CHILDRENS FULL SERVICE PARTNERSHIP

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CHILDRENS FULL SERVICE PARTNERSHIP

• MHSA Webcast Training
• September 1, 2005
• Presented by
• Cricket Mitchell, PhD
• CiMH Consultant

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Overview

• Identification of initial Full Service Population
• Characteristics and components of Full Service
  Partnership Programs (FSPPs)
• Strategies for transformation through FSPPs
• Evidence-based programs and practices?
• Family, youth and professional partnerships?
• Cultural competence
• Interagency collaboration
• Evaluation

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Full Service Population

• Initial Full Service population must be clearly
  identified
• Including numbers to be served
• Discussion of selection process
• Identification of disparities and how they will
  be reduced
• Priority should be given to unserved

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Full Service Partnership Program

• Characteristics of FSPPs
• Collaborative
• Culturally competent
• Individualized, family-driven
• Integrated services
• Emphasize recovery and resilience
• 24/7, whatever-it-takes

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Full Service Partnership Program

• Components of FSPP
• Personal Service Coordinator - case manager
• Access to broad range of services and supports
• Treatment Plan developed collaboratively by case
  manager, family and youth
• To include full access to continuum of services
  and supports needed

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Strategies to Promote Transformation

• Improving Service Quality
• Effective Services Supports Evidence-based
  Practices
• Family, Youth Professional Partnerships
• Family and Youth Driven Services
• Family and Youth Partnership Services, Supports,
  and System Development Activities
• Cultural Competence
• Interagency Collaboration
• Evaluation

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Strategies for FSPPs

• Employ comprehensive program with research
  support as core FSPP service
• County tailored FSPP Build Your Own
• Provide access to continuum of evidence-based
  and/or necessary services and supports

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Improving Service Quality An Introduction to
Adopting Evidence-based Practices

• (in 10 minutes or less)

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The Movement Toward EBP

• Defining Evidence Based Practices
• the integration of the best research evidence
  with clinical expertise and patient values
  (Institute of Medicine)
• Why a movement toward evidence-based
  practices--what were we doing before?
• Split between research and practice
• History of practice design by professional
  consensus rather than controlled research
• Tradition of thinking in terms of access to
  programs not achievement of outcomes

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The Movement Toward EBP

• Whats different now?
• Science base is larger and more specific
• Increase in fiscal accountability
• Focus on being able to deliver consistent
  treatment outcomes
• New level of awareness of accountability to
  stakeholders

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Merits of Evidence-Based Practices

• Achieve outcomes sooner that last longer
• Avoid the adverse consequences of under or over
  serving
• Ethical
• Cost effective

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Levels of Evidence

• Effective-achieves child/family outcomes, based
  on controlled research (random assignment), with
  independent replication in usual care settings
• Efficacious-achieves child/family outcomes, based
  on controlled research (random assignment),
  independent replication in controlled settings
• Not effective- significant evidence of a null,
  negative, or harmful effect
• Promising-some positive research evidence,
  quasi-experimental, of success and/or expert
  consensus
• Emerging -recognizable as a distinct practice
  with face validity or common sense test

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Concerns AboutEvidence-based Practices

• Limits Consumer/ Practitioner Choice
• Devalues Professional Expertise
• Inconsistent with Consumer-Driven, Recovery
  Oriented, Family-Driven Services
• Are Not Culturally Competent

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Selecting Implementing Services

• Levels of science (Including information about
  Diverse Populations and Language Resources)
• Alignment with values
• Cost
• Requirements for Fidelity
• Transport burden and system capacity for change
• Safety and ethical considerations

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Fidelity

• Adopting-Implementing with fidelity to the
  program principles and practices
• Adapting-Applying the practice with adjustments
  from the prescribed program
• Adoption is most likely to result in similar
  outcomes
• Implementing an EBP requires planning, training,
  supervision, infrastructure supports, and agency
  commitment
• AdoptValidateAdaptEvaluate

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Fidelity

• The level of training varies but typically
  involves
• Intensive training (2-3 days)
• Booster training (1 day quarterly for the first
  year)
• Daily/every contact data Weekly supervision
• Evaluation of fidelity Evaluation of outcomes
• Transport strategies may be pre-packaged by
  developers, based on expert trainers, or locally
  developed which will impact the cost and
  transport burden
• Training does not necessarily result in high
  fidelity implementation, need to measure
  adherence to the program and achievement of
  consumer outcomes

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Strategy for FSPPComprehensive Programs with
Research Support as Core

• Wraparound
• required in MHSA for children, youth, families
• Family-Centered Intensive Case Management
• Multisystemic Therapy
• Multidimensional Treatment Foster Care

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FSPP Comprehensive EBP as Core Service
Wraparound

• A collaborative, team-based approach to service
  and support planning
• Intent is for teams to create plans that meet the
  unique needs, and improve the lives of, children
  with complex issues and their families
• Process driven by needs of families, rather than
  by available and reimbursable services
• Access to Continuum of Evidence-based Practices
  Services Supports

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FSPP Comprehensive EBP as Core Service
Wraparound

• No Single Well Defined / Manualized Model
• One Randomized Control Group Study
• FIAP - Hewitt Clarke et al. 1996
• National Wraparound Evaluation
• Leonard Bickman PhD.
• Californias Title IV-E Child Welfare
  Demonstration Project Final Evaluation
  http//cssr.berkeley.edu/childwelfare/researchdeta
  ils.asp?namewaiver

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FSPP Comprehensive EBP as Core Service
Wraparound

• National Wraparound Initiative (NWI) Findings
• Increased access to services
• Increased client satisfaction
• Fewer placements in restrictive settings
• But, no differences in clinical improvementWhy?
• Fidelity
• Studies find association between greater
  wraparound fidelity and better child and family
  outcomes
• Little evidence for services offered
• Wraparound process should identify continuum of
  evidence-based practices for specific child and
  family outcomes from which family can choose
• Please see NWI website for process, activities,
  phases, and fidelity information
  http//www.rtc.pdx.edu/nwi/

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FSPP Comprehensive EBP as Core Service
Wraparound

• Child and Family Team
• Intensive family-driven community intervention
• Strength-based child and family assessment
• Life domain area service planning to support
  enhance permanency plans
• Clinical case management of individualized,
  wraparound service plans
• Follow-along supports services
• Family specialist responsible for case
  management, collaborating with parents
  providers, home-based counseling

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FSPP Comprehensive EBP as Core Service
Wraparound

• Abbreviated List of Necessary Systems-Level
  Conditions
• Supporting policies by agencies
• Appropriate reimbursement statutes
• Adequate continuum of community services
• Data collection across agencies
• Provider flexibility in funding service
  delivery
• Blended or braided funding streams
• Low caseloads
• Adequate support for training, certification,
  supervision

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Other Comprehensive Programs with Research
Evidence

• Family-Centered Intensive Case Management
• Developed by Mary Evans and Mary Armstrong
  through the New York State Office of Mental
  Health
• Multisystemic Therapy
• Scott Henggeler and Colleagues, University of
  South Carolina
• Multidimensional Treatment Foster Care
• Patti Chamerlain and Colleagues, Oregon Social
  Learning Center
• Each has fidelity indicators linked to outcomes

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FSPP Comprehensive EBP as Core Service
Family-Centered Intensive Case Management

• Developed by Mary Evans and Mary Armstrong
  through the New York State Office of Mental
  Health
• Program Model
• Program involves teaching, skill building, family
  support and direct therapeutic intervention
• Families have access to planned and emergency
  respite care
• Flexible service dollars for items such as home
  repair and recreational activities
• Parent-to-parent support
• Parent Support Groups
• Behavior management skills
• Self-help skills
• Linkages to other services

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FSPP Comprehensive EBP as Core Service
Family-Centered Intensive Case Management

• Staffing
• Case Manager-parent advocate team carry a
  caseload of 8 families
• Average length of stay 13 months
• 24/7
• Target of the Intervention
• Families with children ages 5-12 with severe
  emotional and behavioral disorders goal to
  keep kids safe and at home
• Outcomes
• Increases in social and emotional functioning
• Decreases in psychiatric symptoms
• Decrease in hospitalization and other out of home
  care

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FSPP Comprehensive EBP as Core Service
Multisystemic Therapy

• Effective - Adolescents with severe conduct,
  violent behavior, substance abuse. At risk of
  out of home placement.
• Less Robust Outcomes with Mental Health
  Population
• Reduces recidivism 25-70
• Reduces out-of-home placement 47-64
• Decreases mental health problems for serious
  juvenile offenders
• Cost Savings Net benefits per participant
  31,661 to 131,918 (WSIPP)

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FSPP Comprehensive EBP as Core Service
Multisystemic Therapy

• An intensive family and community based service.
• Integrates strategic family therapy, structural
  family therapy, behavioral parent training, and
  cognitive behavioral therapies that have at least
  some empirical support.
• Promotes behavior change in natural environment.
• 60 hours of contact over 4 mos average
• MST Team responsible for engagement

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FSPP Comprehensive EBP as Core Service
Multisystemic Therapy

• Two to four therapists and a supervisor
• Masters or highly skilled bachelors level
• Supervisor is typically doctoral level clinician
• Provide support 24/7 support
• Access to a small flexible fund
• 4-6 families per therapist

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FSPP Comprehensive EBP as Core Service
Multisystemic Therapy

• Avg service cost 4,500 4,743 per youth
• Training and supervision costs range from 15,000
  to 18,000 (exp) per MST team (2-4 clinicians)
• Per L.A. doc an add 36,000 in license/travel
• Training
• 5 day intensive training
• Quarterly 1.5 day booster trainings
• Weekly phone consultation
• New staff trained in So. Carolina

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FSPP Comprehensive EBP as Core Service
Multidimensional Treatment Foster Care

• Effective Adolescents w/severe anti-social
  behavior, emotional disturbance, delinquency
  in, or at risk or, out of home placement.
• Specialized therapeutic foster care model.
• Reduces recidivism 25-70 (31 WSIPP)
• Reduces out-of-home plcmt. 47-64
• Savings 21,836 to 87,622(per 2,052 cost est.
  WSIPP)
• Reduces mental health problems in juvenile
  offenders
• Improves family functioning
• Improves discharge lag time from hospital.

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FSPP Comprehensive EBP as Core Service
Multidimensional Treatment Foster Care

• Therapeutic Foster Care
• Youth is place in a Therapeutic Foster Home
• One youth per home
• 24/7 support for foster parent and natural
  parents
• Youth receive weekly individual therapy with
  focus on developing effective
• Problem solving skills
• Social skills
• Emotional regulation skills

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FSPP Comprehensive EBP as Core Service
Multidimensional Treatment Foster Care

• Parents attend weekly family therapy with focus
  on effective parenting family management
• Clearly defined roles in Treatment Team with
  Foster Parent as primary interventionist and key
  relationship to child
• Youth attend public school, with daily monitoring
  of attendance performance
• Use cognitive-behavioral, behavioral , family
  therapy interventions
• Provides intensive levels of flexible services
• Support available 24/7
• Build youth parental skills

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FSPP Comprehensive EBP as Core Service
Multidimensional Treatment Foster Care

• Program director to oversee the program
• One full time program supervisor for every 10
  youth
• Masters level clinician with supervisor
  experience
• Supervises the treatment team, responsible for
  coordination
• Available 24/7
• One half-time individual therapist for every 10
  youth
• Masters level clinician
• One half-time family therapist for every 10 youth
• Masters level clinician
• Full time foster care recruiter/trainer Parent
  Daily Report caller
• Experienced with foster care and the program, may
  be a former foster parent
• Skills trainer, about 15 hours weekly for 10
  youth
• Bachelors education
• Often involving after-school activities
• Average costs per client 2,691 (CSPV) to 120
  per day per Chamberlain
• Total training, consultation and clinical
  supervision costs for the
• first year are about 40,000

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County Tailored FSPP Build Your Own

• Create a Personal Service Coordinator/Case
  Manager position
• Develop screening and assessment process to
  identify unique family and child needs
• Implement strengths-based, family-driven service
  support planning process
• Build comprehensive continuum of evidence-based
  /or necessary services and supports
• Ensure cultural competence
• Provide integrated, collaborative services

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County Tailored FSPP Build Your Own

• Personal Service Coordinator/Case Manager Key
  Qualifications
• Able to engage children and families
• Able to facilitate strength-based, family-driven
  plan development process
• Able to utilize (perhaps complete) screening and
  assessment to inform treatment planning process

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County Tailored FSPP Build Your Own

• Develop Screening Process that is
• Brief
• Easily Administered
• Able to be used by necessary practitioners
• Comprehensive
• Reliable Valid
• Appropriate for diverse cultural communities and
  able to be delivered in necessary languages
• Links to Assessment Process

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County Tailored FSPP Build Your Own

• In Addition - Assessment Processes should
• Determine diagnosis
• Determine eligibility
• Support individualized, family-driven, culturally
  competent care planning
• Identify dynamic factors to be addressed in
  treatment
• Protective Factors
• Risk Factors
• Ideally - Can monitor progress

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Full Service Partnership ProgramsEvidence-based
as Core or County Tailored

• Build a comprehensive continuum of services and
  supports that
• Result in outcomes that address targeted needs
• Are necessary for children and families to
  participate in treatment

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CIMH Matrix of Selected Evidence-based
Practices
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Offering a Continuum of EBPs An Illustrative
Example Target Population Early Childhood
Outcomes Improved Social, Emotional, and
Behavioral Health

• Nurse Family Partnership
• Home/Community Based
• Incredible Years
• Parent Training
• Parent Child Interaction Therapy
• Clinic-Based
• Also see Child Welfare and Juvenile Justice
  Illustrative Example Slides for Practices

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Offering a Continuum of EBPs An Illustrative
Example Target Population Adolescents in (or
at risk of) Juvenile Justice

• Multidimensional Treatment Foster Care (MTFC)
• Family based alternative to residential care
• Multisystemic Therapy (MST)
• Home/Community Based
• Functional Family Therapy (FFT)
• Home/Community Based or Clinic Based
• Aggression Replacement Training (ART)
• Residential Clinic or School-based
• Also See Child Welfare and Co-Occurring Disorders
  Illustrative Example Slides for Practices

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Offering a Continuum of EBPs An Illustrative
Example Target Population Children in (or at
risk of) Child Welfare

• Positive Parenting Program (Triple P)
• Parent Training Family Therapy c/b
  Home/Community, School, or Clinic-based
• Family Connections
• Home/Community Based
• Early Intervention Foster Care
• Family Based alternative to residential care,
  young children
• Also See Early Childhood and Juvenile Justice
  Illustrative Example Slides for Practices

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Offering a Continuum of EBPs An Illustrative
Example Target Population Youth with
Co-Occurring Disorders

• Multidimensional Family Therapy (MDFT)
• Family Therapy Individual, Clinic Based
• Brief Strategic Family Therapy (BST)
• Family Therapy, Home/Community Based
• Also See Juvenile Justice Illustrative Example
  Slide for Practice

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Offering a Continuum of EBPs An Illustrative
Example Target Population Transition Age Youth

• Cognitive Behavioral Therapy for trauma victims
• (Mannarino Deblinger)
• Dialectical Behavior Therapy (DBT) (for females)
• CBT Interpersonal Psychotherapy - Depression
• SAMHSA Toolkits
• Assertive Community Treatment
• Supported Employment
• Family Psychoeducation
• Illness Management
• Integrated Dual Disorders Treatment
• Medication Algorithm
• Please see A Roadmap to Mental Health Services
  for Transition Age Young Women A Research
  Review, by Lynne Marsenich, www.cimh.org Also
  see all other EBPs listed in this presentation

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Practice Level Transformational Supports

• Support Activities
• Are delivered directly to children and families
• Enable children and families to participate in
  Mental Health Services, including FSPP
• Some support activities have research evidence
• i.e. therapeutic child care programs that
  actively promote healthy development.

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Practice Level Transformational Supports

• Family/Youth Partnership Supports
• Individual Family/Youth Advocacy
• Family/Youth Support Groups
• Training
• Outreach Information Dissemination i.e.
  Newsletter, Hot Warm Lines, Web Sites, Others
  
• Mentoring /or One-to-One Supportive Services
• (Adapted from The Practices/Activities of
  Statewide and Local Family Organizations - UACC)

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Practice Level Transformational Supports

• Respite
• Child Care
• Transportation
• Tutoring
• Flex Funds
• Targeted Assistance for Activities
• Targeted Assistance for Basic Needs

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Cultural Competence

• Education, Outreach Anti-Stigma Campaigns
• Linguistically Competent Services
• Bilingual Practitioners
• Interpreter Services
• Targeted Campaigns to Increase and Evaluate
  Access
• Targeted Efforts to Improve Evaluate Service
  Quality Outcomes
• Support, Implement Evaluate Culturally Specific
  Services Traditional Practices

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Interagency Collaboration

• Gain Access to Cross System Services
• No Wrong Door
• Integrated Cross Agency Service Planning
• Coordinate Services
• Eliminate Duplication
• Complementary Services Supports
• Improve Continuity of Care
• Maximize Resources
• Leveraging Funding

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Outcome Evaluation

• Level I Service Fidelity
• Level II Practice Level Outcomes
• Level III System Level Outcomes

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Outcome Evaluation

• Level I Service Fidelity
• Monitor the degree to which a child/family
  receives a service as it is designed.
• Allows determination of whether or not outcomes
  result from service or poor delivery of service.

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Outcome Evaluation

• Level II Practice Level Outcomes
• Measures effectiveness of a particular practice
  or cluster of practices.
• Measures Individual Change Child family
  outcomes that can be observed during or soon
  after treatment.
• Measures are shared by clusters of children
  families services that have common
  characteristics. For example, one set of measures
  is used for the juvenile justice population
  regardless of different services received.
  Another is used for 0-5 population, etc.

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Outcome Evaluation

• Level III System Level Outcomes
• Measure overall effectiveness of the system.
• Designed to provide data about how the overall
  system(s) is doing.
• Similar to earlier Performance Outcome
  Measurement Process.

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Summary - FSPPs

• 24/7, whatever it takes for a specified initial
  target population
• Collaborative partnerships with families and
  youth
• Individualized, culturally competent, integrated
  services
• Case manager responsible for engagement and
  partnership
• Emphasize resilience, strength-based

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Summary Strategies for Transformation and for
FSPPs

• Improving service quality
• Evidence-based core FSPP program
• Offer continuum of evidence-based services and
  supports for families
• Family, youth, professional partnerships
• Family youth driven services
• Supportive services and activities
• Cultural competence
• Interagency collaboration
• Evaluation