12006-07 System of Care Start-up Webinar Series1
Clinical Directors and Transforming Services
and Supports in a System of Care
Wilfredo Soto, ConnecticutFrank Pace, Rhode Island
Kim Williams and Ken Martinez, Technical Assistance Partnership
April 3, 2007
Meet the presenters!
Wilfredo Soto
Kim Williams
Frank Pace
Ken Martinez
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Service Delivery Components Benefit Design/Service Array
Evidence-Based Practice
Outreach and Referral
Intake/Access
Screening, Assessment, and Evaluation
Decision-making and Oversight (Care planning, care authorization, care monitoring, and review)
Flexible Funds
Care Management or Care Coordination
Crisis Management at the Service Delivery and Systems Level
Service Planning using a Wraparound Approach
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Infrastructure Elements Utilization Management
Staffing Structure
Staff Involvement, Support, and Development
Orientation and Training of Key Stakeholders
Coordination with Social Marketing
Provider Network
Protecting Privacy
Ensuring Rights
Continuous Quality Improvement
National Evaluation Interface
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Develop structures and processes from the start to support key stakeholder, youth, and family involvement Direct service or
implementation committee
Focus groups Stakeholder groups Cultural & linguistic
competence
SOC Orientation Concrete supports Communication protocols Training opportunities Cross-system training
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Is your administrative and management organization in place?
Is your clinical director on board and integrally involved in the infrastructure development of your system of care?
Does the clinical director have a key role in the planning process for designing the structure of the proposed service delivery system?
Does the clinical director serve in a decision-making role on your management team?
What is the relationship between the clinical director and the service evaluation activities?
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Hiring a Clinical Director Not business as usual Not a “clinical hat” only Expertise in infrastructure building Understands the impact of culture on diagnoses
and service delivery Understands/practices family-driven and youth-
guided care Readiness for evidence-based treatments/
practices, practice-based evidence and their implementation
Aware of need for service system improvements Collaborates with youth, families, and
community stakeholders
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Role of the Clinical Director Need to be involved from the beginning of
system-building Need to be accessible to families/youth Structures in place: open access to the clinical
director Provide training to community providers “Fix it” meetings Relationship with project director Relationship with family organization Relationship with youth coordinator
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Family/Youth Perspectives Use family- and youth-friendly language Be careful using acronyms and agency jargon
unfamiliar to families and youth Create environment that is “safe” Use creative approaches to engage full participation Set the stage from the beginning of having a
youth/family member in the room – avoid tokenism – try to have at least two to allow support – diverse representation of participants
Look for opportunities for collaboration Clarify, educate, and validate their role in the
community Provide accessibility and relationship-building with
families and youth
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Family/Youth Perspectives Provide high level of communication by
clinical director with providers in the community
Conduct focus groups with youth and families
Solicit family input through various methods
Hear from youth and families about their need for diverse providers and therapeutic modalities
Design of non-traditional services and supports best informed by youth and families
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Questions???
Please press *7 on your phone to un-mute your line.
Please press *6 to re-mute your phone after you are finished.
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Know Your Population of Focus
What does this really mean?
Do homework: Look at the needs/gaps in your community Diversity, geography, experience Drill down into knowing your population of focus in-
depth Previous experience with interventions What worked? What didn’t work? Identify community needs and assets Know the available resources to meet needs of population
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Pressures to Rush to Service Delivery
Anticipate and handle the pressures Keep Federal Project Officer informed Community pressure: “got huge grant, provide
services, NOW” Providers: knocking on the door, want piece of
money available Community politics: budget cuts, court orders Youth & families: know we got the money, we
need services now!
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What happens when you rush to deliver services? Tendency to just put more money into
existing services Short circuit collaborative process Impedes “transforming” system Impedes assessment and gap analysis Resistance to change by direct care
providers
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Collaboration One system should not unilaterally proceed
to make all the service delivery and clinical practice decisions without participation of key stakeholders, family, and youth
Collaboration with partners that usually have not been involved, such as the early childhood system, primary care, housing system, law enforcement, etc.
Collaboration on clinical services: how does it work?
What clinical services are provided within all the component systems?
Avoid mental health system making all the practice decisions
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Planning for use of Evidence-Based Treatments/ Practices and Practice-Based Evidence
Know your population of focus
Community needs are assessed
Identify treatments/practices that match the community’s needs
Ensure that they are culturally-relevant and appropriate-do they need to be adapted?
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Planning for use of Evidence-Based Treatments/ Practices and Practice-Based Evidence, cont.
Individualized care (comprehensive, flexible, culturally- and developmentally-responsive) is first priority
EBPs/PBEs must be linked with all other systems of support and intervention to promote sustainability and generalizability
The inclusion/infusion of culture and family/youth involvement in EBP research and practice is essential
Organizational culture must be fostered to support the implementation of effective practices
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Lessons From Communities: Gaps in Building Clinical Services and Supports Development of service implementation
plans Coordinate with launch of National
Evaluation Crisis planning/safety planning process Flexible funding
Where are decisions for this made? What is the turnaround time on access to
flex funds? Are flex funds budgeted?
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Lessons From Communities: Gaps in Building Clinical Services and Supports, cont. Individualized service planning using
Wraparound approach Staffing Coordination and standardization among
the different care coordination entities Availability and access to the clinical
service that best meets the needs of the family
Family-driven and youth-guided
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Questions???
Please press *7 on your phone to un-mute your line.
Please press *6 to re-mute your phone after you are finished.
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Websites for Evidence-Based and Promising Practices
Resource Guide for Promoting an Evidence-Based Culture in Children’s Mental Health http://www.systemsofcare.samhsa.gov/ResourceGuide/index.html
Matrix of Children’s Behavioral Health Interventions
http://www.systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFINAL1.pdf
National Registry of Evidence Based Programs and Practices (NREPP)http://modelprograms.samhsa.gov/template_cf.cfm?page=model_list
Office of Juvenile Justice Delinquency Prevention Model Programs Guidehttp://www.dsgonline.com/mpg2.5/mpg_index.htm
Georgetown University National Technical Assistance Center http://gucchd.georgetown.edu/
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Websites for Evidence-Based and Promising Practices, cont.
National Wraparound Initiativehttp://www.rtc.pdx.edu/nwi
National Implementation Research Network
http://nirn.fmhi.usf.edu
Decision Support 2000+ http://206.196.29.126/Sites/ds2000/Library.aspx
Center for Evidence-Based Practice: Young Children With Challenging Behaviorhttp://challengingbehavior.fmhi.usf.edu/fixsen-etal-may03.html
State of Hawaii
http://www.hawaii.gov/health/mental-health/camhd/library/pdf/ebs/ebs016.pdf
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Resources Family Leadership in Systems of Care: What is Family
Driven? http://ffcmh.org/systems_whatis.htm Building Systems of Care: A Primer
http://gucchd.georgetown.edu or [email protected] Implementing High-Quality Collaborative Individualized
Service/Support Planning: Necessary Conditions; http://www.rtc.pdx.edu or [email protected]
Promising Practices in Wraparound for Children with Serious Emotional Disturbance and Their Families 1998http://www.air.org/cecp/
Mini-Website on Wraparound Resourceshttp://cecp.air.org/wraparound/materials.html
Quality and Fidelity in Wraparound, Focal Point 2004www.rtc.pdx.edu or [email protected] or 503-725-4175
Dedicated Website to Individualized Care and Wraparound; http://www.paperboat.com
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Presenter Contact Information Frank Pace: [email protected]
Wilfredo Soto: [email protected]
Kim Williams: [email protected] (317) 876-4602
Ken Martinez: [email protected] (505) 898-2220
