1. the CANS in SF: Process, Progress, Promise April 19, 2010 Nathaniel Israel, PhD SFDPH CBHS CYF-SOC

2. Thank-Yous.. San Francisco’s Children, Youth, and Families San Francisco’s Children, Youth, and Families Sai-Ling Chan-Sew, Director CYF-SOC Sai-Ling Chan-Sew, Director CYF-SOC Community Programs Administration Community Programs Administration John Lyons John Lyons Clinicians, Case Managers, and Program Directors Clinicians, Case Managers, and Program Directors

3. Presentation: Pro, Con, Process Morning: High Energy Morning: High Energy First Talk: High Expectations First Talk: High Expectations Our Way Through: Our Way Through: –Values of CANS Collaboration: Audience Participation Collaboration: Audience Participation Outcome Focus: Objectives in Bold Outcome Focus: Objectives in Bold

4. Starting Point: Get Out! 22 Programs 22 Programs 3 Advocacy Groups 3 Advocacy Groups 2 Themes: 2 Themes: – Programs Complex Needs of Children, Youth, Families, Communities Complex Needs of Children, Youth, Families, Communities Provider History with Community Provider History with Community Provider Confidence in Effectiveness of Practice Provider Confidence in Effectiveness of Practice

5. Families People in Systems aren’t listening to us People in Systems aren’t listening to us –If they are, they’re not changing anything Aren’t investing in us Aren’t investing in us –Humanistic theory: don’t achieve our potential because something is in the way –Here it’s the systems that pay our paychecks: it’s us –Resources are there but they’re not being used effectively to help us

6. Empowering Narratives Stories likely not new Stories likely not new Never been collected in a way that would allow us to: Never been collected in a way that would allow us to: –Be forced to honor them and –Find concrete “next steps” to take to act in new ways that would better help families

7. Framework for Change Value: Value: –Put families and children first ; serve them effectively Tool: Tool: –the __ __ __ __ Process: Process: –Become “communication rich” in actions that matter most for children, youth and families

8. Initial Implementation Can we move from fights and frustrations to rational system that puts families first in policy and progress? Can we move from fights and frustrations to rational system that puts families first in policy and progress? FCMH: FCMH: –Long wait times for assessment –Under-serving FC population –Concern that treatment not matched to need

9. FCMH Implementation Lessons learned: Lessons learned: Meaningful goals can be accomplished Meaningful goals can be accomplished –Wait time reduced by 2/3rds –Confidence that treatment matched to needs Cross-system communication can become understandable and rational Cross-system communication can become understandable and rational –Requires persistent focus on outcome –Everyone involved has to have access to information about the outcome that matters –Progress facilitated by weekly review of progress, and problem solving to make more progress

10. Systemwide Implementation If you can do something on a small scale, then you can do it on a large scale, right? If you can do something on a small scale, then you can do it on a large scale, right? What could the possible barriers be? What could the possible barriers be?

11. Barriers System changes: System changes: –Move to HER Antiquated system did not support any entry of CANS Antiquated system did not support any entry of CANS Had to switch to interim online system Had to switch to interim online system –Funding cuts Scaling Issues: Scaling Issues: –Massive increase in scale with no attendant staffing increase (1 program to 61 programs)

12. Uneven Pace of Implementation Early Adopters Early Adopters –Take it and run! Hesitant Prove-its Hesitant Prove-its –Wait-and-See Kick the CANS Kick the CANS –….and hope it dies.

13. Parallel Processes Clear need for both Technical and Social Implementation / Learning Process Clear need for both Technical and Social Implementation / Learning Process –Chose local web-based app design firm (AJWI) –Began communication process to identify and answer implementation issues, identify system issues, and learn form successes

14. Social Process Multi-Level Training and Communication: Certification Certification SuperUswer Certification SuperUswer Certification –Applying CANS to practice (Treatment Planning, Identification of Outcome patterns) SuperUser Calls SuperUser Calls –Manuals: SUPSM, Tx Planning, EBC –Policy Development (transfer, aging up) –Using CANS to be explicit about treatment goals, learn from each other

15. Technical Process Instant, Multi-Level Feedback from CANS: Instant Feedback for Treatment Planning Instant Feedback for Treatment Planning Instant visual of client needs / strengths Instant visual of client needs / strengths –Evidence based, client based Clinical Formulation Cross-time comparison of client progress Cross-time comparison of client progress Cross-clinician data for supervision Cross-clinician data for supervision Program-Level Clinical Formulation Program-Level Clinical Formulation

16. Goal Utilize processes people are already familiar with to make sense of and act on these new sources of child, youth and family information Utilize processes people are already familiar with to make sense of and act on these new sources of child, youth and family information

17. Client –Level Formulation / Progress

18. Program-Level Clinical Formulation

19. Program-Level Clin. Form. (2)

20. Program Clinical Formulation

21. But the learning and acting can’t stop there…

22. System-Level Profile

24. Cross-Agency Progress

25. Progress in SF: Process Value: Value: –Put families and children first ; serve them effectively Tool: Tool: –the __ __ __ __ Process: Process: –Become “communication rich” in actions that matter most for children, youth and families

26. Progress In SF: Present Now we have identified what are the most pressing needs of our children, youth, and families Now we have identified what are the most pressing needs of our children, youth, and families We have identified the environments in which we must collaborate for success We have identified the environments in which we must collaborate for success We have a way to identify who we need to learn more from to promote effective practices for our children youth and families We have a way to identify who we need to learn more from to promote effective practices for our children youth and families

27. Progress in SF: Next Steps Full circle with families: CANS education for treatment empowerment Full circle with families: CANS education for treatment empowerment ‘Digging in’ to practices that are promising for families ‘Digging in’ to practices that are promising for families Combining knowledge of EBTs and effective local practices to provide the care with the greatest chance of success for families Combining knowledge of EBTs and effective local practices to provide the care with the greatest chance of success for families

28. Thank you! Contact info: nathaniel.israel@sfdph.org Contact info: nathaniel.israel@sfdph.orgnathaniel.israel@sfdph.org Complete your attendance sheet and Evaluation sheet for CEUs / CMEs! Complete your attendance sheet and Evaluation sheet for CEUs / CMEs!