VISION Every youth and family in Pennsylvania will be able to access - - PowerPoint PPT Presentation

VISION

Every youth and family in Pennsylvania will be able to access and navigate a unified network of effective services and supports that are structured in adherence to System of Care Values and Principles.

MISSION

The youth, family, and system leaders of Pennsylvania will work as equal and trusted partners for the purpose of creating sustainable change which will empower youth, families, and all youth serving systems to be responsible and accountable for outcomes that lead to the fulfillment of hopes and dreams.

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 The current systems have a long tradition of

serving youth, and are constantly trying to improve

 They serve many youth and recipients of

service generally rate them as being effective

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 Each of the child serving systems struggle with

youth who have complex problems and their families

 The systems really experience problems when

they have to work together

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Detention/ RTF

t h

Intake Intake CW Sys Intake Referral Referral Referral Referral Referral Referral MH Sys D&A Sys JJ Sys

• Ed. Sys

Intake MCO Sys MR Sys Intake Partial Psych Detox AAA Intake Court

Probation Residential

Eligibility

Counseling

Special Ed Truancy Mentor APS Partial Residential Mobile T Case Mgmt. TSS/BSC Inpatient Case Mgmt.. Care Mgmt. Primary Care Case Work Foster Care Health Sys ER Intake Hospital. Therapist. Psychiatrist

Supports Services Supports Services

Case Mgmt. TSS/BSC Special Ed

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 3,500 in Residential Treatment Facilities  47,000 served by the Juvenile Justice system  40,000 in the Child Welfare system  28,000 in Foster Care  30,000 in Alternative Education  180,000 receiving Behavioral Health Services

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 In 2009 – 2010, there were over 17,000 children

in substitute care through the child welfare or juvenile justice systems, who received behavioral health services

 Their behavioral health costs were more than

double that of youth involved only in behavioral health services

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$9000

Average Annual Cost

$46,000

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$7000 $15,000

Average Annual Cost 9

 Pennsylvania is a Commonwealth of 67 counties  Understanding, accessing and obtaining services is

difficult and confusing

 Current services are based on diagnoses and problems

rather than building on strengths and needs

 Services are fragmented  Limited youth & family participation in many areas  All systems struggle to serve youth with complex

behavioral health needs, multi-system involvement and their families

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History of systems change initiatives:

• CASSP principles (Mental Health)
• High Fidelity Wraparound (Multi-system)
• Family Group Decision Making (Child

Welfare)

• MacArthur Foundation (Juvenile Justice)
• Positive Behavioral Supports (Education)

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Adapted from Pires, S. (2010). Building systems of care: A primer. 2nd Edition. Washington, D.C.: Human Service Collaborative

Fragmented service delivery Categorical programs/funding Reactive to crises Focus on high use/restrictive Youth out-of-home Creation of “dependency” Needs/deficits assessments Youth & Families as problems Cultural blindness Highly professionalized Youth/family must fit services

From

Coordinated service delivery Multidisciplinary Teams Crisis prevention planning Least restrictive settings Youth in families & communities Empowerment/active participation Strength-based assessments Youth & Families as partners Cultural/linguistic competence Coordinated w/informal & natural supports Individualized approach

To

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In 20 In 2007 07, , Of Office of fice of Menta Mental He l Health alth an and Substa d Substanc nce e Abuse Abuse S Ser ervices vices (OMHSAS) and the Children’s Adviso Advisory y Committe Committee e Kne Knew i w it t was as Ti Time f me for a T

• r a Tran

ansf sfor

• rma

mation. tion.

 They selected the High Fidelity Wraparound

model and created the Youth and Family Training Institute

 We operationalize the System of Care

philosophy at the individual family level using the High Fidelity Wraparound (HFW) process

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Outcomes of High Fidelity Wraparound:

(nine controlled, published studies to date; Bruns & Suter, 2010)  Better functioning and mental health outcomes for

wraparound groups (NV, MD, NYS, elsewhere)

 Reduced recidivism and better juvenile justice outcomes (Clark Co., Washington)  Higher rates and more rapid achievement of permanency

when implemented in child welfare (Oklahoma)

 Reduction in costs associated with residential

placements (Milwaukee, LA County, Washington State, Kansas,

many other jurisdictions)

Source: Eric J. Bruns, Ph.D. presentation titled: Outcomes Based is the First Principle! What you need to know about research, outcomes, and wraparound

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 The process is guided by 10 principles, follows

four phases & their activities are based on the four components of the Theory of Change

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 The Theory of Change suggests that if we

focus on the youth and family priorities, integrate our efforts, and develop natural supports, it will improve self-efficacy

 When youth and families begin to believe

in themselves, and systems support their efforts, everyone works harder towards accomplishing their goals

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For every 50 youth/families:

 Four High Fidelity Wraparound Facilitators  Two Family Support Partners  Two Youth Support Partners  One Coach/Supervisor

The Role of the Youth and Family Training Institute: To train, coach, and credential the High Fidelity Wraparound workforce as well as monitor fidelity and family outcomes related to the process model

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How do we bring this to life?

System of Care is a philosophy made up of parameters and standards that provides an

• rganizing framework for systems reform in

partnership with youth and families.

Adapted from Stroul, B. 2005. Georgetown

• University. Washington, D.C

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 Leadership/Governance  Family Driven  Youth Driven  System Integration  High Fidelity Wraparound for youth with complex mental

health issues, multi-system involvement, and their families

 Natural and community supports  Cultural and Linguistic Competence  Evaluation and CQI

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 Establishment of a governance or leadership

team composed of equal youth, family and system partners

 Utilizing a single plan of care, systems

communicate and coordinate service needs determined by youth and family led teams

 Systems work to integrate their efforts using

evidence based practices to reduce costs and eliminate ineffective and redundant services

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 Challenges and barriers identified at the

individual family level lead to policy and practice changes focused on improving long term

• utcomes

 The leadership team and community enact

processes, philosophies and programs that reflect the SOC principles in particular for the target population

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 Systems of Care have been proven effective for youth

with complex behavioral health challenges, multi- system involvement and their families

 Youth experience improved outcomes in mental health

symptoms and school performance, reduced involvement in child welfare and juvenile justice, and positive family functioning

 And there are cost savings – with real, long term benefit

as youth and families become more self-reliant

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 Fewer days in inpatient care: $2,777

savings per child

 Decreased utilization of inpatient care: 54%

reduction in utilization

 Mental health improvements sustained: 90%

• f children still stable after 18 months

 Fewer suicide-related behaviors: 32%

reduction in suicide-behavior

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 Improved school achievement: 49 out of 113

sample had improved grades

 Reduced Juvenile Justice Involvement: of 38 youth

in Juvenile Justice, only two re-offended

 Reduced Child Welfare Involvement: 50% of the 113

HFW graduates had Child Welfare involvement Of these: ~54% were discharged from CW by HFW graduation ~48% of discharges were considered successful

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 More natural supports identified  Improved family relationships reported  Fewer paid services needed

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 It is a huge challenge to change the cycle of

failure and dependency for youth who have complex behavioral health challenges, multi- system involvement and their families

 Working together in equal partnership will enable

us to do what none of us could do alone – that’s why we need Systems of Care!

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“The slowness of change is always respectable in the eyes of those who are in charge. It is a different story for those who are in pain.”

Jonathan Kozol (1967), Death at an Early Age Rider, F. (2008), Involving Families, Inspiring Hope

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 Subject matter experts: what really works?  Good business: strategic partnership  Youth and families as cultural guides  “In it for the long haul” - Continuous

commitment to system improvement

 Youth and families “keep it real”

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 Established strong family voices to advocate,

support & be involved in expanding SOCs

 Established strong youth leaders/youth

• rganizations

Study on State Strategies for Expanding Systems of Care, Beth Stroul and Robert Friedman, March 2011

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Shifts in Roles of Youth and Families

Recipient of service plan info & service requirements Participate in service planning Lead their own HFW team Unheard voice in program evaluation Participate in evaluation Partner in developing and conducting evaluations Recipient of services & supports Partner in planning /developing services/ supports Service/supports providers Uninvited to training activities Angry & resistant Participate in training Self-advocacy & peer support Partner in developing training & being trainers System-level partner

Lazear, K. & Conlon, L. (2004). “Primer Hands On” for Family Organizations. Human Service Collaborative: Washington, D.C. 30

 In PA we believe it takes a three-way

partnership to achieve fundamental system change:

• Strong Youth Leaders
• Willing System Partners
• Strong Family Leaders

 We are defining values and building a structure

for genuine partnership

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 YFTI will provide training coaching and

credentialing for the expansion of High Fidelity Wraparound – currently in 11 counties

 PA System of Care Partnership will support

expansion of System of Care – currently in five counties

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 Expanding youth and family leadership  Policy changes  Finance changes  Service Delivery changes  Areas identified through the planning process…..

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Pennsylvania SOC Expansion Planning Process

Leadership Team

Focus on: Financing, Policy, & Regulation

Planning Coordination Consultant Youth Support and Leadership

Focus on: Developing Statewide Multi- system Capacity

Family Support and Leadership

Focus on: Developing Statewide Multi- system Capacity

Regional Planning Groups Regional Planning Consultants

Focus on: Determining how to bring systems of care throughout the state

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 System of Care Expansion

Implementation Cooperative Agreements (current application in process)

 Creation of state and local partnerships  Working with all counties to implement

System of Care and High Fidelity Wraparound

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