Planning for Sustainability
Sheila A. PiresHuman Service [email protected]
Ashley KeenanParent Support Network of Rhode [email protected]
Michelle ZabelUniversity of [email protected]
Myra AlfredsWestchester County, New [email protected]
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Planning Structure Issues
• Leadership• Staffing• Time and place of meetings• Stakeholder involvement and supports• Committees, work groups, focus groups• Communication and dissemination of information• Outreach to and involvement of families and youth• Outreach to and involvement of diverse and disenfranchised constituencies• Linkage to related reform/planning initiatives• Resources•Attention to sustainability
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
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Strategies for Addressing Cultural and Linguistic Competence in Planning
• Identify, engage and partner/contract with formal and informal community organizations, leaders and cultural brokers
• Engage diverse families and youth in planning
• Conduct sessions for planning group members with trained facilitators to explore attitudes about culture and diversity (e.g., race, “isms”)
• Provide culturally and linguistically appropriate invitations, outreach materials and other information
• Incorporate specific strategies for cultural and linguistic competence in system of care plans
• Utilize cultural competence coordinator to support effective planning Lazear, K. University of South Florida. Primer Hands On (2008)
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Cuyahoga County Planning Process Structure
System of Care Oversight CommitteeChaired by Deputy County Administrator for Human Services
Includes a Broad Representative Stakeholder Group, e.g., major child serving systems, families and youth, Neighborhood Collaboratives, providers, researchers
Cultural & Linguistic
CompetenceEvaluation &
Research
Family & Youth
InvolvementSocial Marketing
Design &Sustainability
Training & Coaching
Staffed bySystem of Care Office
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.
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Example: Communication Mechanisms in the State of North Carolina
Local Collaborative Communication Committee
Website
Regional meetings
Brochures
Meeting calendar
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.
6Pires, S. 2006. Human Service Collaborative. Washington, D.C.
Identify your population(s) of focus. Agree on underlying values and intended outcomes. Identify services/supports and practice model to
achieve outcomes. Identify how services/supports will be organized (so
that all key stakeholders can draw the system design). Identify the administrative/system infrastructure
needed to support the delivery system, including the structure for family/youth partnership.
Cost out the system of care. Develop a strategic financing and sustainability plan.
Critical Steps in a Planning Process
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The Total Population of Children, Youth and Families Who Depend on Public Systems
Pires, S. (1997). The total population of children and families who depend on public systems. Washington, DC: Human Service Collaborative.
Children/youth/families eligible for Tribal Authority funding.
Children/youth/familieseligible for the State Children's
Health Insurance Program (SCHIP)
Poor and uninsured children/youth/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 emotional/behavioral challenge.
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.
Children/youth/families eligible for Medicaid.
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2 - 5%
15%
80%
More complex
needs
Less complex
needs
Intensiveservices – 60% of $$
Home and community services and supports; Early inter- vention -35% of $$
Prevention and Universal Health Promotion – 5% of $$
Prevalence/Utilization Triangle
Pires, S. 2006. Human Service Collaborative. Washington, D.C.
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Example: Transition-Age YouthWhat outcomes do we want to see for this population?
Pires, S. 2005. Building systems of care..Human Service Collaborative. Washington, D.C.
Policy Level •What systems need to be involved? (e.g., Housing, Vocational Rehabilitation, Employment Services, Mental Health and Substance Abuse, Medicaid, Schools, Community Colleges/Universities, Physical Health, Juvenile Justice, Child Welfare)•What dollars/resources do they control?
Management Level•How do we create a locus of system management accountability for this population? (e.g., in-house, lead community agency)
Frontline Practice Level•Are there evidence-based/promising approaches targeted to this population?•What training do we need to provide and for whom to create desired attitudes, knowledge, skills about this population?•What providers know this population best in our community? (e.g., culturally diverse providers)
Community Level•What are the partnerships we need to build with youth and families? •How can natural helpers in the community play a role?•How do we create larger community buy-in?•What can we put in place to provide opportunities for youth to contribute and feel a part of the larger community?
Crafting Logic Models: Phases of Theory Development For Systems of Care
STAGE 1: Form workgroup
STAGE 2: Articulate mission
STAGE 3: Identify goals and guiding principles
STAGE 4: Develop the population context
STAGE 5: Map resources and assets
STAGE 6: Assess system flow
STAGE 7: Identify outcomes and measurement parameters
STAGE 8: Define strategies
STAGE 9: Create and fine-tune the framework
STAGE 10: Elicit feedback
STAGE 11: Use framework to inform, plan evaluation, and technical assistance
STAGE 12: Use framework to track progress and revise theory of change
Hernandez, M. & Hodges, S. (2003). Crafting logic models for systems of care: Ideas into action. Tampa, FL: University of South Florida
The more that planning is directed to making systemic or structural change, the more sustainable the changes will be.
Example #1: Launching a newsletter for families – good goal, not a structural changeAmend the State Medicaid Plan to cover family peer support – good goal anda structural change
Example #2:One-time legislative appropriation to expand home and community services – goodgoal, not a structural changeAmend the State Medicaid Plan to cover an array of home and community-basedservices and pool or braid dollars across systems – good goal and a structural change
Example #3: Educating providers about partnering with families and with youth – good goal, not a structural changeContractual requirements for child/family teams – good goal and structural change
Planning for Sustainable Change
Pires, S. (2002).Building systems of care: A primer. Washington D.C.: Human Service Collaborative.
Strategies for Involving Families and Youth in Planning
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• Disseminate invitations/outreach flyers
• Engage families and youth who work regularly with other families and youth
• Contract with family organizations to develop and sustain process for providing participant supports
• Offer stipends, transportation, food, child care, interpretation, translation
• Hold planning meetings at flexible times and accessible locations
• Conduct focus groups, interviews and surveys
• Provide ongoing training and mentoring
• Have more than token representation
• Publicly acknowledge the contributions of families and youth
Adapted from: Emig, C., Farrow, F. & Allen, M. (1994). A guide for planning: Making strategic use of the family preservation and support services program. Washington, D.C.: Center for the Study of Social Policy & Children’s Defense Fund.
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Roles for a Full Time Youth Engagement Specialist / Youth Coordinator
• Coordinate and foster a youth-guided system and youth-driven movement
• Coach• Raise awareness of the importance of youth voice at all levels of the
system of care• Build bridges and partnerships between the youth and professional
worlds• Foster a youth-guided system and youth-driven movement• Reconnect youth with the community• Educate adults and professionals on the importance of youth
involvement• Work with youth to create a strategic plan of the movement that ties into
the community logic model
Adapted from System of Care- Start Up Webinar Series 2006-2007
Planning for Sustainability: Being Strategic
Presented by Michelle Zabel, MSSDirector, Maryland Child & Adolescent Innovations Institute, Mental
Health Institute & Juvenile Justice InstituteDivision of Child & Adolescent Psychiatry, School of Medicine,
University of Maryland, Baltimore
Seizing Opportunities, Being Realistic
• Link grant and other funding/policy opportunities together (as they arise) to build upon one another and leverage further systems change
• Be aware of the fiscal, political, and cultural climate– Budget issues– Political timeframes– Competing pressures and interests
Creating Linkages, Connecting the Dots
• Review and synthesize existing documents and strategic plans—before beginning the work
• Populations & Outcomes:– Identify results and indicators already in use– Use measures that have strong
• Communication Power (Does the indicator communicate to a broad range of audiences?)
• Proxy Power (Does the indicator say something of central importance about the result?)
• Data Power (Quality data available on a timely basis)• Connect the data requirements across grants and contracts
Using Results Accountability to Frame the Maryland Child & Family Services Interagency Strategic Plan
Result (a quality of life condition we want to achieve): All of Maryland’s children involved with or at-risk for involvement with multiple child-family serving agencies will be successful in life.
Population of Focus (focus for the strategic planning process): Children and youth involved in or at-risk for involvement with multiple child-family serving systems.
Indicators (how we measure this condition):Out-of-home placement: Rate of children under 18 entering out-of-home placementEducation:
o Percentage of 3rd grade students scoring proficient or advanced in reading on the Maryland School Assessment.o Percentage of youth, 18-24, by highest educational attainment (less than a high school diploma or equivalent, high school graduate/equivalent, some college or associate’s degree, and bachelor’s degree or higher)
Juvenile Offense Arrests: oThe rate of arrests of youth ages 15-17 for violent offenses.oThe rate of arrests of youth ages 15-17 for serious non-violent offenses.
THE IMPLEMENTATION OF A COORDINATED INTERAGENCY EFFORT TO DEVELOP A YOUTH
SERVICE SYSTEM THAT CAN BETTER MEET THE NEEDS OF YOUTH AND THEIR FAMILIES AND TARGET
CHILDREN WHO ARE AT-RISK
Maryland Child & Family Services Interagency Strategic Plan
CREATED A SERIES OF RECOMMENDATIONS UNDER EIGHT DIFFERENT THEMES:
•Family & Youth Partnership•Interagency Structures•Workforce Development & Training•Information-Sharing•Improving Access to Opportunities and Care•Continuum of Opportunities, Services & Care•Financing•Education
IMPLEMENTATION IS OCCURRING AND STATE AND LOCAL LEVELS, WITHIN AGENCIES AND ACROSS SYSTEMS
Maryland Child & Family Services Interagency Strategic Plan
Embed System of Care Values and Principals into Policy and Regulation
– Terms that have been institutionalized with definitions in Medicaid regulations (10.09.79) include:
• Care Coordinator
• Caregiver
• Caregiver peer-to-peer support
• Care management entity
• Child and Family Team
• Family support organization
• Family support partner
• Peer-to-peer support
• Plan of Care
• Wraparound
• Youth Peer-to-Peer Support
• Youth Support Partner
– Other systems of care concepts and processes in the Medicaid regulations include:
• The components of a comprehensive and individualized Plan of Care
• The role and responsibilities of the Care Management Entity
• The role and responsibilities of the Child and Family Team
• Service descriptions, including caregiver peer-to-peer support, youth peer-to-peer support, and family and youth training
• Rates are provided for family members and youth to bill Medicaid for services provided under the Waiver
Planning for Sustainability:Being Strategic
How to Build a Fiscal Sustainability Plan That Will Work on Multiple Levels
Presenter: Westchester Community Network:
Myra Alfreds, Director, Children’s Mental Health Services-Westchester County Dept. of Community
Mental Health
What Supports Fiscal Sustainability
Sustain Values & Practices
Family Movement (Family Voice & Choice at Multiple Levels)
Infrastructure
www.westchestercommunitynetwork.com
Philosophy & Approach to Sustainability
Seize the opportunity Involve old & new
partnerships Understand the
populations you are currently serving
Explore cross systems needs & initiatives
Be in the lead, but be willing to share power
Claim everything! But generously share credit for successes
Leave no stakeholder behind.
www.westchestercommunitynetwork.com
System Planning
• Create a Sense of Urgency– Out of home placement costs– Children falling through the cracks– Child welfare performance improvement Plans
(PIP)– System of care planning– Categorical funding– Organizational silos
System Planning
• Secure broad stakeholder involvement • Develop logic model or strategic plan
– Identify outcomes, system and child and family level
• Identify target population-keeping in mind financial eligibility criteria
• Develop concept paper• Bring in Facilitators for group process• Bring in outside experts to help with different
finance challenges if necessary
System Planning
• What services do we want to develop
• What are our priorities
• What are our action strategies
• What is our communication plan
• Have we gathered feedback from all stakeholders
Sustain These to Achieve Fiscal Sustainability
Practices and Approaches Services Training/Workforce Development Social Marketing Infrastructure Committees Partnerships (New and Old)
www.westchestercommunitynetwork.com
Examples of Sustainability
Funding• Child Welfare• Mental Health• Medicaid• Youth Bureau• Local Tax Levy• Health• Office for the Aging• Juvenile Justice
Ideas/Initiatives System of Care Approach Infrastructure PBIS Training Wraparound Family-Decision Making Early Childhood
www.westchestercommunitynetwork.com
