THE SKILL BUILDING CURRICULUM Module 5 Planning, Governance and System Management

1. Primer Hands On-Child Welfare THE SKILL BUILDING CURRICULUM Module 5 Planning, Governance and System Management Developed by: Sheila A. Pires Human Service Collaborative Washington, D.C. In partnership with: Katherine J. Lazear Research and Training Center for Children’s Mental Health University of South Florida, Tampa, FL Lisa Conlan Federation of Families for Children’s Mental Health Washington, D.C.

2. Factors Influencing Group Process Adapted from The Pheiffer Book of Successful Team-Building Tools, Edited by Elaine Biech. 2001 by John Wiley & Sons, Inc.

3. Coming together is a beginning. Keeping together is progress. Working together is success. H. Ford Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative. (2004)

4. Planning Structure Issues • Leadership • Staffing • Time and place of meetings • Stakeholder involvement • Committees or work groups • Communication or dissemination of information • Outreach to broader constituencies • Outreach to and involvement of diverse and disenfranchised constituencies • Linkage to related reform/planning initiatives • Resources Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

5. Stages of Planning For Systems of Care STAGE 1: Form workgroup STAGE 2: Articulate mission STAGE 3: Identify goals and guiding principles STAGE 4: Develop the population context STAGE 5: Map resources and assets STAGE 6: Assess system flow STAGE 7: Identify outcomes and measurement parameters STAGE 8: Define strategies STAGE 9: Create and fine-tune the framework STAGE 10: Elicit feedback STAGE 11: Use framework to inform, plan evaluation, and technical assistance STAGE 12: Use framework to track progress and revise theory of change Hernandez, M. & Hodges, S. (2003). Crafting logic models for systems of care: Ideas into action. Tampa, FL: University of South Florida

6. Action Plan Political Strategy A Planning Process for Family and Children’s Service Reform Outcomes For Children and Families The System As It Is Now The System As It Should Be Principles Reinvestment Commitment Financing Options Multi Year Steps Leadership and Professional Development Strategy Cross Community Cross Agency Governance Strategy State County Community Combined Fiscal Program Strategy ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Friedman, M. (1994). Washington, D.C.: Center for the Study of Social Policy

7. Elements of Effective Planning Processes • Are staffed • Involve key stakeholders • Involve families and youth early in the process and in ways that are meaningful • Ensure meaningful representation of racially and ethnically diverse families and youth • Develop and maintain a multi-agency focus • Build on and incorporate related programmatic and planning initiatives • Continually seek ways to build constituencies, interest, and investment • Pay attention to sustainability and growth of system changes from day one Pires, S. (1991). State child mental health planning. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center of Children’s Mental Health.

8. Strategies for Involving Families and Youth in Planning • Share information about planning meetings by working with family/youth organizations and community agencies, such as Big Brothers/Big Sisters, Boys and Girls Clubs, Family Organizations, Family Preservation services agencies, etc. • Provide orientation/training for families/youth about current policies, plans and workgroups (i.e., CFSR plan, PIP workgroups). • Have involved family/youth leaders engage other families/youth to be involved. • Provide on-going mentorship/support (i.e., Family Service Workers engage youth/family to become involved in planning). • Hold planning meetings in the evenings/weekends, at community centers, schools, and recreation centers. • Conduct focus groups/interviews/surveys to solicit views of many families/ youth. • Pay stipends, transportation, child care; provide food. • Conduct facilitated sessions for planning group to explore attitudes about race, culture, families and youth. • Publicly acknowledge the contributions of individual families and youth. Adapted from: Emig, C., Farrow, F. & Allen, M. (1994). A guide for planning: Making strategic use of the family preservation and support services program. Washington, D.C.: Center for the Study of Social Policy & Children’s Defense Fund.

9. Cultural and Linguistic Competence in Planning • Conduct on-going assessments of the environment • Build support for change • Identify, acknowledge, engage, and partner with formal and informal leadership • Identify and develop needed resources and enhance leadership capacity • Articulate values, establish a mission, and set goals • Plan action steps in partnership with diverse families/youth and communities • Develop strategies to sanction or mandate the incorporation of cultural knowledge into policy making, infrastructure and practice. • Adapted from Cross, T., Bazron, B., Dennis, K., & Issacs, M. (1989). Towards a Culturally Competent System of Care Vol. 1. & NCCC

10. Cuyahoga County Planning Process Structure System of Care Oversight Committee Chaired by Deputy County Administrator for Human Services Includes a Broad Representative Stakeholder Group, e.g., major child serving systems, families and youth, Neighborhood Collaboratives, providers, researchers Cultural & Linguistic Competence Social Marketing Sustainability Family & Youth Involvement Evaluation & Research Training & Coaching Staffed by System of Care Office Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

11. Definition of Governance Decision making at a policy level that has legitimacy, authority, and accountability. Pires, S. (1995). Definition of governance. Washington, DC: Human Service Collaborative.

12. Definition of System Management Day-to-day operational decision making Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

13. Key Issues for Governing Bodies • Has authority to govern • Is clear about what it is governing • Is representative • Has the capacity to govern • Has the credibility to govern • Assumes shared liability across systems for target population Pires, S. (2000). Key issues for governing bodies. Washington, DC: Human Service Collaborative.

14. Examples of Types of Governance Structures • State and/or local interagency body • Non profit board of directors • Quasi governmental entity • Tribal government • Hybrids Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

15. Evolving Governance Structure Illustration 1.2A Policy Level Local Governing Board Agency Directors Family Advocacy Organizational Representative Operational Level DSS Director “Bring the Children Home” SOC Supervisor and Staff “Bring the Children Home” Service Managers Families Served Other Agency Workers BRING THE CHILDREN HOME STATE LEGISLATION Illustration 1.2B COUNTY EXECUTIVE Agency Directors Family/Youth Reps. DSS Director Providers Forum Local Governing Board SOC Team Leader “Bring the Children Home” Interagency Service Management Team Families/Youth Served Other Agency Workers “Bring the Children Home” Service Managers Pires, S. ( 2006). Evolving governance structure. Washington, DC: Human Service Collaborative.

16. System Management: Day-to-Day Operational Decision Making Key Issues • Is the reporting relationship clear? • Are expectations clear regarding what is to be managed and what outcomes are expected? • Does the system management structure have the capacity to manage? • Does the system management structure have the credibility to manage? Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

17. Examples of Types of System Management Structures • State and/or local interagency body • Quasi-governmental entity • Non profit lead agency • Public sector lead agency • For profit commercial managed care entity • Coalition management Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

18. Examples of Management Accountability Cuyahoga County Management Structure Sarasota Co. and Milwaukee Co. Management Structures Deputy County Administrator for Human Services Sarasota County Coalition for Families & Children System of Care Office Milwaukee Co. Division of Child Mental Health Subsets of Children & Families Involved in Child Welfare All children involved in child welfare Children in or at risk for residential placement Children with serious behavioral health challenges Subset of cw population Children in/at risk for RTCs Youth who are status offenders 0-3 population Early Intervention engagement challenges Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

19. Examples of Relationships Between Governance and Management Structures Cuyahoga County, OH Sarasota County, FL Locally-Based, Representative Governance Board & State/District Office Interagency Governing Body Contract Lead Public Agency: SOC Office Coalition Management Entity Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.

20. Example of Governance/Management Structure State Funding Pool Financer/ Payers Local Allocation County Alliance Purchaser Case Rate for each enrolled child • Care Management Entity • Organize and manage provider network • Staff and manage child and family team process • Care management, including case management and utilization management/utilization review • Quality assurance • Outcomes management /monitoring • Management Information System (tracks children, services, dollars) Provider Provider Provider Pires, S. (1996). Contracted system management structure. Washington, DC: Human Service Collaborative.

21. Examples of Types of Family/Youth Partnership in System Governance and Management • Input/evaluation of key management • Input/evaluation of quality of services and programs • Local system of care input • Resource allocation • Service planning and implementation • Policies and procedures • Grievance and resolution procedures Conlan, L. (2003). Implementing family involvement. Burlington, VT: Vermont Federation of Families for Children’s Mental Health.

22. Culturally Competent Management Structures • Hire from diverse communities • Incorporate quality improvement that addresses issues important to racial and ethnic communities (e.g., disparity and disproportionality) • Outreach to and engage racially/ethnically diverse stakeholders, other “minority populations” • Conduct cultural “self assessments” Pires, S. (2006). Primer Hands On – Child Welfare. Washington, D.C.: Human Service Collaborative.