1. Building Effective Service Systems for Children and Families Presentation by: Sheila A. Pires Human Service Collaborative Washington, DC The President’s New Freedom Commission for Mental Health September 11, 2002 Chicago, Illinois

2. The Total Population of Children and Families Who Depend on Public Systems Pires, S. (1996). Human Service Collaborative, Washington, D.C. Children and families eligible for Medicaid Children and families eligible for the State Children’s Health Insurance Program (SCHIP) Poor and uninsured children and 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 disorder 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

3. Examples of Sources of Behavioral Health Funding for Children and Families in the Public Sector Pires, S. (1995). Examples of sources of behavioral health funding for children & families in the public sector. Washington, D.C. Human Service Collaborative Other WAGES Children’s Medical Services/Title V - Maternal and Child Health Mental Retardation/Development al Disabilities Title XXI - State Children’s Health Insurance Program (SCHIP) Vocational Rehabilitation Local Funds Medicaid Medicaid In-Patient Medicaid Outpatient Medical Rehabilitation Services Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT) Mental Health MH General Revenue MH Medicaid Match MH Block Grant Education ED General Revenue ED Medicaid Match ED Block Grant Special Education Part C, Early Interv. Substance Abuse SA General Revenue SA Medicaid Match SA Block Grant Juvenile Justice JJ General Revenue JJ Medicaid Match JJ Block Grant Child Welfare CW General Revenue CW Medicaid Match IV-E (Foster Care and Adoption Assistance) IV-B (Child Welfare Services) Family Preservation/Family Support

4. Current Systems Problems Pires, S. (1996). Human Service Collaborative, Washington, D.C. Patterns of utilization Cost Administrative inefficiencies Poor outcomes

5. Efficacy of Services (Barbara Burns’ Research at Duke University) Pires, S. (1996). Human Service Collaborative, Washington, D.C. Most evidence of efficacy: Intensive case management, in-home services, therapeutic foster care Weaker evidence (because not much research done): Crisis services, respite, mentoring, family education and support Least evidence (and lots of research): Inpatient, residential treatment, therapeutic group home

6. Categorical vs. Non-Categorical System Reforms Pires, S. (1996). Human Service Collaborative, Washington, D.C Categorical System Reforms Mental Health Child Welfare Juvenile Justice Etc. Shared Population Focus Non-Categorical Reforms

7. Customizing Care for Children with Serious Emotional/Behavioral Disorders and Their Families - Operational Characteristics Pires, S. (1996). Human Service Collaborative, Washington, D.C. Collaboration across agencies at policy, management and service levels Partnership with families Cultural and linguistic competence Blended, braided, or coordinated financing Shared governance and liability across systems and with families Shared outcomes across systems, reflecting community values Organized pathway to services and supports Interagency/family services planning and monitoring teams

8. Customizing Care for Children with Serious Emotional/Behavioral Disorders and Their Families - Operational Characteristics (continued) Pires, S. (1996). Human Service Collaborative, Washington, D.C. Single plan of care One accountable care manager Cross-agency coordination Individualized services/supports “wrapped around” child and family Home-and community-based alternatives Broad, flexible array of services and supports Integration of clinical treatment services and natural supports, linkage to community resources Integration of evidence-based treatment approaches Cross-agency management information systems

9. Local Ownership State Commitment Pires, S. (1996). Human Service Collaborative, Washington, D.C.

10. Financing Strategies to Support Improved Outcomes for Children Friedman, M. Center for the Study of Social Policy First Principle:Program Drives Financing Redeployment:Using the Money We Already Have –The cost of doing nothing –Shifting funds from “deep end” treatment to early intervention –Moving across fiscal years Refinancing:Generating New Money by Increasing Federal Claims –The commitment to reinvest funds for families and children –Foster care and adoption assistance (Title IV-E) –Medicaid (Title XIX)

11. Financing Strategies to Support Improved Outcomes for Children (continued) Friedman, M. Center for the Study of Social Policy Raising Other Revenue to Support Families and Children –Donations –Special taxes and taxing districts for children –Fees and third party collections including child support –Trust funds Financing Structures which Support Service Goals –Seamless services: financial claiming invisible to families and children –Funding pools: Breaking the lock of agency ownership of funds –Flexible dollars: removing the barriers to meeting the unique needs of families –Incentives: Rewarding good practice

12. Finance: the art of passing currency from hand to hand until it finally disappears. n Robert W. Sarnoff, son of David Sarnoff and head of NBC

13. For Further Information Contact: Sheila A. Pires Human Service Collaborative 1728 Wisconsin Avenue, NW Washington, D.C. 20007 (202) 333-1892 sapires@aol.com