Allegheny County
System of Care Initiative
Presented by:
Ellen Beatty, Parent
Robert Clanagan, Early Childhood Family Support Coordinator
Keith Solomon, Operations Coordinator
Allegheny County Department of Human Services
Office of Behavioral Health
System of Care Initiative
Overview
• National Perspective
• Allegheny County System of Care Initiative
(SOCI)
– History & Values
– Practice Model
• Consumer/Family, Community, and System Partnership
• Value-Based Service Process
• Continuous Quality Improvement (CQI)
– What makes SOCI Different?
– Questions & Answers
What is a System of
Care?
• A coordinated network of community services
and supports for children and youth with serious
mental health needs.
• Families, youth and providers become partners
so that each child can function better at home, in
school, and the community.
Defining Characteristics
• A broad array of coordinated services & supports
• Care Planning and Management is integrated across
multiple levels
• Cultural and Linguistic Competence
• Building Partnerships
– Families
– Youth
– On all levels
• Service Delivery
• Management
• Policy
Goals of System of Care
• Improve functioning of children, youth and
their families at home, at school, and in the
community
• Improve coordination and service integration
by overcoming system fragmentation
• Empower families by providing information,
education, and choice
National Perspective:
System Reform Initiatives
FROM
TO
Fragmented service delivery
Categorical programs/funding
Limited services
Reactive, crisis-oriented
Coordinated service delivery
Blended resources
Comprehensive service array
Focus on prevention/early
intervention
Least restrictive settings
Focus on “deep end,” restrictive
Children out-of-home
Centralized authority
Creation of “dependency”
Children within families
Community-based ownership
Creation of “self-help”
National Perspective:
Frontline Practice Shifts
FROM
TO
Control by professionals
Only professional services
Partnerships with families
Partnership between natural
and professionals supports
and services
One service coordinator
Single plan for child & family
Family partnerships
Strengths
Cultural Competence
Multiple case managers
Multiple service plans
Family blaming
Deficits
Mono-cultural
National Perspective:
Case Management vs. Care Coordination
• Case Management
– Little authority over
resources
– Child centered
– Reactive
– Service provided to
placement
– Organization of existing
services
– Uses current system
• Care Coordination
– More control over
resources
– Family centered
– Proactive
– Unconditional care
– Creation of services when
not available
– Family and community
supports
Allegheny County:
• Community Connections for Families (CCF)
– SAMHSA Grant (1998)
– 5 Community-based sites for ages 6-16
• Partnership for Youth Transition (PYT)
– SAMHSA Grant (2002)
– Expansion of 2 CCF sites for ages 14-25
• Early Childhood
– SAMHSA Grant (2005)
– Planning year; 4 new sites for ages 0-6
Community Teams
• Community Partner Sites
– Program Supervisor
• Staff supervision and outreach activities
• Invisible caseload
– Family Support Specialist
– Youth Support Specialist
• Serving all consumers and interested community members
• Outreach and individual support/support group activities
– Service Coordinators
• CCF: 15-20 assigned consumers
• PYT: 10-15 assigned consumers
SOCI Team
• Allegheny County Department of Human Services
• Office of Behavioral Health
• SOCI Central Office
– Administration
• Project Director
• Administrative Support
– Operations
• Family and Youth Coordinators
• Community Development
– Evaluation
– Training & Technical Assistance
SOCI Core Values
CASSP Foundation
Consumer/Family
Focused & Driven
Youth Centered
& Driven
Community Based
Least Restrictive
Multi-System
Culturally Competent
SOCI Additions
Safety (Consumer, Family,
Community)
Individualized
Relentless Advocacy
Outcomes-Based
Cost Effective / Cost
Responsible
Education / Vocation
Physical & Mental Well-Being
Strength-Based
Collaboration
SOCI Practice Model
• Partnerships
– Consumer & Family
– Community
– System
• Value-Based Service Process
• Continuous Quality Improvement (CQI)
Consumer/Family
Partnerships
Family Organization
Support Groups
Natural Supports
Value-Based
Service Process
Engagement
Crisis Stabilization
Strengths and Needs Disc.
Establish a Team
Plan Supports/Services
Implement Plan
Track & Adapt
Transition
System Partnerships
Formal Services
State/County/Federal
System Partners
Community
Partnerships
Advisory Boards
Community Support Teams
Informal Supports
SOCI Practice Model:
Partnership
• Consumer/Family Focused & Driven
– Focus on Empowerment & Advocacy
– Family and Youth Involvement at all levels (as recipient and
staff)
• Community Empowerment
– Staff are hired from communities served
– Outreach to and engagement of community as a whole
• Collaboration
– Knowledge and respect of multiple systems
– Opportunities for partnership & understanding
Philosophy of Service
Coordination
•
•
•
•
Know Your Consumers & Families
Know Your Community
Know Your System Partners
Wrap the Community around the
Consumer/Family
• Develop a Service Plan that is built around
consumer/family and community strengths
(From the Value-Based Service Process)
Value-Based Service
Process Elements
• Consumer/Family Engagement
– Listen to story, record hopes and dreams
– Staff is easily accessible and flexible
– “Open the door” to extended family & natural
supports
– Establish an environment where the consumer/family
drives the process
• Crisis Planning and Stabilization
– Utilize natural supports
– Proactive planning/crisis prevention
– Address immediate crisis and safety concerns
Value-Based Service
Process Elements
• Functional Strengths & Needs Assessment
– CANS/YANSA
– Consumer/Family Strengths Assessment
– Input from support team
• Developing & Maintaining Support Teams
–
–
–
–
Create the Village
Consumer/Family driven, reflect culture/preferences
Include all natural, community, and system resources
Recruit any additional formal & informal supports
Value-Based Service
Process Elements
• Service/Support Plan Development
–
–
–
–
Family vision is the focus of the plan
Strengths-based goals, objectives & strategies
Individualized, creative, blend of informal & formal
Collaborative effort across all systems
• Service/Support Plan Implementation
– Consistent check-in/review/revision
– Linkage to services, supports & resources
– Increase use of informal supports over time
Value-Based Service
Process Elements
• Transition
– Planning from the beginning
– Consistent follow-up
– Ongoing availability (informal basis)
• Tracking & Adapting (CQI)
– Data-driven process
– Communicate findings
Outcomes
Continuous
Quality
Improvement
SOCI
Evaluation
MIS
Partnerships:
Consumer/Family
Community
System
Continuous Quality
Improvement
• Partnership between Operations & Evaluation
• Efforts to Outcomes
– Get out what you put in
– Mission & Values
• Defining
• Measuring
– Efforts
• Tracking
• Linking to Outcomes
Why Measure Efforts?
• Track Consistency of Practice with Mission and
Values
• Asks: Are we doing what we said we’d do?
• Accountability to Consumers/Families
• Inform Quality Improvement
• Inform Outcomes
• Replication
CQI Model: Components
• Value-Based Service Process Indicators
• Value-Based Service Process Monitoring Tools
–
–
–
–
Record/Case Review
Team Meeting Satisfaction Survey
CQI Survey
Observation Forms
• Initial Meeting
• Team Meeting
• Partner Community Review (PCR)
• eCAPS
• Performance Based Contract
Additional CQI Model
Components
• Community Evaluation Team (CET)
• CANS / YANSA
• CART Satisfaction Surveys
• Flex Fund Analyses
• Focus Groups
Creating a Feedback Loop
• Report and Discuss Data
–
–
–
–
–
Regular Reporting Schedule
Combine with Outcome Data
Community Evaluation Team (CET)
Supervision Meetings
Advisory Committees
• Use Results in Planning
• Use Results in Training
• Operations
Training
Operations
Evaluation
CCF Study Participants
• Descriptive Study N = 373
• Outcomes Study N = 201
• Interviewed by Family Members & Youth 11+
• Baseline and 6 Months up to 36 Months
• Average Follow-up Rate = 85%
• Data Collection Occurred between 12/01/99
and 10/31/04
CCF Demographics
• Gender
– 75% Male
– 25% Female
• Race
– 64% African American
– 28% Caucasian
– 8% Other Races (Native American, Bi-racial, Hispanic/Latino)
• Diagnosis
– 66% have more than one MH Diagnosis
– 65% have ADHD
– 45% Have ODD/Conduct Disorder
• Average Age – 11 years
CCF Serves a Hard to
Reach Population
• Almost half are self-referred (46%)
• Over half are African-American males
• Many CCF Children:
– Have parents with mental illness (62%)
– Live in households with incomes < $20,000 (85%)
– Have a parent with a substance abuse problem
(59%)
– Have a parent who was convicted of a crime (49%)
– Have been exposed to domestic violence (39%)
Risk Factors
• Prior to CCF Enrollment, consumers had
experienced:
– Running away (14%)
– Attempting Suicide (5%)
– Psychiatric Hospitalization (15%)
– Physical Abuse (9%)
Outcomes Highlights
• Families are More Stable
– Caregivers report a statistically significant reduction
in strain
– Caregivers report significant improvements in:
• Resource availability
• Adequate income
• Access to childcare
• Ability to maintain employment
Baseline to 24-months
Outcomes Highlights
• Children are Doing Better in School
– Detentions Decreased (17%)
– Suspensions Decreased (16%)
– A & B Averages Increased (19%)
– Homework Completion Increased (9%)
– Class Attention Increased (28%)
• Caregivers Feel More Positive About School
System
Baseline to 24-months
Outcomes Highlights
• Caregivers Like the System of Care Approach
– High Caregiver Satisfaction
– Caregivers Feel Respected
– Family Engagement Process is Highly Rated
Baseline to 24-months
Outcomes Highlights
• System Partners Report:
– Improvements in Interagency Collaboration
– Better Understanding of Advocacy
– Keener Awareness of Natural and Community
Supports
– Greater Ability to Form Trusting Relationships with
Children and Families
Baseline to 24-months
What Makes System of
Care Different?
• Consumer/Family Involvement and Participation
– Participation in all aspects of program development
– Family Support Specialist and Family Support
Coordinator positions for parent-professionals
– Youth Support Specialist and Youth Support
Coordinator positions for professional young adult
consumers
– Consumer/Family/Community Review
What Makes System of
Care Different?
• Emphasis on Community Empowerment,
Development, and Organization
– Offices are located in a natural setting within the
community
– Staff have been hired from the community
– Staff are involved in their community
– Community Support Team – “It takes a village”
– Community Advisory Boards
What Makes System of
Care Different?
• Focus on Informal Supports and Resources
– Grandparents & Extended Family
– Friends
– Churches
– Other Local Community Organizations
What Makes System of
Care Different?
• Cultural Competency
– Have Developed Trust
– Recognized Nationally
– Self-Referrals
– Consumer Satisfaction
• Continuous Quality Improvement (CQI) Process
Contact Information
• Ellen Beatty, Parent
– 412-758-7740
• Robert Clanagan, E.C. Family Support Coordinator
– 412-350-3060
– rclanagan@county.allegheny.pa.us
• Keith Solomon, Operations Coordinator
– 412-350-3817
– ksolomon@county.allegheny.pa.us
• Gwen White, Project Director
– 412-350-4944
– gwhite@dhs.county.allegheny.pa.us
Questions & Answers