PARTNER AGENCIES County Mental Health County Child Welfare
Chadwick Center CDSS CIBHS CDHS Academy
Slide 4
CONVENING
Slide 5
FSG.ORG 5 2013 FSG THERE ARE SEVERAL TYPES OF PROBLEMS Source:
Adapted from Getting to Maybe Simple Complicated Baking a
CakeSending a Rocket to the Moon Social sector treats problems as
simple or complicated Complex Raising a Child
Slide 6
FSG.ORG 6 2013 FSG IMAGINE A DIFFERENT APPROACH MULTIPLE
PLAYERS WORKING TOGETHER TO SOLVE COMPLEX ISSUES Understand that
social problems and their solutions arise from interaction of many
organizations within larger system Collective Impact Cross-sector
alignment with government, nonprofit, philanthropic and corporate
sectors as partners Organizations actively coordinating their
action and sharing lessons learned All working toward the same goal
and measuring the same things
Slide 7
FSG.ORG 7 2013 FSG COLLECTIVE IMPACT IS THE COMMITMENT OF A
GROUP OF IMPORTANT ACTORS FROM DIFFERENT SECTORS TO A COMMON AGENDA
FOR SOLVING A SPECIFIC SOCIAL PROBLEM. Source: Channeling Change:
Making Collective Impact Work, 2012
Slide 8
FSG.ORG 8 2013 FSG DIFFERENCES BETWEEN COLLECTIVE IMPACT AND
COLLABORATION Source: Jeff Edmondson, Strive
CollaborationCollective Impact Convene around specific programs /
initiatives Work together over the long term to move outcomes
ProveLearn and improve Addition to what you doIs what you do
Advocate for ideasAdvocate for what works Collective impact
initiatives also are nearly always cross-sector, whereas
collaborations often occur within a single sector
Slide 9
FSG.ORG 9 2013 FSG COLLECTIVE IMPACT INVOLVES FIVE KEY ELEMENTS
Common Agenda Common understanding of the problem Shared vision for
change Mutually Reinforcing Activities Differentiated approaches
Willingness to adapt individual activities Coordination through
joint plan of action Continuous Communication Consistent and open
communication Focus on building trust Backbone Support Separate
organization(s) with staff Resources and skills to convene and
coordinate participating organizations Source: Channeling Change:
Making Collective Impact Work, 2012; FSG Interviews Shared
Measurement Collecting data and measuring results Focus on
performance management Shared accountability
Slide 10
FSG.ORG 10 2013 FSG COLLECTIVE IMPACT DEPENDS ON ESSENTIAL
INTANGIBLES FOR ITS SUCCESS Fostering Connections between People
The Power of Hope Relationship and Trust building Leadership
Identification and Development Creating a Culture of Learning
Collective Impacts Intangible Elements Source: Channeling Change:
Making Collective Impact Work, 2012; FSG Interviews
Slide 11
FSG.ORG 11 2013 FSG Shared Measurement Is a Critical Piece of
Pursuing a Collective Impact Approach Improved Data Quality
Tracking Progress Toward a Shared Goal Enabling Coordination and
Collaboration Learning and Course Correction Catalyzing Action
Benefits of Using Shared Measurement Source: FSG Internal
Slide 12
FSG.ORG 12 2013 FSG PARTNERSHIP WITH CHADWICK CENTER Focus on
four areas Overall Collaboration between Mental Health and Child
Welfare Screening Assessment Service Array
Slide 13
FSG.ORG 13 2013 FSG CHADWICK CENTER Expertise in Trauma
Informed Services Expertise in Screen and Assessment Expertise in
guiding implementation across disciplines
Slide 14
FSG.ORG 14 2013 FSG STRUCTURE OF THE LEARNING COLLABORATIVE
Quarterly Convening Rotating between Redding and Davis Webinar
check-in calls between convenings Webinar Learning sessions San
Francisco and San Bernadino CAT results Individual Technical
Assistance by Chadwick Center as requested Sharing of Research and
models
Slide 15
FSG.ORG 15 2013 FSG LEARNING COLLABORATIVE SESSIONS Each
session had a focus Session one: Overview presentation on Trauma
Informed Services Roundtable Discussion sessions on: Screening,
Assessment, Data, Service Array, Collaboration building
Slide 16
COMMUNITY ASSESSMENT TOOLS NORTHERN REGION SURVEY RESULTS
Slide 17
RESPONSES BY DEPARTMENT
Slide 18
RESPONSES BY ROLE
Slide 19
ASSESSMENT EVALUATION SCREENING Screening Administered to
Everyone in Group Brief Easy to Complete Gives Yes or No
Information Focused on a Specific Topic Assessment Administered to
Targeted People In-Depth Requires Training Gives Unique Client
Picture Informs Treatment Typically Completed Over 1-3 Visits
Psychological Evaluation Even More In-Depth Completed by
Psychologists (typically) Gives Very Specific Information
Slide 20
SCREENING PRACTICES (CW) 83% Screening Tool is Used 67% Using a
standardized questionnaire Type of Tool: Information Integration
Tool Screening responses were messy Definitions, Roles, Timing
Slide 21
SCREENING PRACTICES Most (57%) CW staff report not knowing if
screening results are shared with clinicians 10% rarely share
results with clinicians The screening process can be confusing New
process for most counties Among those who felt they knew how
screening occurs, some confusion: CANs, MHST, BDI, GAIN, Katie A,
Intake Assessment, paper form, questionnaire
Slide 22
MH EXPERIENCES WITH SCREENING 49% say CW workers share
assessment results sometimes or almost always 14% say CW workers
rarely or almost never share assessment results When the have them:
Results are generally clear (89%) and useful (90%)
Slide 23
ASSESSMENT PRACTICES (MH) 46% dont know or disagree that
standardized tools are being used
Slide 24
ASSESSMENT PRACTICES Most clinicians report sharing results
with CW workers (88%) 12% rarely share results with CW workers
Privacy/Confidentiality is a grey area Left up to culture of
organization For better and for worse
Slide 25
CW EXPERIENCES WITH ASSESSMENTS 51% say therapists share
assessment results sometimes or almost always 20% say therapist
rarely or almost never share assessment results When the have them:
Results are generally clear (77%) and useful (93%)
Slide 26
TRAUMA-INFORMED PRACTICES 80% believe its important for CW kids
to access trauma-focused treatment 62% believe staff are
willing/able to implement trauma-focused treatment 57% believe
county leaders are committed to implementing trauma-focused
treatment 65% in MH; 47% in CW Initiative Fatigue?
Engagement/Skepticism?
Slide 27
NORMS &PRACTICES TAKEAWAYS Screening is confusing
Confidentiality is tricky Opportunities for use of
evidence-informed assessment tools in CW and MH Staff interested in
norms & practices
Slide 28
Building a Better Cockpit
Slide 29
Values & Beliefs
Slide 30
CULTURAL AWARENESS
Slide 31
CROSS-SYSTEM COLLABORATION
Slide 32
Cross-System Collaboration
Slide 33
ORGANIZATIONAL CULTURE AND CLIMATE Across Service Settings:
Stronger client engagement and alliance Rapport, satisfaction,
participation Increased staff openness, adherence to effective
practices, performance, commitment, retention, and attendance
Higher quality services Survey of Organizational Functioning (SOF)
Staff Attributes and Organizational Climate (Broome, Flynn, Knight,
& Simpson, 2007; Glisson, 2002; Locke, 1976; Moos & Moos,
1998; Moos & Schaefer, 1987; Schaefer & Moos, 1996;
Schoenwald, & Hoagwood, 2001; Weisman & Nathanson,
1985)
Slide 34
STAFF ATTRIBUTES Range: 10-50 High Scores = Stronger Staff
Attributes
Slide 35
ORGANIZATIONAL CLIMATE Range: 10-50 High Scores = Stronger Org
Climate
Slide 36
VALUES AND BELIEFS TAKEAWAYS Cultural awareness seems to be a
strength Cross-system collaboration seems to be an emerging
strength Specific next steps identified Strengthening relationships
Familiarity with norms/practices Organizational culture Several
strengths (cohesion/efficacy) Opportunities to attend to challenges
(communication and stress) Similar Organizational Climate patterns
across MH and CW
Slide 37
BASIC PROCESS
Slide 38
SCREENING Identifying children with mental health and trauma
related needs through screening is crucial and has been identified
through multiple initiatives on the State and Federal level. Many
counties have begun screening efforts, but the success is
undetermined.
Slide 39
CASAT SCREENING PILOT Completed pilot in Tulare County using
two brief, validated screening tools Screening was administered to
children and caregivers by caseworker
Slide 40
TULARE COUNTY PILOT STUDY Measures: Strengths and Difficulties
Questionnaire (SDQ) and the SCARED-Short. These results are
consistent with the National Survey of Child and Adolescent
Well-Being (NSCAW). Our preliminary assumption based on these
results is that it is advantageous to use both a general mental
health and trauma-specific screener. Tool% with Any Concern%
without Any Concern N SDQ36.563.5734 SCARED-short21.878.2725 Any
Concern (both tools) 43.956.1725
Slide 41
NORTHERN REGION SCREENING IMPLEMENTATION COMMUNITY (NRSIC)
Slide 42
ABOUT NRSIC Assists counties with implementing an
evidence-informed screening approach Implementation team from each
selected county Engage stakeholders from multiple levels These
stakeholders will test strategies and practices related to the
implementation of screening approaches Will use the EPIS Model of
Implementation as a Framework
Slide 43
IMPLEMENTATION TEAM MEMBERSHIP Senior Leader Day-to-Day Manager
Child Welfare Caseworker Mental Health Partner Family Partner
Optional Members: CW Referral Liaison Representative from
IT/Quality Assurance Additional Team Member with expertise related
to screening
Slide 44
ASSESSMENT Trauma Informed Mental Health Assessment Pathway
(TI-MHAP) CASAT is working with Tulare County Building into
EHR
Slide 45
TREATMENT Need to examine what services currently exist in
county What needs to be added, changed, subtracted? Compare what
you have to what you need numbers, diagnoses, etc. CEBC has a
process established to review MH service array
Slide 46
CHALLENGE: CROSS SYSTEM INFORMATION SHARING
Slide 47
FSG.ORG 47 2013 FSG STORIES FROM THE FIELD Highlights from
Glenn, Butte and Shasta County
Slide 48
FSG.ORG 48 2013 FSG WHAT WE LEARNED Implementation is a Long
Journey Even when there is a commitment to a New Direction.
Collaboration, and Leadership Early identification and intervention
is critical for children in care Cross system and cross agency
sharing was helpful in supporting learning, and implementation
Clarification on what a Trauma Informed Agency looks like
Leaderships role in supporting the development of a Trauma
system
Slide 49
FSG.ORG 49 2013 FSG WORKFORCE DEVELOPMENT ACTIVITIES Training
on: SOP and Trauma Impact of Trauma on Child Development Trauma
Informed Organizations: Steps Towards Transformation Secondary
Trauma and the Child Welfare Professional
Slide 50
FSG.ORG 50 2013 FSG TRAINING Child Welfare and Mental Health:
Gaining Understanding of Each System CANS Assessment Tool What Does
Trauma Have To Do With It: Making Child Welfare System Trauma
Informed A Systems Approach to Integrating Trauma into Screening,
Assessment, Treatment and Case Planning
Slide 51
FSG.ORG 51 2013 FSG IMPLEMENTATION AND SYSTEMS CHANGES Each
county implemented a screening process Still in process of refining
Each county implemented an assessment process using a formal
assessment tool Each county identified their data and aligned
sources to inform their system delivery Each county has worked
through issues of confidentiality and have systems in place for
sharing
Slide 52
FSG.ORG 52 2013 FSG ONGOING CHALLENGES Out of county placements
Staff turn over in both CW and MH Inadequate staffing for ICC and
IHBS Data sharing and tracking Child welfare and Behavioral Health
different data systems still not resolved Tracking outcomes for
each child
Slide 53
FSG.ORG 53 2013 FSG ONGOING CHALLENGES Meeting the goal of
Service Array Lack of services in rural areas: Specialty services
for 0-3 Youth with behavioral issues resulting in placement
disruption Aligning assessments with services
Slide 54
NORTHERN CALIFORNIA RESEARCH and TRAINING ACADEMY Chadwick
Center
