Changing Interventions: Creating Innovation Worth Sustaining

1. Changing Interventions: Creating Innovation Worth Sustaining RBS Implementation Preparation Forum November, 2008 Sacramento, California

2. Key Themes in RBS

3. RBS Elements • Structure: How does a community & system organize to accomplish better goals and objectives? • Process: How does your project respond to a family/child in need? • Resource: How do you make assets available in the most efficient way?

4. What’s the Big Question? • First, can you define the need • Second, can you demonstrate the need has been heard & can be articulated by those with enough power to do something about it • Third, can you demonstrate whether the need has been addressed • Finally, can you follow the process of help over time as outcomes to answer:

5. Are children with high needs living in the community with their families and “acting normal enough”?

6. Key Innovations • Recent advances & innovations in children’s treatment have focused on organization rather than intervention • Wraparound, Intensive Case Management, Team Decision Making, FGDM, etc. • While those activities contribute to help, they don’t assure a fundamentally changed service

7. Moving From Organization to Help • A Key Component of RBS is the construction of new services or interventions including: • Environmental Interventions: Identifying ways to use the group environment in a purposeful way to meet needs & contribute to healing • Intensive Treatment Options: Creating ways for intensive treatment to be available and constructed so that children don’t have to sacrifice attachments in order to access treatment • Parallel Pre-Discharge Options: Moving from a continuum model of treatment/support delivery to a free-form model, community interventions occur simultaneously to treatment options, discharge as a process not an event • Follow-Up Post Discharge Service: Recognizing that success occurs as an ongoing process rather than a key milestone process

8. Imagine the Interventions • In order to construct the right organization we need to imagine the new interventions • Form follows function if we can imagine new approaches • After that RBS can be used to create a way to make it happen

9. Environmental Interventions • What is the role of a group setting in helping children and families be together and participate in community life? • Constructing the innovation: • What is the nature of the interaction? How is it helpful? What is the fit with your project’s values? • What is the correct dosage? How long? How much? How often?

10. Something to Think About: Environmental Interventions • Family Co-Op Model: As ongoing census goes down, enrolled family members agree to supplement staffing to assure stabilization • Shared Family Models: Facility is used to bring two or more families together to learn how to manage together • Whole Family Support: Entire family resides at facility on weekends, rest of the week at home with “just-in-time” support

11. Intensive Treatment Options • Can intensive treatment be delivered seamlessly regardless of the child’s location? • Constructing the Innovation • What are the activities that will contribute to positive outcomes? • What types of structures would need to be in place to assure treatment potency? • If “group” is a powerful metaphor in your treatment philosophy, how can you design that even when children live at home?

12. Something to Think About: Intensive Treatment Options • Family Managed Treatment Co-Ops: Families empowered to employ a clinician across multiple families • Community Development Sessions: Clinicians learn how to transfer the “healing conversation” to local community leaders i.e. business, coaches, bus drivers, etc. • Twittering Treatment Plans: Youth and families with cell phones using the Twitter platform to record treatment progress

13. Parallel Community Treatment Options • Can participation in community be a core option for programs that are engaged in facility based programming? • Constructing the Innovation • Designing participation from day one not day you deem the child stable. • Individualizing participation based on unique aspects of the child & family: balancing parent preferences, location challenges, creating sound introductions, developing community where there isn’t any

14. Something to Think About: Co-Occurring Community Supports • Staff Redirection: Using existing staff to support community participation from first day of admission • Mobile Placement: Renting apartments in youth and family locales to assure participation. • Community Buddy Systems: Recruiting community peer connections to support youth while in place based services & maintain connections • Street Stabilization Models: Deploying supports for runaways to stabilize “out there” rather than “in here” • Runaway Accompaniment Models: Recruiting street youth to provide support to youth who leave place or engaging communities (taxi drivers) to radio in whereabouts

15. Follow-Up Post Discharge Options • What unique aspects does RBS provide rather than other community options for youth and families? • Constructing the Innovation • Developing something entirely different than other community based options • Making the right decision about who goes where: why RBS versus other community resources? • Avoiding over-reaction to challenge: the path to outcome is not likely to be linear • Balancing between place based and community based: how will you monitor the balance between the two

16. Something to Think About: Post-Discharge Options • Seamless Movement: Assuring that staff who work within the place are the same as outside of the place • Creating Stabilization Teams: People who can move in and move out to provide stabilization, the same who work with you at home would work with you in facility • Family Flex Fund Cooperative: Helping families manage flex funds cooperatively across multiple families