System of Care Practice Review: Assessing Adherence and Recommendations

1. Introduction • SOCPR Objectives • Document experiences of children with SED and their families enrolled in systems of care. • Document adherence to the system of care (SOC) philosophy by the direct service providers and system. • Assess the degree to which the SOC philosophy is implemented at the practice level and generate recommendations for improvement. • System of Care Values • Child Centered and Family Focused • Community Based • Culturally Competent 10 Guiding Principles SOC values are further defined by the 10 guiding principles listed on slide 9.

2. Sections of The SOCPR • Section 1 Demographic Information: • Includes the child’s demographic information. • Creates a “snapshot” of the child’s current service situation. • Section 2 Document Review: • Criteria that guides the case record review. • Comprised of case history summary and the current service/treatment plan. • Completed prior to conducting interviews. • Section 3 Interview Protocol: • Interview for the primary caregiver, the child/youth, the formal service provider and the informal helper. • The interview protocol allows for the collection of data related to the 3 system of care values and a 4th value that explores the impact of implementing the SOC values with the child and family receiving services. • Section 4 Summative Questions: • Requires case reviewers to summarize and integrate information gathered from the above noted sections. • The summative questions allow the interviewer to assign ratings to each of the sections described above.

3. SOC Guiding Principles • Children have access to a comprehensive array of services. • Services are individualized. • Services are received within the least restrictive environment. • Families are included as full participants. • Services are integrated and coordinated. • Case management is provided to ensure service coordination and system navigation. • The system promotes early identification and intervention. • Children with SED are ensured a smooth transitions to adult services when they reach maturity. • The rights of children with SED are protected. • Children with SED receive services regardless of race, religion, national origin, sex, physical disability, or other characteristics.

4. Applications of the SOCPR Purpose: The SOCPR was designed to provide a tool for assessing whether system of care principles are operationalized at the level of practice, where children and their families have direct contact with service providers. The SOCPR collects and analyzes data obtained from multiple sources to determine adherence to system of care values and principles. • Agency Application • Used to evaluate the fidelity of practice to the SOC principles. • Documents the experience of the child and family within the agency/program. • Effective Quality Assurance and Improvement measure. • Provides recommendations for staff training. • System Application • Identification of strengths and areas that need improvement. • Provides decision makers with valuable information for system enhancements. • Provides guidance and identifies system training needs. Holden, and Hernandez 2004) highlight the utility and importance of the SOCPR: “Further understanding of service experience and other practice level parameters is a fundamental component to understanding and improving our approaches to children’s mental health services.”

5. SOCPR Domains • Domain 1: Child Centered and Family Focused: The needs of the child and family dictate the types and mix of service provided. • Subdomains: • Individualization: A unique service plan for each child and family that incorporates strengths and needs across life domains. • Full Participation: The child, family, providers and other significant persons are involved in setting the service plan goals. • Case Management: The child and family receive the services they need in a coordinated manner, the type and intensity are appropriate and are driven by changing needs over time. • Domain 2:Community Based:Services are provided within or close to the child’s home community, in the least restrictive setting possible. • Subdomains: • Early Intervention: positive outcomes are enhanced with early identification and intervention. • Access to Services: Each child and family has access to comprehensive services across physical, emotional, social and educational domains. The services are flexible enough to allow the family to integrate them into their daily routine. • Minimal Restrictiveness: Systems serve the child in as normal an environment as possible. Interventions provide the necessary service in the least intrusive manner possible. • Integration and Coordination: Coordination among providers, continuity of services and movement within the components of the system are of central importance.

6. SOCPR Domains • Domain 3:Culturally Competent:Services are attuned to the cultural, racial and ethnic background and identity of the child and family. • Subdomains: • Awareness: Service providers are aware of the impact of their own culture and the culture of each family being served. • Agency Culture: The child and family are assisted in understanding the agency’s culture; how the system operates, its rules and regulations and what is expected of them. • Sensitivity and Responsiveness: The ability to adapt services to the cultural context of each child and family. • Informal Supports: Cultural competence is reflected in the inclusion of the family’s informal/natural sources of support in formal service planning and delivery. • Domain 4:Impact: The SOC philosophy implies that the implementation of SOC principles at the practice level produce positive outcomes for child and family receiving services. • Subdomains: • Improvement: Services that have had a positive impact on the child and family have enabled them to improve their situation. • Appropriateness of Service: Services that have had a positive impact on the child and family, have provided appropriate services that have met their needs.

7. The Policy Framework & SOCPR Ontario’s Policy Framework SOC Principles • Services are individualized. • Families are included as full participants in service planning and delivery. • Child, youth and family centered. • Community driven – services and supports should be provided as close to home as possible. • Services are received within the least restrictive environment. • Children have access to a comprehensive array of services. • Services are received within the least restrictive environment. • Children with SED receive services regardless of race, religion, national origin, sex, physical disability or other characteristics. • The rights of children with SED are protected. • Accessible. • Services are integrated & coordinated. • Case management ensures service coordination and system navigation. • Children with SED are ensured a smooth transition to adult services when they reach maturity. • Coordinated and collaborative. • By using the SOCPR an organization/ system is taking steps to ensure that they are accountable. • All of the SOC principles help an agency and system deliver evidence-based and accountable services. • Evidence-based and accountable.

8. Training and Evaluation • Training Opportunity: • Review the SOC philosophy. • Communicating the purpose and objectives of the SOCPR. • Review implementation procedures. • Practice using qualitative interviewing techniques. • Hands-on use of the SOCPR protocol and the rating/scoring system using a coaching model. • Facilitate debriefing/feedback sessions. • Evaluation Opportunity: • Define scope of the evaluation. • Independent review team conducts the evaluation. • Provision of a final report. • Facilitate feedback and discussion of results to community/agency. “The SOCPR is useful in providing specific and contextual feedback to services providers and systems as they attempt to make quality improvements while implementing a system of care.” In order to ensure a high level of inter-rater reliability, uniform training of the review team is essential.

9. System of Care Ottawa Project CYMHN: SOC PROJECT LEADERSHIP TEAM SOC Project Logistics and Operations Coordinated Access & Referral Project Management SOCPR Training Team Task Committees

10. CYMHN: SOC PROJECT LEADERSHIP TEAM Responsibilities: Lead governing body for SOC Project in Ottawa and the proposed model. Guides and Implements System of Care Values and Principles in the Ottawa community. Delegates duties and tasks to SOC Project Logistics and Operations Team. Approve implementation of strategic work plans. Liaison with stakeholder groups. Liaison with MCYS.

11. SOC Project Logistics and Operations Team (Cont’d) • Consult with CYMHN SOC project Leadership Team on SOC Values and Principles. • Helps set strategy related to implementation of SOC in the Ottawa community including evidence based practices. • Coordinates training for communities in Ontario interested in the SOC. • Collaborates with interested third parties related to research, development and other funding opportunities.

12. SOC Project Logistics and Operations Team • Develop proposed work-plan, activities, associated outcomes and measurement tools to be used in implementing SOC. • Input into the community training plans related to the SOC and Multicultural Competence. • Creates sub-committees addressing special interests and linking with community networks (LHIN, Cross Sectoral and caregiver/consumer groups).

13. Coordinated Access Responsibilities: • Liaison with CYMHN SOC Project Leadership Team. • Project management of SOC in Ottawa. • Collaboration with CoE and other possible funding sources. • Coordinates training of new evaluators. • Coordinates systems training strategy for the community. • Administrative support to the committees

14. Task Committees Committees SOCPR Training Team SOC Consulting Team Multicultural Brokerage Team Other as needed

15. SOCPR Training Team Responsibilities: • Provide training and coaching to the community. • Continue to support system evaluation efforts using the SOCPR tool. • Assist with the development of the SOCPR community training plan. • Recommendations to CYMHN for on-going use of the SOCPR.

16. Contact Us Natasha Tatartcheff-Quesnel, Manager, Ottawa Children’s Coordinated Access and Referral to Services. Address: 2675 Queensview Dr. Ottawa, ON K2B 8K2 Telephone: (613) 720-0577 ext. 1256 Fax: (613) 288-0426 Email natasha@coordinatedaccess.ca Michael Hone, Director of Clinical Services, Crossroads Children’s Centre. Address: 1755 Courtwood Cr. Ottawa, ON K2C3J2 Telephone: (613) 723-1623 ext. 228 Fax: (613) 723-7393 Emailmhone@crossroadschildren.ca Francine Gravelle, Director of Clinical Services, Youth Services Bureau of Ottawa Address: 2675 Queensview Dr. Ottawa, ON K2B 8K2 Telephone: (613) 729-0577 ext. 1242 Fax: (613) 729-1918 Email fgravelle@ysb.on.ca