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THE SKILL BUILDING CURRICULUM

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Title: 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
20
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
  • Statewide Information System
  • Case Review System
  • Quality Assurance System
  • Staff and Provider Training
  • Service Array
  • Agency Responsiveness to the Community
  • Foster and Adoptive Licensing, Recruitment and
    Retention

Primer Hands On - Child Welfare (2007)
24
Resonance Between CFSR and SOC Outcomes
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
25
Major Issues Identified Through Child and Family
Services Reviews
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
26
Examples of State Successes in Program
Improvement Plan Implementation
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
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
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
Reinvestment Commitment Financing Options
Multi Year Steps
Leadership and Professional Development
Strategy Cross Community Cross Agency
Governance Strategy State County Community
Combined Fiscal Program Strategy ---------------
--------------------------------------------------
--------------------------------------------------
--------------------------------------------------
---------------
Friedman, M. (1994). Washington, D.C. Center for
the Study of Social Policy
96
Elements of Effective Planning Processes
  • Are staffed
  • Involve key stakeholders
  • Involve families and youth early in the process
    and in ways that are meaningful
  • Ensure meaningful representation of racially and
    ethnically diverse families and youth
  • Develop and maintain a multi-agency focus
  • Build on and incorporate related programmatic
    and planning initiatives
  • Continually seek ways to build constituencies,
    interest, and investment
  • Pay attention to sustainability and growth of
    system changes from day one

Pires, S. (1991). State child mental health
planning. Washington, DC Georgetown University
Child Development Center, National Technical
Assistance Center of Childrens Mental Health.
97
Strategies for Involving Families and Youth in
Planning
  • Share information about planning meetings by
    working with family/youth organizations and
    community agencies, such as Big Brothers/Big
    Sisters, Boys and Girls Clubs, Family
    Organizations, Family Preservation services
    agencies, etc.
  • Provide orientation/training for families/youth
    about current policies, plans and workgroups
    (i.e., CFSR plan, PIP workgroups).
  • Have involved family/youth leaders engage other
    families/youth to be involved.
  • Provide on-going mentorship/support (i.e., Family
    Service Workers engage youth/family to become
    involved in planning).
  • Hold planning meetings in the evenings/weekends,
    at community centers, schools, and recreation
    centers.
  • Conduct focus groups/interviews/surveys to
    solicit views of many families/ youth.
  • Pay stipends, transportation, child care provide
    food.
  • Conduct facilitated sessions for planning group
    to explore attitudes about race, culture,
    families and youth.
  • Publicly acknowledge the contributions of
    individual families and youth.

Adapted from Emig, C., Farrow, F. Allen, M.
(1994). A guide for planning Making strategic
use of the family preservation and support
services program. Washington, D.C. Center for
the Study of Social Policy Childrens Defense
Fund.
98
Cultural and Linguistic Competence in Planning
  • Conduct on-going assessments of the environment
  • Build support for change
  • Identify, acknowledge, engage, and partner with
    formal and informal leadership
  • Identify and develop needed resources and enhance
    leadership capacity
  • Articulate values, establish a mission, and set
    goals
  • Plan action steps in partnership with diverse
    families/youth and communities
  • Develop strategies to sanction or mandate the
    incorporation of cultural knowledge into policy
    making, infrastructure and practice.
  • Adapted from Cross, T., Bazron, B., Dennis, K.,
    Issacs, M. (1989). Towards a Culturally
    Competent System of Care Vol. 1. NCCC

99
Cuyahoga County Planning Proc
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