governance and system management sheila a. pires human service collaborative [email protected] lisa...
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Governance and System Management
Sheila A. PiresHuman Service [email protected]
Lisa ConlanParent Support Network of Rhode [email protected]
Michelle ZabelUniversity of [email protected]
Bruce StrahlTechnical Assistance [email protected]
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Definition of Governance
Decision making at a policy level that has legitimacy, authority, and accountability.
Definition of System ManagementDay-to-day operational decision making
Pires, S. (1995). Definition of governance. Washington, DC: Human Service Collaborative.
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Key Issues for Governing Bodies
Has authority to govern Is clear about what it is governing Is representative Has the capacity to govern Has the credibility to govern Assumes shared liability across systems for
the population(s) of focus
Pires, S. (2000). Key issues for governing bodies. Washington, DC: Human Service Collaborative.
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Examples of Types of Governance Structures
• State and/or local interagency body
• Non profit board of directors
• Quasi governmental entity
• Tribal governance
• Hybrids
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
5Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
System Management: Day-to-Day Operational Decision Making
Key Issues
• Is the reporting relationship clear?
• Are expectations clear regarding what is to be managed and what outcomes are expected?
• Does the system management structure have the capacity to manage?
• Does the system management structure have the credibility to manage?
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Examples of Types of SystemManagement Structures
• State and/or local interagency body
• Quasi-governmental entity
• Non profit lead agency
• Public sector lead agency
• For profit commercial managed care entity
• Shared management structure/hybrid
• Tribal authorityPires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
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New Jersey - Contracted Management Structure
CHILD
Screening with Uniform Protocols
Child Welfare
Juvenile Justice/Court
SchoolReferral
Community Agencies
Family & Self
Other
Contracted Systems Administrator CSA
•Registration•Screening for self-referrals•Tracking•Assessment of level of care needed•Care coordination•Authorization of services
Community Agencies•Uncomplicated care•Service authorized•Service delivered
Care Management Organization•Complex multi-system involved children•Individualized plan developed•Full plan of care authorized
Family Support OrganizationFamily to Family Support
Adapted from NJ System of Care
Youth Support Organizations
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Wraparound Milwaukee - Lead Public Agency Management Structure
Child WelfareFunds thru Case Rate
(Budget for InstitutionalCare for CHIPS Children)
Mental Health•Crisis Billing•Block Grant
•HMO Commercial Insurance
Medicaid Capitation(1557 per Month
per Enrollee
Juvenile Justice(Funds Budgeted for
Residential Treatment for Delinquent Youth)
Management Entity:Wraparound Milwaukee
Management Service Organization (MSO)$30M
Child and Family Teams
ProviderNetwork
240 Providers85 Services
CareCoordination
Plans of Care
9.5M 2.0M10M8.5M
Per Participant Case Rate
Family Organization$300,000
Mgt. Entity: Co. BH Div.
Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch
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Deputy County Administrator for Human Services
System of Care Office*
Children in or at risk for residential
placement
Youth with status offenses
Children with serious behavioral health
challenges
0-3 population Early Intervention engagement challenges
Subsets of Children & Families –Focus of Care Coordination
Partnerships
Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.
Cuyahoga County OH - In-House Management Structure
System of Care Oversight Committee
*Functions as anAdministrative ServicesOrganization
Lead Family Coordinator
Lead Youth Coordinator
{
{
1010
Regional CareManagement Entities
•Ensure child & family team plan of care**•Ensure intensive care coordination•Manage utilization at servicelevel
**Plans of Care (w/priority on community-based/naturalsupports) determine medicalnecessity, except inpatient, residential/group, which require prior authorization
DCHMCO MCO MCO
MHDDAD
ASO TPA
DFCS
DJS
DOE
Care Management Entities:Locus of management accountability for children
with complex, multi-system involvement
Use Same Decision Support Tool –CANS – to determine need for CME
Pires, S. 2008. Washington, D.C.: Human Service Collaborative
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• At the Youth & Family Level:– Child Family Team (CFT) Facilitation using Wraparound Model – Care Coordination with assessment tools– Care Monitoring and Review– Peer Support Partners
• At the Systems Level:– Information Management & Web-based Information System – Provider Network Recruitment and Management– Utilization Review – Evaluation, Outcomes and Continuous Quality Improvement
• Financing Model- Case Rate
Maryland Specific Supports & Functions of a Care Management Entity
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Pires, S. (1996). Contracted system management structure. Washington, DC: Human Service Collaborative.
Example of Governance/Management Structure
State Funding Pool
Local Allocation
County Alliance
Case Rate for each enrolled child
Provider ProviderProvider
Financer/Payers
Purchaser
Care Management Entity – Lead Non Profit•Organize and manage provider network•Staff and manage child and family team process• Intensive care management •Utilization management•Quality assurance•Outcomes management /monitoring•Management Information System (tracks children, services, dollars)
State Interagency
Body
Natural Supports Natural Supports
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BOARD POLICY STATEMENTThe Governing Board of All Children System of Care, in recognition of the growing diversity in the population of children and youth needing behavioral health services, seeks to create and maintain a culturally responsive helping environment capable of comprehensively addressing the unique needs of children of color. Children of color have historically been under referred to treatment and specifically in Alden County. It is the responsibility of ACSC to not only make its services accessible to all, but to affirm by policy and action its commitment to children of all cultures.
It is the policy of ACSC to develop and maintain: links with key referral sources in our state’s communities of color; standards for providing services to ethnically, culturally diverse children; a culturally competent work force, reflective of the cultural diversity of the service population; intake procedures, treatment planning, and therapeutic interventions which recognize, enhance and strengthen cultural identity, dignity, and esteem; a treatment milieu in which racism, stereotyping, bigotry and prejudices are inappropriate and not tolerated.
Example: Board Policy Statement Addressing Cultural and Linguistic Competence
Adapted from: People of Color Leadership Institute and Day, P.A. Cultural Competence Materials for MSW Students, Staff, Faculty and the CommunityUniversity of Minnesota, Duluth
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• Input/evaluation of key management• Input/evaluation of quality of services and
programs• Local system of care input• Resource allocation• Service planning and implementation• Policies and procedures• Grievance and resolution procedures
Examples of Types of Family/Youth Partnership in System Governance and Management
Conlan, L. (2003). Implementing family involvement. Burlington, VT: Vermont Federation of Families for Children’s Mental Health.
Presented by Michelle Zabel, MSSDirector, Maryland Child & Adolescent Innovations Institute, Mental
Health Institute & Juvenile Justice InstituteDivision of Child & Adolescent Psychiatry, School of Medicine,
University of Maryland, Baltimore
Governance & System Management
The Maryland Children’s Cabinet and the Governor’s Office for Children
VISION Children’s Cabinet: All Maryland’s children are successful in life. Governor’s Office for Children: Maryland will achieve child well-being through
interagency collaboration and state/local partnerships.
MISSION The Children’s Cabinet, led by the Executive Director of the Governor’s Office
for Children (GOC), will develop and implement coordinated State policies to improve the health and welfare of children and families. The Children’s Cabinet will work collaboratively to create an integrated, community-based service delivery system for Maryland’s children, youth and families. Our mission is to promote the well being of Maryland’s children.
COMPOSITION The Secretaries of the Departments of Budget and Management, Disabilities,
Health and Mental Hygiene, Human Resources, and Juvenile Services, and the State Superintendent of the Maryland State Department of Education.
Chaired by the Executive Director of the Governor’s Office for Children.
Individual Care Planning with Child and Family Teams: Care Management Entity (CME)
Local Systems Management
State Systems Management
Local Governance
State Governance
Family Support Organizations
A Scenario for State and Local Governance Structures
Local Management Boards• Purpose is to “ensure the implementation of a local interagency service
delivery system for children, youth, and families.” (Human Services Article, Annotated Code of Maryland)
• Composed of:– Public and private community representatives and,– A senior representative or department head of the: (i) local health
department; (ii) local office of the Department of Juvenile Services; (iii) core service agency; (iv) local school system; and (v) local department of social services.
• LMBs are tasked with:– Strengthening the decision-making at the local level; – Designing and implementing strategies that achieve clearly defined
results for children, youth, and families as outlined in a local 5-year strategic plan;
– Maintaining accountability standards for locally agreed upon results for children, youth, and families;
– Influencing the allocation of resources across systems to accomplish desired results;
– Building local partnerships to coordinate children, youth and family services within the county to eliminate fragmentation and duplication of services; and,
– Creating an effective system of services, supports, and opportunities to improve outcomes for all children, youth and families.
Infrastructure
Administrative Service Organization
• Key Functions Include:
• Care Authorization
• Provider Credentialing and Enrollment
• Billing/Reimbursement and Provider Payment
• Utilization Management
• Continuous Quality Improvement
• Outcomes Data
• Information Management
Regional Care Management Entities
• A CME is a structure that serves as a “locus of accountability” for youth with complex needs and their families.
• Provide Supports to Youth and Families:– Child Family Team Facilitation using Wraparound Service Delivery Model– Care Coordination using Standardized Assessment Tools– Care Monitoring and Review– Peer Support Partners
• Provide System Level Functions:– Information Management & Web-based Information System– Provider Network Recruitment and Management– Utilization Review of Service Use, Cost, and Effectiveness – Evaluation and Continuous Quality Improvement– Cross-System and Jurisdiction Financing
• Populations to Be Served:– 1915(c) Psychiatric Residential Treatment Facilities (PRTF) Demonstration Project
Medicaid Waiver– SAMHSA funded SOC grants – MD CARES and Rural CARES– Child Welfare’s Place Matters Group Home Diversion using Resource Coordinators– Other Out-of-Home Diversion using Care Coordination
Local System Management and Service Delivery Infrastructure
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Wicomico County, MD System of Care Structure
211 System(screening)
Service Coordination/SystemsNavigation - CANS
Care Management EntityCare Coordinators
Family Partners
Family Partner-Ship Center
Families andYouth
Agencies/Court
SOC Community Advisory Board
Adapted from Wicomico County, MD
Local Management Board
Governance and System Management
Bruce Strahl
Technical Assistance Partnership
Great Governance
Starts With Great Collaboration
Collaboration Defined: A mutually beneficial relationship between two or more parties
who work toward common goals by sharing responsibility, authority and accountability for achieving results
Critical Characteristics of SOC Governance
• Balanced-true sharing of responsibility, power and authority
• Inclusive-with significant and authentic decision making roles for all who desire a role
• Broad-Many places available to be a part of decision making for family, youth state and community partners
• Defined- Roles concise, clear and understandable
• Simple
Governance Characteristics (continued)
• Culturally and linguistically competent• Clear communications flow and work flow
and easily explainable to all stakeholders with diagram
• Efficient and effective• Clear roles and procedures for decision
making• Responds quickly but also accommodates a
more deliberate approach when needed
Broad Based Governance SystemSTAKEHOLDERS
MEETING EVERY OTHER MONTHFull Partnership
Facilitator
Agenda 2 Framed Major Challenges
Work Group Meet
Work Group (Some) Report Progress
Agency Pitch – NetworkingMemorandum of Agreement
WG WGWGWG WG
Odd Number Group 11-13-17-19 PD, PI, Community Leaders, Lead Family,
Family Member, Youth, Policy Makers, Lead Evaluator
Role
Frame Major Strategic challenges to go to full partnership
Set agenda for full partnership meeting
Model SOC principles
Barrier busting
Conscience of SOC, Cultural competency, family inclusion, collaboration
Help the PD
Model Change
Do It 1st
High Standard of Care/Quality
Administrative Team Grant Requirements
Grant Administration
Staffing
Budget
Quality
Decisions Broad SOC Community Strategy
Intake System
Social Marketing
Referrals to Community Services
Participation in Child & Family Teams
Family Involvement
Coordinating Committee
Standing or Ad Hoc
OK
OK
Send a Work Group Out
Family and Youth Involvement in Your Governance System
• Where should Family and Youth be in your governance system?
• Pair family members and pair youth
• Prepare a welcome for them
• Provide background information and meeting protocols to new families
• More tips
The 7 Keys to Governance Success
1) A cross functional team including youth, families, required partners and community partners participate in the development of a broad based governance structure.
2) The broad based governance structure provides a variety of meaningful decision making opportunities for partners to participate and be involved in governance on the coordinating council, full partnership, work groups and administrative team.
7 Keys (continued)
3) Diagrams and procedures exist of the governance structure and all partners have a clear understanding of how work and communications flow as well as how decisions are made. SOC decisions are not made outside of the agreed upon governance structure and process.
4) The governance structure reflects the cultural make up of the community and population served.
7 Keys (continued)
5) An evident commitment exists to review and enhance the governance system at regular intervals using broad community and partnership involvement.
6) Orientation, preparation and education must be utilized for all partners for authentic and meaningful participation to take place in the governance system.
7) “Collective Will” is the most important ingredient. Without it, structures and processes will not work and can be manipulated but with it, structural challenges can be overcome.