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Cuyahoga Tapestry System of Care

Weaving Solutions with Children and their

Families

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Table of Contents• Introduction…………………..3

• What makes Tapestry different?...............................6

– Family Voice & Choice……..7– Wraparound………………...9– Focus on Strengths………….11– Braided Funding…………....13– What does this mean for a

family?................................15– What does this mean for a

provider?............................17

• Who is the Cuyahoga Tapestry System of Care?...................19

– Partners…………………….20– Table of Organization…….22– Workers…………………….23– Families……………………..24

• Why did Cuyahoga County need a new business model for serving families?...................27

• How did this new way of doing business for and with families develop?.................30

– Timeline…………………….31– Training & Coaching……...33– Goals……………………….34

• How do we know it’s working?.............................36

• Contact Information……….42

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• When a family enters the Cuyahoga Tapestry System of Care, they have heard the phrase “We can help” more times than they can count, and they are frustrated.

• The children or youth in the family feel that they have never found a “fit” with the services offered to them, or that those services were not enough.

• The parents or caregivers in the family have been missing work because of the behavioral problems of their child, and they know that bad news is on the other end when someone from their child’s school calls.

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• The difference for a family entering the Cuyahoga Tapestry System of Care is that it has been designed to serve multiple needs within a single family.

• The system of care is for the family who has a child at risk for or already involved with multiple child-serving systems or services, like Juvenile Court, the Department of Child and Family Services, alcohol and other drug counseling, and mental health.

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• The Cuyahoga Tapestry System of Care is:

– Family-driven– Youth-guided– Community-based– Team-based– Strengths-based– Focused on empowering families and

helping them learn the skills to sustain their health and wellness

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What else makes Tapestry different?

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“Family Voice and Choice” makes it different!

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• Tapestry is family-driven, which means that not only do parents and caregivers take an active role in shaping their care, they also participate in governance of the entire system of care.– Parent Advocates support families

who are currently enrolled.– A Parent Advisory Council and

Youth Advisory Council guides decisions within the system.

– Parents and caregivers sit on every decision-making committee.

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The “Wraparound” process makes it different!

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• Wraparound: A full-service approach to helping families! Instead of making a child fit into a “standard” service plan, a team of supporters helps the family develop a unique plan to “wrap” around them and keep them safe and at home.

• A wraparound planning process brings people together from different parts of the whole family’s life and is: – Based on the strengths of the family and

neighborhood – Something that a family “does,” not something

that they are “given” – A team effort, with the child, family,

professionals, community and neighborhood supports working together toward a common goal

– A process that respects families, with teams that are sensitive and responsive to your family’s culture, language and community

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A focus on strengths makes it different!

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• Tapestry focuses on strengths – not just in families, but within provider agencies and neighborhood centers as well!– This initiative brings together all

the best efforts of the settlement house tradition, community-based care for families, and established mental health, child welfare, and juvenile justice provider agencies with the schools and churches.

– It is a “whole life” approach to serving families!

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Braided funding makes it different!

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• Tapestry braids formal Medicaid billable mental health services with informal supports.

• This lets dollars follow the child, instead of the old way of doing business that meant communities paid for potentially repetitive services.

• Tapestry gives families access to an astonishingly thorough network of no-cost or low-cost services.

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What does that mean for a family?

• Families aren’t forced to travel from agency to agency for the diverse range of services they need

• Families stay where they are comfortable, in their home and in their neighborhood

• Families connect with a Parent Advocate, who knows the system and their neighborhood

• Families stay together!

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• Parents are at the center of the wraparound team that meets to develop the plan to address the needs of their family.

• Every wraparound plan that is developed is unique to that family.

• The wraparound planning process occurs in the neighborhood where the family lives.

• The funding for that wraparound plan is drawn from several sources and blended together.

• The goal of the plan is to keep the family together or reunify the family.

• The services that the family receives are from their own neighborhood as well as from established agencies.

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What does that mean for

a provider?• Providers get to do what they

do best based on their strengths, resources, and history—they fill a specific and necessary role on the family team.

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• Wraparound Specialists and Care Managers who coordinate care for family teams use a web-based case-management, service authorization and invoicing system called Synthesis, allowing supervisors to track services, family visits and other quality-assurance points, and creating a fee-for-service model where dollars follow the child.

• In addition to serving more families through self-referral, the system of care now has enrollment specialists placed within the county’s Department of Children and Family Services and Juvenile Court.

• Wraparound Training that helps people understand the principles of family-driven, strengths-based, neighborhood care has been opened to all partners and parents and caregivers within the system of care.

• Tapestry is a leading system of care community in the nation with performance outcomes in the highest category for areas such as System Level Outcomes, Child/Family Outcomes, Satisfaction with Services, Family and Youth Involvement, and Cultural and Linguistic Competency.

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Who is the Cuyahoga Tapestry System of

Care?

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Who are the Tapestry partners?

• Parents, Caregivers & Youth– Parent & Youth Advisory Councils– Parent Advocates

• Neighborhood Collaboratives

For a full list of current neighborhood collaboratives and provider agency partners, visit our online Who’s Who of Agencies.

Neighborhood “collabs” are associations of organizations that develop and promote resources for families. Each is unique, but in combination they are a partnership of faith-based groups, health care providers, schools, recreation facilities (e.g., YMCA), block clubs, mental health and substance abuse providers, social service providers, settlement houses, non-profits, etc.

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Partners continued

• County Funders– Board of County Commissioners– Department of Children & Family

Services– Community Mental Health Board– Alcohol & Drug Addiction Services

Board– Juvenile Court– Board of Mental Retardation &

Developmental Disabilities

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Who are the Tapestry workers?

• 157 Wraparound Facilitators• 28 Supervisors• 14 Resources Specialists• 11 Parent Advocates

– Serving approximately 2,500 families through a High Fidelity Wraparound process

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• Families that are eligible for enrollment in the Cuyahoga Tapestry System of Care have a child who is:– A resident of Cuyahoga County and within the

neighborhood collaborative areas.– Under eighteen (18) years of age at time of referral.– Diagnosis of serious emotional disturbance (per the

DSM IV criteria).– Have major impairments in several life domains.– Has, or is at risk for, involvement in more than one

public child-serving system.[1] – May have had psychiatric hospitalization(s) over the

past year.– Will require multiple sources of support to address

problems across life domains (including intensive community psychiatric supportive treatment, coordinated care and case management).

[1] Includes the Schools/Special Education, Department of Children and Family Services, Juvenile Court, Board of Mental Retardation/Developmental Disabilities, and the Alcohol and Drug Board.

Who are the Tapestry families?

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Cleveland OverviewPoverty

• In 2005, Cleveland, the county’s largest city, had the highest poverty rate among America’s big cities with nearly a third of its people (32.4%) living in poverty, including 47.6% of children under eighteen and 53.3% of children under age five. (U.S. Census Bureau, 2006)

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Tapestry OverviewPoverty

• Nearly 80% of the families enrolled in Tapestry are at or below poverty level. They are among the most economically challenged families in the most economically depressed city in the country.

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Why did Cuyahoga County need a

new business model for serving families?

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Current partners within the system of care have long histories in Cuyahoga County—and saw a need to integrate their efforts to serve the families with the most complicated and numerous needs.

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Tapestry marries clinical expertise with neighborhood know-how– Families benefit because they

can receive the best services the county offers within their homes and neighborhoods—no trips downtown to get what they need

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How did this new way of doing business

for and with families develop?

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Tapestry Timeline

1800’s 1994 2003 2004 2005: January March June October 2006: January February March

Neighborhood Settlement

Houses

Robert Wood Johnson

Foundation Children’s

Mental Health

Casey Family To Family

Implemented at Children &

Family Services

October 2003

Granted SAMHSA

January 2005First

Tapestry Enrollment

January - June 2004• Committees

created• Contracts with

Neighborhood Collaboratives and PEP

March 2005Training

and Coaching

begin

June 2005National

Wraparound Initiative is

applied locally

October 2005Parent

Advocate Activity Form

is created

January 2006PEP has 13 of 16 care managers

staffed

February2006

Expectations set at 2.5 billable hours per day

March2006Care

Manager floater

position created

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Tapestry Timeline continued

August 2006CQI released

& PEP introduces Incentive Program

2006: April June July August September November December 2007: January April May

June 2006Group

Supervision begins

Nov. 200615 Care

Managers staffed, but 06

turnover is 50%

April 2006Intake

Coordinator position created

July 2006PEP CEO shadows

CMs

Sept. 2006$9-10 million

added to SOC for 600 new

kids&

RFP process for new $

Dec. 2006Monthly Program

Fidelity & Individual Staff Activity Report

released&

Care Coordination Contracts completed

January 2007Synthesis imported

from WAM&

New Governor in Ohio

April 2007600 new SOC

families

April-May 2007Work with fiscal architecture for

SOC&

Develop fiscal position paper for new administration at state level

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Training and Coaching Component

“Original” 10Collaboratives

30 Wrap Specialists

10 Resource Specialists

10 System ofCare

Supervisors250 Families at

each site2500 families

annuallyDCFS = 3.3 MM

SAMHSA = 1.1 MM

“New” 4Collaboratives

8 WrapSpecialists

4 Resource Specialists

4 System ofCare

Supervisors150 Families at

each site600 families

annuallyDCFS = 920,000

Managed by the Neighborhood Collaboratives

Child Welfare Funded

Components

New Jointly Funded

Components

CareCoordinationPartnerships

80 Facilitators

8 Supervisors

300 DCFS300 Court200 HMG

Serving 800 Families

HHS = 6.0 MMDCFS = 3.0 MM

ABC dollars from MHB and AOD =

300,000

Based in four Partnerships Located

Across community

Components Funded by CCCMHB

Managed by PEP

Connections

20 Care Managers

2 Supervisors

1 Parent Liaison

Serving300 FamiliesMHB = 2.82 MMDCFS = 248,905

JC = 92,779MRDD = 40,000Other = 1,400

Tapestry

16 Care Managers(PEP employed,

Housed inSettlements)

2 Supervisors

10 Parent Advocates(Hired in

Collaboratives)Serving

240 FamiliesSAMHSA = 1.4 MM

MHB = 600,000

Components Funded by SAMHSA &

Braided Funds

Components Funded by SAMHSA &AODBCC

Operated by Justice Affairs

& Catholic Charities

SCYServices for Community

Youth

Screening and service through

DetentionImplementing

ICTIntegrated

Co-occurring Treatment

Serving60 Families

SAMHSA = 800,000

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Goals of the System of Care Initiative

1. Increased capacity of the systems to work with children, youth and their families;

2. Increased access of systems to provide effective services for children, youth and their families;

3. Improved child and family outcomes such as improvements in child wellbeing, increased stability in living arrangements, and increased school attendance;

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Goals of the System of Care Initiative continued

4. Develop a new business model together for county funders, provider agencies, and neighborhood collaboratives with families. Performance outcomes will be clear in this partnership;

5. Maximize county and state resources as a critical component of the plan;

6. Develop a collaborative workforce and improve our clinical technology in working with families in their neighborhoods.

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How do we know that this new way of doing business

is working?

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• Data from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which provides the grants that launch systems of care, indicate that systems of care save taxpayers money. – On average, wraparound care saves child welfare

systems $7,965 per child in residential placement costs over the course of a month, and saves juvenile justice systems between $800 - $3,000 per child within the same time frame.

• Cuyahoga County’s local data indicate that children thrive in this type of care: – Clinical outcomes improve or stabilize for 89% of

youth with behavioral and emotional problems– 91% of children and youth with a history of

suicide attempts or suicide ideation improve or stabilize

– Other indicators, like school performance, stability at home, employment, show that systems of care work!

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Outcome MeasuresTapestry is data-driven, and has refined its

definition of success with 9 specific outcome measures:

1. Children are with their families in the community

2. Children have increased rates of attendance at school

3. Children have improved performance in school

4. Children show improvement in Ohio Scales Scores (or other nationally recognized assessment instruments)

Tapestry Outcomes

BASELINE LATEST Change

Functioning 36.1 40.3 4.2

Problem Severity

33.2 18.7 -14.5

For example …

Our outcomes show that youth go from a moderate level of functioning impairment and problem severity to mild levels.

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Outcome Measures continued

5. Family assessments indicate improved family functioning

6. Reduced length of stay in psychiatric settings

7. Reduced length of stay in residential settings

8. Reduced recidivism in referrals to Juvenile Court

9. Reduced recidivism and reduced penetration in Child Welfare

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Parents who have experienced Tapestry become champions

for systems of care!

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A mother’s words:

“I believe that the Tapestry program is so rare due to the fact that they try to empower and teach you and the rest of the family, and the child dealing with all the problems, instead of the normal programs where they promise you that they are going to fix your child. The children are not broken. They can’t be fixed, but all can learn to handle the things that are placed in front of you.”

216-443-6062

1400 West 25th Street, 4th Floor

Cleveland, Ohio 44113

www.CuyahogaTapestry.org