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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

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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

Ingham County, Michigan

[email protected]

Example: Evolving Governance Structure

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

Families Served

Other Agency Workers

“Bring the Children Home”

Case Managers


Illustration 1.2B


Agency Directors

Family/Youth Reps.

DMH Director

Local Governing Board

Providers Forum

SOC Team Leader

“Bring the Children Home”

Interagency Care Management Team

Families/Youth Served

Other Agency Workers

“Bring the Children Home”

Care Managers


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

Example of Governance/Management Structure

State Interagency Body

State Funding Pool



Local Allocation

County Alliance


Case Rate for each enrolled child

  • 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)




Natural Supports

Natural Supports


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

New Jersey - Contracted Management Structure














Screening with Uniform Protocols

  • Contracted

  • Systems

  • Administrator CSA

    • Registration

    • Screening for self-referrals

    • Tracking

    • Assessment of level of care needed

    • Care coordination

    • Authorization of services

  • Care Management

  • Organization

  • Complex multi-system

  • involved children

  • Individualized plan developed

  • Full plan of care

  • authorized

  • Community

  • Agencies

  • Uncomplicated care

  • Service authorized

  • Service delivered

Adapted from NJ System of Care

Family Support Organization

Family to Family Support

Youth Support Organizations


Wraparound Milwaukee - Lead Public Agency Management Structure

  • Mental Health

  • Crisis Billing

  • Block Grant

  • HMO Commercial

  • Insurance

Child Welfare

Funds thru Case Rate

(Budget for Institutional

Care for CHIPS Children)

Juvenile Justice

(Funds Budgeted for

Residential Treatment for

Delinquent Youth)

Medicaid Capitation

(1557 per Month

per Enrollee





Management Entity:

Wraparound Milwaukee

Management Service Organization (MSO)


Family Organization


Per Participant Case Rate



240 Providers

85 Services



Child and Family Teams

Plans of Care

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

Cuyahoga County OH - In-House Management Structure Structure

System of Care Oversight Committee

Deputy County Administrator for Human Services

Systemof Care Office*


Lead Family



Lead Youth


Subsets of Children & Families –

Focus of Care Coordination Partnerships

Children in or at risk for residential placement

Children with serious behavioral health challenges

Youth with status offenses

0-3 population Early Intervention engagement challenges

*Functions as an

Administrative Services



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

Care Management Entities: Structure

Locus of management accountability for children

with complex, multi-system involvement

Regional Care

Management Entities








  • Ensure child & family team plan of care**

  • Ensure intensive care coordination

  • Manage utilization at service

  • level

  • **Plans of Care (w/priority on

  • community-based/natural

  • supports) determine medical

  • necessity, except inpatient, residential/group, which require prior authorization




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 Structure

Children’s Cabinet




Medicaid PRTF,

DHR group home,

DJS detention $$$

University of Maryland

Innovations Institute




Maryland Coalition of

Families for Child MH

Regional Care Management


1915 c


  • Child and family team

  • Intensive care management

  • Utilization management

  • Develop broad provider network

  • Monitor outcomes

  • Link families and youth to peer support

Contracted private non profit agencies;

Get about $1200 per child per month

for care management and UM only,

not services

Delaware System of Care Structure

Children with more

intensive needs &

non-Medicaid children

Dept. of Health and Soc. Svcs.

Division of Medicaid and Medical Ass’t.

1115 waiver

Dept. of Services for Children, Youth

and Their Families

Division of Child Mental Health Services


In-house training

and EBP development

OP benefit

equivalent to

30 OP visits

Contracted Provider Agencies

Clinical Services Management Teams

Public entities

Children with less

intensive needs

Department gets bundled rate from Medicaid of about

$4300 per child per month

Governance and system management

Governance and System Management Structure

Rob Abrams

Wraparound Oregon: Early Childhood

CMHI Structure New Community Training

Wraparound Oregon: Early Childhood

Our Planning Year

  • 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

CMHI Structure New Community Training

Wraparound Oregon: Early Childhood

Lessons Learned

  • 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)

CMHI Structure 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

CMHI Structure New Community Training

Wraparound Oregon: Early Childhood

  • 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!

Carol hardesty msw mpa executive director
Carol Hardesty, MSW, MPA StructureExecutive 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
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
Family/Youth Role in Governance Governing Body

  • 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
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
Lessons Learned by Family Ties Empowered

  • 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
Parent Academy Empowered

  • 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 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 Empowered2010 CHILD MENTAL HEALTH INITIATIVE NEW COMMUNITY TRAINING(Issue Briefs #2, #3, #5, #6)

Matt Wojack

Ingham County, Michigan

Set the Stage Empowered

“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: Empowered




…and then develop a work plan for each strategy.

It’s an Iterative Process

How to Bring About Commitment to Change Empowered

“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 Empowered

Promote data-driven decisions, strategically utilize other community pressure

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

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 Director Empowered

Impact, Ingham County System of Care Initiative


[email protected]