Saeed Mirfattah, Director of Programs, FIRST 5 Santa Clar

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CARE MANAGEMENTThrough School Readiness

• Presenters
• Saeed Mirfattah, Director of Programs, FIRST 5
  Santa Clara County
• Melissa Smith, Care Management Supervisor, San
  Jose Unified School District

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Workshop Objective

• The Care Management Programs at FIRST 5 Santa
  Clara County, have been an integral part of both
  the School Readiness (Early Learning Initiative)
  and Family Courts Initiatives, coordinating and
  securing a variety of services for children aged
  0 through 5 and their families with the ultimate
  goal of healthy development, school success, and
  family self-reliance. This presentation will
  provide a conceptual overview and basis of Care
  Management within the School Readiness and Family
  Courts context, providing participants with
  essential information to theory as well as
  practice.

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Santa Clara County
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Santa Clara County at a Glance

• 1,682,585 residents
• 1,315 Square Miles
• 5th largest county in California
• 24 of Bay Areas total population
• 143,338 children under age 5
• 19,781 children under age 5 living in poverty
• 81,717 Median Family Income
• 15 Incorporated Cities/10 Unincorporated
  Communities
• 32 School Districts
• 54 White
• 26 Asian
• 24 Latino
• 3 African-American
• 0.3 Native Hawaiian or Pacific Islander

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Our Vision and Mission

• Vision FIRST 5 Santa Clara County will be a
  catalyst for ensuring that the developmental
  needs of children through age 5 are a priority in
  all sectors of the community.
• Mission FIRST 5 Santa Clara County supports the
  healthy development of children through age 5 and
  enriches the lives of their families and
  communities.

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Core Values Essential Elements

• Collaboration
• Compatible with existing systems
• No duplication
• Maximization of resources
• Common outcome indicators
• Builds capacity with what we know to be strengths
• United in purpose
• Integrity
• Program fidelity (quality assurance)
• Long lasting and positive impact on children and
  families
• Dedicated to continuous improvement
• Diversity
• Equity for all
• Values differences
• No child/family excluded

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Core Values Essential Elements

• Accountability
• Outcomes (results) driven
• Long lasting and positive impact on children and
  families
• Intersection of cost and impact to maximize value
• Highest return on investment
• Positive effect on childs development
• Inclusiveness
• Friendly to all Communities
• Community engaged in design implementation and
  evaluation
• Engaging widest spectrum of community
• Cultural Competency
• Linguistically/culturally appropriate
  representation
• Acknowledge similarities
• Respect differences

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Core Values Essential Elements

• Innovation
• Synthesis of what has been learned elsewhere
• Positive evolution in policy, programming and
  philosophy
• Designed specially for Santa Clara County needs
• Benched marked best practices
• Excellence
• Evidence (research based) comprehensive review of
  literature
• Highest Quality
• Effectiveness and Efficiency

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FIRST 5 Funds 5 Focus Areas
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Systemic Change

• FIRST 5 Santa Clara County, in partnership, has
  dedicated its leadership and resources to the
  development of a community-wide system of
  support for children prenatal through age 5 and
  their families. Essential to the development of
  this system is a community commitment that aligns
  common goals, joint planning, and the sharing of
  information and resources which will result in
  optimal health of children.
• Outcomes
• Increased cultural competency
• Increased service integration and accessibility
  to desired services
• Leveraging of core competencies and expertise of
  partner agencies
• Reduced bureaucracy ( e.g., common forms and
  centralized registry)
• Active community participation or civic
  engagement
• Maximization of fiscal resources

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Macro-Micro Service Model
Macro-Level of Services
Prevention Broad services that provide
education, information and awareness in accord
with the CORE Values
Intervention Targeted specific services that
are align with the CORE Values
Intense Intervention Very Intense
individualized services that meet criteria of
the CORE Values
Micro-Level of Services
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The School Readiness (The Early Learning
Initiative) Context

• 4 Elementary School Districts
• San Jose Unified School District (10 Elementary
  Schools)
• Gilroy Unified School District (4 Elementary
  Schools)
• Franklin McKinley School District (3 Elementary
  Schools)
• Alum Rock Elementary (3 Elementary Schools)
• 20 Elementary Schools selected
• Based on low API scores between 1-3
• 5.8 million FIRST 5 local State investment

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What did we set out to do?

• School Readiness
• Develop a thoughtful, inclusive, and community
  driven process that brings together key
  stakeholders to build a comprehensive foundation
  supporting families while they prepare their
  children aged 0 through 5 to succeed in school.
• and
• coordinate, secure, and improve access to a
  variety of services for individual families while
  improving the overall quality of those services
  and influencing systemic change.

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Barriers to Access

• A key intended outcome is to increase access and
  utilization of existing services and remove
  barriers to accessing services such as
• The overall stress of being a parent
• Transportation
• Child Care
• Lack of information about existing services
• Lack of assistance in parents native language
• Fear of asking for help

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Care Management Defined

• Care Management, in essence, is the coordination
  of services or a Family Success Plan from
  several agencies and across the 5 Essential and
  Coordinated Elements for one person or family
• with the ultimate goal that the person or family
  becomes self-reliant and manages their own
  services.

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Highlights of Accomplishments

• The Care Management Program has
• Assisted families with core parenting skills
• Assisted families in overcoming barriers to
  access
• Assisted families in securing health insurance
• Assisted families in improve the overall behavior
  of their children
• Assisted families in improve their overall health
  
• Assisted in expanding the capacity of local
  organizations to provide services
• Assisted families with a better understanding of
  eligibility criteria

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Eligibility Requirements

• FIRST 5 Care Management
• Child under the age of 5 in the family
• Home address within School Readiness identified
  elementary school attendance areas
• Other Services
• Applicable eligibility requirements based on
  services accessed

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Sample Services

• Dental Health
• Mental Health
• Literacy
• Kindergarten Readiness
• ESL
• In-Home Visitation
• Nutrition
• Arts Enrichment
• Co-operative Preschool
• Early Screening and Diagnosis
• Soccer League
• Childrens Discovery Museum

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The Basic Model
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What have we done so far?

• Convened Service Providers, Community Members,
  School District Personnel and other stakeholders
  in formalized Governance Structures called
  Partnerships across 4 school districts
• Service providers have collaborated to outreach
  to families, to streamline services, and improve
  the overall quality of services delivered
• Families have convened to provide regular and
  on-going feedback with respect to the quality of
  those services and the on-going unmet needs of
  the community

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What have we done so far?

• Gilroy Unified School District
• 4 Identified Elementary School Attendance Areas
• 665 Families served to date
• San Jose Unified School District
• 10 Identified Elementary School Attendance Areas
• 524 Families served to date
• Franklin McKinley Unified School District
• 3 Identified Elementary School Attendance Areas
• 696 Families served to date
• Alum Rock Unified School District
• 3 Identified Elementary School Attendance Areas
• 117 Families served to date

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Sample Year at a Glance (2003)

• 1,173 children received take home book bags
  (Raising a Reader)
• 192 parents graduated from kindergarten
  preparation courses (PIQE)
• 172 children received preventive dental care (The
  Health Trust)
• 105 families received intensive in-home
  visitation (Public Health Dept.)
• 80 families received mental health screening
  (Dept. of Mental Health)
• 76 families participated in parent enrichment
  classes (City of Gilroy)
• 50 families participated in parent participation
  preschool (Metro Ed.)
• 28 families received literacy tutoring (MACSA)
• 23 families attended workshops on environmental
  toxins (SVTC)
• 38 sites serving 592 children received quality
  picture books and curriculum support theme kits
  (San Jose Public Library)

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Core Principles of Care Management

• All people, and all families, have strengths.
• All people, and all families, deserve support.
• Diversity is an asset.
• Self-reliance is a goal.
• Services should be coordinated.
• Collaboration among agencies is crucial.
• Families should drive the process.

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Strength-Based Model
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A Family Driven Model

• Care Managers work closely with families
  developing a partnership to meet their goals and
  access services. The families, however drive the
  process
• Families determine where the service occurs
• Families determine what services are accessed
• Families determine and set their own goals

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Key Steps in Care Management

• Develop a partnership with the family.
• Help the family assess their needs and strengths.
  
• Assist the family in goal setting.
• Co-develop a Family Success Plan.
• Family learns and practices skills.
• Family uses services as stepping stones towards
  reaching their goals.
• Family becomes self-reliant.

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Role of Care Managers

• To help families restore their sense of
  self-reliance, self-respect, and hope.
• To help families assess their own strengths and
  needs.
• To help families create their own long and short
  term goals.
• To help families gain access to the services they
  need to reach their goals.
• To encourage families to develop their own
  strengths and skills.
• To encourage communities to support families.
• To encourage families to advocate for themselves.

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Care Managers as Advocates

• First Step - Assist the family in how to advocate
  for self
• Access information
• Develop new skills
• Assist them when and where needed
• Second Step - Advocate on their behalf
• Use Compassionate presence (attentiveness)
• Use good communication skills
• Maintain good relationships with agencies
• Open lines of communication with agencies

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Minimum Skills Knowledge

• Communication
• Relationship-building
• Inter and Intra-personal
• Boundary setting
• Meeting facilitation
• Interviewing
• Goal setting
• Patience Compassion
• Cultural Linguistic competence
• Knowledge of community resources
• Confidentiality
• Mandated Reporters

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Cultural Competence Diversity

• The ability to learn from and respectfully relate
  with people of your own culture as well as those
  from other cultures.
• The ability to adjust your own and your agencies
  behaviors and policies based on what you learn.
• Recognizing the strengths in all cultures.
• Respecting cultural differences.
• Using cultural knowledge to design and deliver
  services.
• Mutually respectful relationships.
• Cross-cultural communication skills linguistic
  competency.
• Care Managers work with diversity, including
  race, ethnic background, language, gender, sexual
  orientation, class, family form, age, religion or
  spirituality, geographic region, and physical and
  mental ability.

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The Family Success Plan

• Families determine their own goals and how to get
  there.
• Families own words are used to describe their
  goals and concerns.
• The family and the Care Manager retains a copy
  which is updated each time they meet.
• Provides a record of the familys work with the
  Care Manager over a period of time.
• Records familys progress.
• The family and the Care Manager each have tasks
  that fall out of the Family Success Plan.
• Discussion of progress on these tasks forms the
  basis for the next meeting.
• Celebrate with the family their achievements.

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The Referral Process

• Decide, in partnership with the families, on the
  appropriate referral based on conversations and
  interviews.
• Gather detailed info on the agency and provide it
  to the family.
• Communicate with the agency.
• Secure and ensure access.
• Follow up.
• Build family capacity to do the same in the
  future.

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When and How to end the Relationship

• Due to the family-driven nature of the process,
  in most instances, the family determines when the
  relationship ends. This generally occurs when
• The family has achieved its goals
• How well the Care Managers build the capacity of
  individual families, will also influence how long
  a family stays in the program.

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Collaborative Service Delivery

• Care Managers collaborate with a variety of
  agencies and partners to
• Create Partnerships
• Influence systemic change
• Streamline processes
• Improve access for families
• Improve overall service delivery
• Unify the approach to families

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Lessons Learned

• Care Managers can be strong advocates for
  improved services and improved community supports
  for families. The program overall is highly
  successful, popular, and well received. Careful
  supervision and management is needed to address
  the following areas
• Boundary setting is critical
• Transportation is an on-going issue
• Care Managers cant fix everything (and they
  shouldnt try)
• Goal setting is a learned skill
• Maintain focus on quality of services
• Training, training, training
• Co-dependency is a potential pitfall

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How to avoid family dependence

• Be clear from the beginning.
• Maintain a clear and separate role in the family
  system.
• Set healthy boundaries.
• Avoid the enabler role.
• Help the family build interdependence with their
  natural. support systems
• Maintain a balanced life for yourself.
• Be self-reflexive.
• Ask How much progress has the family made?
• Ask Am I burned out?

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Data Tracking

• Outcomes Collection, Evaluation and Reporting
  Service (OCERS)
• Online data base that allows for tracking and
  reporting client level data
• Care Management Program Internal Data Collection
• Number and types of referrals made to outside
  agencies
• Referral tracking
• Case Notes

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Program Evaluation Results

• Over half of families (53 percent) receiving Care
  Management services have a total household income
  that is less than 20,000 per year.
• Families who receive services report an average
  of 2.73 minors living in their homes.
• Nearly two-thirds (66 percent) of the primary
  caregivers in families receiving Care Management
  services lack a high school diploma or GED, which
  suggests that their earning power is limited.
• 21 percent of childrens fathers were living
  outside the home.
• Parents who participated in focus groups reported
  hearing about the Care Management program from a
  variety of sources, suggesting that the program
  has become an integral part of the school
  environment and the greater community.

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Program Evaluation Results

• A variety of outreach methods were used to reach
  families including internal outreach capacity,
  care managers own outreach, school personnel,
  walk-ins, and word of mouth.
• Parents who participated in focus groups
  overwhelmingly agreed that the Care Management
  program has helped them overcome the barriers
  they faced.
• As a result of receiving services, parents
  believe they
• exercise more patience with their children
• provide more effective discipline
• read, sing and play more with their children
• know more about child development
• take better care of their childrens health
• spend more time with their children
• read more to their children

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Areas Served
Zip Codes of Children 0-5 Served by Early
Learning Care Managers
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Populations Served
Ethnicity of children 0-5 Served by Care
Management Compared to the Population of Santa
Clara County and to the School Districts
Source US Census Bureau. California Department
of Education 2002-03 District Profiles for
Franklin-McKinley Elementary, Gilroy Unified and
San Jose Unified School Districts. OCERSPlus
Data through May 2004. Note The category other
was not included as a response category in the
school district data.
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Sample Family Survey Results
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The Family Courts Initiative

• This Family Court Initiative is a first in the
  nation partnership providing support for children
  prenatal through age 5 in the Family Court
  System. Family Court assists families with
  divorce, separation, visitation and child custody
  disputes
• This Initiative was developed to assist children
  and their families within the Family Court System
  to access the resources needed to provide for
  their support by
• Creating a network of quality programs, services
  and activities
• Identifying and addressing gaps in needed
  services and the over and under utilization of
  existing services
• Coordinating prevention, intervention and
  intensive intervention services
• Securing access for families to multiple
  programs, services, and activities identified by
  the families

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Program Objectives

• Through this Initiative, FIRST 5 Santa Clara
  County seeks to
• Be a major catalyst for systemic change within
  the Family Court System
• Foster community collaboration to enable the
  coordination and integration of existing services
  and infrastructures
• Prevent families with children prenatal through
  age 5 from entering Dependency Court

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Program Components

• Resource Specialist and Drug Treatment Court
  Coordinators Bilingual Spanish-speaking resource
  and referral services
• Supplemental Services Fund Funding available to
  pay for court-ordered services for FIRST 5
  families identified by the court as eligible for
  assistance
• Care Management Program 7 care managers are
  located at various court facilities to refer and
  secure services for families
• Strategic Planning and Resource Development
  Identify gaps in services and develop resources
  in the community for those services
• New Skills and Choices Parenting Programs Group
  interventions, counseling, and therapeutic
  supervision for children and their parents.

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The Courts

• Each year approximately 2,600 families are
  referred to Family Court Services
• Over 50 (1,300) of the 2,600 families have a
  child five-years-old or younger who is the
  subject of a custody and/or visitation dispute
  and are currently served by the Family Court
  System
• 650 families in Family Court with children
  five-years-old and under have serious problems
  related to high conflict, substance abuse,
  domestic violence, and child abuse (equaling
  approximately 1,040)

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Care Management

• Resources for Families and Communities in Santa
  Clara County (RFC), a community-based
  organization, was funded to work in partnership
  with FIRST 5 Santa Clara County and Family Court
  to hire Care Managers and deliver Care Management
  Services in Family Court
• RFCs funding began July 2003 for a period of 2
  years
• RFC hired a Program Manager and 7
  bi-lingual/bi-cultural Care Managers and began
  providing services in October 2003
• Care Managers are located on site at 2 Family
  Court locations, Court Mobile, Child Support
  office, Domestic Violence calendar and DV
  Criminal Court
• Care Managers coordinate with a network of local
  service providers to secure access to court
  ordered and/or requested programs, services and
  activities for families and their children
• Supplemental Services Fund available to assist
  families with other services

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The Concept

• Families in the Court System with children
  prenatal through age 5 are referred by Family
  Court Judges, Family Court Services staff,
  community service providers and/or by voluntary
  self-referral
• Each family and their Care Manager co-develop a
  Family Success Plan that includes the
  identification of individualized, desired results
  and a plan to ensure access to services, such as
  securing appointments, transportation and
  interpretation services

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Program Results

• 1180 referrals received from October 2003 through
  December 2004
• 673 - Family Court Park Plaza site
• 81 - Child Support Enforcement office
• 130 - Court Mobile/Notre Dame
• 13 - Domestic Violence Criminal Court
• 159 - RFC and other agencies
• 124 did not meet FIRST 5 criteria, families were
  referred to the RFC Family Advocacy Program
• Languages spoken by families
• 716 English
• 416 Monolingual Spanish
• 31 Monolingual Vietnamese
• 17 Other Languages
• Supplemental Services Funds
• To date 41,881 has been utilized to assist
  families with the following
• - housing
• - transportation
• - parenting classes

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Desired Outcomes

• Decrease in the number of families who are
  referred to Dependency Court
• Decrease in the number of families who return to
  the Family Court System
• Decrease in the barriers to accessing services
  identified by families
• Increase in the number of families who access
  court-ordered services and obtain follow-up
  services
• Increase in the awareness of families and service
  providers regarding the range of services
  available and how to access services through the
  Care Management Program
• Increase in the percent of parents who
  demonstrate an increase in knowledge of health
  and safety, effective parenting skills, early
  childhood development

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In their own words

• I was very impatient with my child, and I had
  problems with my husband because he said I was
  asking too much of the child. Speaking with
  people like psychologists that were invited to
  the school by FIRST 5 taught me the limits and
  what is fair to ask and what is not.
• My child is very stubborn and doesnt know how
  to talk. When I came to this program and I went
  to the classes, I learned that my child has
  autism. Because of this program, I now know how
  to guide my child. I learned what needed to be
  done. Before that, my mind was not open. Now, I
  have more knowledge. Before I was very concerned
  because I didnt know what s/he had.

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In their own words

• It has helped me in being more patient and
  spending more time with my children. I used to
  read to them once in awhile, but now its part of
  my routine every afternoon. Now, they tell me,
  Mom, when is it time for the story?
• I have learned that I need to make more effort
  in reading to them, how to follow the story of
  the book, to sing songs to them, talk to them,
  tell them stories, and what they need to have
  learned before entering Kindergarten. Ive
  learned a lot about nutrition as well, about
  healthy food.

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In their own words

• Thanks to the program, I am involved more
  in-depth. I go to the School Board and the Head
  Start meetings because thats the way we can let
  the government know what our needs are. I
  express myself at those meetings. Sometimes I
  tell them I dont agree with things. I tell them
  because I have a voice and a vote. I can talk,
  and for the first time they are listening to me.
  
• My Care Manager told me I should go to the
  school meetings so that there is a voice for the
  Vietnamese community. Most of the families are
  Mexicans. I felt the same way, so I went. When
  I went, I saw they teach you many useful things.

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The Beginning

• Q A