1. PATHWAYS TO WELLBEING: DEVELOPMENT AND IMPLEMENTATION February 2016

2. 2 Agenda Coordination efforts in serving the dependency population Joint Governance: Guides our Efforts System-wide shift in practice MHST/Service Delivery Model Evaluation Frame Work Continuum Of Care Building Upon Existing Reform Next Steps CFT Development and Implementation

3. 3 Phase One Joint Governance

4. 4 Process Mapping Katie A. Work Flow

5. 5 Initial Data Agreement Identification of shared outcomes County Counsel involvement for interpretation, i.e. HIPPA Attempted procedure for sharing of information on Adult, which led to MOU Changing of Findings and Orders Initial identification of shared client population Jointly enrolled Group Home Clients found throughout system

6. 6 Program Implementation ( 2-year period) Policy and Procedures Established MHST Process Agreement Shift to Universal/Periodic MHSTs Early Katie A. Service Implementation

7. 7 MHST Process “Super Staffings” Screening at detention Assessment Team Expanded Services Treatment AssessTriageScreen

8. 8 Universal Mental Health Screening: 961 Initial, Key Event or Rescreening

9. 9 MHST: Initial 58%, Key Event 14%, Rescreen 17%(6month)

10. 10 Age Breakdown: 0-5 43%, 6-11 29%, 12-20 28%

11. 11 MHST Disposition: Of the 961 67% Newly Accepted or Already Receiving MH Services, 33% No New Case 68% of No New Case 0-5

12. 12 Total Class Served by Month: 871 Unduplicated

13. 13 Child Welfare Subsystem Mental Health Services by Age Group

14. 14 Pathways to Wellbeing Implementation Executive Steering Program Data: Evaluation Framework Active Joint Management Capacity with Contract Providers Continuum of Specialized Services Specialize Assessment Team Expanded Services Joint Staffing Child & Family Teams Joint Training of Social Workers and Clinicians Capturing Teaming Embraced Teaming

15. 15 Evaluation Framework Data & Evaluation Committee Utilized Contractor Evalcorp Guiding Evaluation Questions Identified Three Domains Developed Shared language Goal: to collect meaningful data First look at data reports Evaluation Framework melded our understanding which lead to definition of joint outcomes Three Primary Evaluation Domains

16. 16 Guiding Evaluation Questions

17. 17 Moving from Silos to a Managed System

18. 18 3 Primary Evaluation Domains

19. 19 Current Evaluation Metrics

20. 20 Domain I: Impact on Children/Youth

21. 21 Domain I: Impact on Children/Youth

22. 22 Domain I: Impact on Children/Youth

23. 23 Domain I: Impact on Children/Youth

24. 24 Domain II: Impact on Family/Caregivers

25. 25 Domain III: HCA/HSA Collaboration

26. 26 Long Term Goals for Data Infrastructure

27. 27 Next Steps: Continuum of Care Reform AB 403 Pathways to Wellbeing is viewed as part of a broad reform strategy with our HSA partners We are embracing a bigger vision and need to expand Joint Governance Focused on continued Teaming and heightened Care Coordination Moving from program planning to system-wide access and treatment in a home-like setting Moving toward TOP Assessment Tool to jointly help determine mental health needs and appropriate placements

28. 28 CCR Building on Current Efforts Behavioral Health  VCBH Continuum of Mental Health Care  Prevention  Wellness and Recovery  Assessment and Early Intervention  Treatment  Residential & Acute Care  Trauma Informed Care  Evidence Based Practice  Pathways to Wellbeing  Multidisciplinary Treatment Planning/Child and Family Teaming Child Welfare  Approved Relative Caregivers Program  Resource Family Approval Program  Quality Parenting Initiative  Child and Family Teaming (Core Practice Model)  Pathways to Wellbeing  Family Preservation  Safety Organized Practice

29. 29 Continuum of Care Reform: first look Desired Result September 2014September 2015 Children in care926884 Children in congregate care 9584 Length of stay in care 18 months or longer39.8%44.6% Re-entry into care within 12 months following reunification 10.2%7.5% Relative / family friend placements 38.2%45.4% Reunification within 12 months (entry cohort) 46.6%40.7% Exit to permanency within 12 months 51%43.9%

30. 30 Ventura County Child Welfare Placements Ventura Child Welfare Placement Data on 1/1/16 Facility TypeChild Count% Casa - Shelter 212.29% Court Specified Home 90.98% Foster Family Agency Certified Home 9410.26% Foster Family Home 12914.08% Group Home 535.79% Guardian Home 10611.57% Relative/NREFM Home 46851.09% Small Family Home 80.87% Supervised Independent Living Placement 283.06% 916100% Age 0-5Age 6-11Age 12-17Age 18+ Of those in Group Homes plus the Shelter: 011594 Slide provided by the Human Service Agency

31. 31 Bi-Annual Group Home Placement Data (per Safe Measures, 18 month cycle) Jul ’15 – Dec ‘15 Casa Pacifica (Shelter & RTC) In-County Group Home Out of County Group Home County not Specified TOTAL July 2015283618385 August 2015252820275 September 2015332721384 October 2015362620385 November 201527 21474 December 201525 20474 AVERAGE29%28.16%20%3.16%80.33% Slide provided by the Human Service Agency

32. 32 Group Home Services VCBH Quality Improvement Project Small amount of Group Home youth receiving medication services at outpatient clinics Need for heightened coordination of care VCBH faces the challenge of the development of the Short-term Residential Treatment Centers (ST-RTC)

33. 33 CCR: Development of Short-Term Residential Treatment Center(STRTC) STRTC will seek licensure and demonstrate capacity to meet treatment level needs Will ensure a quick transition to home-based family placement Foster Family Agencies(FFA) and STRTC will deliver an array of “core services” Mental Health in home-based family care regardless of placement setting FFA and STRTC will be certified by the county MH Plan or arrange for Specialty MH Services Standardize Assessment Process to coordinate Child Welfare & Behavioral Health services STRTC and FFA will require accreditation Development of a coordinated monitoring and oversight system between California Department of Social Services and Department of Health Care Services

34. 34 Our Goals…Challenges…Opportunities Continuum of Care Reform: AB 403 LegislatiContinuum of Care Reform: AB 403 Legislation n Expand efforts to ensure Mental Heath services meet the treatment needs of child/youth regardless of the placement Enhance the level of integration among Child Welfare and County Mental Health Expand availability of specialized Mental Health services in a home- based setting

35. CFT DEVELOPMENT AND IMPLEMENTATION

36. 36 CFT Development and Implementation Created Pilot to Develop Model Teams of SW and Clinician in specific geographic areas Issues and Challenges  Facilitation Discomfort  Training Needed on Facilitation Skills  Logistics (family, scheduling and location) Developed Kaizen Goal: Establish Policies and Procedures Workgroup included: Family, Parent Partners, HSA, BHD, Public Health, Foster and Biological Parents, Youth Representatives Scheduled Cross-System Training with focus on: 1. Shifting Paradigm 2. Developing Teaming Approach 3. Training on Facilitation Strategies

37. 37 Challenges and CCR HSA Challenge: Consistent documentation How would this occur – Protocol from CMS/CWS Preliminary Data Results CCR Shifting Approach Teaming Model vs. CFT ‘Centric’ Challenge in Scheduling and Coordination Expanding Teaming (Family Meetings) approach across the entire Foster System

38. 38 Training Multiple/ongoing Training Scheduled Small Groups with HSA and BHD staff “Teaming Model” Two Training Components:  Overview of CFT Philosophy  Facilitation Model Focus on Skill Building Lessons Learned:  Works best in TDM “like” model (trained in facilitation model)  IHBS/Wraparound better suited to acting as facilitator  Future: Facilitator as a unique position; shift in facilitation

39. 39 Thank you for listening