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System of Care Expansion Grant Strategy
Development MeetingRockville, Maryland
December 13, 2011
Rhode Island:
Policy and Regulatory Strategies for System of Care Expansion
Presented by:
Janet L. Anderson, Ed.D
Assistant Director of the RI Department of Children, Youth and Families for Community Services and Behavioral Health
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Transforming RI’s System of Care:
Phase I - Family Care Community Partnerships
(FCCP)- Implemented January of 2009
- Designed for families not involved with the
Department: Prevention and early intervention
through family preservation and community-based
behavioral health programs
Phase II - Family and Community Networks of
Care- to begin on January 1, 2012
- For families and youth active with the
Department
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Transforming RI’s System of Care:
Phase I:
In December of 2008, Department of Children, Youth and Families (DCYF) signed into operation contracts with four lead agencies and their partners.
This act launched a new era in how DCYF does business with providers to achieve the best outcomes for children and families in the State of Rhode Island
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Transforming RI’s System of Care:
Phase I
Family Care Community Partnerships
Definition
A formal collaborative structure for joint planning and decision-making
through which community partners take collective responsibility for
development and implementation of system of care and wraparound
process.
Service delivery processes are organized through four regional “FCCP
Lead” agencies who are the fiscal agents responsible for:
Building partnerships
Developing a comprehensive network of available formal and
informal services and supports
FCCP providers, including all formal and informal community partners
take collective responsibility for the development and implementation of
system of care and wraparound process for eligible families.
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FCCP
Strengthening
Families through
community-based
individualized
wraparound
services and
supports
FCCP
Strengthening
Families through
community-based
individualized
wraparound
services and
supports
FCAB
FCCP
Strengthening
Families through
community-based
individualized
wraparound
services and
supports
FCAB
FCCP
Strengthening
Families through
community-based
individualized
wraparound
services and
supports
DCYF
Executive Office of Health & Human Services
FCABFCAB
State Wide
Family & Community Advisory Board
Phase I: State-Wide Structure
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System of Care - Phase II Implementation Date: January 1, 2012
RI Networks of Care:
Phase II will serve families who are open to the department and actively receiving services. The department is establishing Networks of Care that will partner with the department and families to consolidate the management of services and supports for each child and family according to their unique strengths and needs.
Each Network of Care will have a Network Lead that will be responsible for building a comprehensive array of accessible formal and informal services and supports, including residential and home-based services that will strengthen and support the home setting during and following out-of-home placement.
The Networks must integrate wraparound principles into service delivery and include strong partnerships with education and other entities in order to improve educational stability and success.
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Transforming RI’s System of Care
How did we get here?
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Strategy #1: Effective Use of Federal
Partners
The Department has partnered with the Child, Adolescent and Family Branch/SAMHSA through the use of system of care grants and cooperative agreements to establish a foundation to implement a statewide system of care that includes nationally recognized best practices.
The US Administration for Children and Families (ACF) has emphasized since 2003 the critical importance of a system of care approach for improving child welfare outcomes.
The research findings, expertise and examples of effective best practice stemming from these Federally supported efforts have been utilized to bolster the development of RI’s plan to establish an infrastructure for full implementation of an organized, integrated system of care.
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1989, CASSP – Child and Adolescent Service System Program (Infrastructure) Grant,
SAMHSA
1991-Present, Statewide Family Network Grant – Parent Support Network of RI
1992, Project REACH grant – Center for Mental Health Services (youth with serious
emotional disorders and their families)
1997, Project HOPE grant – Center for Mental Health Services (youth adjudicated),
SAMHSA
2003, Report of RI System of Care Task Force: Toward An Organized System of Care for
RI’s Children, Youth and Families
2005, RI Positive Educational Partnership – Center for Mental Health Services (early
childhood and positive behavior supports and interventions), SAMHSA
2009, RI Family Care Community Partnership Implemented
2011/2012, RI Networks of Care to begin January 1, 2012
Strategy #1: Effective Use of Federal
Partners: RI System of Care History
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Strategy #1: Effective Use of Federal
Partners
RI has a strong history of sustaining the programs established through the support of SAMHSA grants/cooperative agreements.
However, until 2005, the programs remained separate and a statewide integrated system had not been achieved and the outcomes for children, youth and their families had not changed significantly.
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Strategy Change Required:
Establish state-wide plan with clear leadership
responsibility defined and centralized
Funding for programs to build state
infrastructures, not individual programs
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Strategy Change: Funding for
Infrastructure Development
RI’s current Comprehensive Community Mental Health Services for Children and their Families Cooperative Agreement (SAMHSA) began in 2005 and is specially designed as an infrastructure building agreement with the State
This Federal support both spanned and helped to guide RI’s current system of care transformation efforts
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Strategy #2: Establish and Sustain
Centralized Leadership for RI System of Care
2001, the RI System of Care Task Force was
established with joint leadership
Key leadership from House, Senate and the
Department of Administration
Stakeholders met over the course of 2 years to
develop the final report
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Strategy #2: Establish and Sustain
Centralized Leadership for RI System of Care
Result:
The Report of the RI System of Care Task Force, “Toward an Organized System of Care for RI’s Children, Youth and Families,” January 2003 was submitted to the incoming governor and legislative leadership that included these key statements:
“With this letter, we send to you the report of the Rhode Island System of Care Task Force and ask for your full support and your strong leadership in moving us closer to an organized system of care for Rhode Island’s children, youth and families.”
“The members of the System of Care Task Force unanimously endorsed the vision and principles of this report and acknowledged that considerable work needs to yet be accomplished.”
(page 7, The Report of the Rhode Island System of Care Task Force, January 2, 2003)
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Strategy #2: Establish and Sustain
Centralized Leadership for RI System of Care
The Report became a blueprint for the statewide
development toward an organized system of
care for RI
The work of this Task Force became the
springboard for our current system of care
transformation in RI
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Strategy #3: Establish and Sustain
Centralized Leadership for System of Care
The Governor’s Task Force names the RI Department of Children, Youth and Families as the agency to implement the system of care reform:
“The Department is the single authority to establish and provide a diversified and comprehensive program of services for the social well-being and development of children, youth and their families.”
(page 11, The Report of the Rhode Island System of Care Task Force, January 2, 2003)
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Strategy #3:
Key Legislation and It’s Role
Establish Locus of Authority:
The Department is statutorily designated (RIGL 42-72-5) as “the principal agency of the state to mobilize the human, physical, and financial resources available to plan, develop, and evaluate a comprehensive and integrated statewide program of services designed to ensure the opportunity for children to reach their full potential. Such services shall include prevention, early intervention, outreach, placement, care and treatment and aftercare programs.”
The Department’s mission emphasizes shared responsibility among families, communities and government for the safety, protection and wellbeing of children and youth.
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Use of Federal and State legislation to establish framework for system reform:
Strategy #3:
Key Legislation and It’s Role
Federal Law
1. Adoption and Safe Families Act (ASFA) of 1997 (Public Law
105-89)
2. Keeping Children and Families Safe Act of 2003 (Public Law
108-36)
3. Family Preservation and Support Services Program Act of
1993 (Public Law 103-66)
4. American with Disabilities Act (ADA), Part II
5. Mental Health Parity Act of 2007
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Strategy #3:
Key Legislation and It’s Role
Rhode Island General Law (RIGL)
RIGL 42-72-2, Declaration of Policy (DCYF)
RIGL 42-72-5, Power and Scope of Activities (DCYF)
RIGL 42-72-5.2, Development of a Continuum of
Children's Behavioral Health Programs (DCYF)
RIGL 42-72.1-5, Licensing of Children’s Behavioral Health
Programs
RIGL 42-72.7-3, Coordination of Children’s Community
Social Services, Education, and Mental Health Services –
Pilot Program
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Additional Strategies Utilized:
Practice Standards: provide guidance to assist the FCCP in implementing an integrated system of care that uses a system-level wraparound approach in the planning, implementation and evaluation of services and supports for families at risk of DCYF involvement.
http://www.dcyf.ri.gov/docs/notice_fccp_standards.pdf
Data and evaluation critical for accountability and establishing credibility with stakeholders.
Statewide training led by the Department.
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RI: Where We Are
A System in Transformation
The Department has led an intensive multi-year effort to educate the staff, all branches of government, the community, and the providers that a system transformation is needed.
System transformation reflects “best practices”, cost efficiencies and is aligned with our Federal Program Improvement Plan goals.
The system is changing because system partners are committed to the change in philosophy. The commitment is to provide services in the least restrictive, community-based setting appropriate for the child and their family.
As a result of the system changes, including implementation of Phase I of the System of Care, between 2007 and 2011, the average DCYF-funded residential census has been reduced by 37% from 1012 to 641. (All residential placements have been reduced 38% from 1202 to 746 today.)
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1,202
965809
668
0200
400
600800
1,000
1,2001,400
FY2007 FY2009 FY2011 As of
October
1, 2011
Average Residential
Census
Accomplishments:
Reduction in Residential Placements
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RI: Where We Are
A System in Transformation:
Over the past five years, the Department of Children, Youth and Families has:
Reduced the number of youth placed out of state by over 50% from 2007 – 2010
Lowered the number of children entering out of home care by 27% from 2006 – 2010
Developed and implemented Phase I of the System of Care (FCCP) as a front end diversionary program that has successfully reduced the number of families becoming open to the department and reduced the number of children in our care
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Accomplishments: Reduction in Out-
of-State Residential Placements
190
12891
71 58
0
50
100
150
200
# Y
ou
th
FY 08 FY 09 FY 10 FY 11 FY 12
Placement Solutions
Out of State Residential Placements
Quarter 1 by Fiscal Year
* As of December 2011 – Reduced to 48 Out-of -State
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RI: Successes
Families staying together at an increasing rate
Children are remaining safely at home and in their schools
Youth are transitioning from the Youth Development Center (YDC) to home
Children with behavioral health challenges and their families are receiving supports to help ensure growing stability and wellness
Reduction in caregiver strain
Prevention and early intervention with early childhood and elementary school settings is occurring at an increasingly coordinated and integrated manner
The RI System is continuing to develop skilled Wraparound Facilitators and recognizes the significant need for a Family Leadership and Family Support Partners
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Agencies are working together in partnerships to reduce duplication and identify the appropriate resources for families
Prevention dollars are being utilized across the state for mental health awareness and prevent child abuse events to support families in healthy, fun and “normalized” activities
State inter-agency collaborative work is demonstrating fruitful results:
1. DCYF and DHS are working to ensure the best use of State and Federal Funds
1. The activities of the wraparound process are now billable through the Consumer Global Waiver, “Cost Not Otherwise Matchable” (CNOM)
RI: Successes (continued)
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RI: The Challenges
Practice Shift: System wide change: Putting the principles of system of care
and wraparound into practice in our day to day lives is a challenging process
Requires administrative leadership at the state and local level who support and drive the move toward new collaborative business practices, requiring providers to listen, identify differences and find avenues of common ground to work together to serve children and families
Requires administrative leadership to recognize that this is not a one time event but requires on-going, persistent and creative new structures that support this developmental process
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Conclusions: Lessons Learned
This work is difficult and the challenge of building partnerships across agencies, integrating systems and learning to relinquish power in order to reach the best outcomes for the children and families.
To be sustained, system of care development requires multiple year effort.
State leadership must be educated and champions identified with each successive Administration. This includes all branches of government. Mechanisms must be set in place to ensure that the key elements of the system of care development are communicated and supported in spite of top level changes.
With persistence, an openness to continued learning and a willingness to listen carefully to the families and children we serve, we will get there. Our hope is in the voice of the families.
