1 CMHI NEW COMMUNITIES TRAINING LATER DEVELOPMENTAL STAGES Marie Morilus-Black, LCSW-R Child and Youth Director District of Columbia Mental Health Authority Capacity for Family Partnership, Youth Partnership, Cultural and Linguistic Competence, Cross-System Partnership Washington, DC February 9, 2010 Marriott at Metro Center th Street NW

2 Continuous Engagement of Stakeholders The logic model is the tool used by Family Voices Network to transform the system of care in Erie County, NY and in DC All levels of governance, including families and youth, participated in the development of our community’s plan All levels of governance use the same framework to guide their strategic planning process The logic model/strategic plan is the primary tool used in all system level outreach and education

3 Achieve Cross-system Cultural Change Achieve Fiscal Stability Enhance Existing Infrastructure of Care Coordination & Individualized Services System Level Infrastructure System-wide sustainability System fiscal reform at local, state, & federal levels Fully developed local SOC infrastructure Increased community SOC knowledge, decreased stigma Service Delivery Reduced length of stay and # of placements in out of home care Efficient use of resources Least restrictive/most appropriate placements Outcomes Strategies ContextGoals Population of Concern Children 5-17 and Youth in transition, with serious emotional or behavioral challenges: At Imminent Risk for Out of Home, School or Community Placement, And with severe functional impairments, with one or more of the following: Hx of multiple Institutional stays; complex multi-service system involvement; & unsuccessful Tx. -OR- Current RTC/RTF resident with extended LOS System Issues/Strengths Categorical funding; staff attrition; waiting lists; access barriers; racial & ethnic service disparities; knowledge deficit Committed system leaders that effect reform Community Issues/Strengths Rigid mandates; service system role confusion Centralized Intake; committed community stakeholders that embrace system reform Infrastructure Work with Families CAN to develop youth & family involvement Provide training in SOC principles, to become culturally relevant Service Delivery Embrace Wraparound philosophy principles & values into daily practice Develop Integrated Point of Access Identify gaps, barriers & capacity service issues Advocate for local & statewide funding & organizational support Promote cultural competency plan and system reform thru the development of community relationships Use social marketing/education to inform community & stakeholders Work with community groups to increase knowledge & involvement of family, youth and children Evaluation, Reporting and Continuous Quality Improvement Logic Model – Macro Level Community Strategies System Strategies Family Voices Network Intake Committee Cultural Competency Team Social Marketing Team Executive Committee Management Team Governance, Management & Coordination Family, Youth & Child Team Process Vision: Erie County will have a family-driven, strength based integrated system of care that responds with appropriate coordinated services and effective partnering to support self-sufficiency. Services will be timely, flexible, individualized and reduce the need for out-of-home placement as well as shortening the length of stay when there is the need for placement. Family, Youth & Child Involvement at Each Level of SOC Mission: Family Voices Network will provide individualized, integrated, comprehensive, culturally competent and cost-effective community based services that support and promote self-sufficiency of children and families experiencing serious emotional and/or behavioral challenges. Family, Youth & Child Level Increased appropriate Care Coordination referrals Increased stability within the community Increased school attendance Increased natural & community supports

4 Help the Community See Cultural Competence as a Win/Win Families/children/youth receive services that are aligned with their cultural beliefs and consistent with their needs The system of care is best used to meet the needs of all the diverse groups in the community and equitably distributes resources Ethnic/racial communities are able to voice their views which are included as an integral part of on-going service delivery and CQI

5 Struggle Together with the Tough Cultural and Linguistic Questions Key Questions: Are clients from diverse cultural groups equally satisfied with services received and with the outcome of those services? Are clients from different ethnic groups as likely to report improvements in their lives in the various categories measured? Do clients achieve improvements in the areas considered relevant by program managers and evaluators? In the areas clients consider relevant? Do all clients report improvements in their lives?

6 Struggle Together with the Tough Cultural and Linguistic Questions Key Questions: Did the system of care improve outcomes for all children and youth? How did children/youth/family members of color, from immigrant communities or with limited English proficiency fare compared to children and youth in the dominant culture? How did children/youth/family members of low socio- economic backgrounds fare compared to those of better means. How well did the agency perform in meeting its’ goal of increasing the number of providers and staff to reflect the racial/ethnic and linguistic background of the children, youth and family members served? And how do you know?

7 Family Satisfaction “Provider Treated Us with Respect” Family Satisfaction “Provider Treated Us with Respect” (Questionnaire) At 6 months African Americans said mostly or always 89% of the time while Whites were 100% of the time At 12 months African Americans said mostly or always 71% of the time while Whites were 100% of the time My primary service provider understood my needs (Questionnaire) At 6 months African Americans said mostly or always 76% of the time while Whites were 88% of the time At 12 months African Americans said mostly or always 71% of the time while Whites were 100% of the time Assigned and closed but not opened Assigned and closed but not opened (query from CareManager) 23% of the Black/African Americans assigned were assigned and closed without opening while 9% of Whites were assigned and closed without opening Successful Discharge/Discharge Reason "objectives met" Successful Discharge/Discharge Reason "objectives met" (query from CareManager) 25% of Black/African Americans had a discharge reason "objectives met" while 58% of Whites had a discharge reason "objectives met" Note that "objectives met" can be subjective measure, but there is a clear differences between there two groups on this dashboard item CLC IDENTIFIED DISPARITIES

8 Some Data Elements to Measure and include in your CQI Plan Race and Ethnicity Gender Economic Status Source of Referrals Zip Codes Age Preferred Language

9 Suggested Activities Take the time to identify shared interest from system partners to get them to the table Develop a logic model or other framework to organize and understand the ideas and information they share and include at least one identified need of your system partners to keep them at the table Select the outcomes that are important to measure at all levels of the system of care organizational structure and include CLC measures indicators Present the outcomes and framework to stakeholders for feedback and consensus Engage the community you serve by building relationships with faith based and community leaders

10 Lessons Learned Helps you to know that your system of care are culturally and linguistically competent Increases the richness of the community you serve Improve positive outcome for youth and families of all ethnic and cultural backgrounds

11 Lessons Learned Relationship building is on-going and Celebrate successes no matter how small Children behaviors will improve More children stay in their communities with their families System partners will share their funds

12 Contact Information Marie Morilus-Black – (202)