INTEGRATED CARE IN PLACER COUNTY

IMPLICATIONS FOR ACCESS TO MENTAL HEALTH SERVICES

FOR FOSTER YOUTH

August 21, 2014

Because we’re all in the same sandbox after all…

Integrated Care Models---Not a new suggestion…

Little Hoover CommissionsFederal Pew Commission Administrative Office of the Courts--Blue Ribbon Commission

“…a re-abuse of these (foster) children occurs when the counties lack sufficient interagency coordination…”

“Counties that promote such coordination have more success in mitigating further trauma to the children and reducing duplication of efforts”

“…collaborative and seamless services are needed” ”Fragmented services cause major challenges for California’s families…”

Placer’s Model

In 1988, Placer created the first fully integrated county child and family service agency in the western U.S.

Housed administratively within HHS, it is a blending of Welfare, Mental Health, Probation, Health, Alternative and Special Education, and Community Partnerships, all within shared spaces, and linked by common training, leadership and information systems.

Traditional County Services

Child Welfare/CPS

Mental Health Services

Juvenile JusticeSpecial Education

The Placer Children’s Model

Mental Health

Child Welfare/protection

Juv. ProbationSpecial Educ.

Public Health Nursing

Youth and Parent Partners

Leadership CollaborationS.M.A.R.T. POLICY BOARD

Systems Management, Advocacy, and Resource Team: Designated Superior Court Judge (Chair) Chief Probation Officer Director of Health and Human Services Deputy Superintendent of Schools Parent Partner Lead

Semi Monthly 7:30 am meeting to collaboratively assure timely, consistent and seamless services to Placer youth.

Clayton Christensen, Harvard School of Business “The Innovator’s Prescription”

“The speed of disruption (change) is significantly accelerated if an integrated entity wraps its arms around all the elements in order to orchestrate the changes”

How it works? What Does “Integration” Mean?

Functional—Delivering Services with other agencies.(Shared processes, leadership, management)

Structural—Multiple agencies, including private partners, are co located in county or private service sites.

(Shared processes, facilities, training and support resources and information systems)

Fiscal—Allocations from various state, federal and local fonts are shared to the fullest extent allowable, and community shares decision making.

(Shared dollars)

A Few Fiscal Examples…

Source:1. State Block Grant

2. Mental Health Services Act

3. Juv. Justice Crime Prev. Act

4. EPSDT/MediCal

5. Federal SAPT (Perinatal Set Aside)

Program:1. Functional Family Tx./Intensive

Services(300/602)

2. Incredible Years Parent Training/Functional Family Therapy (300/602)/Wraparound/Intensive Trauma Services 3-6 yr olds)

3. Crisis Resolution Center (All Youth)

4. Outpt. Therapy/ Day Treatment

5. Detox and Residential Care

Frontline Practice ShiftsControl by professionals Partnerships with

families/youthOnly professional services Partnership between

natural and professional supports/services

Multiple case managers One service coordinator

Multiple service plans Single plan for child/ youth/family

Family/youth blaming True partnership

Deficits Strengths

Mono Cultural Cultural Competence

Orrego, M. E. & Lazear, K. J. (1998) EQUIPO: Working as Partners to Strengthen Our Community

Community Based and Culturally Competent

• Family and Youth Partners/Agencies/Promotoras co located in HHS offices.

• Family and Youth Partners, and Native and Latino Leaders attend CSOC Monthly Manager’s Meeting

• Parent with lived Experience Facilitates Family Resource Community Collaborative and Campaign for Community Wellness

• Parent Voice on Interagency Management Team

System of Care Outcomes and Return on Investment

• Children and youth less likely to visit an ER for behavioral and/or emotional problems.

• Children and youth were less likely to be arrested. • Children and youth were less likely to repeat a grade. • Children and youth were less likely to drop out of school. • Caregivers missed fewer days of work due to caring for

their children’s mental health conditions.

(2012 Georgetown University Study)

When integrated care is done well…

Empowers stakeholders/communities (Power with, not over)

Insulates from government funding shifts De-stigmatizes parents and youth Fosters independence, decreases dependence Shares stewardship, accountability and risk between

public and private partners Increases accessibility and capacity!

The bottom line….Communities can (and often do) take care of their young people better than public agencies can!

We didn’t wrestle with…

• Confidentiality of information—Single Agency vs. MOU/LOA

• Problem Ownership--There are no “others” in Placer.

• Developing timely screening—this process was informally in place and was refined in response to Katie A.

Challenges and Barriers

• Coding and Clarity of Billing and Documentation Issues

• Consent to Treat—If Parents won’t/can’t consent, what to do?

• Out of County Youth– Determination of Sub Class Eligibility– Intensive Services “slots” in County of

Residence can be scarce.

Because we’re all in the same sandbox after all…

Recommendations for the Journey

• Eyes on the Prize—Don’t let “technical difficulties” get in the way

• Assure “ownership” at all levels• Find more than one “Champion”• Celebrate and Market your success• Agree to Disagree—except when it comes

to being in the sandbox together• Make Promises you CAN and WILL keep