THE SKILL BUILDING CURRICULUM

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Primer Hands On-Child Welfare
THE SKILL BUILDING CURRICULUM Module 3 Process
and Structures in System Building
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.
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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.
3
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.
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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
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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.
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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.
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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.
8
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.
9
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
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The 5Cs of Core Leadership

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

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

• Charismatic
• Facilitative
• Managerial

Pires, S. (2002). Building systems of care A
primer. Washington, D.C. Human Service
Collaborative.
12
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.
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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
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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.
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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 .
16
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.
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Example Cuyahoga County (Cleveland)
Pires, S. (2006). Primer Hands On Child
Welfare. Washington, D.C. Human Service
Collaborative.
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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.