February 2016
PATHWAYS TO WELLBEING:
DEVELOPMENT AND
IMPLEMENTATION
Agenda
Coordination efforts in serving the dependency population
• Joint Governance: Guides our Efforts
• System-wide shift in practice
• MHST/Service Delivery Model
• Evaluation Frame Work
• Continuum Of Care
• Building Upon Existing Reform
• Next Steps
• CFT Development and Implementation
2
Phase One
Joint Governance
3
Process Mapping
Katie A. Work Flow
4
Initial Data Agreement
Identification of shared
outcomes
• County Counsel
involvement for
interpretation, i.e. HIPPA
• Attempted procedure for
sharing of information on
Adult, which led to MOU
• Changing of Findings and
Orders
•
•
Initial identification of
shared client population
 Jointly enrolled
 Group Home
 Clients found
throughout system
5
Early Katie A. Service
Implementation
Program Implementation
( 2-year period)
• Policy and Procedures
Established
• MHST Process
Agreement
• Shift to
Universal/Periodic
MHSTs
6
MHST Process
“Super Staffings”
Screening at detention
Assessment Team
Expanded Services
Screen
Triage
Assess
Treatment
7
Universal Mental Health Screening:
961 Initial, Key Event or Rescreening
GRAPH 1A: TOTAL SCREENINGS PROVIDED, BY MHST TYPE (n=961)*
Initial
140
120
106
20
113
20
20
80
40
Rescreen
Blank
Total
128
100
60
Key Event
2
6
112
4
82
10
75
112
11
16
88
24
23
30
71
0
11
11
75
56
19
10
120
109
2
9
108
23
27
13
91
14
34
18
24
7
13
21
69
66
49
60
70
40
53
23
0
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Date of MHST / Request for Service
8
MHST:
Initial 58%, Key Event 14%, Rescreen 17%(6month)
GRAPH 1B: CUMULATIVE SCREENINGS BY TYPE (n=961)*
Blank, 126, 11%
Rescreen, 186, 17%
Initial, 635, 58%
Key Event, 155, 14%
9
Age Breakdown:
0-5 43%, 6-11 29%, 12-20 28%
GRAPH 2B: CUMULATIVE SCREENINGS BY AGE (n=961)*
18-20, 62, 7%
21+, 3, 0%
0-2, 192, 20%
12-17, 204, 21%
3-5, 223, 23%
6-11, 277, 29%
10
MHST Disposition: Of the 961
67% Newly Accepted or Already Receiving MH Services,
33% No New Case
GRAPH 3B: CUMULATIVE SCREENINGS
BY DISPOSITION / SERVICE STATUS**
(n=961)*
In Process,
34, 3%
Already
Open, 91,
8%
In other MH
Services, 81, 7%
No New
Case, 359,
33%
GRAPH 4B: NO NEW CASE
MADE DUE TO NO REPORTED
CONCERNS BY AGE, JAN - NOV
2015 (n=233)*
12 - 17,
17, 7%
18 - 20, 7, 3%
6 - 11,
51, 22%
0 - 2, 88,
38%
3 - 5, 70, 30%
Accepted, 531, 49%
68% of No New Case 0-5
11
Total Class Served by Month:
871 Unduplicated
GRAPH 7A: TOTAL CLASS AND SUBCLASS MEMBERS IDENTIFIED* (n=871)
Class
SubClass
Total
600
500
400
432
384
439
469
463
505
482
483
493
112
120
126
97
92
105
88
90
344
349
372
371
377
371
373
379
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
532
122
516
123
78
300
200
306
410
393
Oct-15
Nov-15
100
0
Jan-15
12
Child Welfare Subsystem Mental Health
Services by Age Group
13
Pathways to Wellbeing Implementation
Active Joint
Management
• Executive
• Steering
• Program
• Data: Evaluation Framework
Expanded
Services
• Capacity with Contract Providers
• Continuum of Specialized Services
• Specialize Assessment Team
Embraced
Teaming
• Joint Staffing
• Child & Family Teams
• Joint Training of Social Workers and Clinicians
• Capturing Teaming
14
Evaluation Framework
Data & Evaluation Committee
• Utilized Contractor Evalcorp
• Guiding Evaluation Questions
• Identified Three Domains
• Developed Shared language
• Goal: to collect meaningful data
• First look at data reports
• Evaluation Framework melded
our understanding which lead to
definition of joint outcomes
Three Primary Evaluation Domains
15
Guiding Evaluation Questions
16
Moving from Silos to a Managed System
17
3 Primary Evaluation Domains
18
Current Evaluation Metrics
19
Domain I: Impact on Children/Youth
20
Domain I: Impact on Children/Youth
21
Domain I: Impact on Children/Youth
22
Domain I: Impact on Children/Youth
23
Domain II: Impact on Family/Caregivers
24
Domain III: HCA/HSA Collaboration
25
Long Term Goals for Data Infrastructure
26
Next Steps:
Continuum of Care Reform AB 403
• Pathways to Wellbeing is viewed as part of a broad reform
strategy with our HSA partners
• We are embracing a bigger vision and need to expand
Joint Governance
• Focused on continued Teaming and heightened Care
Coordination
• Moving from program planning to system-wide access and
treatment in a home-like setting
• Moving toward TOP Assessment Tool to jointly help determine
mental health needs and appropriate placements
27
CCR Building on Current Efforts
Behavioral Health
Child Welfare
 VCBH Continuum of
Mental Health Care
 Approved Relative Caregivers
Program
 Resource Family Approval
Program
 Quality Parenting Initiative
 Child and Family Teaming (Core
Practice Model)
 Pathways to Wellbeing
 Family Preservation
 Safety Organized Practice
 Prevention
 Wellness and Recovery
 Assessment and Early Intervention
 Treatment
 Residential & Acute Care
 Trauma Informed Care
 Evidence Based Practice
 Pathways to Wellbeing
 Multidisciplinary Treatment
Planning/Child and Family
Teaming
28
Continuum of Care Reform: first look
September 2014
September 2015
Children in care
926
884
Children in congregate care
95
84
Length of stay in care 18 months or longer
39.8%
44.6%
Re-entry into care within 12 months following
reunification
10.2%
7.5%
Relative / family friend placements
38.2%
45.4%
Reunification within 12 months (entry cohort)
46.6%
40.7%
51%
43.9%
Desired Result
Exit to permanency within 12 months
29
Ventura County Child Welfare Placements
Ventura Child Welfare Placement Data on 1/1/16
Facility Type
Casa - Shelter
Court Specified Home
Foster Family Agency Certified Home
Foster Family Home
Group Home
Guardian Home
Relative/NREFM Home
Small Family Home
Supervised Independent Living Placement
Of those in Group Homes plus the Shelter:
Child Count
21
9
94
129
53
106
468
8
28
916
%
2.29%
0.98%
10.26%
14.08%
5.79%
11.57%
51.09%
0.87%
3.06%
100%
Age 0-5
0
Age 6-11
11
Age 12-17
59
Age 18+
4
Slide provided by the Human Service Agency
30
Bi-Annual Group Home Placement Data
(per Safe Measures, 18 month cycle)
Jul ’15 – Dec ‘15
Casa Pacifica
(Shelter & RTC)
In-County
Group Home
Out of County
Group Home
County not
Specified
TOTAL
July 2015
28
36
18
3
85
August 2015
25
28
20
2
75
September 2015
33
27
21
3
84
October 2015
36
26
20
3
85
November 2015
27
27
21
4
74
December 2015
25
25
20
4
74
AVERAGE
29%
28.16%
20%
3.16%
80.33%
Slide provided by the Human Service Agency
31
Group Home Services
VCBH Quality Improvement Project
• Small amount of Group Home youth
receiving medication services at
outpatient clinics
• Need for heightened coordination of
care
• VCBH faces the challenge of the
development of the Short-term
Residential Treatment Centers
(ST-RTC)
32
CCR: Development of Short-Term
Residential Treatment Center(STRTC)
• STRTC will seek licensure and
demonstrate capacity to meet
treatment level needs
• Will ensure a quick transition to
home-based family placement
• Foster Family Agencies(FFA) and
STRTC will deliver an array of
“core services”
• Mental Health in home-based
family care regardless of
placement setting
• FFA and STRTC will be certified by
the county MH Plan or arrange for
Specialty MH Services
• Standardize Assessment Process to
coordinate Child Welfare &
Behavioral Health services
• STRTC and FFA will require
accreditation
• Development of a coordinated
monitoring and oversight system
between California Department of
Social Services and Department of
Health Care Services
33
Our Goals…Challenges…Opportunities
Continuum of Care Reform: AB 403
LegislatiContinuum of Care Reform: AB 403
Expand efforts to
Legislation
n
Enhance the level
ensure Mental
Heath services
meet the
treatment needs
of child/youth
regardless of the
placement
of integration
among Child
Welfare and
County Mental
Health
Expand availability
of specialized
Mental Health
services in a homebased setting
34
CFT DEVELOPMENT
AND IMPLEMENTATION
CFT Development and Implementation
Created Pilot to Develop Model
• Teams of SW and Clinician in specific geographic areas
• Issues and Challenges

Facilitation Discomfort

Training Needed on Facilitation Skills

Logistics (family, scheduling and location)
Developed Kaizen
•
Goal: Establish Policies and Procedures
•
Workgroup included: Family, Parent Partners, HSA, BHD, Public Health, Foster and
Biological Parents, Youth Representatives
•
Scheduled Cross-System Training with focus on:
1.
Shifting Paradigm
2.
Developing Teaming Approach
3.
Training on Facilitation Strategies
36
Challenges and CCR
HSA Challenge:
• Consistent documentation
• How would this occur – Protocol from CMS/CWS
• Preliminary Data Results
CCR Shifting Approach
• Teaming Model vs. CFT ‘Centric’
• Challenge in Scheduling and Coordination
• Expanding Teaming (Family Meetings) approach across the entire
Foster System
37
Training
•
•
•
•
•
Multiple/ongoing Training Scheduled
Small Groups with HSA and BHD staff “Teaming Model”
Two Training Components:

Overview of CFT Philosophy

Facilitation Model
Focus on Skill Building
Lessons Learned:

Works best in TDM “like” model (trained in facilitation model)

IHBS/Wraparound better suited to acting as facilitator

Future: Facilitator as a unique position; shift in facilitation
38
Thank you for listening
39