State Leadership Team, Youth Tri-chair

State Leadership Team, Family Partner

State Leadership Team, System Tri-chair

Youth & Family Training Institute, Director

PA System of Care Partnership, Lead Evaluator

System of Care is a philosophy made up of a

set of values and principles that provides an

organizing framework for systems reform in

partnership with youth and families.

Adapted from Stroul, B. 2005. Georgetown University. Washington, D.C

Kim Bowman Deputy Secretary, Department of Drug and Alcohol

Shaiheed Days Youth

Ellen DiDomenico Executive Director, Governor’s Commission on Children and Families

Keith Graybill Juvenile Court Consultant, Juvenile Court Judges Commission

Heather Hallman Chief of Staff, Office of Children, Youth & Families

Corey Ludden Youth

Stan Mrozowski Director, Bureau of Children’s Behavioral Health Services

Laurie Mulvey Family member

Valarie Oulds-Dunbar Family member

Michael Pennington Director, Office of Juvenile Justice, PA Commission on Crime and Delinquency

Karan Steele Family member

Ladona Strouse Family member

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.

PA Families, Inc. is Pennsylvania’s SAMHSA funded

statewide family network that hires and provides collaborative supervision to the Family

Involvement Specialist(s)

The Youth and Family Training Institute at UPMC is responsible for the implementation and

monitoring of High Fidelity Wraparound, which

will be the youth and family team process for

youth within the population of focus within all

partner counties

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

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

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

1 in 5 children in the general population have a

mental health challenge

Between 50% -75% of all youth in juvenile justice

facilities may have a mental health issue

9.1% of youth in juvenile detention have suicidal

thoughts

11.8 % actually attempt suicide in their lifetimes

2.7 % have attempted suicide in the past month

Sources: National Mental Health Association and Office of Juvenile Justice and Delinquency

More than 80% of children in foster care have

developmental, emotional or behavioral

problems

Source: Comprehensive Textbook of Psychiatry, Kaplan and Sadock, 1995

Some (child welfare-involved) families have

undiagnosed mental health and substance

abuse disorders

Source http://www.childrensbureau.org/corp/adv/sessiondocs/mentalhealth.pdf

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

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

2 - 5%

15%

80%

More

complex

needs

Less

complex

needs

Intensive

Services –

60% of $$ Home &

community

services

and

supports;

early

intervention

– 35% of $$

Prevention

and Universal

Health

Promotion –

5% of $$

Prevalence/Utilization Triangle

Pires, S. 2006. Human Service Collaborative. Washington, D.C.

$9000

Average Annual Cost $46,000

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

$7000

$15,000 Average Annual Cost

History of systems change initiatives:

CASSP principles (Mental Health)

High Fidelity Wraparound (Multi-system)

Family Group Decision Making (Child Welfare)

Balanced & Restorative Justice (Juvenile Justice)

Positive Behavioral Supports (Education)

STATE

State Leadership Team

equal youth, family & system

partner representation

Identify barriers to

systems integration;

Review data & policy

Recommend

modifications based on

SOC standards;

Raise public awareness

COUNTY

County Leadership Team

equal youth, family & system

partner representation

Participate in quality

improvement processes;

Evaluation of system

performance

Facilitate training;

Promote natural &

community supports

INDIVIDUAL

Youth & family are primary

decision makers in planning

their own care

Work as service delivery

providers, such as family

support partners

Mentor peers;

Train provider staff &

community members

Family & Youth Voice - Youth & Family Driven

Strengths Based

Individualized

Culturally, Linguistically Competent

Community Based, Accessible, High Quality, Evidenced Based & Cost Effective/Responsive Approaches

Natural Supports

Integrated & Collaborative Team Based Approach

Using Outcomes Data to Inform

Persistence/unconditional Care

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

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!

“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

Source: Ryder, F. (2008) Involving families, Inspiring Hope

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”

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.

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

We operationalize the System of

Care philosophy at the individual

family level using the High Fidelity

Wraparound (HFW) process

HFW is a youth and family-driven, team-based process for planning and implementing services

and supports

Through the HFW process, teams create plans that are geared toward meeting the unique needs of these youth and their caregivers and families

The HFW team members meet regularly to implement and monitor the plan to ensure its success

Team members include individuals relevant to the

success of the identified youth, including his or her parents/caregivers, other family members and community members, mental health professionals, educators, system representatives, and others

Outcomes of Wraparound: (9 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

The process is guided by 10 principles, follows 4 phases & their

activities are based on the 4 components of the Theory of

Change

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

For every 50 youth/families:

4 Wraparound Facilitators

2 Family Support Partners

2 Youth Support Partners

1 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

Fewer days in inpatient care: $2,777

savings per child

Decreased utilization of inpatient care: 54%

reduction in utilization

Mental health improvements sustained: 90%

of children still stable after 18 months

Fewer suicide-related behaviors: 32%

reduction in suicide-behavior

Improved school achievement: 49 out of 113

sample had improved grades

Reduced Juvenile Justice Involvement: of 38 youth

in Juvenile Justice, only 2 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

More natural supports identified

Improved family relationships reported

Fewer paid services needed

Director: Amy Herschell, PhD

Coordinator: Monica Walker Payne, MA

Data Coordinator: William McKenna, BS

Post-Doctoral Fellow: Ashley Tempel, PhD

Local Interviewers:

Wendi Buzzanco

Amanda Clouse

Jessica Keller

Edward McKenna

Jill Santiago

Sue Soriano

Funded by the Center for Mental Health

Services (CMHS) of the Substance Abuse

and Mental Health Services

Administration (SAMHSA)

Includes 173 communities funded since

1993 and over $1.49 billion spent.

Provides the nation with information about systems of care, how they develop, and how they are sustained across time.

Provides detailed information about the youth served, their families, and their experiences with systems of care.

Offers an objective picture of what works and what doesn’t work locally and nationally.

Information may be used locally and nationally to leverage additional funding.

Descriptive Study (EDIF information) › Demographic and diagnostic information

› Completed with all SOC/HFW families

› Each county enters data into QuickSAT or sends to Evaluation Team for data entry.

Longitudinal Outcome Study › Detailed Outcome Study

› Completed with 220 SOC families state-wide

TRAC-NOMS Study › Less-detailed Outcome Study

› Completed with all SOC/HFW families

Other important components › Fidelity Monitoring, Cost Analysis, Process Assessment

SOC Partner County

SOC Learning Community

Timeline

Nov 2nd - letters of interest due by COB

Nov 2012 - County invitations to submit full application & complete interview

Dec 2012 - SOC partner counties & learning communities announced

If you have questions, please contact

Karen Mallah, PhD, Director mallahk@upmc.edu

Youth Driven

Family Driven

Leadership Teams

Cultural & Linguistic Competence

Natural & Community Supports

High Fidelity Wraparound

Integration of Child Serving Systems

Evaluation & Continuous Quality Improvement

Establishment of a leadership team composed of 50% youth and family members, and 50% 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

Challenges and barriers identified at the individual family level lead to policy and practice changes focused on improving long term outcomes

The leadership team and community enact processes, philosophies and programs that reflect the System of Care principles, in particular for the target population

County System of Care stakeholders consistently support, encourage and promote the fundamental concepts of System of Care including through the dissemination of data, outcomes and information that is culturally and linguistically relevant to diverse audiences

Receive targeted funding & extensive technical assistance from the PA SOC Partnership and YFTI staff

Engage in learning and applying SOC standards through County Leadership Teams

Currently use or have a plan to implement High Fidelity Wraparound (HFW); shared HFW provider option

Commit to working with the evaluation team to insure that descriptive & outcomes data on youth & family participants is collected

Participate in shared learning opportunities with other counties approximately 4x per year

Have more time to find & educate local SOC champions, engage a broad base of stakeholders & build the foundation necessary for SOC implementation

Eligible for limited in-person technical assistance with targeted funding available when become SOC partner county with commitment to establishing a county leadership team, implementing HFW, and facilitating data collection and outcomes measurement

Can access all online and paper technical assistance tools and marketing materials

County residents and staff are welcome to attend all PA SOC Partnership opportunities and events

Expected to attend at least two shared learning opportunities per year Ex. County specific or stakeholder specific groups Topical training or targeted collaborative work

› At least 4 new SOC partner counties, maybe more

› No limit on learning communities

› No. A letter of interest will be required. And, more information may be sought through interviews to gauge the county’s strengths and needs.

› November 2nd, close of business. Please email to: mallahk@upmc.edu AND send by mail to:

Karen Mallah, PA SOC Partnership

120 E Azalea Drive, Room 102

Harrisburg, PA 17110

› OMHSAS is looking at alternative ways to fund HFW so that counties have options.

› We hope to test the viability of more than one county sharing a HFW provider.

› A Learning Community applicant may propose a current plan to work with youth and families in a way that adheres to SOC values & principles, while working on a longer term strategy for bringing the HFW process to their county over time in order to become a SOC partner county.

› Yes. The HFW team within a SOC county

would empower the youth and his/her

natural supports to work in partnership with

OCY, other involved systems, and potential

community supports. Working together with

this care planning team, the youth and his/her custodian would be primary decision

makers in choosing and sustaining a

successful living arrangement.

› Interviewers currently conduct evaluations

with families that are participating in the HFW process and are part of our population

of focus within SOC partner counties. New

interviewers will be hired as SOC partner

counties come on board.

“The SOC should include not just strong or willing partners, but empowered ones. We need better communication so that families, youth and agencies know about the options and are informed. It is very difficult to find the initial entry point for most of our families.”