THE SKILL BUILDING CURRICULUM

1
Primer Hands On-Child Welfare
THE SKILL BUILDING CURRICULUM
Developed by Sheila A. Pires Human Service
Collaborative Washington, D.C. In partnership
with Katherine J. Lazear Research and Training
Center for Childrens Mental Health University of
South Florida, Tampa, FL Lisa Conlan Federation
of Families for Childrens Mental
Health Washington, D.C.
Primer Hands On - Child Welfare (2007)
2
Primer Hands On-Child Welfare PURPOSE

• Build a network of individuals grounded in a
  common strategic framework for building systems
  of care
• Support one anothers efforts
• Advance the larger field

Pires, S., Lazear, K., Conlan, L. (2003). Primer
Hands On A skill building curriculum.
Washington, D.C. Human Service Collaborative.
3
Ways to Use Primer Hands On-Child Welfare

• As a self-contained, intensive two-day training
  covering all Modules provides an overall
  strategic framework
• As separate training sessions on individual
  Modules allows in-depth focus on a given area
• As material that can be drawn on by technical
  assistance providers/consultants supports
  targeted technical assistance.

Pires, S., Lazear, K., Conlan, L. (2003). Primer
Hands On A skill building curriculum.
Washington, D.C. Human Service Collaborative.
4
Primer Hands On-Child Welfare COMPONENTS

• Capacity-building sessions, or topical training
  sessions on individual modules, or materials for
  targeted technical assistance, based on Building
  Systems of Care A Primer
• Skill building curriculum, including curriculum,
  case scenarios, exercises, handouts, Power Point
  slides, and Primer
• Network for peer support and technical
  assistance, linked by list-serve

Pires, S., Lazear, K., Conlan, L. (2003). Primer
Hands On A skill building curriculum.
Washington, D.C. Human Service Collaborative.
5
Primer Hands On-Child Welfare TARGET AUDIENCE
System Builders All stakeholders
providing leadership in building systems of care
for children, youth and families involved, or at
risk for involvement, in the child welfare system.
E.g., families, youth, County managers and State
administrators, providers, CASA volunteers, law
enforcement personnel, judges, frontline workers,
supervisors, researchers, natural helpers,
guardian ad litems, etc.
Pires, S., Lazear, K., Conlan, L. (2006). Primer
Hands On-Child Welfare A skill building
curriculum. Washington, D.C. Human Service
Collaborative.
6
Primer Hands On-Child Welfare OBJECTIVES

• To strengthen the knowledge base and skills of
  system of care leaders to operate strategically
  in system building
• To give system of care leaders teaching tools to
  use in their respective communities

Pires, S., Lazear, K., Conlan, L.( 2003). Primer
Hands On A skill building curriculum.
Washington, D.C. Human Service Collaborative.
7
Primer Hands On-Child Welfare METHODS

• Didactic
• Case method
• Peer-to-peer exchange and team work
• On-going coaching and peer support
• Technical assistance on specific modules

Pires, S., Lazear, K., Conlan, L.(2007). Primer
Hands On- Child Welfare. Washington, D.C. Human
Service Collaborative.
8
Strategic Planning
The science and art of mobilizing all forces
political, economic, financial, psychological,
social to obtain goals and objectives.
Pires, S., Lazear, K., Conlan, L.(2003). Primer
Hands On A skill building curriculum. Adapted
from Websters Dictionary. Washington, D.C.
Human Service Collaborative
9
Elements of Strategic Planning

• Strategic planning is a continual process for
  improving organizational performance by
  developing strategies to produce results.
• Planning is strategic when it focuses on what the
  agency wants to accomplish (outcomes) and on how
  to move the agency towards these larger goals.
• Strategic planning involves engaging all
  stakeholders.
• Strategic planning communicates the agencys
  mission and goals to the public.

Source National Child Welfare Resource Center
for Organizational Improvement, Child and Family
Services Review Technical Assistance.
10
Definition of a System of Care
A system of care incorporates a broad, flexible
array of services and supports for a defined
population(s) that is organized into a
coordinated network, integrates service planning
and service coordination and management across
multiple levels, is culturally and linguistically
competent, builds meaningful partnerships with
families and youth at service delivery,
management, and policy levels, and has supportive
management and policy infrastructure.
Pires, S. (2006). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
11
ACF System of Care Sites

• Contra Costa County, CA
• State of Kansas
• Bedford-Stuyvesant, Brooklyn, NY
• Jefferson County, CO
• Clark County, NV
• State of North Carolina
• State of Oregon
• State of Pennsylvania
• Tribal Sites in North Dakota

Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
12
Retrospective National System of Care Activity

• CASSP - Child and Adolescent Service System
  Program
• RWJ MHSPY Robert Wood Johnson Mental Health
  Services Program for Youth
• CASEY MHI Annie E. Casey Foundation Urban
  Mental Health Initiative
• STATEWIDE FAMILY NETWORK GRANTS
• CMHS GRANTS Center for Mental Health Services
• CSAT GRANTS Center for Substance Abuse
  Treatment
• ACF GRANTS Administration for Children and
  Families
• CMS GRANTS Center on Medicare and Medicaid
  Services
• Child and Family Services Reviews (CFSRs)
• CLARK FOUNDATION Community Partnerships for
  Protecting
• Children
• NEW FREEDOM MENTAL HEALTH COMMISSION
• YOUTH MOVES - Center for Mental Health Services

Pires, S. (2006). Primer Hands On-Child Welfare.
Washington, D.C. Human Service Collaborative.
13
Recent Child Welfare Sponsored System of Care
Activities

• 9 ACF System of Care Grants
• SOC Technical Assistance through Caliber
  Associates
• ACF Region III Policy Academy
• Primer Hands On-Child Welfare Training of
  Trainers

Pires, S. (2006). Primer Hands On-Child Welfare.
Washington, D.C. Human Service Collaborative.
14
Organizing Framework
System of care is, first and foremost, a set of
values and principles that provides an organizing
framework for systems reform on behalf of
children, youth and families.
Stroul, B.( 2002). Issue brief-Systems of care A
framework for system reform in childrens mental
health. Washington, D.C. Georgetown University
Child Development Center
15
Values and Principles for the System of Care
CORE VALUES Child, Youth and Family - Centered
Community Based Culturally and Linguistically
Competent
Adapted from Stroul, B., Friedman, R. (1986). A
system of care for children and youth with severe
emotional disturbances (Rev. ed.) Washington, DC
Georgetown University Child Development Center,
National Technical Assistance Center for
Children's Mental Health. Reprinted by permission.
16
Values and Principles for the System of Care

• Comprehensive array of services and supports
• Individualized services and supports guided by an
  individualized services and supports plan
• Least restrictive environment that is most
  appropriate
• Families, surrogate families and youth full
  participants in all aspects of the planning and
  delivery of services and supports
• Integrated services and supports
• Continued

Stroul, B., Friedman, R. (1986). A system of
care for children and youth with severe emotional
disturbances (Rev. ed.) Washington, DC
Georgetown University Child Development Center,
National Technical Assistance Center for
Children's Mental Health. Reprinted by permission.
17
Values and Principlesfor the System of Care

• Services and supports coordination and management
  accountability across multiple systems
• Early identification and intervention
• Smooth transitions
• Rights protected, and effective advocacy efforts
  promoted
• Receive services without regard to race,
  religion, national origin, gender, sexual
  orientation, physical disability, or other
  characteristics and services and supports should
  be sensitive and responsive to cultural and
  linguistic differences and special needs

Adapted from Stroul, B., Friedman, R. (1986). A
system of care for children and youth with severe
emotional disturbances (Rev. ed.) Washington,
DC Georgetown University Child Development
Center, National Technical Assistance Center for
Children's Mental Health. Reprinted by permission.
18
Principles of Family Support Practice

• Staff families work together in relationships
  based on equality and respect.
• Staff enhances families capacity to support the
  growth and development of all family members.
• Families are resources to their own members,
  other families, programs, and communities.
• Programs affirm and strengthen families
  cultural, racial, and linguistic identities.
• Programs are embedded in their communities and
  contribute to the community building.
• Programs advocate with families for services and
  systems that are fair, responsive, and
  accountable to the families served.
• Practitioners work with families to mobilize
  formal and informal resources to support family
  development.
• Programs are flexible responsive to emerging
  family community issues.
• Principles of family support are modeled in all
  program activities.

Family Support America. (2001). Principles of
Family Support Practice in Guidelines for Family
Support Practice (2nd ed.). Chicago, IL.
19
Youth Development Principles

• Embrace total youth involvement
• Create a healthy and safe environment
• Promote healthy relationships
• Create community partnerships
• Realize interdependence takes time
• Value individual strengths
• Build feedback and self-assessment
• Learn by doing

• Child and Youth Centered
• Community Based
• Comprehensive
• Collaborative
• Egalitarian
• Empowering
• Inclusive
• Visible, Accessible, and Engaging
• Flexible
• Culturally Sensitive
• Family Focused
• Affirming

Pires, S. Silber, J. (1991). On their own
Runaway and homeless youth and the programs that
serve them. Washington, D.C. Georgetown
University Child Development Center.
Child Welfare League of America, DeWitt Wallace
Grant, 1995
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CFSR Child Welfare Principles
Family-centered practice Community-based
services Strengthening the capacity of
families Individualizing services
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
21
PRIMER HANDS ON- CHILD WELFARE HANDOUT
2.1 Alabamas R.C. Goals and Principles Bazelon
Center for Mental Health Law Making Child Welfare
Work How the R.C. Lawsuit Forged New
Partnerships to Protect Children and Sustain
Families Washington D.C. 1998
Primer Hands On - Child Welfare (2007)
22
System of Care Operational Characteristics

• Cross-agency service coordination
• Individualized services supports "wrapped
  around" child family
• Home- community-based alternatives
• Broad, flexible array of services supports for
  children families
• Integration of formal services natural
  supports, and linkage to community resources
• Integration of evidence-based and promising
  practices
• Data-driven focus on Continuous Quality
  Improvement (CQI)

• Collaboration across agencies
• Partnership with families/youth
• Cultural linguistic competence
• Blended, braided, or coordinated financing
• Shared governance across systems with families
  and youth
• Shared outcomes across systems
• Organized pathway to services supports
• Child and family teams
• Single plan of services and supports
• Staff, providers, and families trained and
  mentored in a common practice model
• One accountable service manager

Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
23
CFSR Systemic Factors

1. Statewide Information System
2. Case Review System
3. Quality Assurance System
4. Staff and Provider Training
5. Service Array
6. Agency Responsiveness to the Community
7. Foster and Adoptive Licensing, Recruitment and
   Retention

Primer Hands On - Child Welfare (2007)
24
Resonance Between CFSR and SOC Outcomes
Child Family Services Review System of Care
Children are protected from abuse and neglect. Build safety plans into service/support plans.
Children are safely maintained in their homes whenever possible and appropriate. Prevent out-of-home placements, keep families intact.
Children have permanency and stability in their living arrangements. Minimize disruption in childrens lives and promote continuity and smooth transitions.
The continuity of family relationships and connections is preserved for children. Core value - family focus
Families have enhances capacity to care for their families needs. Strengthen the resiliency of both families and youth and enhance natural helping networks.
Children receive appropriate services to meet their educational needs Focus on all life domains, including education.
Children receive adequate services to meet their physical and mental health needs Holistic approach, broad array of services and supports.
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
25
Major Issues Identified Through Child and Family
Services Reviews
Safety Inconsistent services to protect children at home Inconsistent monitoring of families Insufficient risk or safety assessment Permanency Inconsistent concurrent planning efforts Adoption studies, court proceedings take too long Well-Being Inconsistent match of services to needs Lack of support services to foster and relative caregivers Parents not involved in case planning Lack of health and mental health assessments
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
26
Examples of State Successes in Program
Improvement Plan Implementation
Changing the culture of agencies Aligning child welfare, juvenile justice and mental health through communications and common practice Improving collaboration with community partners Using best practices Reorganizing child welfare as a learning organization through a Continuous Quality Improvement structure Using data to inform decision-making and improve quality.
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
27
Current Systems Problems

• Lack of home and community-based services and
  supports
• Patterns of how children, youth and families use
  services and supports
• Cost
• Administrative inefficiencies
• Knowledge, skills and attitudes of key
  stakeholders
• Poor outcomes
• Financing structures
• Deficit-based, pathology-based, limited types of
  interventions

Pires, S. (1996). Human Service Collaborative,
Washington, D.C.
28
Fundamental Challenge to Building a System of Care
No one system controls everything. Every system
controls something.
Pires, S. (2004). Human Service Collaborative.
Washington, D.C.
29
Characteristics of Systems of Care as Systems
Reform Initiatives
FROM Fragmented service delivery Categorical
programs/funding Limited services Reactive,
crisis-oriented Focus on out-of-home placements
Children out-of-home Centralized
authority Creation of dependency
TO Coordinated service delivery Blended
resources Comprehensive services/supports
array Focus on prevention/early
intervention Individualized services supports
in least restrictive, normalized
environments Children within families Community-ba
sed ownership Creation of self-help
Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
30
Frontline Practice Shifts
Given power imbalance Acknowledgment of power
imbalance with family and that their
fears and concerns are real Im in charge
attitude Positive engagement Controlling
Collaborative Law enforcement
approach Helping/Social worker
approach Multiple case managers One
service manager Multiple service plans for
child Single plan for child and family Family
blaming Family partnerships Deficit-Based Str
engths Focused Mono Cultural Sensitivity to
culture/linguistics and family ritual
Conlon, L. Federation of Families for Childrens
Mental Health and Orrego, M. E. Lazear, K. J.
(1998) EQUIPO Working as Partners to Strengthen
Our Community. Tampa, FL University of South
Florida
31
How Families Become Involved with Child Welfare

• Based on safety concerns, families are
  investigated for their parenting and abuse and
  neglect is founded.
• Families are in need of services and supports to
  increase their parenting skills and preserve
  their family.
• The needs of parents can be serious when they are
  dealing with their own childhood traumatic
  experiences, violence, mental health, cognitive,
  and substance abuse concerns.
• The child or youth within a family may display
  harmful or delinquent behaviors and become court
  ordered to placement.
• Families are unable to access the necessary
  services needed to meet their child or youths
  serious emotional disturbance.
• The majority of families involved with the system
  of care through child welfare become involved
  involuntarily.

Conlan, L., Federation of Families for Childrens
Mental Health
32
Family Centered Practice in Child Welfare

• The family unit is the focus of attention.
• Strengthening the capacity of families to
  function effectively is emphasized.
• Families are linked with more comprehensive,
  diverse, and community-based networks of supports
  and services.
• Families are engaged in designing all aspects of
  the policies, services, and program evaluation.

National Resource Center for Family Centered
Practice and Permanency Planning, Hunter College
School of Social Work.
33
Examples of Family and Youth Shifts in Roles and
Expectations
-Recipient of information requirements (esp. if abuse/neglect) Passive partner in services and supports planning process Service and supports planning team leader
-Unheard voice in program evaluation Participant in program evaluation Partner (or independent) in developing and conducting program evaluations
-Recipient of services/supports Partner in planning and developing services and supports Services and supports providers
-Uninvited key stakeholders in training initiatives Participants in training initiatives Partners and independent trainers
-Anger, adversity resistance Self-advocacy peer support Systems advocacy peer support

Lazear, K. (2004). Primer Hands On for Family
Organizations. Human Service Collaborative
Washington, D.C.
34
Partnering with Families in Child Welfare
Fundamental Shifts in Decision-Making Practice
Team decision making Family group
conferencing Wraparound Partnerships with
neighborhood resources - Family-to-family
- Community partnerships
Child Welfare Families Extended family
networks Community resources Other child-serving
systems
Child Welfare
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
35
System Change Focuses On

• Policy Level
• (e.g., financing regs rates)
• Management Level
• (e.g., data Quality Improvement Human Resource
  Development system organization)
• Frontline Practice Level
• (e.g., assessment services and supports
  planning service coordination services and
  supports provision)
• Community Level
• (e.g., partnership with families, youth, natural
  helpers community buy-in)

Pires, S. (2006). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
36
Categorical vs. Non-Categorical System Reforms
Categorical System Reforms
Non-Categorical Reforms
Pires, S. (2001). Categorical vs. non-categorical
system reforms. Washington, DC Human Service
Collaborative.
37
Child Welfare Population Issues

• All children and families involved in child
  welfare?
• If subsets, who?

Demographic e.g., infants, transition-age youth
Intensity of System Involvement e.g., out of
home placement, multi-system, length of stay
At Risk e.g., Children at home at risk of out
of home placement? Children in permanent
placements at risk of disruption ? (e.g.,
subsidized adoption, kinship care, permanent
foster care)
Level of Severity e.g., Children with serious
emotional/behavioral disorders, serious
physical health problems, developmental
disabilities, co-occurring
Pires, S (2004.) Human Service Collaborative.
Washington, D.C.
38
Prevalence and Utilization
Out of Home Placements IntensiveServices 60
of
More complex needs
Early Intervention and Family Preservation
services and supports 35 of
2 - 5
Primary Prevention and Universal Well-Being
Promotion 5 of
15
Less complex needs
80
Pires, S.( 2006). Human Service Collaborative.
Washington, D.C.
39
Example Transition-Age Youth
What outcomes do we want to see for this
population? (e.g. connection to caring adults,
employment, education, independence)
Policy Level -What systems need to be involved?
(e.g., Housing, Vocational Rehabilitation,
Employment Services, Mental Health and Substance
Abuse, Medicaid, Schools, Community Colleges
/Universities, Physical Health, Juvenile Justice,
Child Welfare) -What dollars/resources do they
control?
Management Level -How do we create a locus of
system management accountability for this
population? (e.g., in-house, lead community
agency)
Frontline Practice Level -Are there
evidence-based/promising approaches targeted to
this population? (e.g., Family Finding) -What
training do we need to provide and for whom to
create desired attitudes, knowledge, skills about
this population?-What providers know this
population best in our community? (e.g.,
culturally diverse providers)
Community Level -What are the partnerships we
need to build with youth and families? -How can
natural helpers in the community play a role?-How
do we create larger community buy-in?-What can we
put in place to provide opportunities for youth
to contribute and feel a part of the larger
community? --What does out system look like for
this population?
Pires, S. 2005. Building systems of care..Human
Service Collaborative. Washington, D.C.
40
Local OwnershipState Commitment Tribal
Ownership/Partnership
Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative
41
Evidence-Based Practices And Promising Approaches
Evidence-Based Practices Show evidence of
effectiveness through carefully controlled
scientific studies, including random clinical
trials Practice-Based Evidence/Promising
Approaches Show evidence of effectiveness through
experience of key stakeholders (e.g., families,
youth, providers, administrators) and outcomes
data
Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
42
Examples
Examples of Evidence-Based Practices

• Multisystemic Therapy (MST)
• Multidimensional Treatment Foster Care (MDTFC)
• Functional Family Therapy (FFT)
• Cognitive Behavioral Therapy (various models)
• Intensive Case Management (various models)

Examples of Promising Practices

• Family Support and Education
• Wraparound Service Approaches
• Mobile Response and Stabilization Services
• Family Group Decision Making

Source Burns Hoagwood. (2002). Community
treatment for youth Evidence-based
interventions for severe emotional and behavioral
disorders. Oxford University Press and State of
New Jersey BH Partnership (www.njkidsoc.org)
43
Kauffman Foundation Best Practices Project/
National Child Traumatic Stress
Network Evidenced-Based Practices for Children in
Child Welfare

• Trauma Focused-Cognitive Behavioral Therapy
  (TF-CBT)
• Abuse Focused-Cognitive Behavioral Therapy
  (AF-CBT)
• Parent Child Interaction Therapy (PCIT)

Contact www.kauffmanfoundation.org

• California Evidence-Based Clearinghouse for Child
  Welfare

Contact www.cachildwelfareclearinghouse.org
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
44
Effectiveness Research(Burns Hoagwood, 2002)

• Most evidence of efficacy Intensive case
  management, in-home services, therapeutic foster
  care
• Less evidence (because not much research done)
  Crisis services, respite, mentoring, family
  education and support
• Least evidence (and lots of research) Inpatient,
  residential treatment, therapeutic group home

Burns Hoagwood. (2002). Community Treatment for
Youth. New York Oxford University Press
45
Shared Characteristics of Evidence-Based (and
Promising) Interventions

• Function as service components within systems of
  care
• Provided in the community
• Utilize natural supports, partner with parents,
  with training and supervision provided by those
  with formal training
• Operate under the auspices of all child-serving
  systems, not just child welfare
• Studied in the field with real world children
  and families
• Less expensive than institutional care (e.g.,
  residential treatment, hospitals) (when the full
  continuum is in place)

Burns, B. and Hoagwood, K.( 2002). Community
treatment for youth. New York Oxford University
Press.
46
3 Lessons in Values

• People come with established values
• These values are constantly tested by situations
  that arise
• These values and the news ones formed are
  constantly shaped by the situations that play out

Lazear, K. (2004). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
47
Process How system builders conduct
themselves Structure What gets built (i.e., how
functions are organized)
Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
48
Structure Something Arranged in a Definite
Pattern of Organization

• I. Distributes
• Power
• Responsibility
• II. Shapes and is shaped by
• Values
• III. Affects
• Practice and outcomes
• Subjective experiences (i.e., how participants
  feel)

Pires, S. (1995). Structure. Washington, DC
Human Service Collaborative.
49
Example
Goal One service support plan one service
manager

• Mental Health
• Individualized Wraparound Approach
• Care manager

• Child Welfare
• Family Group Decision Making
• CW Case Worker

Kinship Care
Subsidized Adoption
Permanent Foster Care
Tutoring Parent Support, etc.
Treatment Foster Care
In-Home Services
Crisis Services

• Juvenile Justice
• Screening Assessment
• Probation officer

Children in at risk for out-of-home placements

• Education
• Child Study Team
• Teacher

Community Services

• MCO
• Prior Authorization
• Clinical Coordinator

Alternative School
EH Classroom Related Services
Out-patient services
Primary Care
Med. Mngt.
Result Multiple service support plans
multiple service manager
Pires, S. (2004). Primer Hands On. Human Service
Collaborative Washington, DC
50
Wraparound Milwaukee
CHILD WELFARE Funds thru Case Rate (Budget for
Institutional Care for CHIPS Children)
JUVENILE JUSTICE (Funds budgeted for Residential
Treatment for Delinquent Youth)
MEDICAID CAPITATION (1557 per month per enrollee)

• MENTAL HEALTH
• Crisis Billing
• Block Grant
• HMO Commercial Insurance

9.5M
8.5M
10M
2.0M
Wraparound Milwaukee Management Service
Organization (MSO) 30M
Families United 300,000
Per Participant Case Rate
Provider Network 240 Providers 85 Services
Service Coordination
Child and Family Team
Plan of Services Supports
Wraparound Milwaukee. (2002). What are the pooled
funds? Milwaukee, WI Milwaukee Count Mental
Health Division, Child and Adolescent Services
Branch.
51
Truisms About Structure

• Certain functions must be structured and not left
  to happenstance
• Structures need to be evaluated and modified if
  necessary over time
• New structures replace existing ones some
  existing ones are worth keeping some are more
  difficult to replace than others
• There are no perfect or correct structures

Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
52
System of Care Functions Requiring Structure

• Planning
• Decision Making/Policy Level Oversight
• System Management
• Service Supports Array
• Evidence-Based Promising Practices
• Outreach and Engagement
• System Entry/Access
• Screening, Assessment, Evaluation
• Decision Making Oversight at the Service
  Delivery Level
• Services Supports Planning
• Services Supports Authorization
• Service Monitoring Review
• Service Coordination
• Crisis Management at the Service Delivery
  Systems Levels
• Utilization Management
• Family Involvement, Support, Development at all
  Levels
• Youth Involvement, Support, Development

• Human Resource Development/Staffing
• Staff Involvement, Support, Development
• Orientation, Training of Key Stakeholders
• External Internal Communication
• Provider Network
• Protecting Privacy
• Ensuring Rights
• Transportation
• Financing
• Purchasing/Contracting
• Provider Payment Rates
• Revenue Generation Reinvestment
• Billing Claims Processing
• Information Management
• Quality Improvement
• Evaluation
• System Exit
• Technical Assistance Consultation
• Cultural Linguisrtic Competence

Pires, S. (2002).Building Systems of Care A
Primer. Washington, D.C. Human Service
Collaborative.
53
Core Elements of an Effective System-Building
Process
The Importance of Leadership Constituency
Building

• A core leadership group
• Evolving leadership
• Effective collaboration
• Partnership with families and youth
• Cultural and linguistic competence
• Connection to neighborhood resources and natural
  helpers
• Bottom-up and top-down approach
• Effective communication
• Conflict resolution, mediation, and team-building
  mechanisms
• A positive attitude

Pires, S. (2002).Building Systems of Care A
Primer. Washington, D.C. Human Service
Collaborative.
54
Core Elements of an Effective System-Building
Process
The Importance of Being Strategic

• A strategic mindset
• A shared vision based on common values and
  principles
• A clear population focus
• Shared outcomes
• Community mappingunderstanding strengths and
  needs
• Understanding and changing traditional systems
• Understanding of major financing streams
• Connection to related reform initiatives
• Clear goals, objectives, and benchmarks
• Trigger mechanismsbeing opportunistic
• Opportunity for reflection
• Adequate time

Pires, S. (2002).Building Systems of Care A
Primer. Washington, D.C. Human Service
Collaborative
55
The 5Cs of Core Leadership

• Constituency (representativeness)
• Credibility
• Capacity
• Commitment
• Consistency

Pires, S. (2005). The 5Cs of core leadership.
Washington, DC Human Service Collaborative.
56
Examples of Leadership Styles

• Charismatic
• Facilitative
• Managerial

Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
57
Partnership Involves

• Team Building
• Communication
• Negotiations
• Conflict Resolution
• Leadership Development
• Mutual Respect
• Skill Building
• Information Sharing

Pires, S. (1996). Partnership involves.
Washington, DC Human Service Collaborative.
58
Principles to Guide Collaboration

• Build, maintain trust so collaborative partners
  are able to share information perceptions,
  feedback and work as a cohesive team.
• Agree on core values that each partner can honor
  in spirit practice.
• Focus on common goals that all will strive to
  achieve.
• Develop a common language so all partners can
  have a common understanding of terms (i.e.,
  family involvement, culturally competent
  services.
• Respect the knowledge and experience each person
  brings.
• Assume the best intentions of all partners.
• Recognize strengths, limitations, and needs and
  identify ways to maximize participation of each
  partner.
• Honor all voices by respectfully listening to
  each partner and attending to the issues they
  raise.
• Share decision making, risk taking and
  accountability so that risks are taken as a team
  and the entire team is accountable for achieving
  the goals.

Stark, D. (1999). Collaboration basics
Strategies from six communities engaged in
collaborative efforts among families, child
welfare, and childrens mental health.
Washington, DC Georgetown Child Development
Center, National Technical Assistance Center for
Childrens Mental Health
59
Challenges to Collaboration Barrier Busters
CHALLENGE BARRIER BUSTERS
Language differences Mental health jargon vs. court jargon Cross training Share each others turf Share literature
Role definition Whos in charge? Mandated service vs. requested services Family driven/accountability Team development training Job shadowing Communication channels Share myths and realities
Information sharing among systems Set up a common data base Share organizational charts/phone lists Share paperwork Promote flexibility in schedules to support attendance in meetings
Addressing issues of child and community safety Document safety plans Develop protocol for high-risk kids Demonstrate adherence to court orders Maintain communication with District Attorneys Myths of bricks and mortar
Maintaining investment from stakeholders Invest in relationships with partners in collaboration Share literature and workshops Track and provide meaningful outcomes
Sharing value base Infuse values into all meetings, training, and workshops Share documentation and include parents in as many meetings as possible Strength-based cross training Develop QA measures based on values
Adapted from Wraparound Milwaukee. (1998).
Challenges to collaboration/barrier busters.
Milwaukee, WI Milwaukee County Mental Health
Division, Child and Adolescent Services Branch.
60
Catalyst/Trigger Mechanisms

• Legislative mandates (new or existing)
• Study findings (needs assessments, research, or
  evaluation)
• Judicial decisions - Class action suits
• Charismatic/powerful leader
• Outside funding sources (federal, foundations)
• Funding changes
• Local scandals and other tragedies
• Coverage of successes
• CFSR findings/Program Improvement Plans

Pires, S. (2002).Building Systems of Care A
Primer. Washington, D.C. Human Service
Collaborative .
61
Building Local Systems of Care Strategically
Managing Complex Change
Human Service Collaborative. (1996). Building
local systems of care Strategically managing
complex change. Adapted from T. Knosler (1991),
TASH Presentations. Washington DC.
62
Example Cuyahoga County (Cleveland)
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
63
Cuyahoga County (Cleveland)
System of Care Oversight Committee
County Administrative Services Organization
FCFC Fast/ABC Residential Treatment Center
Therapeutic Foster Care Unruly/shelter
care Tapestry SCY

State Early Intervention and Family Preservation

System of Care Grants
Neighborhood Collaboratives Lead Provider
Agency Partnerships
Reinvestment of savings
Community Providers and Natural Helping Networks
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
64
Cross-Cutting Characteristics

• Cultural and linguistic competence, that is,
  processes and structures that support capacity to
  function effectively in cross-cultural
  situations
• Meaningful partnership with families and youth,
  including family and youth organizations, in
  system building processes and structural decision
  making, design, and implementation
• A cross-agency perspective, that is, processes
  and structures that operate in a non-categorical
  fashion.
• State, local and tribal partnership and shared
  commitment.

Pires, S. (2002).Building systems of care A
primer. Washington D.C. Human Service
Collaborative.
65
Defining Family and Youth

• Parents and guardians
• Grandparents
• Kin-relatives
• Youth who have been involved with child welfare
• Foster parents
• Adoptive parents

Conlan, L., Federation of Families for Childrens
Mental Health.
66
How Systems of Care Are Structuring
Family Involvement at Various Levels of the System
Level Structure

As voting members on governing bodies as
members of teams to write/review Request For
Proposals (RFPs) and contracts as members of
system design workgroups and advisory boards
raising public awareness
Policy

As administrators part of quality
improvement processes as evaluators of system
performance as trainers in training activities
as advisors in selecting personnel
Management

As members of team for own children service
providers, such as family support workers,
respite providers, service/ support managers,
peer mentors, system navigators
Services
Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
67
American Humane Association Ethical Standards
Families should have a meaningful role at both
the case level in assessing, planning and
evaluating their own needs and services and the
systems level in setting eligibility criteria,
determining service offerings, selecting managed
care intermediaries and providers, etc. This will
require training and support for families.
American Humane Association. 1997. Ethical
standards for the implementation of managed care
in child welfare.
68
Issue of Court-Involved Families
It is important to address the issue of court
involvement, which makes services involuntary for
many families and thus affects their desire and
legal ability to choose services. There is
more danger of under-service (in child welfare)
than in other systemsbecause child welfare
clients are unlikely to advocate on their own
behalf for services. Families may be fully
capable, physically and mentally, to make good
choices about what services and what particular
providers could be of most assistance to them,
but because of court involvement, these families
may not be permitted to exercise any choices. The
challenge for family-drivenservice models is to
bring judicial stakeholders into the discussion
of how much choice a particular family should
have, given the circumstances of the courts
involvement.
Kimmich Feild. 1999. Partnering with families
to reform services Managed care in the child
welfare system. American Humane Association
69
Example Court-Involved Families in System of
Care Wraparound Milwaukee

• Participating families are court-involved
• Participating families are partners on Child and
• Family Teams
• Judges overwhelmingly concur with Child and
  Family Team decisions

Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
70
Issue of Families Lacking Capacity to Partner
Critics argue that family-driven systems have
greater potential than traditional approaches for
exploitation or ill-informed decision- making by
families. While it is true that some families
may be limited in their ability to manage their
own resources, the difficulty some may have in
making decisions is no justification for
circumscribing the decision-making authority of
all participants. Indeed, there will be some
families who, because of legal involvement and
safety issues, will not have the option
of controlling service decisions. However, many
families are quite capable of making (or learning
to make) key decisions concerning their lives,
and systems must be structured to promote and to
support such capability from the start.
Kimmich Feild. 1999. Partnering with families
to reform services Managed care in the child
welfare system. American Humane Association
71
Example Child Welfare SOC Partnering with
Families in Jefferson County, CO
Supported by Parent Coordinator
Parent Partners
Child Welfare Workers
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
72

• PRIMER HANDS ON- CHILD WELFARE
• HANDOUT 4.1
• How Family-Centered Are You?
• The Rhode Island Coalition for Family Support and
  Involvement
• Focus on the strengths of the child, youth and
  family?
• Support relationship building and community
  membership?
• Foster mutual trust and respect between families
  and program staff and/or administration?
• Promote family choice and control?
• Offer families good information and access to
  information?
• Include families in policy decisions and program
  planning?

Primer Hands On - Child Welfare (2007)
73
Youth - Guided

• Youth have rights.
• Youth are utilized as resources.
• Youth have an equal voice and are engaged in
  developing and sustaining the policies and
  systems that serve and support them.
• Youth are active partners in creating their
  individual support plans.
• Youth have access to information that is
  pertinent.
• Youth are valued as experts in creating systems
  transformation.
• Youths strengths and interests are focused on
  and utilized.
• Adults and youth respect and value youth culture
  and all forms of diversity.
• Youth are supported in a way that is
  developmentally targeted to their individual
  needs.

Technical Assistance Partnership
74
Roles for Youth Infusing Youth Voice in All
Levels!

• Engage youth in the CFSR process
• Include on Program Improvement Plan workgroups
• Youth advisory boards
• Youth group development
• Peer mentors
• Educators/trainers/evaluators

Adapted From Materese, M., Technical Assistance
Partnership National Child Welfare Resource
Center for Youth Development
75
Barriers to Youth Participation

• As Identified by Adults
• Time
• Funding
• Staffing
• Access to youth
• Lack of training (in how to work with youth)
• Politics
• Parents
• Adult staff not empowered
• Program evaluation requirements
• Weak leadership
• Racism

• As Identified by Youths
• Ageism/Adultism
• Money
• Racism, sexism, homophobia
• Stereotyping by appearance
• Time
• Transportation
• Language
• Lack of access to information
• Lack of access to opportunities
• Lack of support from adults
• Few role models
• Lack of motivation

Politz, B. (1996). Barriers to youth
participation. Washington, DC Academy for
Educational Development. The Center for Youth
Development.
76
Family and Youth Networks of Support and Advocacy

• Information and referral
• Support groups
• Coaching and mentoring
• Training and education
• Community forums
• Advocacy
• Social opportunities

Conlon, L. Primer Hands On - Child Welfare
77
Creating Family- and Youth-Directed
Organizational Capacity

• Build a new, or contract with an existing,
  national, state, or local family or youth
  directed organization (e.g., Foster Parents
  Associations, Adoptive Parents Associations,
  Grandparents Resource Centers, Parents Anonymous,
  Federation of Families for Childrens Mental
  Health, Foster Youth Associations, YouthMOVE
  Parents Friends of Lesbians and Gays-PFLAG)
• Mutually create clear expectations for the
  organization and for system partners
• Ensure representation from diverse families
  involved in child welfare
• Mutually agree on performance expectations and
  evaluation criteria
• Provide fair compensation for the work

Conlon, L. , Lzear, K, Pires, S. (2007) Primer
Hands On - Child Welfare
78
Role of Family- Youth-Directed Associations
and Organizations

• Mobilize family and youth voice
• Provide a structure for implementing family and
  youth partnership with the system of care
• Engage and support families, youth, and family
  members who may feel disenfranchised from or
  distrustful of child welfare and other systems
  (e.g., birth parents whose children have been
  removed fathers racially/ethnically diverse
  families LGBTQ youth or caregivers)
• Create ties to the larger community and other
  family and youth organizations. (e.g., Federation
  of Families for Childrens Mental Health Foster
  Parents Association Adoptive Resource Center
  Parents Anonymous Grandparents Resource Center).

Conlon, L., Pires, S., Lazear, K. (2007)
Primer Hands On - Child Welfare
79
Why Culture Matters
Culture can be defined as a broad concept that
reflects an integrated pattern of a wide range of
beliefs, practices, and attitudes that make up an
individual.

• It affects
• Parenting and child rearing
• Coping strategies
• Help-seeking behaviors Help-giving behaviors
• Expression of symptoms
• Attitudes and beliefs about services social
  support kinship support
• Utilization of services and social support
• Appropriateness of services and supports (i.e.,
  retraumatization)
• Setting priorities

Lazear, K., (2003) Primer Hands On A skill
building curriculum. Washington, D.C. Human
Service Collaborative.
80
Why Develop Cultural Linguistic Knowledge and
Skills Realities

• To respond to demographic changes in the United
  States
• To address issues of disproportionality in child
  welfare systems.
• are over-represented in restrictive levels of
  care child welfare systems and in out-of-home
  placements
• To eliminate disparities and disproportionality
  in access to services and supports.
• have less access to and availability of services
• are underrepresented in research (e.g., Evidence
  Based Practice)
• To improve the quality of services and outcomes.
• are less likely to receive appropriate services
• often receive a poorer quality of services and
  supports and less likely to achieve permanency
  outcomes
• To meet legislative and regulatory mandates.
• To decrease the likelihood of class action
  lawsuits.
• To achieve Child and Family Services Review
  outcomes.

Lazear, K. Primer Hands On Child Welfare
(2007). Adapted from the National Center for
Cultural Competence, Georgetown University Center
for Child and Human Development, Washington, DC.
Mental Health Culture, Race, and Ethnicity -
Executive Summary - A Supplement to the Mental
Health Report A Report of the Surgeon General,
2001.
81
Disproportionality in Child Welfare

• all states have a disproportionate
  representation of African American children in
  foster care. As of 2000, the child welfare system
  in 16 states had extreme rates of
  disproportionality that were more than three and
  one-half times the proportion of children in
  color in the states total child population.
• Robert B. Hill, Overrepresentation of Children of
  Color in Foster Care in 2000 Revised Working
  Paper, March 2005
• In states where there is a large population of
  Native Americans, this group can constitute
  between 15 to 65 of the children in foster
  care.
• Casey Family Programs, Framework for Change
  (April, 2005)
• Hispanic/Latino children may be significantly
  over-represented based on locality (e.g., Santa
  Clara County, CA Latino children represent 30
  of child population, but 52 of child welfare
  cases).
• Congressional Research Service. August 2005.
  Race/Ethnicity and Child Welfare -

Places to Watch Promising Practices to Address
Racial Disproportionality in Child Welfare. The
Center for Community Partnerships in Child
Welfare of the Center for the Study of Social
Policy (2006).
82
Disparity in Child Welfare

• African Americans are investigated for child
  abuse and neglect twice as often as Caucasians.
• Yaun, J. J. Hedderson and P. Curtis,
  Disproportionate representation of Race and
  Ethnicity in Child Maltreatment Investigation
  and Victimization , Children and Youth Services
  Review, 25 (2003) 359-373 Places to Watch.
• African American children who were determined
  to be victims of child abuse were 36 more
  likely than Caucasian children to be placed into
  foster care.
• - U.S. Department of Health and Human Services
  (2005) -
• First round of CFSRs shows that white children
  achieve permanency outcomes at a higher rate than
  children of color.
• - National Child Welfare Resource Center (2006)
  -

Primer Hands On Child Welfare 2007
83
Disproportionality Theories From Researchers
More likely to be in poor, single parent homes
risk factors for maltreatment
Children of color
More likely to come into contact with social
service or other workers who notice and report
maltreatment
Have less access to services that prevent
placement and hasten permanency
More likely to be reported and less likely to be
reunified due to biased decision making
Adapted from Congressional Research Service.
August 2005. Race/Ethnicity and Child Welfare
84
Disproportionality Theories From Child Welfare
Administrators, Supervisors, Workers
Greater visibility of minority families for
reporting of maltreatment
Lack of familiarity with other cultures and with
what constitutes abusive behavior
Media pressure to remove children
Poverty and related issues, such as homelessness
Lack of community resources to address a range of
issues, such as substance abuse and domestic
violence
Congressional Research Service. August 2005.
Race/Ethnicity and Child Welfare
85
Examples of Partnerships to Address Disproportiona
lity in Child Welfare
Iowa Children of Color Project Linking families
to neighborhood organizations offering
culturally appropriate services/training for
child welfare workers
The Collaborative Circle for the Well-Being of
South Dakotas Native Children Partnership to
reduce the number of Native American children in
foster care increase the number of available
Native foster homes and, to achieve better
outcomes for Native children and families
Texas/Casey Family Programs - Community
Advisory Committees on Disproportionality
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
86
Example Outcomes of Work to Address Racial
Disparity in Child Welfare Wake County, NC
Initiatives Family to Family Racial Disparities
Workgroup Believe in a Child Campaign Child
Welfare Faith Community Partnership Legal
Services
Outcomes When the racial disparity work began in
2002, African American families reported to the
Wake County Human Services Hotline were slightly
more likely to be substantiated for maltreatment
than Caucasian families. By 2004, the
substantiation rate had been reversed. African
American families were being substantiated less
often (22) than Caucasian families (26) the
percentage of African American children entering
foster care is decreasing as is the overall
percentage of Wake Countys African American
foster children. (Although the disproportionality
rate continues to be high with respect to the
percentage of African American children in the
total population, progress is occurring.)
Places to Watch Promising Practices to Address
Racial Disproportionality in Child Welfare. The
Center for Community Partnerships in Child
Welfare of the Center for the Study of Social
Policy (2006).
87
Cultural Competence Continuum
Cultural competence is a developmental process
that evolves over an extended period. Individuals
and organizations are at various levels of
awareness, knowledge and skills along the
cultural competence continuum. (NCCC adapted from
Cross et al., 1989)
Cross, T., Bazron,B., Dennis, K., Isaacs, M.
(1989) Towards a culturally competent system of
care Vol. 1,.
88
Culturally Competent Organizations

• Cultural competence requires that organizations
  
• have a defined set of values and principles, and
  demonstrate behaviors, attitudes, policies and
  structures that enable them to work effectively
  cross-culturally.
• have the capacity to (1) value diversity, (2)
  conduct self-assessment, (3) manage the dynamics
  of difference, (4) acquire and institutionalize
  cultural knowledge and (5) adapt to diversity and
  the cultural contexts of the communities they
  serve.
• incorporate the above in all aspects of policy
  making, administration, practice, service
  delivery and involve systematically consumers,
  key stakeholders and communities.

Adapted from Cross, T., Bazron,B., Dennis, K.,
Isaacs, M. (1989). Towards a culturally competent
system of care Vol. 1, National Technical
Assistance Center for Childrens Mental Health,
Georgetown University Child Development Center,
Washington DC. NWICWA, (1993).
89
Cultural and Linguistic Competence Definitions
A Definition of Cultural Competence
Culture competence is accepting and respecting
diversity and difference in a continuous process
of self assessment and reflection on ones
personal (and organizational) perceptions of the
dynamics of culture.
A Definition of Linguistic Competence
Linguistic competence is the capacity of an
organization and its personnel to communicate
effectively and convey information in a way that
is easily understood by diverse audiences,
including persons of limited English proficiency,
those who have low literacy skills or are not
literate, and individuals with disabilities. 
Lazear, K. (2006). Human Service Collaborative
Washington, D.C. Adapted from Youth Involvement
in Systems of Care A Guide to Empowerment
(2006) and Goode Jones (modified 2004).
National Center for Cultural Competence,
Georgetown University Center for Child Human
Development.
90
Core Elements of a Culturally and Linguistically
Competent System of Care

• Commitment from top leadership agency resources
• Data collection Organizational self-assessment
  evaluation and research activities that provide
  ongoing feedback about progress, needs,
  modifications, and next steps
• Identification and involvement of key diverse
  persons in a sustained, influential, and critical
  advisory capacity
• Mission statements, definitions, policies, and
  procedures reflecting the values and principles
• Strategic plan Internal capacity to oversee and
  monitor the implementation process targeted
  service delivery strategies
• Recruitment and retention of diverse staff
  training and skill development
• Certification, licensure, and contract standards
  

Isaacs, M., Benjamin, M., et al. (1989-1998).
Towards a culturally competent system of care
(Vols 1-3). Washington, DC Georgetown University
Child Development Center, National Technical
Assistance Center for Childrens Mental Health.
91
Factors Influencing Group Process
Adapted from The Pheiffer Book of Successful
Team-Building Tools, Edited by Elaine Biech.
2001 by John Wiley Sons, Inc.
92
Coming together is a beginning. Keeping together
is progress. Working together is success.
H. Ford
Building Systems of Care A Primer. Washington,
D.C. Human Service Collaborative. (2004)
93
Planning Structure Issues

• Leadership
• Staffing
• Time and place of meetings
• Stakeholder involvement
• Committees or work groups
• Communication or dissemination of information
• Outreach to broader constituencies
• Outreach to and involvement of diverse and
  disenfranchised constituencies
• Linkage to related reform/planning initiatives
• Resources

Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
94
Stages of Planning For Systems of Care
STAGE 1 Form workgroup STAGE 2 Articulate
mission STAGE 3 Identify goals and guiding
principles STAGE 4 Develop the population
context STAGE 5 Map resources and assets STAGE
6 Assess system flow STAGE 7 Identify
outcomes and measurement parameters STAGE 8
Define strategies STAGE 9 Create and fine-tune
the framework STAGE 10 Elicit feedback STAGE 11
Use framework to inform, plan evaluation, and
technical assistance STAGE 12 Use framework to
track progress and revise theory of change
Hernandez, M. Hodges, S. (2003). Crafting logic
models for systems of care Ideas into action.
Tampa, FL University of South Florida
95
A Planning Process for Family and Childrens
Service Reform
Outcomes For Children and Families
The System As It Is Now
The System As It Should Be
Principles