1. KATIE A. PRESENTATION AUGUST 6, 2015

2. NORTHERN KATIE A LEARNING COLLABORATIVE Counties Participated: 1)Shasta 2)Lake 3)Nevada 4)Inyo 5)Tuolumne 6)Glenn 7)Mendocino

3. PARTNER AGENCIES County Mental Health County Child Welfare Chadwick Center CDSS CIBHS CDHS Academy

4. CONVENING

5. FSG.ORG 5 © 2013 FSG THERE ARE SEVERAL TYPES OF PROBLEMS Source: Adapted from “Getting to Maybe” Simple Complicated Baking a CakeSending a Rocket to the Moon Social sector treats problems as simple or complicated Complex Raising a Child

6. FSG.ORG 6 © 2013 FSG IMAGINE A DIFFERENT APPROACH – MULTIPLE PLAYERS WORKING TOGETHER TO SOLVE COMPLEX ISSUES Understand that social problems – and their solutions – arise from interaction of many organizations within larger system Collective Impact Cross-sector alignment with government, nonprofit, philanthropic and corporate sectors as partners Organizations actively coordinating their action and sharing lessons learned All working toward the same goal and measuring the same things

7. FSG.ORG 7 © 2013 FSG COLLECTIVE IMPACT IS THE COMMITMENT OF A GROUP OF IMPORTANT ACTORS FROM DIFFERENT SECTORS TO A COMMON AGENDA FOR SOLVING A SPECIFIC SOCIAL PROBLEM. Source: Channeling Change: Making Collective Impact Work, 2012

8. FSG.ORG 8 © 2013 FSG DIFFERENCES BETWEEN COLLECTIVE IMPACT AND COLLABORATION Source: Jeff Edmondson, Strive CollaborationCollective Impact Convene around specific programs / initiatives Work together over the long term to move outcomes ProveLearn and improve Addition to what you doIs what you do Advocate for ideasAdvocate for what works Collective impact initiatives also are nearly always cross-sector, whereas collaborations often occur within a single sector

9. FSG.ORG 9 © 2013 FSG COLLECTIVE IMPACT INVOLVES FIVE KEY ELEMENTS Common Agenda Common understanding of the problem Shared vision for change Mutually Reinforcing Activities Differentiated approaches Willingness to adapt individual activities Coordination through joint plan of action Continuous Communication Consistent and open communication Focus on building trust Backbone Support Separate organization(s) with staff Resources and skills to convene and coordinate participating organizations Source: Channeling Change: Making Collective Impact Work, 2012; FSG Interviews Shared Measurement Collecting data and measuring results Focus on performance management Shared accountability

10. FSG.ORG 10 © 2013 FSG COLLECTIVE IMPACT DEPENDS ON “ESSENTIAL INTANGIBLES” FOR ITS SUCCESS Fostering Connections between People The Power of Hope Relationship and Trust building Leadership Identification and Development Creating a Culture of Learning Collective Impact’s Intangible Elements Source: Channeling Change: Making Collective Impact Work, 2012; FSG Interviews

11. FSG.ORG 11 © 2013 FSG Shared Measurement Is a Critical Piece of Pursuing a Collective Impact Approach Improved Data Quality Tracking Progress Toward a Shared Goal Enabling Coordination and Collaboration Learning and Course Correction Catalyzing Action Benefits of Using Shared Measurement Source: FSG Internal

12. FSG.ORG 12 © 2013 FSG PARTNERSHIP WITH CHADWICK CENTER Focus on four area’s –Overall Collaboration between Mental Health and Child Welfare –Screening –Assessment –Service Array

13. FSG.ORG 13 © 2013 FSG CHADWICK CENTER Expertise in Trauma Informed Services Expertise in Screen and Assessment Expertise in guiding implementation across disciplines

14. FSG.ORG 14 © 2013 FSG STRUCTURE OF THE LEARNING COLLABORATIVE Quarterly Convening –Rotating between Redding and Davis Webinar check-in calls between convenings Webinar Learning sessions –San Francisco and San Bernadino –CAT results Individual Technical Assistance by Chadwick Center as requested Sharing of Research and models

15. FSG.ORG 15 © 2013 FSG LEARNING COLLABORATIVE SESSIONS Each session had a focus –Session one: Overview presentation on Trauma Informed Services Roundtable Discussion sessions on: –Screening, Assessment, Data, Service Array, Collaboration building

16. COMMUNITY ASSESSMENT TOOLS NORTHERN REGION SURVEY RESULTS

17. RESPONSES BY DEPARTMENT

18. RESPONSES BY ROLE

19. ASSESSMENT EVALUATION SCREENING Screening Administered to Everyone in Group Brief Easy to Complete Gives ‘Yes’ or ‘No’ Information Focused on a Specific Topic Assessment Administered to Targeted People In-Depth Requires Training Gives Unique Client Picture Informs Treatment Typically Completed Over 1-3 Visits Psychological Evaluation Even More In-Depth Completed by Psychologists (typically) Gives Very Specific Information

20. SCREENING PRACTICES (CW) 83% Screening Tool is Used 67% Using a standardized questionnaire – Type of Tool: Information Integration Tool Screening responses were messy – Definitions, Roles, Timing

21. SCREENING PRACTICES Most (57%) CW staff report not knowing if screening results are shared with clinicians 10% rarely share results with clinicians The screening process can be confusing – New process for most counties – Among those who felt they knew how screening occurs, some confusion: CANs, MHST, BDI, GAIN, Katie A, Intake Assessment, paper form, questionnaire

22. MH EXPERIENCES WITH SCREENING 49% say CW workers share assessment results sometimes or almost always 14% say CW workers rarely or almost never share assessment results When the have them: –Results are generally clear (89%) and useful (90%)

23. ASSESSMENT PRACTICES (MH) 46% don’t know or disagree that standardized tools are being used

24. ASSESSMENT PRACTICES Most clinicians report sharing results with CW workers (88%) 12% rarely share results with CW workers Privacy/Confidentiality is a grey area – Left up to culture of organization – For better and for worse

25. CW EXPERIENCES WITH ASSESSMENTS 51% say therapists share assessment results sometimes or almost always 20% say therapist rarely or almost never share assessment results When the have them: –Results are generally clear (77%) and useful (93%)

26. TRAUMA-INFORMED PRACTICES 80% believe it’s important for CW kids to access trauma-focused treatment 62% believe staff are willing/able to implement trauma-focused treatment 57% believe county leaders are committed to implementing trauma-focused treatment – 65% in MH; 47% in CW – Initiative Fatigue? Engagement/Skepticism?

27. NORMS &PRACTICES TAKEAWAYS Screening is confusing Confidentiality is tricky Opportunities for use of evidence-informed assessment tools in CW and MH Staff interested in norms & practices

28. Building a Better Cockpit

29. Values & Beliefs

30. CULTURAL AWARENESS

31. CROSS-SYSTEM COLLABORATION

32. Cross-System Collaboration

33. ORGANIZATIONAL CULTURE AND CLIMATE Across Service Settings: – Stronger client engagement and alliance Rapport, satisfaction, participation – Increased staff openness, adherence to effective practices, performance, commitment, retention, and attendance – Higher quality services Survey of Organizational Functioning (SOF) – Staff Attributes and Organizational Climate (Broome, Flynn, Knight, & Simpson, 2007; Glisson, 2002; Locke, 1976; Moos & Moos, 1998; Moos & Schaefer, 1987; Schaefer & Moos, 1996; Schoenwald, & Hoagwood, 2001; Weisman & Nathanson, 1985)

34. STAFF ATTRIBUTES Range: 10-50 High Scores = Stronger Staff Attributes

35. ORGANIZATIONAL CLIMATE Range: 10-50 High Scores = Stronger Org Climate

36. VALUES AND BELIEFS TAKEAWAYS Cultural awareness seems to be a strength Cross-system collaboration seems to be an emerging strength –Specific next steps identified Strengthening relationships Familiarity with norms/practices Organizational culture –Several strengths (cohesion/efficacy) –Opportunities to attend to challenges (communication and stress) Similar Organizational Climate patterns across MH and CW

37. BASIC PROCESS

38. SCREENING Identifying children with mental health and trauma related needs through screening is crucial and has been identified through multiple initiatives on the State and Federal level. Many counties have begun screening efforts, but the success is undetermined.

39. CASAT SCREENING PILOT Completed pilot in Tulare County using two brief, validated screening tools Screening was administered to children and caregivers by caseworker

40. TULARE COUNTY PILOT STUDY Measures: Strengths and Difficulties Questionnaire (SDQ) and the SCARED-Short. These results are consistent with the National Survey of Child and Adolescent Well-Being (NSCAW). Our preliminary assumption based on these results is that it is advantageous to use both a general mental health and trauma-specific screener. Tool% with Any Concern% without Any Concern N SDQ36.563.5734 SCARED-short21.878.2725 Any Concern (both tools) 43.956.1725

41. NORTHERN REGION SCREENING IMPLEMENTATION COMMUNITY (NRSIC)

42. ABOUT NRSIC Assists counties with implementing an evidence-informed screening approach Implementation team from each selected county Engage stakeholders from multiple levels These stakeholders will test strategies and practices related to the implementation of screening approaches Will use the EPIS Model of Implementation as a Framework

43. IMPLEMENTATION TEAM MEMBERSHIP Senior Leader Day-to-Day Manager Child Welfare Caseworker Mental Health Partner Family Partner Optional Members: CW Referral Liaison Representative from IT/Quality Assurance Additional Team Member with expertise related to screening

44. ASSESSMENT Trauma Informed Mental Health Assessment Pathway (TI-MHAP) CASAT is working with Tulare County Building into EHR

45. TREATMENT Need to examine what services currently exist in county What needs to be added, changed, subtracted? Compare what you have to what you need – numbers, diagnoses, etc. CEBC has a process established to review MH service array

46. CHALLENGE: CROSS SYSTEM INFORMATION SHARING

47. FSG.ORG 47 © 2013 FSG STORIES FROM THE FIELD Highlights from Glenn, Butte and Shasta County

48. FSG.ORG 48 © 2013 FSG WHAT WE LEARNED Implementation is a Long Journey –Even when there is a commitment to a New Direction. Collaboration, and Leadership Early identification and intervention is critical for children in care Cross system and cross agency sharing was helpful in supporting learning, and implementation Clarification on what a Trauma Informed Agency looks like –Leaderships role in supporting the development of a Trauma system

49. FSG.ORG 49 © 2013 FSG WORKFORCE DEVELOPMENT ACTIVITIES Training on: SOP and Trauma Impact of Trauma on Child Development Trauma Informed Organizations: Steps Towards Transformation Secondary Trauma and the Child Welfare Professional

50. FSG.ORG 50 © 2013 FSG TRAINING Child Welfare and Mental Health: Gaining Understanding of Each System CANS Assessment Tool What Does Trauma Have To Do With It: Making Child Welfare System Trauma Informed A Systems Approach to Integrating Trauma into Screening, Assessment, Treatment and Case Planning

51. FSG.ORG 51 © 2013 FSG IMPLEMENTATION AND SYSTEMS CHANGES Each county implemented a screening process –Still in process of refining Each county implemented an assessment process using a formal assessment tool Each county identified their data and aligned sources to inform their system delivery Each county has worked through issues of confidentiality and have systems in place for sharing

52. FSG.ORG 52 © 2013 FSG ONGOING CHALLENGES Out of county placements Staff turn over in both CW and MH Inadequate staffing for ICC and IHBS Data sharing and tracking –Child welfare and Behavioral Health different data systems still not resolved –Tracking outcomes for each child

53. FSG.ORG 53 © 2013 FSG ONGOING CHALLENGES Meeting the goal of Service Array –Lack of services in rural areas: Specialty services for 0-3 Youth with behavioral issues resulting in placement disruption Aligning assessments with services

54. NORTHERN CALIFORNIA RESEARCH and TRAINING ACADEMY Chadwick Center