1. Grantmakers for Children, Youth and Families Conference October 10, 2012

2. Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes Introductions Why Systems Building? Foundation Case Studies Connecticut Colorado Small-Group Discussion 3-Part Discussion Concluding Comments

3. Introductions Judith Meyers President and CEO, The Children’s Fund of Connecticut Deidre Johnson Program Officer, The Colorado Trust Phillip Chung Assistant Director of Research, Evaluation, and Strategic Learning, The Colorado Trust Jennifer Schroeder President, The Implementation Group

4. Why Systems Building?  System: “a set of interrelated parts that interact and function together to produce a common outcome” (Coffman & Parker, 2010)  Systems building: the process of improving the individual parts, and more importantly, how these parts interact  Goal of systems building: improve the continuum of quality care for children and families

5. Judith Meyers, Ph.D. President and CEO Children’s Fund of Connecticut

6. Framework: Vision of a Comprehensive System for Children’s Health Every child in Connecticut will receive high quality health promotion and prevention services within a family- centered medical home, and will have timely access to community-based services and supports as needed, where needed, to assure optimal development.

7. Children’s Fund of CT: Strategies 1. Develop Framework 2. Fund Communities and Provide TA: Systems Development Community Plans Demonstrations/Replications Practice Change EPIC Workforce Development 3. Research & Dissemination of Findings 4. Policy Reform

8. Child Health Services Building Blocks Family Support Services Universal Selective Indicated Care Coordination Medical Home [Accessible, Continuous, Comprehensive, Coordinated, Family-Centered, Compassionate, Culturally Effective] Child Health Services Developmental Services Medical Services Home –Based Services Prt C (B-to-3) Title V Desired Outcomes for School Readiness Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development. Early Care and Education Programs.

9. Systems Development: Support for Communities  Purpose: Promote full integration of child health in comprehensive community early childhood planning and implementation  Grants to communities – Public/Private  Provide Technical Assistance  Results based accountability frame  Information, webinars, intensive support  Child Health System Performance  Health Related Indicators for School Readiness  Inventory of Community Resources resources/  How well services are integrated across/embedded in child serving systems  Engaging child health provider  Accessing and using data

10. Systems Development: Model Demonstration/Replication for Key Components  Child FIRST (Child and Family Interagency Resource, Support, and Training) - evidence based early childhood home visiting intervention, embedded in a system of care

11. Practice Improvement  Educating Practices in the Community (EPIC) Brings timely information and training to child health professionals to change their practices Sample modules Screening - Developmental/Behavioral Health/Autism Collaborative Health Care Oral health Care Coordination Hearing Loss  Early Childhood Mental Health Workforce Infant/toddler mental health competencies

12. Research and Dissemination

13. Advancing Policy Reform 1. Governance - state and local 2. Standards that define quality 3. Research, evaluation and data development 4. Financing sufficient to assure the delivery of high quality programs and practices in a comprehensive manner based on adopted standards; infrastructure support; Medicaid 5. Provider and practitioner support to assure the quality of services and the development of workforce with the capacity to meet the needs (competencies) 6. Public/private partnerships

14. Challenges for Funders Collaboration with other funders Lack of alignment across systems Lack of capacity – dollars, experience in systems building Lack of data For rural communities systems change at the local level is difficult to effect without regional collaboration. Engaging health providers

15. Deidre Johnson Program Officer The Colorado Trust

16. Early Childhood Health Integration GOAL To better integrate health into Colorado’s broader early childhood development system as a means of improving health outcomes for more than 700,000 children.

17. Colorado Early Childhood Councils  Introduced in Colorado in 1997  Multi-sector partnerships working to coordinate services in local communities:  Early Learning  Family Support and Parent Education  Health  Social Emotional and Mental Health  Goal: Improve child outcomes by creating a system of care that is more effective and easier for families to navigate.

18. Early Childhood Colorado Framework

19. Selected Child Health Outcomes  Access to preventive oral/medical health care  Assuring Better Child Health and Development  Cavity Free at Three  Enrolling children in health insurance  Access to a Medical Home approach  Immunizations  Physicians and dentists accepting Medicaid/CHP+  Access to timely, appropriate prenatal care  Increased knowledge of the importance of health/wellness  Increased number of environments providing early identification and mental health consultation

20. Conceptual Framework  Context - Improving the political environment that surrounds the system so it produces the policy and funding changes needed to create and sustain it.  Components - Establishing high-performance programs and services within the system that produce results for system beneficiaries.  Connections - Creating strong and effective linkages across system components that further improve results for system beneficiaries.  Infrastructure - Developing the supports systems need to function effectively and with quality.  Scale - Ensuring a comprehensive system is available to as many people as possible so it produces broad and inclusive results for system beneficiaries. ~ J. Coffman (2007)

21. Timeline

22. Early Childhood of La Plata County  Developed and implemented the Community Access and Referral Enrollment System (CARES) a sliding fee scale program to increase access to medical, dental and mental health care services by offering discounted care to the underinsured. (www.laplatacares.org)www.laplatacares.org  Created an Early Childhood Community Resource Guide – an online, bilingual asset/inventory database of resources available in La Plata County for children from birth to age 8  Created a Pediatric Health Care Home Coalition to increase communication and collaboration among medical and non-medical early childhood service providers, decrease duplication and increase early intervention.

23. Phase II - Goals  Demonstration of effective systems-building activities that further advance health integration accomplishments achieved during the first three years.  Active and sustained engagement of health partners.  Active and sustained coordination of health integration activities within the Early Childhood Council.  Demonstrated planning for sustainability of health integration activities beyond the completion of the Phase II health integration grant.

24. Lessons Learned & Advice for Funders  Defining systems, systems building and systems outcomes  Dealing with different developmental stages and varying local resources – Grantee readiness  Program Implementation vs. Systems-Building  Language matters when working across systems  Engaging health providers  Aligning and collaborating with state level partners  Planning and technical assistance – Iterative approach

25. Small-Group Discussion Part 1 (10 minutes): How integrated vs. silo’d are the systems in the communities you serve? Part 2 (10 minutes): How would you measure success in systems building in the communities you serve? Part 3 (10 minutes): As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

26. 090 00 0 1876543215 9 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

27. 090 00 9 876543215 8 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

28. 090 00 8 876543215 7 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

29. 090 00 7 876543215 6 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

30. 090 00 6 876543215 5 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

31. 090 00 5 876543215 4 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

32. 090 00 4 876543215 3 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

33. 090 00 3 876543215 2 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

34. 090 00 2 876543215 1 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

35. 090 00 1 876543215 0 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 1: How integrated vs. silo’d are the systems in the communities you serve?

36. Part 1 Report-Back Part 1: How integrated vs. silo’d are the systems in the communities you serve?

37. Part 2 Small-Group Discussion Part 2: How would you measure success in systems building in the communities you serve?

38. 090 00 0 1876543215 9 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

39. 090 00 9 876543215 8 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

40. 090 00 8 876543215 7 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

41. 090 00 7 876543215 6 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

42. 090 00 6 876543215 5 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

43. 090 00 5 876543215 4 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

44. 090 00 4 876543215 3 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

45. 090 00 3 876543215 2 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

46. 090 00 2 876543215 1 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

47. 090 00 1 876543215 0 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve?

48. Part 2 Report-Back Part 2: How would you measure success in systems building in the communities you serve?

49. Part 3 Small-Group Discussion Part 3: As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

50. 090 00 0 1876543215 9 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

51. 090 00 9 876543215 8 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

52. 090 00 8 876543215 7 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

53. 090 00 7 876543215 6 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

54. 090 00 6 876543215 5 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

55. 090 00 5 876543215 4 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

56. 090 00 4 876543215 3 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

57. 090 00 3 876543215 2 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

58. 090 00 2 876543215 1 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

59. 090 00 1 876543215 0 004987654321039876543210987654321021987654321098765432100 HoursMinutesSeconds 10-minute Small-Group Work Part 2: How would you measure success in systems building in the communities you serve? As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

60. Part 3 Report Back Part 3: As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? What are some of the challenges in reaching success indicators? How would you communicate your role in supporting systems building work to both your grantees and your Board?

61. Contact Information  Judith Meyers, President and CEO of The Children’s Fund of Connecticut (meyers@adp.uchc.edu)meyers@adp.uchc.edu  Jennifer Schroeder, President, The Implementation Group (jen@theimplementationgroup.com)jen@theimplementationgroup.com  Deidre Johnson, Program Officer, The Colorado Trust (Deidre@coloradotrust.org)Deidre@coloradotrust.org  Phillip Chung, Assistant Director of Research, Evaluation and Strategic Learning, The Colorado Trust (Phillip@coloradotrust.org)Phillip@coloradotrust.org