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System of care..

System of care. Why should nz care?. KARIN ISHERWOOD Planning & Funding Capital Coast DHB Dr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development. ACKNOWLEDGEMENTS. Ms Sue Treanor Director The Werry Centre Mr Bruce Kamradt Director

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System of care..

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  1. System of care.. Why should nz care? KARIN ISHERWOOD Planning & Funding Capital Coast DHBDr BRONWYN DUNNACHIE The Werry Centre for Child & Adolescent Mental Health Workforce Development

  2. ACKNOWLEDGEMENTS Ms Sue Treanor Director The Werry Centre Mr Bruce Kamradt Director Milwaukee Wrap Around Programme

  3. WHAT WILL WE COVER  Introductions/Background/a Journey… System of Care Philosophy & Underpinnings Explanation & History Wrap Around Milwaukee The Concept of Technical Assistance Local Initiatives & Comparisons  Developing a System of Care in New Zealand

  4. THE WERRY CENTRE • Contracted by MOH & HWNZ • Sits within Auckland University School of Population Health, Tamaki Campus • Responsible for Workforce Development across Infant, Child & Youth Mental Health/AOD sectors nationally • 18 FTE, 5 based in South Island (Christchurch)

  5. OUR MAHI EXAMPLES • Development & Implementation of a Competency Framework (Real Skills Plus CAMHS) • Mentoring: Emergent Leadership Development • Family/Whanau Participation • Youth Participation • Student Placement Development: MHPP • CAPA/7HH

  6. OUR MAHI EXAMPLES • Training: SACS-BI, CBT, ASD, Eating Disorder • Well-Child • Regional Forums • Parenting Programme: Incredible Years • Sector Days • Family Therapy Development

  7. A JOURNEY.. • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use. • He is the oldest of 2 children, having a 9 year old sister Kelsy. • Josh lives with his mother &sister. His father has had no contact with the family since Josh was an infant. • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.

  8. A JOURNEY.. • Josh is seen for an assessment at the Youth Mental Health Service by Gill, a Pakeha Social Worker who feels Josh needs further investigation by the Psychiatrist for management of mood &substance use. • Contact with Josh is supplemented by contact with his mother &a teacher at his school. • The clinicians on the team believe that it will be important to involve Josh’s family & school in his care. • A meeting is set up at the Youth Service with all parties. Mother fails to attend. She is contacted by phone after the meeting & the outcome is shared with her..

  9. A JOURNEY.. • The clinicians continue to work with Josh attempting to involve all parties in his care through regular phone contact & further meetings at the service. • After several appointments where Josh has failed to attend & the school reports he has been truant, his mother is contacted who reports that Josh has ‘run away’. • A referral is made to CYF who eventually locate Josh & he is returned home. • Further attempts are made to re-engage Josh with the Youth service without success.

  10. A JOURNEY.. • The team contact his Social Worker at CYF &express their concern that until Josh is in a stable residence, contact with Josh is unlikely to be helpful. His file is closed.

  11. QUESTIONS.. • What do you think about this scenario? • Are there things that could have been done differently?

  12. IIMHL International Initiative for Mental Health Leadership • A A ‘Virtual’ Agency (began in 2003) • Improve mental health services • Recovery focussed, evidence based practice • Support innovative leadership • Facilitate connections between leaders • Government to Government Initiative • 7 member countries • NZ, USA, Canada, Scotland, Ireland, England, Australia • Yearly exchanges to promote shared innovative practice

  13. SYSTEM OF CARE SIMPLY PUT • A system of care is a range of • Services & Supports • Guided by a • Philosophy • Supported by an • Infrastructure

  14. SYSTEM OF CARE DEFINITION • Spectrum of effective, community based services & supports for children & youth with or at risk for mental health or other challenges & their families • Organised into a coordinated network • Builds meaningful partnerships with families & youth • Addresses cultural & linguistic needs • Function better at home, school, community & life

  15. SYSTEM OF CARE BACKGROUND • Developed in the USA, following report findings • Major framework for improving mental health &substance use delivery systems, services &outcomes for 25 years • Used to shape system reforms in states, communities, tribes & territories • Extensively researched & evaluated • Found to be effective in improving organisation &delivery of children’s mental health services

  16. SYSTEM OF CARE CORE VALUES • Family Driven &Youth Guided • Strengths & needs of child &family determine type M& mix of services &supports provided • Community Based • Supportive, adaptive infrastructure of structure, processes &relationships at the community level • Culturally &Linguistically Competent  Agencies, programs &services reflect cultural population, to aid access &utilisation of appropriate services

  17. SYSTEM OF CARE GUIDING PRINCIPLES • Access to a Broad Array of Effective Services • Traditional, non-traditional, formal &informal, natural • Each Child & Family is Different • Plans reflect uniqueness of each family • Services & Supports Least restrictive, most typical & developmentally appropriate

  18. SYSTEM OF CARE GUIDING PRINCIPLES • Youth & Families are Full Partners • Planning &delivery of services, policies &procedure that govern care in their community, state, territory, tribe & nation • Cross-System Collaboration • Linkages among child-serving systems for management, service coordination & integrated management of service delivery & costs • Provide Care Management  Services are coordinated, families can move through system as needed

  19. SYSTEM OF CARE GUIDING PRINCIPLES • Developmentally Appropriate Services & Supports Optimal social-emotional outcomes in home & community Facilitate transition of youth to adult system as needed • Incorporate Mental Health Promotion, Prevention & Early Identification & Intervention Improve long-term outcomes& mechanisms to identify problems at an earlier stage

  20. SYSTEM OF CARE GUIDING PRINCIPLES • Continuous Accountability Mechanisms Track, monitor &manage achievement of goals  Fidelity to system of care philosophy  Check quality, effectiveness &outcomes at system level, practice level &child &family level • Protect the Rights of Children & Families  Promote effective advocacy efforts

  21. SYSTEM OF CARE GUIDING PRINCIPLES • Services do not Discriminate • Be responsive &sensitive to differences of race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio economic status, geography, language, immigration status & other characteristics Keeping these principles in mind, let’s look at development

  22. SYSTEM OF CARE DEVELOPING THE SYSTEM • Underpins National Delivery of Child Mental Health • Newly developed services expected to adhere to principles • Use the System of Care Philosophy as a Guide  Not a model to be replicated  Arrays of services will depend on community  Consider particular needs, goals, priorities, populations

  23. SYSTEM OF CARE DEVELOPING THE SYSTEM • Adapt Approach Based on Changes • Political, administrative, fiscal, community context & data • Each community Creates Individual Process  plan, implement & evaluate

  24. SYSTEM OF CARE EACH PROGRAMME IS UNIQUE & DIFFERENT • One Program is Particularly Successful • Wraparound Milwaukee—Bruce Kamradt • 2009 Innovations in American Government Award, Harvard University’s Ash Institute

  25. SYSTEM OF CARE EACH PROGRAMME IS UNIQUE & DIFFERENT • Share the Knowledge, Spread Wealth  Educate State, communities &sectors  SAMHSA partnered with Georgetown University’s National Technical Assistance Centre for Children’s Mental Health  Developed a training package based on the success of WA  In September 2011, piloted the training with representatives from 7 states &3 countries

  26. WRAPAROUND MILWAUKEE QUICK HISTORY • Situation • Bruce Kamradt &colleagues aware of same kids cycling through child welfare, juvenile justice, MH • Each service was funded individually • Services were limited & fragmented • System reacted to crises • Removing kids was usual, lots of out of home care • Government was offering SOC grants  First pilot—25 Kid Project (17 out of 25 kids home in 90)

  27. Wraparound Milwaukee SYSTEM OF CARE IN ACTION!! • Care Management Entity • Responsible for day to day management of system of care  Can be done by any agency

  28. Wraparound Milwaukee • Ten Functions of CME • Assessment &enrolment of youth in CME • Mobile Crisis Services (can contract it out) • Care coordination (can contract it out) • Operation of Provider Network (array of services) • Fiscal management—(child welfare, juvenile justice, health) 6. Quality assurance, quality improvement 7. Information technology (built their own system) • Create mechanisms for family advocacy • Clinical &medical oversight • Training, staff development, public relations (developed their own curriculum) How does Wraparound Work?

  29. Wraparound Milwaukee FOUR PHASES OF WRAPAROUND

  30. Wraparound Milwaukee • PHASE 1: • PREPARATION/ • ENGAGEMENT & WELCOMING • Set the Tone for Collaborative Teamwork • Orient the family to the process • Begin initial crisis & safety planning • Listen & learn the family’s story • Explore strengths, needs, culture & vision • Identify & engage team & orient them to process • Arrange the first Child & Family Team Meeting • Create agenda for first meeting

  31. Wraparound Milwaukee • PHASE 2: • INITIAL PLAN DEVELOPMENT • Develop the Team, All Members are Heard & Valued • Determine ground rules • Distribute agenda • Document strengths of all members & the community • Develop an initial family vision to guide needs discussion • Identify & prioritise youth & family needs • Brainstorm & select strategies to meet needs • Review & finalise the initial crisis/safety plan • Assign roles & responsibilities • Schedule the next meetings

  32. Wraparound Milwaukee • PHASE 3: • Plan Implementation & Refinement • Continuous Review of Progress, Change Plan as Needed • The initial plan is implemented • Progress tracked by facilitator, discussed & reviewed • Success is evaluated & celebrated • New strategies are determined when necessary • The team builds cohesiveness, communication & trust • Facilitator addresses team member buy-in and family satisfaction • Updates are documented, logistics are addressed

  33. Wraparound Milwaukee • PHASE 4: • Plan Completion & Transition • Family Defines ‘Good Enough’ Transition to Informal & Natural Supports • Plans are made for transition out of formal Wraparound • Process & plan is modified to reflect ‘unwrapping’ • Team celebrates successes & work is documented • Transition portfolio is completed including • Important contacts • Past records • Follow-up plan for family

  34. Wraparound Milwaukee VALUES • One Family has One Plan • Build on strengths to meet needs • Families run their own plan • Best fit with culture &preferences • Community-based responsiveness • Increase parent choice &family independence • Care for children in context of families • Plans fail, families don’t • Hold people accountable • Unconditional approach • Never Give Up!

  35. Wraparound Milwaukee SERVICE STRUCTURES • Reflect Need, Rather than What is Funded • One electronic record, accessible to each service • Notes on time • Crisis teams have access to info after hours via computer • Contract people in, look for innovative people, not only clinicians • Each family gets 14 hours of direct service per month • Services purchased on fee for service basis • Consumers choose their own providers • Care coordination • Family advocacy

  36. Wraparound Milwaukee OUTCOMES • Does it Work, Can They Prove It? • Fewer kids in institutions or inpatient • Shorter stay when they do go in • 500 days of inpatient care compared to 5000 • 3,700 per month per child, compared to 8-9000 • School attendance increases • Academic achievement increases Is it as good as it sounds?

  37. Wraparound Milwaukee Miscellaneous Things that Stood Out • Care in context of family • If no family, then work on building a family • Family &youth partnerships—voice, choice &ownership • Care coordinators are key • 50% of plan should be informal services • Family advocacy is paramount

  38. Wraparound Milwaukee Family advocacy • Provided by Families United of Milwaukee • Build relationship with family • Support family to take active role in planning &decision making • Emphasiseimportance of voice, choice &ownership • Advocate with families in schools, courts, etc. • Coach families to partner with workers to effect change • Involved in Partnership Council • Welcoming families/Family Orientation • Training &coaching of providers • On quality committees, management team, review panels • Do whatever it takes!!!

  39. Wraparound Milwaukee CHALLENGES • According to a Panel of Service Partners • Engagement of families • Getting the right people at the table • Best practice among all systems—cross discipline • Meaningful sharing of information • Define each agencies roles &responsibilities • Education needs for young people • Different data management systems across agencies • Overlap of Wraparound Coordinator versus CYF Case Manager

  40. Wraparound Milwaukee CHALLENGES • Fairly Familiar • Drivers for NZ development of services • We know that children & families are central • Always working on improving the services we provide • Recognise that we are stronger when we work together

  41. The Concept of Technical Assistance Technical Assistance is the support offered to the System of Care to enable competence &confidence when partnering with infants, children &young people& their families/whanau, with mental health &/or AOD concerns

  42. Technical Assistance An Example • The Georgetown University Centre for Child &Youth Human Development • Partner with service-providers, government agencies, consumer &advocacy organisations& universities

  43. WHAT THEY DO • Continuing Education • Clinical Practicuum • Conferences • Workshops • Distance Learning • ‘Professional’ Preparation

  44. THEIR FOCUS System of Care Service Delivery Underpinned By: • Interdisciplinary strengths &evidence-based practice • Family Centred: Full partnership with families & youth • Community based • Culturally & linguistically competent • Effective Facilitative Leadership

  45. WHAT HAVE WE DEVELOPED?

  46. SYSTEM OF CARE NEW ZEALAND SYSTEMS New zealand systems • High & Complex Needs Funding • Individualised plan, multi-agency, buying services based on need • Strengthening Families • Child &family focused, family often guiding, multi agency • WhanauOra • Flexible, family at centre, navigator, service collectives • Plus Local Innovative Programs How would we develop our own System of Care?

  47. SYSTEM OF CARE NEW ZEALAND IMPLEMENTATION • Policy, Administrative, Regulatory Changes Needed • Cross-sector agreement to change delivery philosophy • Develop or Expand Services & Supports • Array of home &community, including CME • Creating or Improving Financial Strategies • Using existing funds creatively, useful doesn’t equal costly • Providing Training, Technical Assistance & Coaching • Sustainable, The Werry Centre &TePou, some DHBs • Generating Support • Families &youth, high level decision makers, providers etc

  48. SYSTEM OF CARE MULTIPLE LEVELS OF IMPLEMENTATION • Changes to State • Policies, financing, workforce development • Changes to Local System • Plan, implement, develop infrastructure, manage, evaluate • Changes to Service Delivery/Practice Level • Array of effective, evidence-informed treatments, services &supports to improve outcomes • Evaluation • Now consider this…

  49. Remember Josh?? • Josh, a Māori male aged 13, is referred to a specialist mental health service by his GP following concerns regarding his low mood & daily marijuana use. • He is the oldest of 2 children, having a 9 year old sister Kelsy. • Josh lives with his mother & sister. His father has had no contact with the family since Josh was an infant. • Both Josh’s parents have had personal histories of substance addictions, mood problems, family estrangement & social disadvantage.

  50. Josh and his whānau are referred to Wrap Around New Zealand • The service partners with Josh, his whānau and all of the services and agencies that are currently involved to develop a goals-based plan for Josh and is whānau • With their Wrap-around New Zealand Service co-ordinator, Josh and his whānau consider all of the options of across-sectoral service delivery, and decide upon their preferences for service delivery

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