Clinical Directors and Transforming Services and Supports in a System of Care

1. Clinical Directors and Transforming Services and Supports in a System of Care Wilfredo Soto, Connecticut Frank Pace, Rhode Island Kim Williams and Ken Martinez, Technical Assistance Partnership April 3, 2007

2. Meet the presenters! Kim Williams Wilfredo Soto Frank Pace Ken Martinez

3. Service Delivery Components • Benefit Design/Service Array • Evidence-Based Practice • Outreach and Referral • Intake/Access • Screening, Assessment, and Evaluation • Decision-making and Oversight (Care planning, care authorization, care monitoring, and review) • Flexible Funds • Care Management or Care Coordination • Crisis Management at the Service Delivery and Systems Level • Service Planning using a Wraparound Approach

4. Utilization Management Staffing Structure Staff Involvement, Support, and Development Orientation and Training of Key Stakeholders Coordination with Social Marketing Infrastructure Elements • Provider Network • Protecting Privacy • Ensuring Rights • Continuous Quality Improvement • National Evaluation Interface

5. Direct service or implementation committee Focus groups Stakeholder groups Cultural & linguistic competence SOC Orientation Concrete supports Communication protocols Training opportunities Cross-system training Develop structures and processes from the start to support key stakeholder, youth, and family involvement

6. Is your administrative and management organization in place? • Is your clinical director on board and integrally involved in the infrastructure development of your system of care? • Does the clinical director have a key role in the planning process for designing the structure of the proposed service delivery system? • Does the clinical director serve in a decision-making role on your management team? • What is the relationship between the clinical director and the service evaluation activities?

7. Hiring a Clinical Director • Not business as usual • Not a “clinical hat” only • Expertise in infrastructure building • Understands the impact of culture on diagnoses and service delivery • Understands/practices family-driven and youth- guided care • Readiness for evidence-based treatments/ practices, practice-based evidence and their implementation • Aware of need for service system improvements • Collaborates with youth, families, and community stakeholders

8. Role of the Clinical Director • Need to be involved from the beginning of system-building • Need to be accessible to families/youth • Structures in place: open access to the clinical director • Provide training to community providers • “Fix it” meetings • Relationship with project director • Relationship with family organization • Relationship with youth coordinator

9. Family/Youth Perspectives • Use family- and youth-friendly language • Be careful using acronyms and agency jargon unfamiliar to families and youth • Create environment that is “safe” • Use creative approaches to engage full participation • Set the stage from the beginning of having a youth/family member in the room – avoid tokenism – try to have at least two to allow support – diverse representation of participants • Look for opportunities for collaboration • Clarify, educate, and validate their role in the community • Provide accessibility and relationship-building with families and youth

10. Family/Youth Perspectives • Provide high level of communication by clinical director with providers in the community • Conduct focus groups with youth and families • Solicit family input through various methods • Hear from youth and families about their need for diverse providers and therapeutic modalities • Design of non-traditional services and supports best informed by youth and families

11. Questions??? Please press *7 on your phone to un-mute your line. Please press *6 to re-mute your phone after you are finished.

12. Know Your Population of Focus • What does this really mean? • Do homework: • Look at the needs/gaps in your community • Diversity, geography, experience • Drill down into knowing your population of focus in-depth • Previous experience with interventions • What worked? What didn’t work? • Identify community needs and assets • Know the available resources to meet needs of population

13. Pressures to Rush to Service Delivery • Anticipate and handle the pressures • Keep Federal Project Officer informed • Community pressure: “got huge grant, provide services, NOW” • Providers: knocking on the door, want piece of money available • Community politics: budget cuts, court orders • Youth & families: know we got the money, we need services now!

14. What happens when you rush to deliver services? • Tendency to just put more money into existing services • Short circuit collaborative process • Impedes “transforming” system • Impedes assessment and gap analysis • Resistance to change by direct care providers

15. Collaboration • One system should not unilaterally proceed to make all the service delivery and clinical practice decisions without participation of key stakeholders, family, and youth • Collaboration with partners that usually have not been involved, such as the early childhood system, primary care, housing system, law enforcement, etc. • Collaboration on clinical services: how does it work? • What clinical services are provided within all the component systems? • Avoid mental health system making all the practice decisions

16. Planning for use of Evidence-Based Treatments/ Practices and Practice-Based Evidence • Know your population of focus • Community needs are assessed • Identify treatments/practices that match the community’s needs • Ensure that they are culturally-relevant and appropriate-do they need to be adapted?

17. Planning for use of Evidence-Based Treatments/ Practices and Practice-Based Evidence, cont. • Individualized care (comprehensive, flexible, culturally- and developmentally-responsive) is first priority • EBPs/PBEs must be linked with all other systems of support and intervention to promote sustainability and generalizability • The inclusion/infusion of culture and family/youth involvement in EBP research and practice is essential • Organizational culture must be fostered to support the implementation of effective practices

18. Lessons From Communities: Gaps in Building Clinical Services and Supports • Development of service implementation plans • Coordinate with launch of National Evaluation • Crisis planning/safety planning process • Flexible funding • Where are decisions for this made? • What is the turnaround time on access to flex funds? • Are flex funds budgeted?

19. Lessons From Communities: Gaps in Building Clinical Services and Supports, cont. • Individualized service planning using Wraparound approach • Staffing • Coordination and standardization among the different care coordination entities • Availability and access to the clinical service that best meets the needs of the family • Family-driven and youth-guided

20. Questions??? Please press *7 on your phone to un-mute your line. Please press *6 to re-mute your phone after you are finished.

21. Websites for Evidence-Based and Promising Practices • Resource Guide for Promoting an Evidence-Based Culture in Children’s Mental Health http://www.systemsofcare.samhsa.gov/ResourceGuide/index.html • Matrix of Children’s Behavioral Health Interventions http://www.systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf • National Registry of Evidence Based Programs and Practices (NREPP) http://modelprograms.samhsa.gov/template_cf.cfm?page=model_list • Office of Juvenile Justice Delinquency Prevention Model Programs Guide http://www.dsgonline.com/mpg2.5/mpg_index.htm • Georgetown University National Technical Assistance Center http://gucchd.georgetown.edu/

22. Websites for Evidence-Based and Promising Practices, cont. • National Wraparound Initiative http://www.rtc.pdx.edu/nwi • National Implementation Research Network http://nirn.fmhi.usf.edu • Decision Support 2000+ http://206.196.29.126/Sites/ds2000/Library.aspx • Center for Evidence-Based Practice:  Young Children With Challenging Behavior http://challengingbehavior.fmhi.usf.edu/fixsen-etal-may03.html • State of Hawaii http://www.hawaii.gov/health/mental-health/camhd/library/pdf/ebs/ebs016.pdf

23. Resources • Family Leadership in Systems of Care:What is Family Driven?http://ffcmh.org/systems_whatis.htm • Building Systems of Care: A Primer http://gucchd.georgetown.eduor deaconm@georgetown.edu • Implementing High-Quality Collaborative Individualized Service/Support Planning: Necessary Conditions; http://www.rtc.pdx.eduor rtcpubs@pdx.edu • Promising Practices in Wraparound for Children with Serious Emotional Disturbance and Their Families 1998 http://www.air.org/cecp/ • Mini-Website on Wraparound Resources http://cecp.air.org/wraparound/materials.html • Quality and Fidelity in Wraparound, Focal Point 2004 www.rtc.pdx.eduor rtcpubs@pdx.eduor 503-725-4175 • Dedicated Website to Individualized Care and Wraparound; http://www.paperboat.com

24. Presenter Contact Information • Frank Pace: frank.pace@dcyi.ri.gov • Wilfredo Soto: scarter@theparkproject.org • Kim Williams: kwilliams@ffcmh.org (317) 876-4602 • Ken Martinez: kmartinez@air.org (505) 898-2220