Governance and System Management Track 2 Sheila A. Pires

1. Governance and System Management Track 2 Sheila A. Pires Human Service Collaborative sapires@aol.com Rob Abrams Multnomah County, Oregon rabrams@mail.mesd.k12.or.us Carol Hardesty Westchester County, New York chh2@westchestergov.com Matt Wojack Ingham County, Michigan wojack@ceicmh.org

2. 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 BRING THE CHILDREN HOME STATE LEGISLATION Illustration 1.2B COUNTY EXECUTIVE 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 2 Pires, S. (1996). Evolving governance structure. Washington, DC: Human Service Collaborative.

3. Example of Governance/Management Structure State Interagency Body State Funding Pool Financer/ Payers Local Allocation County Alliance Purchaser 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) Provider Provider Provider Natural Supports Natural Supports 3 Pires, S. (1996). Contracted system management structure. Washington, DC: Human Service Collaborative.

4. New Jersey - Contracted Management Structure Other School Referral Family &Self CHILD Child Welfare Juvenile Justice/ Court Community Agencies 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 4

5. 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 9.5M 8.5M 10M 2.0M Management Entity: Wraparound Milwaukee Management Service Organization (MSO) $30M Family Organization $300,000 Per Participant Case Rate Provider Network 240 Providers 85 Services Care Coordination Child and Family Teams Plans of Care Mgt. Entity: Co. BH Div. 5 Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch

6. Cuyahoga County OH - In-House Management Structure System of Care Oversight Committee Deputy County Administrator for Human Services Systemof Care Office* { Lead Family Coordinator { Lead Youth Coordinator 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 Organization 6 Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

7. Care Management Entities: Locus of management accountability for children with complex, multi-system involvement Regional Care Management Entities DCH MCO MCO MCO MHDDAD ASO TPA • 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 DFCS DJS DOE Use Same Decision Support Tool – CANS – to determine need for CME 7 7 Pires, S. 2008. Washington, D.C.: Human Service Collaborative

8. Maryland System of Care Initiative Children’s Cabinet DHMH DHR DJS Medicaid PRTF, DHR group home, DJS detention $$$ University of Maryland Innovations Institute 1115 waiver ASO Maryland Coalition of Families for Child MH Regional Care Management Entities 1915 c waiver • 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

9. Delaware System of Care 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 HMOs 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

10. Governance and System Management Rob Abrams Wraparound Oregon: Early Childhood

11. CMHI 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

12. CMHI 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)

13. CMHI 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

14. CMHI 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!

15. Carol Hardesty, MSW, MPAExecutive 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.

16. 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

17. Family/Youth Role in Governance • Families/youth must have a presence at multiple levels: • Policy formulation • Program planning • Direct services • Training • Evaluation

18. 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

19. Lessons Learned by Family Ties • 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

20. Parent Academy • 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

21. Parent Academy (cont’d)

22. 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

23. Governance and System Management2010 CHILD MENTAL HEALTH INITIATIVE NEW COMMUNITY TRAINING(Issue Briefs #2, #3, #5, #6) Matt Wojack Ingham County, Michigan

24. Set the Stage “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

25. How does the community define: Outcomes Goals Strategies… …and then develop a work plan for each strategy. It’s an Iterative Process

26. How to Bring About Commitment to Change “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

27. As we track our outcomes, we use multiple measures Promote data-driven decisions, strategically utilize other community pressure

28. How to “Hold Steady” with commitment to new work… 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

29. Matt Wojack, Project Director Impact, Ingham County System of Care Initiative 517-346-8038 wojack@ceicmh.org www.impactsystemofcare.org