the national system of care movement the rhode island system of care movement a history of systems...
TRANSCRIPT
The National System of Care MovementThe Rhode Island System of Care Movement
A HISTORY OF SYSTEMS OF CARE &WRAPAROUND:
NATIONAL & RI PERSPECTIVES This section covers:
• List the benefits of Systems of Care (SOC) and Wraparound
• Describe the origins of SOC and Wraparound
• Explain Rhode Island’s SOC transformation
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Learning Objectives
After learning this material, you should be able to:
Click to Continue
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WHY SYSTEMS OF CARE AND WRAPAROUND?What are the benefits of this systemic change and practice method?
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Reflection Activity
• What has worked well for children and families in Rhode Island’s current system?
• What could be even better?
Click here to see some of the systemic concerns that prompted the System of Care (SOC) movement…
Take a few minutes to reflect on your experience as a human services professional.
• The systems of care approach was originally created in response to concerns that:– Children in need of mental health treatment were not
getting the services they needed– Services were often provided in restrictive out-of-home
settings– Few community-based services were available– Service providers did not work together– Families were not adequately involved in their child's care– Cultural differences were rarely taken into account
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What Prompted the SOC Movement?
U.S. DHHS, Administration for Children and Families,
Child Welfare Information Gateway
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The Willie M. Story
“By age 10, Willie had so many problems getting along with his family that a social worker had to be called in - enter the Division of SocialServices within the state Department of Human Resources (DHR) and a county department of social services. Two years later, the troubledyoungster started stealing from his elementary school and landed in juvenile court - enter the judicial system and the Administrative Office of the Courts.
The local judge tried to find a placement for Willie, but various treatment programs wouldn‘t accept a child of his young age and with his mix of emotional and mental handicaps. Having no other option, the local judge sent Willie to a state training school hoping that the contained environment might set him straight-enter the Division of Youth Services, also within DHR.”
1970s in North Carolina
Continued…Source: "Willie M." Treatment for Disturbed Young5ters Ambitious Community -Based Service System Lurches Forwardby Kendall Guthrie and Bill Finger
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The Willie M. Story
“This training school, even after putting Willie in its special treatment ward, made no progress. Willie would either assault the staff or whimper in a corner, sucking his thumb.
Perhaps special education and psychiatric help within a state mental institution could help Willie, the training school officials decided -enter the Division of Mental Health, Mental Retardation, and Substance Abuse Services, within DHR, and the Department of Public Instruction, which distributes state money for special education.
But Willie couldn't cope with the specialized learning programs either.”
Continued…
Source: "Willie M." Treatment for Disturbed Young5ters Ambitious Community -Based Service System Lurches Forwardby Kendall Guthrie and Bill Finger
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The Willie M. Story
“In frustration, the mental hospital discharged him to court officials back home. The court tried to find a suitable foster care placement, butWillie couldn't function in the school system. Too violent for adolescent wards, too young for adult treatment, too smart for mental retardation centers, but too volatile for special education classes in public schools - Willie didn't fit anywhere.”
Continued…Source: "Willie M." Treatment for Disturbed Young5ters Ambitious Community -Based Service System Lurches Forwardby Kendall Guthrie and Bill Finger
How many parts of the system was Willie M. exposed to at such an early age? And why couldn’t he get help?
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The Willie M. Story
“Six different state agencies and various judicial offices had tried to deal with Willie. But in the vast state services delivery system, there seemed to be no niche that could help him. Apparently, no means existed among these agency officials to forge a new system to draw on available services and find a way to help Willie prepare for adulthood.”
Willie and others like him had no options…so what would become of Willie?
Answer:
ENTER-THE WILLIE M. CLASS ACTION LAWSUIT
Continued…Source: "Willie M." Treatment for Disturbed Young5ters Ambitious Community -Based Service System Lurches Forwardby Kendall Guthrie and Bill Finger
Since the mid-1970s, mental health officials, social workers, and juvenile court officials had recognized the lack of treatment facilities for violent and emotionally disturbed youth.
Judges found themselves sending the children to training schools, not because they had a record of serious criminal activity but because no one else would take them.
In September 1979, seven attorneys from five private firms and two public interest agencies filed a class-action lawsuit in Federal District Court in Charlotte, NC (Willie's home) on behalf of four named plaintiffs, the first of whom was Willie.
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The Willie M. Class Action Lawsuit
Continued…
In 1980, settlement of the lawsuit stipulated that the state of North Carolina create almost a whole new service delivery system for SED children, ranging from highly restrictive residential programs to daytime therapy in a child's home.
The lawsuit forced officials to spend $744 million over two decades to help these children.
The lawsuit fostered interagency collaboration, placement in least restrictive environments and the creation of new services and treatment centers in a timely fashion to meet a child’s needs.
The lawsuit helped many children once thought to be beyond help. It became a national model and one of the first Systems of Care in the country.
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Results
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Results
“Today, mental health officials hail the Willie M. program as a landmark experiment, a giant step forward in the way North Carolina - and the nation - cares for mentally ill children.”
Source: www.newsobserver.com
Willie M., then 10 or 11, shakes hands with former Governor Jim Hunt at the ribbon-
cutting ceremony for the Whitaker School in Butner, one of many so-called 'Willie M.'
schools opened after the lawsuit.
Think about the children and families you have worked with…are any of their stories similar to Willie M.’s?
What systemic and practice changes would have helped?
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What is so special about a System of Care and Wraparound?
Consider how SOC and Wraparound can help…
• A System of Care incorporates a broad array of services and supports that is organized into a coordinated network, integrates care planning and management across multiple levels, is culturally and linguistically competent, and builds meaningful partnerships with families and youth at service delivery and policy levels.
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What is a System of Care (SOC)?
System of Care Movement, www.soc-mo.dmh.mo.gov
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SOC adheres to these values…
Family-driven and youth guidedHome and community-basedStrength-based and individualizedCulturally and linguistically competentIntegrated across systemsConnected to natural support networksData-driven and outcomes-oriented
…which come alive in the Wraparound Practice Method
A team-based planning process intended to provide individualized, coordinated, family-driven care to meet the complex needs of children and youth who are at risk of becoming involved or who are involved with one or more of DCYF’s divisions:
– Child welfare– Children’s behavioral health – Juvenile corrections services
The Wraparound process requires that families, providers and key members of the family’s social support network collaborate to build a creative plan and engage in shared decision making to:
– Respond to the particular needs of the child and family– Identify services that are flexibly adjusted as the family’s needs change
What is Wraparound?
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Wraparound Practice is Guided by 10 Principles
1. Family voice and choice
2. Team based
3. Culturally competent
4. Collaboration
5. Community-based
6. Individualized
7. Strength based
8. Unconditional care
9. Outcome based
10.Natural supports
Stay tuned for more on this in the Fundamentals module…
Wraparound puts System of Care values and principles into practice for service planning and provision
It is familiar to us since we already strive to be family centered
Research proved to us that the outcomes over many years are promising!
And even though we are in the beginning stages of our System of Care transformation in RI, we are already seeing positive outcomes.
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Why Wraparound?
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Early Positive Signs in RI…
• Reduced the number of children in residential care by over 30%
• Reduced the number of youth placed out of state by over 50% from 2007 -2010
• Reduced the number of child maltreatment victims 18% from 4,400 in 2006 to 3,620 in 2010
• Lowered the number of children entering out of home care by 27% from 1,893 in 2006 to 1,380 in 2010
• Developed and implemented Phase I of the System of Care (FCCP) as a front end diversionary program that has successfully reduced the number of families becoming open to the Department and reduced the number of children in our care
Over the past five years DCYF has:
The SOC and Wraparound helps Families, Community Partners and DCYF by…
Community Improving quality
of care Experiencing greater
satisfactionPromoting shared responsibility & accountability
DCYF Improving quality of care
Ensuring least restrictive placementsReducing length of time in care
Families Validating natural
supportsImproving permanency
outcomesBuilding capacity in
neighborhoods
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Now that we understand a bit about Systems of Care and Wraparound Practice…
…and have learned why Rhode Island chose this route for our system and families…
…let’s take a look at the origins of SOC and Wraparound.
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ORIGINS OF SYSTEMS OF CARE AND WRAPAROUND PRACTICEWhen, where and how did SOC and Wraparound evolve?
• In the 1970s, intense advocacy from family, community, and professional groups resulted in national policy initiatives, commissions, and seminal reports addressing these problems.
• Two early milestones were:– In 1978, President Jimmy Carter established the President’s Commission on Mental
Health to “conduct such public hearings, inquiries, and studies as may be necessary to identify the mental health needs of the Nation.” The American Presidency Project
– In 1982, Jane Knitzer’s publication, Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services reported:• “(1) an overview of problems and policy issues regarding the delivery of mental
health services to children and adolescents, (2) the results from a 50-state survey of state officials concerned with children's mental health and a discussion of the roles other state agencies play in delivering mental health services to children, and (3) a state-by-state analysis of statutes to voluntarily commit children to psychiatric institutions.” www.eric.ed.gov, ED223346
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How did the SOC Movement Begin?
Excerpted from the Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, Center for Mental Health Services Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services SAMHSA Web Center for Mental Health Services (CMHS). 3/2001.
In response to the many calls for action, Congress appropriated funds for a new children’s mental health initiative in 1984, and the landscape of services for this population began to change.
“Under the Children’s Mental Health Initiative of 1984, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed a federal program to promote and support a systems of care philosophy. This was the first federally organized effort to provide funding and help states design systems of care to deal with children’s mental health needs.”
http://www.livestrong.com/article/166275-a-system-of-care-for-childrens-mental-health/#ixzz1VOCQPJeL 24
How did the SOC Movement Begin?
In the 1970s Karl Dennis , then the Executive Director of Kaleidoscope, Inc. in Chicago, IL, and his colleagues pioneered what later came to be known as “wraparound services” for children in foster care.
Kaleidoscope also was one of the first programs in the United States to provide intensive in-home services to foster care children and to offer therapeutic foster care.
Mr. Dennis and his colleagues found that “84% of those (SED) youth could be kept at home with their own families if we correctly provided services to those families.” (pg. 5, Dennis & Lourie, 2006).
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Some early SOC efforts & successes…
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Some early SOC efforts & successes continued…
In 1980 the Willie M. class action lawsuit settlement (profiled earlier in this presentation) led to the creation of therapeutic foster homes, interagency collaboration, and the start of Wraparound practices in North Carolina.
In 1984 the Alaska Youth Initiative was formed and resulted in returning almost all youth with complex needs who had been placed in out-of-state institutions to their communities; over 30 other states replicated this initiative.
Click underlined words for more information
In response to the Willie M. settlement, Dr. Lenore Behar, Wraparound pioneer and former director of North Carolina’s Mental Health Agency, piloted an integrated approach to services in North Carolina– This became the first large scale SOC in the U.S.
– Dr. Behar coined the term “Wraparound” based on the concept of “no eject, no reject” (i.e., care and services for every child for as long as they need care and services).
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Large Scale SOC and Wraparound Practice is Born
Click underlined words for more information
• The diagram that spans the next 3 slides depicts the progression of supportive legislation and funding that helped to shape the current Systems of Care across the country.
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The National SOC Movement
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Support for the SOC Movement
1970s Grassroots efforts to serve SED children in home instead of in institutionsOutcomes:•A National movement began
1978 President’s Commission on Mental Health was formedOutcomes•Research data convinced the nations that systemic changes were necessary
1983 to PresentSAMHSA FUNDING was made availableOutcomes: •Larger Scale SOC Initiatives Became Possible
1986 State Comprehensive Mental Health Services Plan ActOutcomes:•Community-based service systems for persons with serious mental illness
•Mandated participation of family members & consumers in the development of state plans
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Support for the SOC Movement
Mid-1980s Federation for Families and NAMI CAN
Outcomes:•Family Voice & Choice
1983 CASSPwas formedOutcomes:•Interagency Collaboration
1989 Robert Wood Johnson Foundation FundingOutcomes:•Technologies to support funding and collaboration
1992 Comprehensive Community Mental Health Services for Children & Their FamiliesOutcomes:•Child-centered, Family Driven•Community-based•Linguistic and cultural competencies
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Support for the SOC Movement
1993 Anne E. Casey’s Mental Health Initiative for Urban ChildrenOutcomes:•Inclusion of Parents, Natural Supports and
Neighborhood Residents as Equal Partners•Emotional well-being became a focus
Mid-1990s National Advocacy from Youth Groups and Service ArenaOutcomes: •Youth Leadership & Involvement
1997 Adoption Safe Families Act (ASFA)Outcomes:•Safety•Permanency •Well Being
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Do you see evidence of how these values are supported by the legislation & funding?
Family-driven and youth guidedHome and community-basedStrength-based and individualizedCulturally and linguistically competentIntegrated across systemsConnected to natural support networksData-driven and outcomes-oriented
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The National System of Care and Wraparound Movement has
come to Rhode Island.
Let’s take a look at our transformation.
Logo courtesy of the National Wraparound Initiative web site:http://www.nwi.pdx.edu
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RHODE ISLAND’S SYSTEM OF CARE TRANSFORMATIONWhat systemic preparations have we made in Rhode Island?Where are we currently in the change process?
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DCYF is building capacity on so many levels to support SOC in Rhode Island…
Pires, S. (2006). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
THE POLICY LEVEL(financing, rates, statutory, regulatory)
THE MANAGEMENT LEVEL (data, quality improvement, human resources development,
system organization)
THE DIRECT PRACTICE LEVEL(assessment, care planning, care management, service/supports provision)
THE COMMUNITY LEVEL (partnership with families, youth, natural helpers, community built-in)
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The transformation to SOC looks like this…
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-based ownership
Creation of “self-help”
Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.
Focus on ChangeThe Department has led an intensive multi-year effort to educate
the staff, all branches of government, the community and the providers that a system transformation is needed.
System transformation reflects “best practices”, cost efficiencies and is aligned with our federal Program Improvement Plan goals.
The system is changing because we, along with our system partners, are committed to the change in philosophy….that we should provide services in the least restrictive, community-based setting appropriate for the child and their family.
As a result of the system changes, including implementation of Phase I of the System of Care, between 2007 and 2011, the average DCYF funded residential census has been reduced by 37% from 1012 to 641. (All residential placements have been reduced 38% from 1202 to 746 today.)
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• 1989, CASSP – Child and Adolescent Service System Program (Infrastructure) Grant , SAMHSA
• 1991-Present, Statewide Family Network Grant• 1992, Project REACH grant – Center for Mental Health Services
(youth with serious emotional disorders and their families)• 1997, Project HOPE grant – Center for Mental Health Services
(youth adjudicated) SAMHSA• 2003, Report of RI System of Care Task Force: Toward An
Organized System of Care for RI’s Children, Youth and Families• 2005, RI Positive Educational Partnership – Center for Mental
Health Services (early childhood and positive behavior supports and interventions) SAMHSA
• 2009, Implemented RI Family Care Community Partnerships (FCCPs)
• 2011/2012, Established Networks of Care
Rhode Island System of Care History
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Phase I (2009)The FCCPs provide effective
community-based services and supports using a wraparound planning model to children and families not open to DCYF
Referrals are made by DCYF, other community agencies, or families themselves
The Networks of Care and DCYF provide effective community based services and supports using a wraparound planning model to children, youth and families open to DCYF
Referrals are made by DCYF to the Networks of Care
Rhode Island’s SOC Movement
Phase II (2011-2012)
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What are the Family Care Community Partnerships (FCCP-Phase I)?
A formal collaborative structure for joint planning and decision-making through which community partners take collective responsibility for development and implementation of system of care and high fidelity Wraparound process.
Service delivery processes are organized through four regional “FCCP Lead” agencies who are the fiscal agents responsible for:– Building partnerships
– Developing a comprehensive network of available formal and informal services and supports
FCCP providers, including all formal and informal community partners take collective responsibility for the development and implementation of system of care and high fidelity Wraparound process for eligible families.
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Who are the Family Care Community Partnerships?
Who is Eligible for FCCP-Phase I?Children and families who are:
At risk for child abuse, neglect and/or dependency and DCYF involvement
Children birth to age 18 years old who meet criteria for having a serious emotional disturbance (SED)
Youth with SED 18 to 21 years old in accordance with DCYF Policy 700.0240, Services to Youth Ages 18-21
Youth concluding sentence to the Rhode Island Training School (RITS) who agree to participate, including youth leaving the RITS and youth leaving temporary community placement (TCP)
• Similar to the FCCPs, Networks of Care are “comprised of a Network Lead and collaborative, interdependent agencies and stakeholders united by written contracts or agreements and possessing the capacity to” meet the needs of referred children, youth and families while adhering to System of Care and Wraparound values, principles and practices.
• The Network Lead and its partners must have the capacity to provide comprehensive, quality, timely services to referred children, youth and families.
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What is a Network of Care (NOC-Phase II)?
Rhode Island Partnership for Family and Community System of Care – Phase II – Networks of Care DCYF, Request for Proposals, June 2011
• “The Department will assign children, youth and families to a Network of Care in a manner that ensures equitable distribution as to type of placement, locality and level of intensity.”
• “The Department will screen each child, youth and family utilizing a standardized process and make recommendations regarding need to the Network.”
• “Networks of Care must accept all referrals and may not refuse or reject any Department referrals.”
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How are referrals made to the Networks of Care?
Rhode Island Partnership for Family and Community System of Care – Phase II – Networks of Care – DCYF, Request for Proposals, June 2011
• There will be two Lead Agencies with RI’s Networks of Care.• Contract negotiations are underway and are expected to be finalized before
the end of the year.• In order to insure the best transition, Phase II will be implemented
incrementally beginning with:1. Children & youth in congregant care – paid residential and treatment foster care2. Any family whose child or youth’s placement changes to congregant care
• Decisions regarding the transition of additional children, youth & families into the Network of Care are underway for the following groups:
Children and youth in DCYF (generic) foster care Children and youth in kinship care Children and youth being maintained in the home
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Networks of Care - Phase II
Children and youth from birth to age 18 with the exceptions specified by state law, and their families. Also youth to age 19 referred because of juvenile justice involvement and children and youth to age 21 who are diagnosed with a serious emotional disturbance (SED).
These children, youth and/or their families will be open to the Department and will have service needs not covered by other funding sources.
These children, youth and families will include but not be limited to those under legal supervision or commitment, in temporary custody, under legal guardianship, in voluntary placement or adjudicated wayward/delinquent.
The service population does not include children, youth and families served by or eligible for services from the Family Care Community Partnerships.
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Eligibility Requirements for the Networks of Care-Phase II?
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As we transform our system in Rhode Island, we are building opportunities to work as a team to improve outcomes for children and families.
~~~~~To support you in this transformation, the modules that follow will provide an overview of the Language, Roles, Phases and Practices of SOC and Wraparound Team Meeting Methods.
RHODE ISLAND’S SYSTEM OF CARE
RHODE ISLAND’S SYSTEM OF CARE
WRAPAROUND
WRAPAROUND
PhasesEngagement and PreparationPlanningService Implementation Transition
“New” Practices/TermsStrengths, Needs & Culture Discovery
Functional AssessmentsCrisis PlansWrap Plans
Transition Plans
Team MeetingJoining together across roles and systems to support the family on their journey to achieving their goals (safety, permanency, well-being, etc.)
RolesFamily (Voice & Choice)
DCYF Network Care Coordinators
Family Support ResourcesNatural Supports
RI is Building Opportunities
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FamilyNatural Supports
Professionals Supports - community schools, child
welfare, etc…
To receive credit for Module I, you will need to complete an online quiz. To take the quiz, you will need to provide the following indentifying information:• Last name• First name• Month you were born in• Name of the agency you work for
The Child Welfare Institute will maintain the confidentiality of all data
and information associated with your participation on the quiz.
• Click on the link below to take the Module 1 Quiz:https://docs.google.com/spreadsheet/viewform?formkey=dDl4MDNudndZQWZtMDVRMmtJTEJQLXc6MQ
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Quiz
A System of Care for Children's Mental Health by Sandi Busch , July 5, 2010 http://www.livestrong.com/article/166275-a-system-of-care-for-childrens-mental-health
Dennis, Karl and Lourie, Ira (2006) Everything is NORMAL Until Proven Otherwise, A Book About Wraparound Services. CWLA Press, Washington D.C.
Excerpts from presentation by Janet Anderson, Ed.D, Assistant Director of DCYF for Community Services and Behavioral Health at the Child Abuse Prevention and Children’s Mental Health Summit, June 6, 2011, Newport, RI entitled, Understanding National Trends and Best Practices: Rhode Island's Family Care Community Partnerships
Excerpts from the Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, Center for Mental Health Services Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services SAMHSA Web Center for Mental Health Services (CMHS) 3/2001.
National Wraparound Initiative, www.nwi.pdx.edu RI Department of Children, Youth and Families (2011). Request for Proposals, Rhode Island
Partnership for Family and Community System of Care – Phase II Networks of Care.
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References and Resources
• System of Care Movement, www.soc-mo.dmh.mo.gov • The American Presidency Project,
http://www.presidency.ucsb.edu/ws/?pid=6643#axzz1VO8g0Kro• U.S. Department of Health and Human Services, Administration for Children and Families,
Child Welfare Information Gateway, www.childwelfare.gov/management/reform/soc/history/history.cfm
• VandenBerg, j., Bruns, E., & Burchard, J. (2003). History of the wraparound process. Focal Point: A National Bulletin on Family Support and Children’s Mental Health: Quality and fidelity in Wraparound, 17(2), 4-7
• Vroon VanDenBerg LLP (2008). Consultation and training materials related to RI’s System of Care
• "Willie M." Treatment for Disturbed Young5ters, Ambitious Community -Based Service System Lurches Forward, by Kendall Guthrie and Bill Finger, www.nccppr.org/.../Willie_M._Treatment_for_Disturbed_Youngsters.pdf
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References and Resources