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Governance and System Management Track 2 Sheila A. Pires Human Service Collaborative [email protected] Rob Abrams Multnomah County, Oregon [email protected] Carol Hardesty Westchester County, New York [email protected] Matt Wojack - PowerPoint PPT Presentation
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Governance and System ManagementTrack 2
Sheila A. Pires Human Service Collaborative
Rob AbramsMultnomah County, Oregon
Carol HardestyWestchester County, New York
Matt WojackIngham County, Michigan
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
{
{
77
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
www.impactsystemofcare.org
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