Planning for Sustainability Sheila A. Pires Human Service Collaborative Ashley Keenan Parent Support Network of Rhode Island Michelle Zabel University of Maryland Myra Alfreds Westchester County, New York

2 Planning Structure Issues Leadership Staffing Time and place of meetings Stakeholder involvement and supports Committees, work groups, focus groups Communication and dissemination of information Outreach to and involvement of families and youth Outreach to and involvement of diverse and disenfranchised constituencies Linkage to related reform/planning initiatives Resources Attention to sustainability Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

3 Strategies for Addressing Cultural and Linguistic Competence in Planning Identify, engage and partner/contract with formal and informal community organizations, leaders and cultural brokers Engage diverse families and youth in planning Conduct sessions for planning group members with trained facilitators to explore attitudes about culture and diversity (e.g., race, “isms”) Provide culturally and linguistically appropriate invitations, outreach materials and other information Incorporate specific strategies for cultural and linguistic competence in system of care plans Utilize cultural competence coordinator to support effective planning Lazear, K. University of South Florida. Primer Hands On (2008)

4 Cuyahoga County Planning Process Structure System of Care Oversight Committee Chaired by Deputy County Administrator for Human Services Includes a Broad Representative Stakeholder Group, e.g., major child serving systems, families and youth, Neighborhood Collaboratives, providers, researchers Cultural & Linguistic Competence Evaluation & Research Family & Youth Involvement Social Marketing Design & Sustainability Training & Coaching Staffed by System of Care Office Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

5 Example: Communication Mechanisms in the State of North Carolina Local Collaborative Communication Committee Website Regional meetings Brochures Meeting calendar Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

6 Pires, S Human Service Collaborative. Washington, D.C. Identify your population(s) of focus. Agree on underlying values and intended outcomes. Identify services/supports and practice model to achieve outcomes. Identify how services/supports will be organized (so that all key stakeholders can draw the system design). Identify the administrative/system infrastructure needed to support the delivery system, including the structure for family/youth partnership. Cost out the system of care. Develop a strategic financing and sustainability plan. Critical Steps in a Planning Process

7 The Total Population of Children, Youth and Families Who Depend on Public Systems Pires, S. (1997). The total population of children and families who depend on public systems. Washington, DC: Human Service Collaborative. Children/youth/families eligible for Tribal Authority funding. Children/youth/families eligible for the State Children's Health Insurance Program (SCHIP ) Poor and uninsured children/youth/families who do not qualify for Medicaid or SCHIP. Families who are not poor or uninsured but who exhaust their private insurance, often because they have a child with a serious emotional/behavioral challenge. Families who are not poor or uninsured and who may not yet have exhausted their private insurance but who need a particular type of service not available through their private insurer and only available from the public sector. Children/youth/families eligible for Medicaid.

% 15% 80% More complex needs Less complex needs Intensive services – 60% of $$ Home and community services and supports; Early inter- vention - 35% of $$ Prevention and Universal Health Promotion – 5% of $$ Prevalence/Utilization Triangle Pires, S Human Service Collaborative. Washington, D.C.

9 Example: Transition-Age Youth What outcomes do we want to see for this population? Pires, S Building systems of care..Human Service Collaborative. Washington, D.C. Policy Level What systems need to be involved? (e.g., Housing, Vocational Rehabilitation, Employment Services, Mental Health and Substance Abuse, Medicaid, Schools, Community Colleges/Universities, Physical Health, Juvenile Justice, Child Welfare) What dollars/resources do they control? Management Level How do we create a locus of system management accountability for this population? (e.g., in-house, lead community agency) Frontline Practice Level Are there evidence-based/promising approaches targeted to this population? What training do we need to provide and for whom to create desired attitudes, knowledge, skills about this population? What providers know this population best in our community? (e.g., culturally diverse providers) Community Level What are the partnerships we need to build with youth and families? How can natural helpers in the community play a role? How do we create larger community buy-in? What can we put in place to provide opportunities for youth to contribute and feel a part of the larger community?

Crafting Logic Models: Phases of Theory Development For Systems of Care STAGE 1: Form workgroup STAGE 2: Articulate mission STAGE 3: Identify goals and guiding principles STAGE 4: Develop the population context STAGE 5: Map resources and assets STAGE 6: Assess system flow STAGE 7: Identify outcomes and measurement parameters STAGE 8: Define strategies STAGE 9: Create and fine-tune the framework STAGE 10: Elicit feedback STAGE 11: Use framework to inform, plan evaluation, and technical assistance STAGE 12: Use framework to track progress and revise theory of change Hernandez, M. & Hodges, S. (2003). Crafting logic models for systems of care: Ideas into action. Tampa, FL: University of South Florida

The more that planning is directed to making systemic or structural change, the more sustainable the changes will be. Example #1: Launching a newsletter for families – good goal, not a structural change Amend the State Medicaid Plan to cover family peer support – good goal and a structural change Example #2: One-time legislative appropriation to expand home and community services – good goal, not a structural change Amend the State Medicaid Plan to cover an array of home and community-based services and pool or braid dollars across systems – good goal and a structural change Example #3: Educating providers about partnering with families and with youth – good goal, not a structural change Contractual requirements for child/family teams – good goal and structural change Planning for Sustainable Change Pires, S. (2002).Building systems of care: A primer. Washington D.C.: Human Service Collaborative.

Strategies for Involving Families and Youth in Planning 12 Disseminate invitations/outreach flyers Engage families and youth who work regularly with other families and youth Contract with family organizations to develop and sustain process for providing participant supports Offer stipends, transportation, food, child care, interpretation, translation Hold planning meetings at flexible times and accessible locations Conduct focus groups, interviews and surveys Provide ongoing training and mentoring Have more than token representation Publicly acknowledge the contributions of families and youth Adapted from: Emig, C., Farrow, F. & Allen, M. (1994). A guide for planning: Making strategic use of the family preservation and support services program. Washington, D.C.: Center for the Study of Social Policy & Children’s Defense Fund.

13 Roles for a Full Time Youth Engagement Specialist / Youth Coordinator Coordinate and foster a youth-guided system and youth-driven movement Coach Raise awareness of the importance of youth voice at all levels of the system of care Build bridges and partnerships between the youth and professional worlds Foster a youth-guided system and youth-driven movement Reconnect youth with the community Educate adults and professionals on the importance of youth involvement Work with youth to create a strategic plan of the movement that ties into the community logic model Adapted from System of Care- Start Up Webinar Series

Planning for Sustainability: Being Strategic Presented by Michelle Zabel, MSS Director, Maryland Child & Adolescent Innovations Institute, Mental Health Institute & Juvenile Justice Institute Division of Child & Adolescent Psychiatry, School of Medicine, University of Maryland, Baltimore

Seizing Opportunities, Being Realistic Link grant and other funding/policy opportunities together (as they arise) to build upon one another and leverage further systems change Be aware of the fiscal, political, and cultural climate –Budget issues –Political timeframes –Competing pressures and interests

Creating Linkages, Connecting the Dots Review and synthesize existing documents and strategic plans—before beginning the work Populations & Outcomes: –Identify results and indicators already in use –Use measures that have strong Communication Power (Does the indicator communicate to a broad range of audiences?) Proxy Power (Does the indicator say something of central importance about the result?) Data Power (Quality data available on a timely basis) Connect the data requirements across grants and contracts

Using Results Accountability to Frame the Maryland Child & Family Services Interagency Strategic Plan Result (a quality of life condition we want to achieve): All of Maryland’s children involved with or at-risk for involvement with multiple child-family serving agencies will be successful in life. Population of Focus (focus for the strategic planning process): Children and youth involved in or at- risk for involvement with multiple child-family serving systems. Indicators (how we measure this condition):  Out-of-home placement: Rate of children under 18 entering out-of-home placement  Education: o Percentage of 3 rd grade students scoring proficient or advanced in reading on the Maryland School Assessment. o Percentage of youth, 18-24, by highest educational attainment (less than a high school diploma or equivalent, high school graduate/equivalent, some college or associate’s degree, and bachelor’s degree or higher)  Juvenile Offense Arrests: o The rate of arrests of youth ages for violent offenses. o The rate of arrests of youth ages for serious non-violent offenses.

THE IMPLEMENTATION OF A COORDINATED INTERAGENCY EFFORT TO DEVELOP A YOUTH SERVICE SYSTEM THAT CAN BETTER MEET THE NEEDS OF YOUTH AND THEIR FAMILIES AND TARGET CHILDREN WHO ARE AT-RISK Maryland Child & Family Services Interagency Strategic Plan

CREATED A SERIES OF RECOMMENDATIONS UNDER EIGHT DIFFERENT THEMES: Family & Youth Partnership Interagency Structures Workforce Development & Training Information-Sharing Improving Access to Opportunities and Care Continuum of Opportunities, Services & Care Financing Education IMPLEMENTATION IS OCCURRING AND STATE AND LOCAL LEVELS, WITHIN AGENCIES AND ACROSS SYSTEMS Maryland Child & Family Services Interagency Strategic Plan

Embed System of Care Values and Principals into Policy and Regulation –Terms that have been institutionalized with definitions in Medicaid regulations ( ) include: Care Coordinator Caregiver Caregiver peer-to-peer support Care management entity Child and Family Team Family support organization Family support partner Peer-to-peer support Plan of Care Wraparound Youth Peer-to-Peer Support Youth Support Partner –Other systems of care concepts and processes in the Medicaid regulations include: The components of a comprehensive and individualized Plan of Care The role and responsibilities of the Care Management Entity The role and responsibilities of the Child and Family Team Service descriptions, including caregiver peer-to- peer support, youth peer-to- peer support, and family and youth training Rates are provided for family members and youth to bill Medicaid for services provided under the Waiver

Planning for Sustainability: Being Strategic How to Build a Fiscal Sustainability Plan That Will Work on Multiple Levels Presenter:  Westchester Community Network: Myra Alfreds, Director, Children’s Mental Health Services-Westchester County Dept. of Community Mental Health

What Supports Fiscal Sustainability  Sustain Values & Practices  Family Movement (Family Voice & Choice at Multiple Levels)  Infrastructure

Philosophy & Approach to Sustainability  Seize the opportunity  Involve old & new partnerships  Understand the populations you are currently serving  Explore cross systems needs & initiatives  Be in the lead, but be willing to share power  Claim everything! But generously share credit for successes Leave no stakeholder behind.

System Planning Create a Sense of Urgency –Out of home placement costs –Children falling through the cracks –Child welfare performance improvement Plans (PIP) –System of care planning –Categorical funding –Organizational silos

System Planning Secure broad stakeholder involvement Develop logic model or strategic plan –Identify outcomes, system and child and family level Identify target population-keeping in mind financial eligibility criteria Develop concept paper Bring in Facilitators for group process Bring in outside experts to help with different finance challenges if necessary

System Planning What services do we want to develop What are our priorities What are our action strategies What is our communication plan Have we gathered feedback from all stakeholders

Sustain These to Achieve Fiscal Sustainability  Practices and Approaches  Services  Training/Workforce Development  Social Marketing  Infrastructure  Committees  Partnerships (New and Old)

Examples of Sustainability Funding Child Welfare Mental Health Medicaid Youth Bureau Local Tax Levy Health Office for the Aging Juvenile Justice Ideas/Initiatives  System of Care Approach  Infrastructure  PBIS  Training  Wraparound  Family-Decision Making  Early Childhood

Contact Information Myra Alfreds, MSW