ILLINOIS CHILDREN’S HEALTHARE FOUNDATION Children’s Mental Health Initiati ve,

ILLINOIS CHILDREN’S HEALTHARE FOUNDATIONChildren’s Mental Health Initiative,

Building Systems of Care, Community by Community

What Makes a Good Plan?Webinar, Friday, February 4, 2011

10:00-12:00 pm

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Ground Rules/Items to Note:

A Few Ground Rules/Items to Note:• The presentation will follow along the two documents

you received via email earlier today:– What Makes a Good Plan?– Implementation Plan Guidelines

• Please submit questions along the way – we will make every attempt to answer or will provide a follow-up memo on those that weren’t addressed. There will be an open Q&A at the end of the session as well.

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What Makes a Good Plan?

Presenters:

Tammy Lemke, ILCHF PresidentHarvey Saver, ILCHF Program Officer

Dr. Ira Chasnoff, NTI UpstreamDr. Rich McGourty, NTI Upstream

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What Makes a Good Plan?“How Will We Know if a Plan Is Good?”

The question, “How will we know if a plan is good?” has been discussed at great length by the ILCHF Board of Directors, ICLHF staff, and CMHI Consultants.

Essentially, the children’s mental health system of care Implementation Plan from each of the communities should answer three basic questions:

What is the problem?What is the proposed solution? How do we know if it’s working? Do children improve?

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The full Implementation Plan Packet will arrive, and each reviewer will be asked to make a judgment.

Will this plan establish an effective and enduring children’s mental health system of care for all children in the community?

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The document

How Will We know if a Plan Is Good?

is intended to help the reviewers of the Implementation Plan come to a sound judgment based on a shared understanding as to what constitutes a good plan for a children’s mental health system of care.

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Nine Considerations and What to Look For: Positive Signs and Negative Signs – Focus and Direction– Operational Excellence– Professional Excellence– Human Resource Systems– Evaluation– Organizational Structure– Management Leadership– Medical Home– Financial Sustainability

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What Makes a Good Plan?Focus and Direction:

Focus and direction in a plan sets forward the logic of the plan. It asserts how the community will focus its resources and why. It is grounded in a deep understanding of the community and imparts a sense of informed purpose.

Focus and direction implies setting priorities. In contrast, a plan that attempts to do everything right away is likely to be no plan at all. The hard decisions about how to allocate limited resources are necessary to drive action.

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Positive Signs: Focus and Direction:– A sense of strategic purpose unfolding over the five years of the

plan.– A clear rationale for how the resources of the plan are put to work

in the first year. – An obvious answer to the question “What is the planning building

toward?” – The plan uses plain, clear language.– Agencies and providers are making changes that serve the greater

good.– There is attention to building a system that is sustainable over the

long term, with specific and logical steps to move in that direction.

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Negative Signs: Focus and Direction:

– Bland, global language that does not go beyond vision and values.

– An emphasis on more planning and information gathering rather than action.

– No real change; more of the same strategies and approaches.– The plan seems designed to sustain agencies rather than help

children.– Real changes are put off until late in the implementation plan.– Sustainability relies on a continuous cycle of writing grants

and living on soft money.

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Operational Excellence:

Operational excellence refers to quality at the systems level. If there is operational excellence, children do not “fall through the cracks” because there are no cracks.

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What Makes a Good Plan?Positive Signs: Operational Excellence:

– There is a clear definition of the target population– There is a bold quality to the plan that has the support of the participating

agencies.– For each age group there is a well-articulated system to identify and screen,

assess, refer and treat children and a plan to achieve it.– How a medical home for each child is defined and how it is to be achieved is

spelled out.– If health promotion, prevention and early intervention are part of the plan,

how these activities are integrated into the system of care is made clear. – The plan anticipates difficulties based on prior experience and includes

actions to overcome these difficulties.– The plan includes periodic reviews that stress continuous improvement.– The plan refers to hard-to-reach populations.– The plan is realistic and does not expect everything to happen all at once.

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What Makes a Good Plan?Negative Signs: Operational Excellence:

– The plan is primarily based on small adjustments – “tweaks” to things as they are.

– The plan is long on screening but short on assessment, referral and treatment.

– There is little or no reference to how a child without a medical home will find one.

– Health promotion, prevention and early intervention are part of the plan but are not well-integrated into the full plan.

– The plan ignores Murphy’s Law; it is brittle rather than robust and can be easily disrupted by foreseeable events like personnel changes.

– The plan focuses solely on population centers and says little about hard-to-reach populations.

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Professional Excellence:

A strong plan takes into account the lack of professionals with training and experience in serving children, especially young children.

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Positive Signs: Professional Excellence:

– The plan states the community’s existing resources – the planners know who they have and what professional resources are missing.

– There is a training plan that addresses both near-term and long-term needs for professional resources.

– The plan includes the full professional community – those who serve Medicaid populations and those who do not.

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What Makes a Good Plan?Negative Signs: Professional Excellence:

– The plan is blind to gaps in professional resources.– The plan to build access to professional resources is not

realistic.– The plan relies upon only a part of the professional

community. – The plan relies on general training with no relationship

to the hoped-for outcomes.

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Human Resource Systems:

High turnover is common in mental health, especially at the front lines. This is where a system of care can be most vulnerable. Correspondingly, an effective human resource system can make a positive impact.

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Positive Signs: Human Resource Systems:

– For all key roles there is an effective way to recruit, select, orient, train and utilize people.

– The plan makes provision for handling people who are mismatched to their roles and are unable to competently serve children and families facing mental health issues.

– A committee or other structure responsible for the continuous learning/improvement of those who serve children and families in the system of care.

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Negative Signs: Human Resource Systems

– No plan for funneling people into key roles in the system of care.

– Little or no investment in training people.– Assigning people who are known to be incompetent to

the system of care.– Leaving the assignment of people to chance.

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Evaluation:

Evaluation is driven by the goals and objectives developed through the planning process. There must be a clear idea of where the program is headed and how to know when it gets there.

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Positive Signs: Evaluation:

– Over-riding goals with clear, measurable objectives provide a path for review, feedback, and revision on an on-going basis and for final evaluation.

– The goals and objectives are achievable.– Both process and outcome measures are being used.– Clear data points are presented with an explanation of

how they will be collected, managed, and analyzed.– The local evaluation supports the cross-site evaluation.– HIPAA and human subjects protection issues are

considered.

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Negative Signs: Evaluation:

– There is no sense of how the programming piece and the evaluation piece “hang together.”

– Process and outcome objectives are not measurable.

– There is no explanation of how data will be collected, including standardized instruments, focus groups, etc.

– The local evaluation does not address the requirements for the cross-site evaluation.

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What Makes a Good Plan?Organizational Structure:

Structure is about who does what.

At the macro level it requires clarity about what each institution/agency is responsible for in the system of care.

At the micro level it means there is clear accountability for each professional in the system of care and, importantly, for how professionals relate to one another across organizational boundaries.

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Positive Signs: Organizational Structure:

– Each institution/agency that serves children has a role in the children’s mental health system of care, and the role is clear.

– Letters of commitment from each agency spell out the expectations, the role of the agency, and the financial commitment on both sides, including “in kind” services.

– The process for creating the communication protocols and memoranda of understanding needed to link the institutions/agencies are part of the plan. This includes a way to share information.

– The plan describes how referrals are managed and what follow-up is needed when a child is at risk for falling through the cracks.

– All members of the system of care seek to avoid service gaps and service redundancies.

– There is a group who will see to it that every institution/agency lives up to its part of the system of care.

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What Makes a Good Plan?Negative Signs: Organizational Structure:

– The children’s mental health system of care appears to be the province of a few organizations rather than the whole community.

– Roles are global and/or vague.– Inter-agency cooperation and communication is espoused but there

is no way to systematically build toward a really strong system of care.

– There is no way to challenge the tendency for institutions/agencies to operate within their silos.

– Letters of commitment are carbon copies of one another.– Letters of commitment are more a letter of support rather than a

commitment to be part of the action.

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Management/Leadership:

Managing is about making a system of care operate at a high level. It focuses on providing on-going oversight.

Leadership is about innovation and change. It focuses on anticipating change and challenging the system of care to become better.

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Positive Signs: Management/Leadership:

– The plan has a way to measure effectiveness and feeds that information to those who are responsible for the system of care.

– There is stable leadership.– The participating institutions/agencies are included in the

decision-making that affects the system of care.– There is a method for resolving disagreements regarding the

system of care and the expectations it has for each of the participating institutions/agencies/professionals.

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What Makes a Good Plan?Negative Signs: Management/Leadership:

– The system of care operates without on-going feedback.– There is no continuity plan. That is, after the first generation

leadership of the system of care moves on, there is no mechanism to assure that the system of care will be handed off to well-prepared and committed people.

– The management and leadership of the system of care are within the lead agency and consequently may lose the support of the wider community.

– The participants in the system of care are not committed to a model of shared leadership. They are too willing to allow the system of care to become the project of one agency or a very small number of people.

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What Makes a Good Plan?Takes into account ILCHF’s Commitment to concepts of the Medical Home :

– Trusting Relationship – seeing a child/family over time;

– Improved primary care – knowing a child/family’s medical history; – Prevention – makes optimal use of prevention and early

intervention; – Comprehensive – responds to all the child’s needs, including mental

health; and,

– Connected – able to refer with confidence and coordinate needed treatment.

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Positive Signs: Medical Home:

– Medical providers understand the medical home feature of the system of care and how they and their patients can benefit from it.

– There is a strategy for re-directing a child/family from relying upon ERs and ambulatory care settings for primary care to a medical home.

– The schools and other touch points in a child’s life play a role in helping a child/family establish a medical home.

– The system of care facilitates the sharing of information needed to support a medical home approach, especially the communication among providers.

– There is a plan to link all children who receive an assessment to have a physician integrated into the assessment team.

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Negative Signs: Medical Home:

– Referring a child/family to a medical provider without follow-up is the extent of the medical home feature of the system of care.

– Medical providers are unclear on how the medical home feature of the system of care works.

– The concept of a medical home is seen as a mechanism to build medical practices rather than as a key feature of a system of care.

– The sharing of information among providers is inconsistent leading to poorly coordinated assessment and treatment.

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Financial Sustainability :

Building in “financial sustainability” to a plan in a time of financial uncertainty and recession is challenging. There is a balance to be struck between investing in new strategies while retaining (and building upon) what is already in place.

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Positive Signs: Financial Sustainability:

– Investing in people and systems which have a long-term payback potential.

– A plan which identifies low cost-moderate/high payoff strategies.

– A balance of upstream (health promotion, prevention, early intervention) and downstream interventions.

– A community consensus in support of maintaining the system of care using a broad array of funding resources.

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Negative Signs: Financial Sustainability:

– Investing in people and systems that may not be available to the community long-term.

– A plan which relies upon expensive technological features that may require on-going updates.

– An imbalance of strategies favoring expensive interventions for children in their middle and late teens.

– A plan that hires personnel in the hope their salaries will be covered by yet-to-be specified revenue after the CMHI funding ends.

– A plan that is publicly identified with one or two agencies rather than as a community-wide enterprise.

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Question & Answer Period


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Implementation Plan Guidelines

Table of Contents

– ILCHF’s Children’s Mental Health Initiative (CMHI): Overview

– CMHI Guiding Principles– CMHI Key Definitions– Phases of the Children’s Mental Health Initiative (Round 1)– Detailed Timeline for Review of Implementation Plans– Format for the Implementation Plan– Template and Structure for the Implementation Plan– Required Attachments– CMHI Phase 2: The Implementation Years - Timetable

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ILCHF’s Children’s Mental Health Initiative (CMHI): Overview

Multi- Phase Initiative set out to improve the lives of children - four key evaluation questions about its investments in children’s mental health systems of care:

– Did children improve following their involvement in the system of care?

– Are sustainable children’s mental health systems of care being developed in the communities?

– What adjustments are needed in order to better serve the children and families in their communities; and

– What modifications does ILCHF need to make to ensure future allocations of resources are appropriate and to ensure the systems can be replicated?

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Phases of the CMHI: The Children’s Mental Health Initiative (CMHI), Building Systems of Care, Community by Community, includes the following Phases:

Phase 1 (Year 1) – Planning to Enhance and/or Develop a System of Care

ILCHF selected five communities across the State of Illinois to provide them with the resources needed (technical assistance and financial resources up to $300,000) to build upon and/or enhance their community’s children’s mental health system of care (SOC). Each community selected for the 1st round of the CMHI is currently undertaking a 13-month Planning Phase to perform a comprehensive assessment. This was to include the development of a formal strategic plan, organizational structure, financial model and plan for sustainability. The strategic assessment must include an analysis of the community’s strengths (assets) and weaknesses (gaps in services), as well as an analysis of the current system of care in the community.

Each community will make a formal presentation of their community’s proposed 5-year Implementation Plan to the ILCHF Board of Directors on June 23, 2011.

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Phase 2 (Years 2-4) – Implementation of Systems of Care Plans

The ILCHF Board will award implementation grants to CMHI communities based upon their ability to build and/or enhance an effective and sustainable children’s mental health system of care. ILCHF expects that these plans will be unique to each community. They will each develop and implement a system that focuses upon a specific set of outcomes and benchmarks. They will be monitored against their own outcomes, as well as the overall, cross-site CMHI evaluation that will be implemented by NTI Upstream on behalf of ILCHF.

As a part of their implementation activities, each CMHI community will develop a manual that documents their planning steps; their organizing strategies; and, the structure and processes involved in implementing their community model that transforms the way that they provide care for the mental health needs of children.

NOTE: ILCHF’s financial commitments for each Implementation Year will be based on the CMHI community reaching its established goals and measurable objectives each year, as well as the Foundation’s financial position.

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Phase 3 (Years 5-6) – Continued Implementation and Sustainability of Plans

A significant long-term outcome that ILCHF will look for from the CMHI communities is that their systems of care will be sustainable. Each community will be monitored for 2 years after the 3 years of funding for the implementation of CMHI. This evaluation will provide information as to how the strength of the community collaboration, program infrastructure, philosophy, services, and funding are able to be maintained, as well as to determine the relevant factors that have influenced their sustainability.

Phase 4 (To be determined) - Mentoring/Learning Communities

The goal of the CMHI is to build and/or enhance children’s mental health systems of care in the State of Illinois, community by community. ILCHF anticipates that the 1st round of selected communities will later serve as mentors/learning communities to be paired with other communities that are prepared to develop and/or enhance their own children’s mental health system of care. New CMHI communities that are subsequently funded will be able to share and make use of the manuals developed during the initial CMHI.

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Detailed Timeline for Review/Consideration of Implementation Plans:

Tuesday, May 31, 2011 12 noon Community Teams to submit completed Implementation Plans

Thursday, June 23, 2011 Time TBD Community Teams to present their plans to the ILCHF Board of Directors. Each Team will have

approximately 30 minutes to present followed by a 15 minute Q&A session. Additional

guidance will be issued at a later date.

July/August, 2011 Plans to be reviewed and development of recommendation for funding

Late August, 2011 Board to review and make funding decisions.

September 1, 2011 Implementation Year 1 Begins

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Format for the Implementation Plan:

• Format: You must use standard 1” margins and 11 point Arial typeface, single-sided on 8½ x 11 paper. Pages must be consecutively numbered, and the numbering should continue from one section to the next, including all of the required attachments. The information must be provided and labeled in the order of the Template below.

• Page Limit: There is a 30-page limit on the information that is requested in Sections I-VI of the Template. The page limit is exclusive of the cover page, Table of Contents, and information that you must provide in Attachments.

• Proposal Submission Guidelines. – 6 complete, unbound copies of the cover page, Table of Contents, Sections I-VI, the Budget

and Budget Narrative, and all required attachments.– 1 complete, unbound set of all required Lead Agency financial documentation and any

optional attachments – 1 CD containing Sections I–VI, the Budget and Budget Narrative, and all required

attachments. Please note the following:– None of the information in Sections I-VI should be provided in a pdf format.– Each of the required documents should be saved to the CD as a separate, stand-alone file.

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Template and Structure for the Implementation Plan:

I. Executive SummaryII. Focus and DirectionIII.Professional Excellence and Human Resource SystemsIV.EvaluationV. Organizational Structure and LeadershipVI.Financial Model & Lead Agency Documentation

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Template and Structure for the Implementation Plan: I. Executive Summary– In general, provide the readers with a summary of four

questions:• Who are you? • What is the problem?• What is the proposed solution?• How do we know if it’s working?

– Not to exceed 2 pages

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Template and Structure for the Implementation Plan: II. Focus and Direction: Developing/Enhancing your System

– This is where your Community describes your plan’s goals, objectives and expected outcomes and how you expect to get there (timeline and resources)• Note: The Implementation Plan to be submitted is for a period of 5 years – we do

not expect all activities to be started let alone completed in year 1 – and, depending on the plan activity – year 3, 4 or 5.

– Plans for Change– Evidence Base– Challenges and Their Resolution– Detailed Work Plan for Year 1 Implementation– Adherence to ILCHF’s Guiding Principles (see template)

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Template and Structure for the Implementation Plan: III. Professional Excellence and Human Resource Systems

A strong plan takes into account the lack of professionals with training and experience in serving children, especially young children.

– Overall Strengths of your human resource systems– Overall Weaknesses of your human resource systems– What are your plan to bring human resources to the community?

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Template and Structure for the Implementation Plan: IV. Evaluation

– Evaluation Methodology– Evaluation Process– IRB?– HIPAA Issues?

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Template and Structure for the Implementation Plan: V. Organizational Structure and Leadership

– Key People and Organizations• Lead Agent (at this time, ILCHF is assuming Lead Agents

will remain the same)• Community Team Members (see template)• Collaborative Community Partners (see template)• MOUs

– Leadership, Structure and Function

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Template and Structure for the Implementation Plan: VI. Financial Model and Lead Agency Documentation

Five Year Financial Model and Detailed Year 1 Implementation Operating Budget. The Implementation Plan must be accompanied by a five-year projection of income and expenses and an operational budget for Year 1 of the Implementation Plan (See Appendix 5 and 6). A budget narrative that describes the details of those budgets must be included. Include these documents as Attachment G.

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Template and Structure for the Implementation Plan: VI. Financial Model and Lead Agency Documentation

The Financial Model has been designed to reflect the three significant functional expense areas of the CMHI:

System of Care Organizational Structure and Leadership. Ensuring a children’s mental health system of care is enhanced and/or developed and has the organizational structure and leadership to be sustainable.

Execution of the Plan: Direct Service Expenses. Do children improve? Ensuring services (professionals and materials) are available to meet the needs of children in your community.

Evaluation & Monitoring of the Project. Is our community making a positive difference? Is the CMHI making a positive difference? What adjustments need to be made in order to better serve children and families?

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Future Webinars/Meetings:

February 8, 2011 2:00-3:00p

ILCHF’s Commitment to the Concepts of Medical Home – What is EDOPC?

Presenters: Tammy Lemke, ILCHF President Anita Berry, Advocate Healthcare

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February 11, 2011 2:00-3:00p

What makes a System of Care Systematic?

Presenter: Dr. Rich McGourty, NTI Upstream

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Future Webinars/Meetings:February 16, 2011 2:00-3:00p

What is a Financial Model? Why is it important? What does ILCHF expect to see?

Presenter: Tammy Lemke, ILCHF President

Source of Funding

ILCHF Medicaid State Other Funders

Salaries

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March 10, 2011 2-3:30p

How to develop an assessment model and how to begin implementing ideas and initiatives that deal with training and workforce issues.

Presenter: Dr. Ira Chasnoff, NTI Upstream

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Future Webinars/Meetings:TENTATIVE – Not Yet ConfirmedWednesday, February 23, 2011 9:00-4:00 p

What: Evaluators’ Meeting

Where: Renaissance HotelOak Brook, IL

Why: Development of the Cross-site Evaluation Plan andProject Directors Meeting

Tentative Schedule: 9:00-2:00p Evaluator’s Meeting

2:00-4:00p Project Directors Meeting

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Documents

ILLINOIS CHILDREN’S HEALTHARE FOUNDATION Children’s Mental Health Initiati ve,