1. Governance and System Management
Sheila A. Pires
Human Service Collaborative
Lisa Conlan
Parent Support Network of Rhode Island
Michelle Zabel
University of Maryland
Bruce Strahl
Technical Assistance Partnership

2. Definition of Governance
Decision making at a policy level that has legitimacy, authority, and accountability.
Definition of System Management
Day-to-day operational decision making 2
Pires, S. (1995). Definition of governance. Washington, DC: Human Service Collaborative. 2

3. Key Issues for Governing Bodies Has authority to govern
Is clear about what it is governing
Is representative
Has the capacity to govern
Has the credibility to govern
Assumes shared liability across systems for the population(s) of focus 3
Pires, S. (2000). Key issues for governing bodies. Washington, DC: Human Service Collaborative. 3

4. Types of Governance Structures
Examples of
Types of Governance Structures
State and/or local interagency body
Non profit board of directors
Quasi governmental entity
Tribal governance
Hybrids
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. 4 4

5. System Management: Day-to-Day Operational Decision Making
Key Issues
Is the reporting relationship clear?
Are expectations clear regarding what is to be managed and what outcomes are expected?
Does the system management structure have the capacity to manage?
Does the system management structure have the credibility to manage? 5
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. 5

6. Examples of Types of System Management Structures
State and/or local interagency body
Quasi-governmental entity
Non profit lead agency
Public sector lead agency
For profit commercial managed care entity
Shared management structure/hybrid
Tribal authority 6
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. 6

7. New Jersey - Contracted Management Structure
Other
School
Referral
Family
& Self
CHILD
Child
Welfare
Juvenile
Justice/
Court
Community
Agencies
Screening with Uniform Protocols
Contracted
Systems
Administrator CSA
Registration
Screening for self-referrals
Tracking
Assessment of level of care needed
Care coordination
Authorization of services
Care Management
Organization
Complex multi-system
involved children
Individualized plan developed
Full plan of care
authorized
Community
Agencies
Uncomplicated care
Service authorized
Service delivered
Adapted from NJ System of Care
Family Support Organization
Family to Family Support
Youth Support Organizations 7 7

8. Wraparound Milwaukee - Lead Public Agency Management Structure
Mental Health
Crisis Billing
Block Grant
HMO Commercial
Insurance
Child Welfare
Funds thru Case Rate
(Budget for Institutional
Care for CHIPS Children)
Juvenile Justice
(Funds Budgeted for
Residential Treatment for
Delinquent Youth)
Medicaid Capitation
(1557 per Month
per Enrollee
9.5M
8.5M
10M
2.0M
Management Entity:
Wraparound Milwaukee
Management Service Organization (MSO)
$30M
Family Organization
$300,000
Per Participant Case Rate
Provider
Network
240 Providers
85 Services
Care
Coordination
Child and Family Teams
Plans of Care
Mgt. Entity: Co. BH Div. 8
Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch 8

9. Cuyahoga County OH - In-House Management Structure
System of Care Oversight Committee
Deputy County Administrator for Human Services
System of Care Office* {
Lead Family
Coordinator {
Lead Youth
Coordinator
Subsets of Children & Families –
Focus of Care Coordination Partnerships
Children in or at risk for residential placement
Children with serious behavioral health challenges
Youth with status offenses
0-3 population Early Intervention engagement challenges
*Functions as an
Administrative Services
Organization 9
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative. 9

10. Care Management Entities:
Locus of management accountability for children
with complex, multi-system involvement
Regional Care
Management Entities
DCH
MCO
MCO
MCO
MHDDAD
ASO
TPA
Ensure child & family team plan of care**
Ensure intensive care coordination
Manage utilization at service
level
**Plans of Care (w/priority on
community-based/natural
supports) determine medical
necessity, except inpatient, residential/group, which require prior authorization
DFCS
DJS
DOE
Use Same Decision Support Tool –
CANS – to determine need for CME 10 10
Pires, S Washington, D.C.: Human Service Collaborative 10

11. Specific Supports & Functions of a Care Management Entity
Maryland
Specific Supports & Functions of a Care Management Entity
At the Youth & Family Level:
Child Family Team (CFT) Facilitation using Wraparound Model
Care Coordination with assessment tools
Care Monitoring and Review
Peer Support Partners
At the Systems Level:
Information Management & Web-based Information System
Provider Network Recruitment and Management
Utilization Review
Evaluation, Outcomes and Continuous Quality Improvement
Financing Model
- Case Rate 11 11

12. Example of Governance/Management Structure
State Interagency Body
State Funding Pool
Financer/
Payers
Local Allocation
County Alliance
Purchaser
Case Rate for each enrolled child
Care Management Entity – Lead Non Profit
Organize and manage provider network
Staff and manage child and family team process
Intensive care management
Utilization management
Quality assurance
Outcomes management /monitoring
Management Information System (tracks children, services, dollars)
Provider
Provider
Provider
Natural Supports
Natural Supports 12
Pires, S. (1996). Contracted system management structure. Washington, DC: Human Service Collaborative. 12

13. BOARD POLICY STATEMENT
Example: Board Policy Statement Addressing Cultural and Linguistic Competence
BOARD POLICY STATEMENT
The Governing Board of All Children System of Care, in recognition of the growing diversity in the population of children and youth needing behavioral health services, seeks to create and maintain a culturally responsive helping environment capable of comprehensively addressing the unique needs of children of color. Children of color have historically been under referred to treatment and specifically in Alden County. It is the responsibility of ACSC to not only make its services accessible to all, but to affirm by policy and action its commitment to children of all cultures.
It is the policy of ACSC to develop and maintain: links with key referral sources in our state’s communities of color; standards for providing services to ethnically, culturally diverse children; a culturally competent work force, reflective of the cultural diversity of the service population; intake procedures, treatment planning, and therapeutic interventions which recognize, enhance and strengthen cultural identity, dignity, and esteem; a treatment milieu in which racism, stereotyping, bigotry and prejudices are inappropriate and not tolerated. 13
Adapted from: People of Color Leadership Institute and Day, P.A. Cultural Competence Materials for MSW Students, Staff, Faculty and the Community
University of Minnesota, Duluth 13

14. Input/evaluation of key management
Examples of Types of Family/Youth Partnership in System Governance and Management
Input/evaluation of key management
Input/evaluation of quality of services and programs
Local system of care input
Resource allocation
Service planning and implementation
Policies and procedures
Grievance and resolution procedures
Conlan, L. (2003). Implementing family involvement. Burlington, VT: Vermont Federation of Families for Children’s Mental Health. 14 14

15. Presented by Michelle Zabel, MSS
Governance & System Management
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
Slide up during registration 15

16. The Maryland Children’s Cabinet and the Governor’s Office for Children
VISION
Children’s Cabinet: All Maryland’s children are successful in life.
Governor’s Office for Children: Maryland will achieve child well-being through interagency collaboration and state/local partnerships.
MISSION
The Children’s Cabinet, led by the Executive Director of the Governor’s Office for Children (GOC), will develop and implement coordinated State policies to improve the health and welfare of children and families. The Children’s Cabinet will work collaboratively to create an integrated, community-based service delivery system for Maryland’s children, youth and families. Our mission is to promote the well being of Maryland’s children.
COMPOSITION
The Secretaries of the Departments of Budget and Management, Disabilities, Health and Mental Hygiene, Human Resources, and Juvenile Services, and the State Superintendent of the Maryland State Department of Education.
Chaired by the Executive Director of the Governor’s Office for Children.

18. A Scenario for State and Local Governance Structures
Individual Care Planning with Child and Family Teams: Care Management Entity (CME)
Local Systems Management
State Systems Management
Local Governance
State Governance
Family Support Organizations

19. Local Management Boards
Purpose is to “ensure the implementation of a local interagency service delivery system for children, youth, and families.” (Human Services Article, Annotated Code of Maryland)
Composed of:
Public and private community representatives and,
A senior representative or department head of the:  (i) local health department;  (ii) local office of the Department of Juvenile Services;  (iii) core service agency;  (iv) local school system; and  (v) local department of social services. 
LMBs are tasked with:
Strengthening the decision-making at the local level;
Designing and implementing strategies that achieve clearly defined results for children, youth, and families as outlined in a local 5-year strategic plan;
Maintaining accountability standards for locally agreed upon results for children, youth, and families;
Influencing the allocation of resources across systems to accomplish desired results;
Building local partnerships to coordinate children, youth and family services within the county to eliminate fragmentation and duplication of services; and,
Creating an effective system of services, supports, and opportunities to improve outcomes for all children, youth and families.
Infrastructure

20. Administrative Service Organization
Key Functions Include:
Care Authorization
Provider Credentialing and Enrollment
Billing/Reimbursement and Provider Payment
Utilization Management
Continuous Quality Improvement
Outcomes Data
Information Management

21. Regional Care Management Entities
A CME is a structure that serves as a “locus of accountability” for youth with complex needs and their families.
Provide Supports to Youth and Families:
Child Family Team Facilitation using Wraparound Service Delivery Model
Care Coordination using Standardized Assessment Tools
Care Monitoring and Review
Peer Support Partners
Provide System Level Functions:
Information Management & Web-based Information System
Provider Network Recruitment and Management
Utilization Review of Service Use, Cost, and Effectiveness
Evaluation and Continuous Quality Improvement
Cross-System and Jurisdiction Financing
Populations to Be Served:
1915(c) Psychiatric Residential Treatment Facilities (PRTF) Demonstration Project Medicaid Waiver
SAMHSA funded SOC grants – MD CARES and Rural CARES
Child Welfare’s Place Matters Group Home Diversion using Resource Coordinators
Other Out-of-Home Diversion using Care Coordination
Local System Management and Service Delivery Infrastructure

22. Care Management Entity Service Coordination/Systems
Wicomico County, MD
System of Care Structure
Local Management Board
Family Partner-
Ship Center
SOC Community
Advisory Board
Care Management Entity
Care Coordinators
Family Partners
211 System
(screening)
Service Coordination/Systems
Navigation - CANS
Families and
Youth
Agencies/Court
Adapted from Wicomico County, MD

23. Governance and System Management
Bruce Strahl
Technical Assistance Partnership

24. Great Governance
Starts With Great Collaboration Collaboration Defined: A mutually beneficial relationship between two or more parties who work toward common goals by sharing responsibility, authority and accountability for achieving results

25. Critical Characteristics of SOC Governance
Balanced-true sharing of responsibility, power and authority
Inclusive-with significant and authentic decision making roles for all who desire a role
Broad-Many places available to be a part of decision making for family, youth state and community partners
Defined- Roles concise, clear and understandable
Simple

26. Governance Characteristics (continued)
Culturally and linguistically competent
Clear communications flow and work flow and easily explainable to all stakeholders with diagram
Efficient and effective
Clear roles and procedures for decision making
Responds quickly but also accommodates a more deliberate approach when needed

27. Broad Based Governance System
STAKEHOLDERS
MEETING EVERY OTHER MONTH
Coordinating Committee
Odd Number Group PD, PI,
Community Leaders, Lead Family,
Family Member, Youth, Policy Makers,
Lead Evaluator
Full Partnership
Facilitator
Agenda
2 Framed Major Challenges
Work Group Meet
Work Group (Some) Report Progress
Agency Pitch – Networking OK
Role
Frame Major Strategic challenges to go to full partnership
Set agenda for full partnership meeting
Model SOC principles
Barrier busting
Conscience of SOC, Cultural competency, family inclusion, collaboration
Help the PD
Model Change
Do It 1st
High Standard of Care/Quality OK
Memorandum of Agreement WG
Send a Work Group Out
Standing or Ad Hoc
Decisions
Broad SOC Community Strategy
Intake System
Social Marketing
Referrals to Community Services
Participation in Child & Family Teams
Family Involvement
Administrative Team
Grant Requirements
Grant Administration
Staffing
Budget
Quality

28. Family and Youth Involvement in Your Governance System
Where should Family and Youth be in your governance system?
Pair family members and pair youth
Prepare a welcome for them
Provide background information and meeting protocols to new families
More tips

29. The 7 Keys to Governance Success
1) A cross functional team including youth, families, required partners and community partners participate in the development of a broad based governance structure.
2) The broad based governance structure provides a variety of meaningful decision making opportunities for partners to participate and be involved in governance on the coordinating council, full partnership, work groups and administrative team.

30. 7 Keys (continued)
3) Diagrams and procedures exist of the governance structure and all partners have a clear understanding of how work and communications flow as well as how decisions are made. SOC decisions are not made outside of the agreed upon governance structure and process.
4) The governance structure reflects the cultural make up of the community and population served.

31. 7 Keys (continued)
5) An evident commitment exists to review and enhance the governance system at regular intervals using broad community and partnership involvement.
6) Orientation, preparation and education must be utilized for all partners for authentic and meaningful participation to take place in the governance system.
7) “Collective Will” is the most important ingredient. Without it, structures and processes will not work and can be manipulated but with it, structural challenges can be overcome.