Pathways to Mental Health: Building Shared Governance and Collaborative Mental Health Services for California s Foster Children RICHARD KNECHT, M.S. INTEGRATED HUMAN SERVICES GROUP Possible helpful outcomes for today Increase understanding of State s efforts to fully comply with the Katie A. Settlement Agreement, implement a unique Core Practice Model, and thoughtfully create shared governance and processes. Understand differences between county focused Pathways to Mental Health compliance and State Department s mandates under the Settlement Agreement. Increase awareness of how solutions for reform-based challenges will be found at the County and Community Level. Recognize implications for providers in the Pathways to Mental Health work, and the Continuum of Care Reforms. Recognize opportunities for Adaptation and Innovation Isn t the Katie A. Lawsuit over? Can your county child welfare, probation and mental health teams document that you are collaboratively delivering timely and effective mental health services to all eligible foster youth? Can your county child welfare and mental health partnership assert that every element of the Integrated Pathways to Mental Health Services Core Practice Model is adhered to? Katie A. Compliance is platform for CCR implementation. 1
Settlement Implementation for State Departments is Systemically Different from County Level Efforts While many counties are making progress toward consistent Child and Family Teaming, capacity building and delivery of timely screening, assessment and treatment State Integration is largely systemic and inherently complex. Pathways to Mental Health Requires Program Enhancements for Children and Youth in Foster Care Timely Screening for MH needs and services Community Based Intensive Services Child and Family Teaming Therapeutic Foster Care (TFC) Consistent Practices between Welfare and MH partners Joint Management Structure and Process Mental Health and Child Welfare Authorities must collaborate Shared Accountabilities Data Evaluation/Shared Quality Improvement processes Training TA and CPM revision Statewide Progress toward Collaborative Practice (2012-16) Core Practice Model dually authored in 2013 Katie A./Pathways Technical Assistance (2013-15) Data and Info Sharing agreement and early Reporting Performance Outcomes System now has Foster Youth specific parameters CWS Case Reviews have Mental Health and Family Voice Measures External Quality Review (EQRO)has Pathways Compliance Assessment CDSS/DHCS Memorandum of Agreement (March 2016) Integrated Care Technical Assistance Calls (January 2016) 2
What Does Shared Management Structure Look like? Community Team Co Chairs with lived experience 24 person stakeholder conversation to guide state practice and instill genuine Shared Governance Executive Team State Department Senior Staff Transformation Manager Guide SMS Processes Assist Two Departments to Transform State Implementation Teams Execute the work of the SMS County Support/Technical Assistance Implementation of Service Delivery Action Plan/Sandbox Model Community Team Monthly 5 Hour Convening Oversee implementation of Integrated Practice from a Consumer-Centric View Engage and Empower Youth and Parents Direct State Depts. on Implementation Connect Pathways to Mental Health to other reform efforts underway Transform two Departments DIRECTORS As Needed EXECUTIVE TEAM Transformation Manager (TM) Deputy Director (CDSS), Division Chief (DHCS) TM COMMUNITY TEAM Youth CDSS & DHCS STATE TEAM Parents Providers TM Consultants, Analyst, Program Local CWS Representative Specialist, First Line and Second Local MHP Representative Line Management CWDA CBHDA CDSS State Team Member DHCS State Team Member TM TIME LIMITED AD HOC WORKGROUPS State Team and internal COUNTIES and/or external subject matter experts on the Child Welfare and Mental Health Plans issue. 3
System Change Focuses On Directors Executive Team State Implementation Teams (DHCS/CDSS) Community Team Transformation Manager And Co Chairs Workgroups Counties and Providers Multi Perspective Collaboratives are hard https://www.youtube.com/watch?v=spzrtlqbgyk Policy Level--Financing; procedures and practices Management Level--data; Quality Improvement; system organization Frontline Practice Level--assessment; care planning; care management; services/supports provision Community Level--partnership with families, youth, natural helpers; community buy-in Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. 4
Key Adaptation Questions For State and County Agencies How will Community Team best support and challenge two state agencies to evolve, adapt and transform? Are we willing to challenge our own rules about how we ve served families in the past? Is it possible and valuable to let go of the control and power that the system seems to demand from us? Are we willing to be lead by children, youth and their caregivers, who know and love them better than government can or will? 5
Community Team Early Progress Charter Shared Decision Making Process Co Chairs with Lived Experience Developed Logic/Implementation Model Prioritized Settlement Agreements Approved Interdepartmental Memorandum of Agreement Youth and Parent roles emerging and maturing Making progress toward Settlement Accountability Approved Integrated Training Plan and Integrated Core Practice Model Evolution of Plan Documents Blue Prints for Sandbox Building Master Blue Print Settlement Agreement Sandbox Build Plan (CPM Fiscal and Service Delivery ACO Workgroups) Action Plan Four Pillars Implementation Plan (SMS) Continuum of Care Documents Sandbox Implementation Plan Pillar 1-- Training and Technical Assistance Pillar 3-- Oversight and Accountability Engagement Satisfaction Appropriateness Service Effectiveness Access Linkages Cost Effectiveness Pillar 2-- Information and Data Management Pillar 4--Core Practice Model 6
Early Challenges to Shared Management Lots of lawyers with strong opinions Active but insufficient youth and family voice Community Team Composition Large and Interest Diverse Competing Reform and Legislative Initiatives in Sacramento Many anxious for more rapid change CCR Reforms are not yet fully connected for state team members Ongoing Challenges Therapeutic Foster Care not on the ground, so transitioning youth to community will be temperate at best. State Guidance very deliberate and sometimes unclear. Separate County Contracts increase burden on providers MHP and MCP Coordination still very challenging in some counties/regions. Continuum of Care Reform A comprehensive framework that supports achieving permanency for children, youth, and families across placement settings Increased engagement with children, youth and families Increased capacity for home-based family care Limited use of congregate care System and infrastructure changes: rates, training, accreditation, accountability & performance, mental health services CCR has challenges, and will need provider feedback to evolve and adapt its approaches. 7
CCR will require Adaptation like never before Discontinue Group Homes Short-Term Residential Treatment Centers State/County Implementation Team CDSS, DHCS, CWDA, CPOC, CBHDA, CSAC County Representatives CCR Implementation Framework CCR Implementation Workgroups 23 Stakeholder Implementation Advisory Committee Providers, Youth, Caregivers, Tribes, Advocates, Counties, Legislative Staff and others CCR Implementation Timeline 1/2016 3/16 6/16 9/16 1/2017 6/17 1/2018 9/16 Stakeholder Engagement 2016 Legislation 2017 Legislation 2018 Legislation Legislative Reports and Updates Initial Policy & Program Development Interim Standards Regulations Children who cannot be safely placed in a family can receive short-term residential care with individualized care plans and intensive therapeutic interventions that support transition to a family 22 Program Rate Oversight Resource Mental & Family Training Probation Structures Licensing Framework Health Approval Deliverables Program Instructions Capacity Building Activities Accountability & Oversight Interim Standards County and Provider Accreditation Process Regulations Implementation Guides License application review process ACLs/ACINs/CFLs Training Gap analysis Oversight framework/measures Forms Training Curricula Provider Performance dashboard RFA Written Directives Child Welfare Assessment Tool Consumer Survey Initial AB 403 ACIN Rate Structure Finalized Rate Licensure & Rate Setting of Providers Provider & County Implementation Guides Retention & Recruitment of Caregivers Initial Training State, County, Provider staff and Caregivers Ongoing Training & Technical Assistance Assessment Tool Resource Family Approval: Early Implementation RFA County Plan Resource Family Approval - Statewide Implementation Written Directives Development v.3 Oversight & Accountability Framework Data Measure & Methodology 8
Reform of the System for Counties: Six County Level Opportunities for More Effective Integration What Can Counties and Partners do now to get ready? Convene Semi Core Monthly Practice Interagency Model Implementation Management Teams including judges. Child and Family Teaming Client Assessment Processes Develop RFP for County TFC and Quality FFA/STRTP Improvement(SIP/PIP) services contingent on funding and guidance. Training and Coaching Functional Assessment Use Provider Licensure CANS and if your Oversight county MHP is using it, and identify method and needed steps to share the assessment process and outcomes and analysis across the two serving entities(training/cross Child System Sharing) Probation Licensing and Certification Advise Welfare potential FFA and STRTP contractors to let you know when they're hosting CCL for annual or tri annual and schedule your MHP Medi Cal certification site visit for the same time. MHP LEA/COE Table Conversation How do Katie A and CCR create adaptive challenges for my agency? Is my leadership team/board/agency prepared to respond to these changes? Do youth and parents have a voice in my organization? What opportunities exist for my agency to create shared responsibility for our outcomes with those we serve? Integrated Training What is it and how will it effect providers? 9
Integrated Core Practice Model Discipline-Specific Behaviors - Engagement Behavioral Health Juvenile Child Welfare Probation a. Build trust by ensuring that a. When a youth is placed in a SEE SPECIFIC CHILD WELFARE children, youth and family detention or placement facility, BEHAVIORS ABOVE members understand that what is support continued contact and said in therapeutic settings is kept involvement of the family in confidential unless there is specific the development of service permission to share; when plans and post-detention/ content arises that is important placement planning. information for the team, support appropriate sharing by the individual; be sure they know this does not apply to situations requiring mandated reporting. b. As you learn about the child, b. Help youth, parents and youth and family, identify what others identify pro-social they think are their most pressing people or other connections to concerns, and prioritize those help with team development needs early in the planning and activity planning later in process. the process; work to engage these identified connections to support the family. c. Meet the child, youth and family at times and in locations that are convenient for them and where they are comfortable. Your work around an integrated practice model is important for the field. As a result of your work, CA is in a leadership position in moving the field forward. While keeping all 58 counties going in the same direction is not easy, the state has come a long way in relative short period of time. Bryan Samuels, Chapin Hall, Former ACF Chief What s next? State-county communication will be increasingly Dually- Authored Engaging Training Providers to Share Content and Delivery of Technical Assistance Connecting State and Counties to Shared Data Expanding Roles for Youth and Parent Partners at State Level Cross-walking State s Oversight and Accountability Efforts to reduce redundancy and connect CWS and MH Efforts at County Level Treatment Foster Care and Continuum of Care reforms readiness! More timely and transparent data Accreditation in lieu of Licensure/Certification???? 10
Coming Soon What Can Providers Do at this point? Continuum of Adaptation Revised Medi Cal Billing and Documentation Guide Integrated Core Practice Model Integrated Training Plan All County Information and Notices More Oppportunities for Adaptation! Collaborate and partner with other CBO s Explore Opportunities in New Geographies Re Engineer existing Business Lines Recruit and Support TFC and ISFC homes New/Diversify Funding Streams (Commercial Business) Create Unique Value for county Evidenced Based Practices Readiness for Partnership Use of Data and Outcomes Training Resources Close Operation New Learning/ Skills Increase Org. Capacity Collaboration Merger/ Acquisition/ 11
Resources California Institute for Behavioral Health Care http://www.cibhs.org/katie-implementation-technicalassistance-and-training DHCS Katie A. Website Address http://www.dhcs.ca.gov/pages/katieaimplementation.aspx CPM Guide and Medi-Cal Manuals Available at: http://www.childsworld.ca.gov/pg3346.htm But Remember The Best Solutions are local! Contact Information richard.knecht@dss.ca.gov rknecht@solutions-mrg.com 12