Cuyahoga Tapestry System of Care

1
Cuyahoga Tapestry System of Care

• Weaving Solutions with Children and their
  Families

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Table of Contents

• Introduction..3
• What makes Tapestry different?....................
  ...........6
• Family Voice Choice..7
• Wraparound...9
• Focus on Strengths.11
• Braided Funding....13
• What does this mean for a family?.................
  ...............15
• What does this mean for a provider?...............
  .............17
• Who is the Cuyahoga Tapestry System of
  Care?...................19
• Partners.20
• Table of Organization.22
• Workers.23
• Families..24

• Why did Cuyahoga County need a new business model
  for serving families?...................27
• How did this new way of doing business for and
  with families develop?.................30
• Timeline.31
• Training Coaching...33
• Goals.34
• How do we know its working?......................
  .......36
• Contact Information.42

3

• When a family enters the Cuyahoga Tapestry System
  of Care, they have heard the phrase We can
  help more times than they can count, and they
  are frustrated.
• The children or youth in the family feel that
  they have never found a fit with the services
  offered to them, or that those services were not
  enough.
• The parents or caregivers in the family have been
  missing work because of the behavioral problems
  of their child, and they know that bad news is
  on the other end when someone from their childs
  school calls.

4

• The difference for a family entering the Cuyahoga
  Tapestry System of Care is that it has been
  designed to serve multiple needs within a single
  family.
• The system of care is for the family who has a
  child at risk for or already involved with
  multiple child-serving systems or services, like
  Juvenile Court, the Department of Child and
  Family Services, alcohol and other drug
  counseling, and mental health.

5

• The Cuyahoga Tapestry System of Care is
• Family-driven
• Youth-guided
• Community-based
• Team-based
• Strengths-based
• Focused on empowering families and helping them
  learn the skills to sustain their health and
  wellness

6
What else makes Tapestry different?
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Family Voice and Choice makes it different!
8

• Tapestry is family-driven, which means that not
  only do parents and caregivers take an active
  role in shaping their care, they also participate
  in governance of the entire system of care.
• Parent Advocates support families who are
  currently enrolled.
• A Parent Advisory Council and Youth Advisory
  Council guides decisions within the system.
• Parents and caregivers sit on every
  decision-making committee.

9
The Wraparound process makes it different!
10

• Wraparound A full-service approach to helping
  families! Instead of making a child fit into a
  standard service plan, a team of supporters
  helps the family develop a unique plan to wrap
  around them and keep them safe and at home.
• A wraparound planning process brings people
  together from different parts of the whole
  familys life and is
• Based on the strengths of the family and
  neighborhood
• Something that a family does, not something
  that they are given
• A team effort, with the child, family,
  professionals, community and neighborhood
  supports working together toward a common goal
• A process that respects families, with teams that
  are sensitive and responsive to your familys
  culture, language and community

11
A focus on strengths makes it different!
12

• Tapestry focuses on strengths not just in
  families, but within provider agencies and
  neighborhood centers as well!
• This initiative brings together all the best
  efforts of the settlement house tradition,
  community-based care for families, and
  established mental health, child welfare, and
  juvenile justice provider agencies with the
  schools and churches.
• It is a whole life approach to serving families!

13
Braided funding makes it different!
14

• Tapestry braids formal Medicaid billable mental
  health services with informal supports.
• This lets dollars follow the child, instead of
  the old way of doing business that meant
  communities paid for potentially repetitive
  services.
• Tapestry gives families access to an
  astonishingly thorough network of no-cost or
  low-cost services.

15
What does that mean for a family?

• Families arent forced to travel from agency to
  agency for the diverse range of services they
  need
• Families stay where they are comfortable, in
  their home and in their neighborhood
• Families connect with a Parent Advocate, who
  knows the system and their neighborhood
• Families stay together!

16

• Parents are at the center of the wraparound team
  that meets to develop the plan to address the
  needs of their family.
• Every wraparound plan that is developed is unique
  to that family.
• The wraparound planning process occurs in the
  neighborhood where the family lives.
• The funding for that wraparound plan is drawn
  from several sources and blended together.
• The goal of the plan is to keep the family
  together or reunify the family.
• The services that the family receives are from
  their own neighborhood as well as from
  established agencies.

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What does that mean for a provider?

• Providers get to do what they do best based on
  their strengths, resources, and historythey fill
  a specific and necessary role on the family team.

18

• Wraparound Specialists and Care Managers who
  coordinate care for family teams use a web-based
  case-management, service authorization and
  invoicing system called Synthesis, allowing
  supervisors to track services, family visits and
  other quality-assurance points, and creating a
  fee-for-service model where dollars follow the
  child.
• In addition to serving more families through
  self-referral, the system of care now has
  enrollment specialists placed within the countys
  Department of Children and Family Services and
  Juvenile Court.
• Wraparound Training that helps people understand
  the principles of family-driven, strengths-based,
  neighborhood care has been opened to all partners
  and parents and caregivers within the system of
  care.
• Tapestry is a leading system of care community in
  the nation with performance outcomes in the
  highest category for areas such as System Level
  Outcomes, Child/Family Outcomes, Satisfaction
  with Services, Family and Youth Involvement, and
  Cultural and Linguistic Competency.

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Who is the Cuyahoga Tapestry System of Care?
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Who are the Tapestry partners?

• Parents, Caregivers Youth
• Parent Youth Advisory Councils
• Parent Advocates
• Neighborhood Collaboratives

Neighborhood collabs are associations of
organizations that develop and promote resources
for families. Each is unique, but in combination
they are a partnership of faith-based groups,
health care providers, schools, recreation
facilities (e.g., YMCA), block clubs, mental
health and substance abuse providers, social
service providers, settlement houses,
non-profits, etc.
For a full list of current neighborhood
collaboratives and provider agency partners,
visit our online Whos Who of Agencies.
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Partners continued

• County Funders
• Board of County Commissioners
• Department of Children Family Services
• Community Mental Health Board
• Alcohol Drug Addiction Services Board
• Juvenile Court
• Board of Mental Retardation Developmental
  Disabilities

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Who are the Tapestry workers?

• 157 Wraparound Facilitators
• 28 Supervisors
• 14 Resources Specialists
• 11 Parent Advocates
• Serving approximately 2,500 families through a
  High Fidelity Wraparound process

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Who are the Tapestry families?

• Families that are eligible for enrollment in the
  Cuyahoga Tapestry System of Care have a child who
  is
• A resident of Cuyahoga County and within the
  neighborhood collaborative areas.
• Under eighteen (18) years of age at time of
  referral.
• Diagnosis of serious emotional disturbance (per
  the DSM IV criteria).
• Have major impairments in several life domains.
• Has, or is at risk for, involvement in more than
  one public child-serving system.1
• May have had psychiatric hospitalization(s) over
  the past year.
• Will require multiple sources of support to
  address problems across life domains (including
  intensive community psychiatric supportive
  treatment, coordinated care and case management).

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

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

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Tapestry OverviewPoverty

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

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Why did Cuyahoga County need a new business
model for serving families?
28

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

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• Tapestry marries clinical expertise with
  neighborhood know-how
• Families benefit because they can receive the
  best services the county offers within their
  homes and neighborhoodsno trips downtown to get
  what they need

30
How did this new way of doing business for and
with families develop?
31
Tapestry Timeline
October 2005 Parent Advocate Activity Form is
created
February 2006 Expectations set at 2.5 billable
hours per day
January 2005 First Tapestry Enrollment
March 2005 Training and Coaching begin
Robert Wood Johnson Foundation Childrens Mental
Health
October 2003 Granted SAMHSA
1800s 1994 2003 2004
2005 January March
June October 2006 January
February March
Neighborhood Settlement Houses

• January - June 2004
• Committees created
• Contracts with Neighborhood Collaboratives and
  PEP

June 2005 National Wraparound Initiative is
applied locally
January 2006 PEP has 13 of 16 care managers
staffed
March 2006 Care Manager floater position created
Casey Family To Family Implemented at Children
Family Services
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Tapestry Timeline continued
January 2007 Synthesis imported from WAM New
Governor in Ohio
April-May 2007 Work with fiscal architecture for
SOC Develop fiscal position paper for new
administration at state level
August 2006 CQI released PEP introduces
Incentive Program
Nov. 2006 15 Care Managers staffed, but 06
turnover is 50
June 2006 Group Supervision begins
2006 April June July August
September November December 2007
January April May
April 2006 Intake Coordinator position created
July 2006 PEP CEO shadows CMs
Sept. 2006 9-10 million added to SOC for 600 new
kids RFP process for new
Dec. 2006 Monthly Program Fidelity Individual
Staff Activity Report released Care
Coordination Contracts completed
April 2007 600 new SOC families
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Training and Coaching Component
34
Goals of the System of Care Initiative

• Increased capacity of the systems to work with
  children, youth and their families
• Increased access of systems to provide effective
  services for children, youth and their families
• Improved child and family outcomes such as
  improvements in child wellbeing, increased
  stability in living arrangements, and increased
  school attendance

35
Goals of the System of Care Initiative continued

1. Develop a new business model together for county
   funders, provider agencies, and neighborhood
   collaboratives with families. Performance
   outcomes will be clear in this partnership
2. Maximize county and state resources as a critical
   component of the plan
3. Develop a collaborative workforce and improve our
   clinical technology in working with families in
   their neighborhoods.

36
How do we know that this new way of doing
business is working?
37

• Data from the federal Substance Abuse and Mental
  Health Services Administration (SAMHSA), which
  provides the grants that launch systems of care,
  indicate that systems of care save taxpayers
  money.
• On average, wraparound care saves child welfare
  systems 7,965 per child in residential placement
  costs over the course of a month, and saves
  juvenile justice systems between 800 - 3,000
  per child within the same time frame.
• Cuyahoga Countys local data indicate that
  children thrive in this type of care
• Clinical outcomes improve or stabilize for 89 of
  youth with behavioral and emotional problems
• 91 of children and youth with a history of
  suicide attempts or suicide ideation improve or
  stabilize
• Other indicators, like school performance,
  stability at home, employment, show that systems
  of care work!

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Outcome Measures

• Tapestry is data-driven, and has refined its
  definition of success with 9 specific outcome
  measures
• Children are with their families in the community
• Children have increased rates of attendance at
  school
• Children have improved performance in school
• Children show improvement in Ohio Scales Scores
  (or other nationally recognized assessment
  instruments)

For example Our outcomes show that youth
go from a moderate level of functioning
impairment and problem severity to mild levels.
Tapestry Outcomes BASELINE LATEST Change
Functioning 36.1 40.3 4.2
Problem Severity 33.2 18.7 -14.5
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Outcome Measures continued

• 5. Family assessments indicate improved family
  functioning
• 6. Reduced length of stay in psychiatric settings
• 7. Reduced length of stay in residential settings
• 8. Reduced recidivism in referrals to Juvenile
  Court
• 9. Reduced recidivism and reduced penetration in
  Child Welfare

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Parents who have experienced Tapestry become
champions for systems of care!
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• A mothers words
• I believe that the Tapestry program is so rare
  due to the fact that they try to empower and
  teach you and the rest of the family, and the
  child dealing with all the problems, instead of
  the normal programs where they promise you that
  they are going to fix your child. The children
  are not broken. They cant be fixed, but all can
  learn to handle the things that are placed in
  front of you.

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216-443-60621400 West 25th Street, 4th
FloorCleveland, Ohio 44113www.CuyahogaTapestry.
org