Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes

Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes Grantmakers for Children, Youth and Families Conference October 10, 2012

Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes • Introductions • Why Systems Building? • Foundation Case Studies • Connecticut • Colorado • Small-Group Discussion • 3-Part Discussion • Concluding Comments

Introductions • Judith Meyers • President and CEO, The Children’s Fund of Connecticut • Deidre Johnson • Program Officer, The Colorado Trust • Phillip Chung • Assistant Director of Research, Evaluation, and Strategic Learning, The Colorado Trust • Jennifer Schroeder • President, The Implementation Group

Why Systems Building? • System: “a set of interrelated parts that interact and function together to produce a common outcome” (Coffman & Parker, 2010) • Systems building: the process of improving the individual parts, and more importantly, how these parts interact • Goal of systems building: improve the continuum of quality care for children and families

The Connecticut Experience Judith Meyers, Ph.D. President and CEO Children’s Fund of Connecticut

Framework: Vision of a Comprehensive System for Children’s Health Every child in Connecticut will receive high quality health promotion and prevention services within a family-centered medical home, and will have timely access to community-based services and supports as needed, where needed, to assure optimal development.

Children’s Fund of CT: Strategies • Develop Framework • Fund Communities and Provide TA: • Systems Development • Community Plans • Demonstrations/Replications • Practice Change • EPIC • Workforce Development • Research & Dissemination of Findings • Policy Reform

Child Health Services Building Blocks Desired Outcomes for School Readiness . Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development Early Care and Education Programs Family Support Services . Care Coordination Prt C (B-to-3) Title V Indicated Developmental Services Medical Services Home –Based Services Selective Child Health Services Medical Home [Accessible, Continuous, Comprehensive, Coordinated, Family-Centered, Compassionate, Culturally Effective] Universal

Systems Development:Support for Communities • Purpose: Promote full integration of child health in comprehensive community early childhood planning and implementation • Grants to communities – Public/Private • Provide Technical Assistance • Results based accountability frame • Information, webinars, intensive support • Child Health System Performance • Health Related Indicators for School Readiness • Inventory of Community Resources resources/ • How well services are integrated across/embedded in child serving systems • Engaging child health provider • Accessing and using data

Systems Development: Model Demonstration/Replicationfor Key Components • Child FIRST (Child and Family Interagency Resource, Support, and Training) - evidence based early childhood home visiting intervention, embedded in a system of care

Practice Improvement • Educating Practices in the Community (EPIC) • Brings timely information and training to child health professionals to change their practices • Sample modules • Screening - Developmental/Behavioral Health/Autism • Collaborative Health Care • Oral health • Care Coordination • Hearing Loss • Early Childhood Mental Health Workforce • Infant/toddler mental health competencies

Research and Dissemination

Advancing Policy Reform • Governance- state and local • Standardsthat define quality • Research, evaluation and data development • Financing sufficient to assure the delivery of high quality programs and practices in a comprehensive manner based on adopted standards; infrastructure support; Medicaid • Provider and practitioner support to assure the quality of services and the development of workforce with the capacity to meet the needs (competencies) • Public/private partnerships

Challenges for Funders • Collaboration with other funders • Lack of alignment across systems • Lack of capacity – dollars, experience in systems building • Lack of data • For rural communities systems change at the local level is difficult to effect without regional collaboration. • Engaging health providers

The Colorado Experience: The Colorado Trust’s Early Childhood Health Integration strategy Deidre Johnson Program Officer The Colorado Trust

Early Childhood Health Integration GOAL To better integrate health into Colorado’s broader early childhood development system as a means of improving health outcomes for more than 700,000 children.

Colorado Early Childhood Councils • Introduced in Colorado in 1997 • Multi-sector partnerships working to coordinate services in local communities: • Early Learning • Family Support and Parent Education • Health • Social Emotional and Mental Health • Goal: Improve child outcomes by creating a system of care that is more effective and easier for families to navigate.

Early Childhood Colorado Framework

Selected Child Health Outcomes • Access to preventive oral/medical health care • Assuring Better Child Health and Development • Cavity Free at Three • Enrolling children in health insurance • Access to a Medical Home approach • Immunizations • Physicians and dentists accepting Medicaid/CHP+ • Access to timely, appropriate prenatal care • Increased knowledge of the importance of health/wellness • Increased number of environments providing early identification and mental health consultation

Conceptual Framework • Context - Improving the political environment that surrounds the system so it produces the policy and funding changes needed to create and sustain it. • Components - Establishing high-performance programs and services within the system that produce results for system beneficiaries. • Connections - Creating strong and effective linkages across system components that further improve results for system beneficiaries. • Infrastructure - Developing the supports systems need to function effectively and with quality. • Scale - Ensuring a comprehensive system is available to as many people as possible so it produces broad and inclusive results for system beneficiaries. ~ J. Coffman (2007)

Timeline

Early Childhood of La Plata County • Developed and implemented the Community Access and Referral Enrollment System (CARES) a sliding fee scale program to increase access to medical, dental and mental health care services by offering discounted care to the underinsured. (www.laplatacares.org) • Created an Early Childhood Community Resource Guide – an online, bilingual asset/inventory database of resources available in La Plata County for children from birth to age 8 • Created a Pediatric Health Care Home Coalition to increase communication and collaboration among medical and non-medical early childhood service providers , decrease duplication and increase early intervention.

Phase II - Goals • Demonstration of effective systems-building activities that further advance health integration accomplishments achieved during the first three years. • Active and sustained engagement of health partners. • Active and sustained coordination of health integration activities within the Early Childhood Council. • Demonstrated planning for sustainability of health integration activities beyond the completion of the Phase II health integration grant.

Lessons Learned & Advice for Funders • Defining systems, systems building and systems outcomes • Dealing with different developmental stages and varying local resources – Grantee readiness • Program Implementation vs. Systems-Building • Language matters when working across systems • Engaging health providers • Aligning and collaborating with state level partners • Planning and technical assistance – Iterative approach

Small-Group Discussion • Part 1 (10 minutes): • How integrated vs. silo’d are the systems in the communities you serve? • Part 2 (10 minutes): • How would you measure success in systems building in the communities you serve? • Part 3 (10 minutes): • As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? • What are some of the challenges in reaching success indicators? • How would you communicate your role in supporting systems building work to both your grantees and your Board?

0 4 9 0 0 0 0 1 8 7 6 5 4 3 2 1 0 5 9 6 2 9 8 7 6 5 4 3 0 1 0 3 9 8 7 4 1 5 5 0 9 8 7 6 5 4 3 2 1 0 2 1 9 8 3 2 7 4 3 2 1 0 9 6 7 8 5 4 3 2 1 0 0 6 10-minute Small-Group Work Hours Minutes Seconds • Part 1: How integrated vs. silo’d are the systems in the communities you serve?

0 3 9 0 0 0 9 0 8 6 5 4 3 2 1 7 0 9 5 1 8 7 6 5 4 3 2 3 0 4 9 8 7 6 5 4 8 2 3 9 8 7 6 5 4 2 7 1 0 2 1 9 8 1 5 6 0 0 3 2 1 0 4 8 9 6 5 4 3 2 1 0 7 10-minute Small-Group Work Hours Minutes Seconds • Part 1: How integrated vs. silo’d are the systems in the communities you serve?

Part 1 Report-Back Part 1: How integrated vs. silo’d are the systems in the communities you serve?

Part 2 Small-Group Discussion Part 2: How would you measure success in systems building in the communities you serve?

0 4 9 0 0 0 0 1 8 7 6 5 4 3 2 1 0 5 9 6 2 9 8 7 6 5 4 3 0 1 0 3 9 8 7 4 1 5 5 0 9 8 7 6 5 4 3 2 1 0 2 1 9 8 3 2 7 4 3 2 1 0 9 6 7 8 5 4 3 2 1 0 0 6 10-minute Small-Group Work Hours Minutes Seconds Part 2: How would you measure success in systems building in the communities you serve?

0 3 9 0 0 0 9 0 8 6 5 4 3 2 1 7 0 9 5 1 8 7 6 5 4 3 2 3 0 4 9 8 7 6 5 4 8 2 3 9 8 7 6 5 4 2 7 1 0 2 1 9 8 1 5 6 0 0 3 2 1 0 4 8 9 6 5 4 3 2 1 0 7 10-minute Small-Group Work Hours Minutes Seconds Part 2: How would you measure success in systems building in the communities you serve?

0 3 9 0 0 0 3 0 8 6 5 4 3 2 1 7 0 9 5 1 8 7 6 5 4 3 2 3 0 4 9 8 7 6 5 4 2 2 3 9 8 7 6 5 4 2 7 1 0 2 1 9 8 1 5 6 0 0 3 2 1 0 4 8 9 6 5 4 3 2 1 0 7 10-minute Small-Group Work Hours Minutes Seconds • Part 2: How would you measure success in systems building in the communities you serve?

Part 2 Report-Back Part 2: How would you measure success in systems building in the communities you serve?

Part 3 Small-Group Discussion Part 3: • As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? • What are some of the challenges in reaching success indicators? • How would you communicate your role in supporting systems building work to both your grantees and your Board?

0 4 9 0 0 0 0 1 8 7 6 5 4 3 2 1 0 5 9 6 2 9 8 7 6 5 4 3 0 1 0 3 9 8 7 4 1 5 5 0 9 8 7 6 5 4 3 2 1 0 2 1 9 8 3 2 7 4 3 2 1 0 9 6 7 8 5 4 3 2 1 0 0 6 10-minute Small-Group Work Hours Minutes Seconds • As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described? • What are some of the challenges in reaching success indicators? • How would you communicate your role in supporting systems building work to both your grantees and your Board?

Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes

Bridging Silos: Building Stronger Systems of Care to Improve Child Outcomes

Presentation Transcript

Health Care Quality Indicators

Chapter 1: Health Care Delivery Systems Feipei Lai National Taiwan University

The IEEE 802.1 Standards

Child Outcomes

Measuring Outcomes of Child Welfare Programs

Software Engineering CST 1b

Trauma-Informed Care Training

Patient-Centered Outcomes of Health Care

Using the Child Outcomes Summary Form

Measuring Child Outcomes with the Summary of Functional Performance: An Introduction

Bridging Government and ENGINEERS*

Food Safety Basics for Residential Child Care Institutions (RCCI)

Using the Child Outcomes Summary Form

Spacing, Timing , Planning: Ways to Improve Pregnancy Outcomes

Software Engineering CST 1b

BUILDING SYSTEMS OF CARE: CRITICAL STRUCTURES AND PROCESSES

Software Engineering CST 1b

SWPBIS Building Tier 2/3 Systems

Patient-reported Outcomes of Care in Physical Therapy Practice

BUILDING SUCCESSFUL INFORMATION SYSTEMS

Software Engineering CST 1b