Clinical Directors and
Transforming Services and
Supports in a System of Care
Wilfredo Soto, Connecticut
Frank Pace, Rhode Island
Kim Williams and Ken Martinez, Technical Assistance
Partnership
April 3, 2007
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Meet the presenters!
Kim Williams
Wilfredo Soto
Frank Pace
Ken Martinez
Service Delivery Components
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Benefit Design/Service Array
Flexible
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Evidence-Based Practice
Care
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Outreach and Referral
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Intake/Access
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Screening, Assessment, and
Evaluation
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Decision-making and
Oversight (Care planning,
care authorization, care
monitoring, and review)
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Funds
Management or Care
Coordination
Crisis
Management at the Service
Delivery and Systems Level
Service
Planning using a
Wraparound Approach
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Infrastructure Elements
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Utilization Management
Provider
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Staffing Structure
Protecting
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Staff Involvement,
Support, and
Development
Ensuring
Network
Privacy
Rights
Continuous
Quality
Improvement
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Orientation and Training National Evaluation
of Key Stakeholders
Interface
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Coordination with Social
Marketing
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Develop structures and processes from the start to
support key stakeholder, youth, and family involvement
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Direct service or
implementation
committee
Focus groups
Stakeholder groups
Cultural & linguistic
competence
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SOC Orientation
Concrete supports
Communication protocols
Training opportunities
Cross-system training
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Is your administrative and management
organization in place?
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Is your clinical director on board and integrally
involved in the infrastructure development of your
system of care?
Does the clinical director have a key role in the
planning process for designing the structure of
the proposed service delivery system?
Does the clinical director serve in a decisionmaking role on your management team?
What is the relationship between the clinical
director and the service evaluation activities?
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Hiring a Clinical Director
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Not business as usual
Not a “clinical hat” only
Expertise in infrastructure building
Understands the impact of culture on diagnoses
and service delivery
Understands/practices family-driven and youthguided care
Readiness for evidence-based treatments/
practices, practice-based evidence and their
implementation
Aware of need for service system improvements
Collaborates with youth, families, and
community stakeholders
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Role of the Clinical Director
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Need to be involved from the beginning of
system-building
Need to be accessible to families/youth
Structures in place: open access to the clinical
director
Provide training to community providers
“Fix it” meetings
Relationship with project director
Relationship with family organization
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Relationship with youth coordinator
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Family/Youth Perspectives
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Use family- and youth-friendly language
Be careful using acronyms and agency jargon
unfamiliar to families and youth
Create environment that is “safe”
Use creative approaches to engage full participation
Set the stage from the beginning of having a
youth/family member in the room – avoid tokenism
– try to have at least two to allow support – diverse
representation of participants
Look for opportunities for collaboration
Clarify, educate, and validate their role in the
community
Provide accessibility and relationship-building with
families and youth
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Family/Youth Perspectives
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Provide high level of communication by
clinical director with providers in the
community
Conduct focus groups with youth and
families
Solicit family input through various
methods
Hear from youth and families about
their need for diverse providers and
therapeutic modalities
Design of non-traditional services and
supports best informed by youth and
families
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Questions???
Please press *7 on your phone to
un-mute your line.
Please press *6 to re-mute your
phone after you are finished.
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Know Your Population of Focus
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What does this really mean?
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Do homework:
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Look at the needs/gaps in your community
Diversity, geography, experience
Drill down into knowing your population of focus indepth
Previous experience with interventions
What worked? What didn’t work?
Identify community needs and assets
Know the available resources to meet needs
of population
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Pressures to Rush to Service
Delivery
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Anticipate and handle the pressures
Keep Federal Project Officer informed
Community pressure: “got huge grant, provide
services, NOW”
Providers: knocking on the door, want piece of
money available
Community politics: budget cuts, court orders
Youth & families: know we got the money, we
need services now!
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What happens when you rush to
deliver services?
Tendency to just put more money into
existing services
 Short circuit collaborative process
 Impedes “transforming” system
 Impedes assessment and gap analysis
 Resistance to change by direct care
providers
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Collaboration
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One system should not unilaterally proceed
to make all the service delivery and clinical
practice decisions without participation of
key stakeholders, family, and youth
Collaboration with partners that usually
have not been involved, such as the early
childhood system, primary care, housing
system, law enforcement, etc.
Collaboration on clinical services: how does
it work?
What clinical services are provided within all
the component systems?
Avoid mental health system making all the
practice decisions
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Planning for use of Evidence-Based Treatments/
Practices and Practice-Based Evidence
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Know your population of focus
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Community needs are assessed
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Identify treatments/practices that match
the community’s needs
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Ensure that they are culturally-relevant
and appropriate-do they need to be
adapted?
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Planning for use of Evidence-Based Treatments/
Practices and Practice-Based Evidence, cont.
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Individualized care (comprehensive, flexible,
culturally- and developmentally-responsive) is first
priority
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EBPs/PBEs must be linked with all other systems of
support and intervention to promote sustainability
and generalizability
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The inclusion/infusion of culture and family/youth
involvement in EBP research and practice is
essential
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Organizational culture must be fostered to support
the implementation of effective practices
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Lessons From Communities: Gaps in Building
Clinical Services and Supports
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Development of service implementation
plans
Coordinate with launch of National
Evaluation
Crisis planning/safety planning process
Flexible funding
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Where are decisions for this made?
What is the turnaround time on access to
flex funds?
Are flex funds budgeted?
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Lessons From Communities: Gaps in Building
Clinical Services and Supports, cont.
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Individualized service planning using
Wraparound approach
Staffing
Coordination and standardization among
the different care coordination entities
Availability and access to the clinical
service that best meets the needs of the
family
Family-driven and youth-guided
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Questions???
Please press *7 on your phone to
un-mute your line.
Please press *6 to re-mute your
phone after you are finished.
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Websites for Evidence-Based and
Promising Practices
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Resource Guide for Promoting an Evidence-Based Culture in Children’s
Mental Health
http://www.systemsofcare.samhsa.gov/ResourceGuide/index.html
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Matrix of Children’s Behavioral Health Interventions
http://www.systemsofcare.samhsa.gov/headermenus/docsHM/MatrixFI
NAL1.pdf
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National Registry of Evidence Based Programs and Practices (NREPP)
http://modelprograms.samhsa.gov/template_cf.cfm?page=model_list
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Office of Juvenile Justice Delinquency Prevention Model Programs
Guide
http://www.dsgonline.com/mpg2.5/mpg_index.htm
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Georgetown University National Technical Assistance Center
http://gucchd.georgetown.edu/
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Websites for Evidence-Based and
Promising Practices, cont.
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National Wraparound Initiative
http://www.rtc.pdx.edu/nwi
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National Implementation Research Network
http://nirn.fmhi.usf.edu
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Decision Support 2000+
http://206.196.29.126/Sites/ds2000/Library.aspx
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Center for Evidence-Based Practice: Young Children With
Challenging Behavior
http://challengingbehavior.fmhi.usf.edu/fixsen-etal-may03.html
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State of Hawaii
http://www.hawaii.gov/health/mentalhealth/camhd/library/pdf/ebs/ebs016.pdf
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Resources
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Family Leadership in Systems of Care: What is Family
Driven? http://ffcmh.org/systems_whatis.htm
Building Systems of Care: A Primer
http://gucchd.georgetown.edu or deaconm@georgetown.edu
Implementing High-Quality Collaborative
Individualized Service/Support Planning: Necessary
Conditions; http://www.rtc.pdx.edu or rtcpubs@pdx.edu
Promising Practices in Wraparound for Children with
Serious Emotional Disturbance and Their Families 1998
http://www.air.org/cecp/
Mini-Website on Wraparound Resources
http://cecp.air.org/wraparound/materials.html
Quality and Fidelity in Wraparound, Focal Point 2004
www.rtc.pdx.edu or rtcpubs@pdx.edu or 503-725-4175
Dedicated Website to Individualized Care and
Wraparound; http://www.paperboat.com
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Presenter Contact Information
Frank
Pace: frank.pace@dcyi.ri.gov
Wilfredo
Soto:
scarter@theparkproject.org
Kim
Williams: kwilliams@ffcmh.org
(317) 876-4602
Ken
Martinez: kmartinez@air.org
(505) 898-2220
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