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System of care. Why should nz care?. KARIN ISHERWOOD Planning & Funding Capital Coast DHB Dr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development. ACKNOWLEDGEMENTS. Ms Sue Treanor Director The Werry Centre Mr Bruce Kamradt Director

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slide1

System of care..

Why should nz care?

KARIN ISHERWOOD Planning & Funding Capital Coast DHBDr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development

slide2

ACKNOWLEDGEMENTS

Ms Sue Treanor

Director

The Werry Centre

Mr Bruce Kamradt

Director

Milwaukee Wrap Around Programme

slide3

WHAT WILL WE COVER

 Introductions/Background/a Journey…

System of Care Philosophy & Underpinnings

Explanation & History

Wrap Around Milwaukee

The Concept of Technical Assistance

Local Initiatives & Comparisons

 Developing a System of Care in New Zealand

slide4

THE WERRY CENTRE

  • Contracted by MOH & HWNZ
  • Sits within Auckland University School of Population Health, Tamaki Campus
  • Responsible for Workforce Development across Infant, Child & Youth Mental Health/AOD sectors nationally
  • 18 FTE, 5 based in South Island (Christchurch)
slide5

OUR MAHI

EXAMPLES

  • Development & Implementation of a Competency Framework (Real Skills Plus CAMHS)
  • Mentoring: Emergent Leadership Development
  • Family/Whanau Participation
  • Youth Participation
  • Student Placement Development: MHPP
  • CAPA/7HH
slide6

OUR MAHI

EXAMPLES

  • Training: SACS-BI, CBT, ASD, Eating Disorder
  • Well-Child
  • Regional Forums
  • Parenting Programme: Incredible Years
  • Sector Days
  • Family Therapy Development
slide7

A JOURNEY..

  • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use.
  • He is the oldest of 2 children, having a 9 year old sister Kelsy.
  • Josh lives with his mother &sister. His father has had no contact with the family since Josh was an infant.
  • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.
slide8

A JOURNEY..

  • Josh is seen for an assessment at the Youth Mental Health Service by Gill, a Pakeha Social Worker who feels Josh needs further investigation by the Psychiatrist for management of mood &substance use.
  • Contact with Josh is supplemented by contact with his mother &a teacher at his school.
  • The clinicians on the team believe that it will be important to involve Josh’s family & school in his care.
  • A meeting is set up at the Youth Service with all parties. Mother fails to attend. She is contacted by phone after the meeting & the outcome is shared with her..
slide9

A JOURNEY..

  • The clinicians continue to work with Josh attempting to involve all parties in his care through regular phone contact & further meetings at the service.
  • After several appointments where Josh has failed to attend & the school reports he has been truant, his mother is contacted who reports that Josh has ‘run away’.
  • A referral is made to CYF who eventually locate Josh & he is returned home.
  • Further attempts are made to re-engage Josh with the Youth service without success.
slide10

A JOURNEY..

  • The team contact his Social Worker at CYF &express their concern that until Josh is in a stable residence, contact with Josh is unlikely to be helpful. His file is closed.
slide11

QUESTIONS..

  • What do you think about this scenario?
  • Are there things that could have been done differently?
slide12

IIMHL

International Initiative for Mental Health Leadership

  • A A ‘Virtual’ Agency (began in 2003)
    • Improve mental health services
    • Recovery focussed, evidence based practice
    • Support innovative leadership
    • Facilitate connections between leaders
  • Government to Government Initiative
    • 7 member countries
    • NZ, USA, Canada, Scotland, Ireland, England, Australia
    • Yearly exchanges to promote shared innovative practice
slide13

SYSTEM OF CARE

SIMPLY PUT

  • A system of care is a range of
    • Services & Supports
  • Guided by a
    • Philosophy
  • Supported by an
    • Infrastructure
slide14

SYSTEM OF CARE

DEFINITION

  • Spectrum of effective, community based services & supports for children & youth with or at risk for mental health or other challenges & their families
  • Organised into a coordinated network
  • Builds meaningful partnerships with families & youth
  • Addresses cultural & linguistic needs
  • Function better at home, school, community & life
slide15

SYSTEM OF CARE

BACKGROUND

  • Developed in the USA, following report findings
  • Major framework for improving mental health &substance use delivery systems, services &outcomes for 25 years
  • Used to shape system reforms in states, communities, tribes & territories
  • Extensively researched & evaluated
  • Found to be effective in improving organisation &delivery of children’s mental health services
slide16

SYSTEM OF CARE

CORE VALUES

  • Family Driven &Youth Guided
    • Strengths & needs of child &family determine type M& mix of services &supports provided
  • Community Based
    • Supportive, adaptive infrastructure of structure, processes &relationships at the community level
  • Culturally &Linguistically Competent

 Agencies, programs &services reflect cultural population, to aid access &utilisation of appropriate services

slide17

SYSTEM OF CARE

GUIDING PRINCIPLES

  • Access to a Broad Array of Effective Services
    • Traditional, non-traditional, formal &informal, natural
  • Each Child & Family is Different
    • Plans reflect uniqueness of each family
  • Services & Supports

Least restrictive, most typical & developmentally appropriate

slide18

SYSTEM OF CARE

GUIDING PRINCIPLES

  • Youth & Families are Full Partners
    • Planning &delivery of services, policies &procedure that govern care in their community, state, territory, tribe & nation
  • Cross-System Collaboration
    • Linkages among child-serving systems for management, service coordination & integrated management of service delivery & costs
  • Provide Care Management

 Services are coordinated, families can move through system as needed

slide19

SYSTEM OF CARE

GUIDING PRINCIPLES

  • Developmentally Appropriate Services & Supports

Optimal social-emotional outcomes in home & community

Facilitate transition of youth to adult system as needed

  • Incorporate Mental Health Promotion, Prevention & Early Identification & Intervention

Improve long-term outcomes& mechanisms to identify problems at an earlier stage

slide20

SYSTEM OF CARE

GUIDING PRINCIPLES

  • Continuous Accountability Mechanisms

Track, monitor &manage achievement of goals

 Fidelity to system of care philosophy

 Check quality, effectiveness &outcomes at system level, practice level &child &family level

  • Protect the Rights of Children & Families

 Promote effective advocacy efforts

slide21

SYSTEM OF CARE

GUIDING PRINCIPLES

  • Services do not Discriminate
    • Be responsive &sensitive to differences of race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio economic status, geography, language, immigration status & other characteristics

Keeping these principles in mind,

let’s look at development

slide22

SYSTEM OF CARE

DEVELOPING THE SYSTEM

  • Underpins National Delivery of Child Mental Health
    • Newly developed services expected to adhere to principles
  • Use the System of Care Philosophy as a Guide

 Not a model to be replicated

 Arrays of services will depend on community

 Consider particular needs, goals, priorities, populations

slide23

SYSTEM OF CARE

DEVELOPING THE SYSTEM

  • Adapt Approach Based on Changes
    • Political, administrative, fiscal, community context & data
  • Each community Creates Individual Process

 plan, implement & evaluate

slide24

SYSTEM OF CARE

EACH PROGRAMME IS UNIQUE & DIFFERENT

  • One Program is Particularly Successful
    • Wraparound Milwaukee—Bruce Kamradt
    • 2009 Innovations in American Government Award, Harvard University’s Ash Institute
slide25

SYSTEM OF CARE

EACH PROGRAMME IS UNIQUE & DIFFERENT

  • Share the Knowledge, Spread Wealth

 Educate State, communities &sectors

 SAMHSA partnered with Georgetown University’s National Technical Assistance Centre for Children’s Mental Health

 Developed a training package based on the success of WA

 In September 2011, piloted the training with representatives from 7 states &3 countries

slide26

WRAPAROUND

MILWAUKEE

QUICK HISTORY

  • Situation
    • Bruce Kamradt &colleagues aware of same kids cycling through child welfare, juvenile justice, MH
    • Each service was funded individually
    • Services were limited & fragmented
    • System reacted to crises
    • Removing kids was usual, lots of out of home care
    • Government was offering SOC grants

 First pilot—25 Kid Project (17 out of 25 kids home in 90)

slide27

Wraparound Milwaukee

SYSTEM OF CARE IN ACTION!!

  • Care Management Entity
    • Responsible for day to day management of system of care

 Can be done by any agency

slide28

Wraparound Milwaukee

  • Ten Functions of CME
    • Assessment &enrolment of youth in CME
    • Mobile Crisis Services (can contract it out)
    • Care coordination (can contract it out)
    • Operation of Provider Network (array of services)
    • Fiscal management—(child welfare, juvenile justice, health)

6. Quality assurance, quality improvement

7. Information technology (built their own system)

    • Create mechanisms for family advocacy
    • Clinical &medical oversight
    • Training, staff development, public relations (developed their own curriculum)

How does Wraparound Work?

slide29

Wraparound Milwaukee

FOUR PHASES OF WRAPAROUND

slide30

Wraparound Milwaukee

  • PHASE 1:
  • PREPARATION/
  • ENGAGEMENT & WELCOMING
  • Set the Tone for Collaborative Teamwork
    • Orient the family to the process
    • Begin initial crisis & safety planning
    • Listen & learn the family’s story
    • Explore strengths, needs, culture & vision
    • Identify & engage team & orient them to process
    • Arrange the first Child & Family Team Meeting
    • Create agenda for first meeting
slide31

Wraparound Milwaukee

  • PHASE 2:
  • INITIAL PLAN DEVELOPMENT
  • Develop the Team, All Members are Heard & Valued
      • Determine ground rules
      • Distribute agenda
      • Document strengths of all members & the community
      • Develop an initial family vision to guide needs discussion
      • Identify & prioritise youth & family needs
      • Brainstorm & select strategies to meet needs
      • Review & finalise the initial crisis/safety plan
      • Assign roles & responsibilities
      • Schedule the next meetings
slide32

Wraparound Milwaukee

  • PHASE 3:
  • Plan Implementation & Refinement
  • Continuous Review of Progress, Change Plan as Needed
      • The initial plan is implemented
      • Progress tracked by facilitator, discussed & reviewed
      • Success is evaluated & celebrated
      • New strategies are determined when necessary
      • The team builds cohesiveness, communication & trust
      • Facilitator addresses team member buy-in and family satisfaction
      • Updates are documented, logistics are addressed
slide33

Wraparound Milwaukee

  • PHASE 4:
  • Plan Completion & Transition
  • Family Defines ‘Good Enough’ Transition to Informal & Natural Supports
      • Plans are made for transition out of formal Wraparound
      • Process & plan is modified to reflect ‘unwrapping’
      • Team celebrates successes & work is documented
      • Transition portfolio is completed including
        • Important contacts
        • Past records
        • Follow-up plan for family
slide34

Wraparound Milwaukee

VALUES

  • One Family has One Plan
    • Build on strengths to meet needs
    • Families run their own plan
    • Best fit with culture &preferences
    • Community-based responsiveness
    • Increase parent choice &family independence
    • Care for children in context of families
    • Plans fail, families don’t
    • Hold people accountable
    • Unconditional approach
    • Never Give Up!
slide35

Wraparound Milwaukee

SERVICE STRUCTURES

  • Reflect Need, Rather than What is Funded
    • One electronic record, accessible to each service
    • Notes on time
    • Crisis teams have access to info after hours via computer
    • Contract people in, look for innovative people, not only clinicians
    • Each family gets 14 hours of direct service per month
    • Services purchased on fee for service basis
    • Consumers choose their own providers
    • Care coordination
    • Family advocacy
slide36

Wraparound Milwaukee

OUTCOMES

  • Does it Work, Can They Prove It?
    • Fewer kids in institutions or inpatient
    • Shorter stay when they do go in
    • 500 days of inpatient care compared to 5000
    • 3,700 per month per child, compared to 8-9000
    • School attendance increases
    • Academic achievement increases

Is it as good as it sounds?

slide37

Wraparound Milwaukee

Miscellaneous

Things that Stood Out

  • Care in context of family
  • If no family, then work on building a family
  • Family &youth partnerships—voice, choice &ownership
  • Care coordinators are key
  • 50% of plan should be informal services
  • Family advocacy is paramount
slide38

Wraparound Milwaukee

Family advocacy

  • Provided by Families United of Milwaukee
    • Build relationship with family
    • Support family to take active role in planning &decision making
    • Emphasiseimportance of voice, choice &ownership
    • Advocate with families in schools, courts, etc.
    • Coach families to partner with workers to effect change
    • Involved in Partnership Council
    • Welcoming families/Family Orientation
    • Training &coaching of providers
    • On quality committees, management team, review panels
    • Do whatever it takes!!!
slide39

Wraparound Milwaukee

CHALLENGES

  • According to a Panel of Service Partners
    • Engagement of families
    • Getting the right people at the table
    • Best practice among all systems—cross discipline
    • Meaningful sharing of information
    • Define each agencies roles &responsibilities
    • Education needs for young people
    • Different data management systems across agencies
    • Overlap of Wraparound Coordinator versus CYF Case Manager
slide40

Wraparound Milwaukee

CHALLENGES

  • Fairly Familiar
    • Drivers for NZ development of services
    • We know that children & families are central
    • Always working on improving the services we provide
    • Recognise that we are stronger when we work together
slide41

The Concept of Technical Assistance

Technical Assistance is the support offered to the System of Care to enable competence &confidence when partnering with infants, children &young people& their families/whanau, with mental health &/or AOD concerns

slide42

Technical Assistance

An Example

  • The Georgetown University Centre for Child &Youth Human Development
  • Partner with service-providers, government agencies, consumer &advocacy organisations& universities
slide43

WHAT THEY

DO

  • Continuing Education
  • Clinical Practicuum
  • Conferences
  • Workshops
  • Distance Learning
  • ‘Professional’ Preparation
slide44

THEIR FOCUS

System of Care Service Delivery Underpinned By:

  • Interdisciplinary strengths &evidence-based practice
  • Family Centred: Full partnership with families & youth
  • Community based
  • Culturally & linguistically competent
  • Effective Facilitative Leadership
slide46

SYSTEM OF CARE

NEW ZEALAND SYSTEMS

New zealand systems

  • High & Complex Needs Funding
    • Individualised plan, multi-agency, buying services based on need
  • Strengthening Families
    • Child &family focused, family often guiding, multi agency
  • WhanauOra
    • Flexible, family at centre, navigator, service collectives
  • Plus Local Innovative Programs

How would we develop our own System of Care?

slide47

SYSTEM OF CARE

NEW ZEALAND IMPLEMENTATION

  • Policy, Administrative, Regulatory Changes Needed
    • Cross-sector agreement to change delivery philosophy
  • Develop or Expand Services & Supports
    • Array of home &community, including CME
  • Creating or Improving Financial Strategies
    • Using existing funds creatively, useful doesn’t equal costly
  • Providing Training, Technical Assistance & Coaching
    • Sustainable, The Werry Centre &TePou, some DHBs
  • Generating Support
    • Families &youth, high level decision makers, providers etc
slide48

SYSTEM OF CARE

MULTIPLE LEVELS OF IMPLEMENTATION

  • Changes to State
    • Policies, financing, workforce development
  • Changes to Local System
    • Plan, implement, develop infrastructure, manage, evaluate
  • Changes to Service Delivery/Practice Level
    • Array of effective, evidence-informed treatments, services &supports to improve outcomes
  • Evaluation
  • Now consider this…
remember josh
Remember Josh??
  • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use.
  • He is the oldest of 2 children, having a 9 year old sister Kelsy.
  • Josh lives with his mother & sister. His father has had no contact with the family since Josh was an infant.
  • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.
slide50

Josh and his whānau are referred to Wrap Around New Zealand

  • The service partners with Josh, his whānau and all of the services and agencies that are currently involved to develop a goals-based plan for Josh and is whānau
  • With their Wrap-around New Zealand Service co-ordinator, Josh and his whānau consider all of the options of across-sectoral service delivery, and decide upon their preferences for service delivery
slide51

The services are contracted by Wrap-Around New Zealand and Josh and his whānau

  • The goals-plan is reviewed and further developed
  • The plan is put into process
  • Josh and his whānau meet regularly with the Service Coordinator and Service Providers to review the plan
  • Strengths are acknowledged and ‘hiccoughs’ are addressed
slide52

Josh and his whānau with the service coordinator and the service providers agree to a new plan of support as goals are met. They remain the ‘owners’ of this plan and carry this as they move on to the next destination in their journey

  • Wrap Around New Zealand continue to review outcomes of service delivery, and are supported by The Werry Centre Technical Assistance Support Programme
slide54

CONTACT:

Dr Bronwyn Dunnachie

021 353 027

www.werrycentre.org.nz