

(Budget for InstitutionalCare for CHIPS Children)

Mental Health•Crisis Billing•Block Grant

•HMO Commercial Insurance

Medicaid Capitation(1557 per Month

per Enrollee

Juvenile Justice(Funds Budgeted for

Residential Treatment for Delinquent Youth)

Management Entity:Wraparound Milwaukee

Management Service Organization (MSO)$30M

Child and Family Teams

ProviderNetwork

240 Providers85 Services

CareCoordination

Plans of Care

9.5M 2.0M10M8.5M

Per Participant Case Rate

Family Organization$300,000

Mgt. Entity: Co. BH Div.

Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch

6

Deputy County Administrator for Human Services

System of Care Office*

Children in or at risk for residential

placement

Youth with status offenses

Children with serious behavioral health

challenges

0-3 population Early Intervention engagement challenges

Subsets of Children & Families –Focus of Care Coordination

Partnerships

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

Cuyahoga County OH - In-House Management Structure

System of Care Oversight Committee

*Functions as anAdministrative ServicesOrganization

Lead Family Coordinator

Lead Youth Coordinator

{

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Regional CareManagement Entities

•Ensure child & family team plan of care**•Ensure intensive care coordination•Manage utilization at servicelevel

**Plans of Care (w/priority on community-based/naturalsupports) determine medicalnecessity, except inpatient, residential/group, which require prior authorization

DCHMCO MCO MCO

MHDDAD

ASO TPA

DFCS

DJS

DOE

Care Management Entities:Locus of management accountability for children

with complex, multi-system involvement

Use Same Decision Support Tool –CANS – to determine need for CME

Pires, S. 2008. Washington, D.C.: Human Service Collaborative

Maryland System of Care Initiative

University of MarylandInnovations Institute

DHMH DHR DJS

ASO

Maryland Coalition ofFamilies for Child MH

Regional Care ManagementEntities

•Child and family team•Intensive care management•Utilization management•Develop broad provider network•Monitor outcomes•Link families and youth to peer support

Medicaid PRTF,DHR group home,DJS detention $$$

Contracted private non profit agencies;Get about $1200 per child per monthfor care management and UM only,not services

1115waiver

1915 cwaiver

Children’s Cabinet

Delaware System of Care

HMOs

OP benefit equivalent to30 OP visits

Dept. of Services for Children, Youthand Their Families

Division of Child Mental Health Services

Clinical Services Management TeamsPublic entities

Contracted Provider Agencies

In-house trainingand EBP development

Dept. of Health and Soc. Svcs.Division of Medicaid and Medical Ass’t.

Children with lessintensive needs

Children with moreintensive needs &non-Medicaid children

1115 waiver

Department gets bundled rate from Medicaid of about $4300 per child per month

Governance and System Management

Rob Abrams

Wraparound Oregon: Early Childhood

Key Elements of Structure -

Building Collaboration & Governance:We started with relationships and allowed that to build the structure

Structure

•Training Committee

•Family Organization

•Multiple Agency Intake Committee

•Evaluation Team

•Social Marketing

•Cultural & Linguistic Competence

Our Planning Year

CMHI New Community Training

Wraparound Oregon: Early Childhood

Key Elements of Structure -

Building Collaboration & Governance:Governance

•Steering Committee

•Role of Expert Facilitation

•Families at All Levels

•Having a clear road map means not responding to unintended pressures

•Trust in Partners and Process

•Intergovernmental Agreements

Values and Principles

Champions

Use Technical Assistance

Patience ~ Go Slow to Go Fast (thanks to Sheryl Schrepf)

Lessons Learned

CMHI New Community Training

Wraparound Oregon: Early Childhood

Lessons Learned (cont’d)

Key Elements of Structure -

Building Collaboration & Governance:Cultural Partners-Develop Contracts

Spread the Money

Clarify all assumptions

Transparency

Flexibility

Hire locally

Wraparound Oregon: Early Childhood

CMHI New Community Training

Lessons Learned (cont’d)

Key Elements of Structure -

Building Collaboration & Governance:Develop a strong and sustainable family organization

Build a work force development and training program

Rely on the strengths of your community

Build intentional relationships

Have FUN!

Wraparound Oregon: Early Childhood

CMHI New Community Training

Carol Hardesty, MSW, MPAExecutive Director

Family Ties of Westchester is a grassroots organization that provides advocacy and support services to families of

children with emotional and behavioral difficulties. At its seven Resource Centers in Mount Kisco, Mount Vernon,

New Rochelle, Ossining, Peekskill, White Plains and Yonkers, Family Ties offers support groups, training in

parenting skills, advocacy efforts, and respite opportunities. Family Ties recognizes parents as full partners in planning for their children’s treatment and services and helps empower them to take part in the

decision-making process at multiple levels.

Children’s Core Services Committee (CCSC) Westchester’s Governing Body

• In existence since 1990• Has always included families• Became governing body for Westchester’s 1999-

2005 System of Care• Youth became members in 2003• All issues addressed by CCSC come directly from

families/youth• Multiple subcommittees emerge through

Westchester’s Issues To Action process• CCSC is Westchester County’s longest standing

cross-system planning group• New State and Federal grants have emerged from

this process

Family/Youth Role in Governance

• Families/youth must have a presence at multiple levels:– Policy formulation– Program planning– Direct services– Training– Evaluation

Families and Youth Need “Helping Hands” to Become Empowered

• Family and youth organizations don’t have instant “voice and choice” by virtue of merely existing as organizations

• Those in power: government, provider agencies, schools, etc. must be willing to share power. Government, for example, can alter contracts, include families/youth in RFP processes, lend credibility to the movement

• Trust must exist among government, provider agencies, and family/youth organizations

Lessons Learned by Family Ties

• Parents don’t come into Family Ties ready to operate at policy, program, direct service, training, and evaluation levels

• Organized family support needs to both attend to the needs of families, and empower them to take part in the governance process

• A graduated series of trainings and experiences is needed to facilitate parents readiness for governance and systems level work

Parent Academy

• As a mature family organization, Family Ties has opted to design a Parent Academy to ultimately prepare parents for leadership roles in:

– Family Ties

• Group leadership

• Parent trainers

• Resource Center Leadership Councils

• Board membership

– Local Communities

• Community networks

• Local Communities That Care

• Various boards and committees

– System of Care

• Governing body

• County and State level committees

• Part of local RFP process: planners and reviewers

Parent Academy (cont’d)

Level IIIFDC/PEP CredentialingNetwork Facilitation

Support Group FacilitationTrain the Trainer

Spokesperson TrainingLeadership Training

Level IIManaging Family Conflict, Goal Setting,

Domestic Violence, Building Community Relationships,

Workshop Series: Nutrition, Psychotropic Medication, Community Garden, Budgeting

Basic TrainingCommon Sense Parenting, ABC, Strengthening Families,

EPIC, Multi-Family Groups, Families Facing Solutions, Staying Connected to Your Teen,

Kinship Care: Caring For Your Own & PASTA, MAPP, Mommy & Me

PARENT ACADEMY & GOVERNANCE

• SOC Leadership Committee regularly advised on progress

• Other SOC agencies are invited to include appropriate training in the Parent Academy

• Children’s Core Services Committee (governing body) also regularly updated on progress

• Parent Academy participants included on governing body

Governance and System Management

2010 CHILD MENTAL HEALTH INITIATIVE NEW COMMUNITY TRAINING

(Issue Briefs #2, #3, #5, #6)

Matt Wojack

Ingham County, Michigan

Set the Stage“Something Big is Happening”“Really Need to have you Involved”

Family and Youth from the Get-go

Then It all starts with a Theory of Change…

Define Values

How does the community define:

Outcomes

Goals

Strategies…

…and then develop a work plan for each strategy.

It’s an Iterative Process

How to Bring About Commitment to Change

“We can do better for families.”

“We can provide supports to families more economically.”

Link Data Collected to Goals

Teach Stakeholders to Use Data & to Prioritize Data

As we track our outcomes, we use multiple measures

Promote data-driven decisions, strategically utilize other community pressure

How to “Hold Steady” with commitment to new work…

Multiple entities, at multiple levels promoting integrated work: High Risk Meeting

Mid-Level Managers Frontline Staff

SOC Community Team

Continuous Quality Improvement Saves the Day

Matt Wojack, Project DirectorImpact, Ingham County System of Care Initiative

517-346-8038

wojack@ceicmh.org

www.impactsystemofcare.org