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Governance and System Management Track 1 – Early Developmental Stages Vickie Miene Vickie Miene NE Iowa NE Iowa

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Presentation on theme: "Governance and System Management Track 1 – Early Developmental Stages Vickie Miene Vickie Miene NE Iowa NE Iowa"— Presentation transcript:

1 Governance and System Management Track 1 – Early Developmental Stages Vickie Miene Vickie Miene NE Iowa NE Iowa Bruce Strahl Bruce Strahl TA Partnership TA Partnership Michelle Zabel University of Maryland Lisa Conlan Parent Support Network of Rhode Island

2 Governance and System Management Governance and System Management Lessons Learned from Iowa Vickie Miene

3 Building Governance Structure Keep the Principles Always Visible

4 Community Circle of Care Organizational Chart Iowa Department of Human Services Gary Lippe, Project Director State Level Resource Team of State Level Family Groups Public & Private Stakeholders Secretary II Arleen M. Wentworth Youth Coordinator Jill M. Kluesner Key Family Contact Gloria J. Klinefelter Principle Investigator and Technical Assistance Coordinator Vickie L. Miene, LMHC Data Collector Social Marketer tbh Secretary II Julie Peck Evaluation Manager Jennifer A. Cook Evaluation Associate Rob J. Fernandez Community Advisory Council & Planning Committee Family, Youth and Community Stakeholders Child Health Specialty Clinics Debra Waldron, M.D, MPH Director & Chief Medical Officer University of Iowa College of Public Health Thomas E. Vaughn Center for Disabilities and Development Robert Bacon, Director, Iowa’s University Center for Excellence on Disabilities State Local Liaison Secretary II Nicole Johnson Secretary II Jenna Lanser Secretary II Glynis Varney Parent Coordinators Tamara K. Lauritzen Parent Coordinator Mary Kay Lynch Parent Coordinator Linda L. Van Natta Parent Coordinator Billi Mitchell Oelwein/Decorah Deborah Bahe, ARNP Dubuque/Clinton Mary Drury, ARNP SAMHSA Funded Positions Pink: Fully Funded Positions Blue: 50% or Less Funded Positions White: Non-Funded Positions Social Worker 1 Dawn Milius Social Worker I Carol Hagen Melanie K. Tietz Oelwein Nurse Care Coordinator Brenda Carradus Decorah Nurse Care Coordinator Sarah A. Wanless Social Worker I Carol Lippe Dubuque Nurse Care Coordinator Shannon M. Hines Clinton Nurse Care Coordinator Sharon Kleppe Social Worker I Amber Ohsann Data Collector Cultural Competency Cord Harold Blatt Don Van Dyke, M.D. Clinical Consultant Bill Bowden, Finance Judy Stephenson, Human Resources Tara Levin psychologist Psychiatrists at UIHC – Tele-health Outreach/Support Parent Consultant

5 Child, family & community Population – C&Y ages 0-21 with behavioral & MH challenges -Strengths & needs drive service planningStrengths & needs drive service planning -Training & supports empower families -Services reflect & build on community context Child, family & community strategies -Family Team Process -Family-driven, youth guided services -Data informed planning & service delivery -Family support & empowerment Long-term outcomes -Improved child & family functioningImproved child & family functioning -fewer days hospitalizedfewer days hospitalized -better school performancebetter school performance System processes / procedures -Policy & regulation -Fiscal / Financial practices (reimbursement) -Cultural/social attitudes & understanding -Capacity for family and youth organization System strategies -Change rules & regulations -Data driven decisions & accountability -Increase family & youth Voice -Relationship building System level outcomes -Braided / blended funding -Increase system efficiency -Services are truly family & youth drivenServices are truly family & youth driven -Siloed systems will become a culture of collaborationSiloed systems will become a culture of collaboration -Increased sustainability Goal: Develop SOC infrastructure using a bottom up approach. Goal: Implement the mental health care component of the CMHI in Northeast Iowa. Short & intermediate outcomes -Increased awareness of MHIncreased awareness of MH services & supports -Attainment of plan goalsAttainment of plan goals -More access, options, & continuityMore access, options, & continuity -Service gaps identifiedService gaps identified Local, community & regional -Geography & distance -Socioeconomic status -Available service capacity -Cultural & historical traditions -Sense of community -Political will & collaboration -Social networks -Community diversity Local, community & regional -Expand service and support capacity -Communication & outreach -Develop youth & family capacity to inform local & regional service system development -Empowerment strategies Local, community & regional -Greater service and support capacityGreater service and support capacity -More access, options, & continuityMore access, options, & continuity -Increased collaborationIncreased collaboration -Increased awareness of mental health optionsIncreased awareness of mental health options -Families, youth and community leaders are fully involvedFamilies, youth and community leaders are fully involved Point of entry characteristics -Service capacity -Administrative culture, rules, regulation, service hours, etc. -Differential access and services by agency, school or school district -Staff characteristics, education & training Point of entry strategies -Navigation team & wraparound process -Data drive service provision -Timely access to services -Implement family advocate models -Ongoing staff training & development -Communication & outreach -Supports to ‘non’ MH system partners Point of entry outcomes -Full continuum available -Efficient, effective services -Enhanced service quality -Continuity of care assured -Increased staff competencies -Increased awareness among providers & familiesIncreased awareness among providers & families Long-term outcomes -Increased family satisfactionIncreased family satisfaction -Increased provider satisfactionIncreased provider satisfaction

6 6 Building Local Systems of Care: Strategically Managing Complex Change Human Service Collaborative. (1996). Building local systems of care: Strategically managing complex change. [Adapted from T. Knosler (1991), TASH Presentations]. Washington: DC.

7 Community Circle of Care CQI Process 10 County Planning Committee BDF Advisory Group CCC Staff Member Parent/youth Members Community Members Dubuque Advisory Group CCC Staff Member Parent/youth Members Community Members HAWC Area Advisory Group CCC Staff Members Parent/Youth Members Community Members Clinton/Jackson Advisory Group CCC Staff Member Parent/youth Members Community Members Local Care Coordination Staff Individual Family Team Meetings led by Care Coordinators Team Meetings led by ARNP CCC All Staff Meetings

8 Governance and System Management Track 1 – Early Developmental Stages Bruce Strahl Technical Assistance Partnership

9 SOC Governance is Different, it is more about Creating opportunities for partnership and collaboration Creating opportunities for partnership and collaboration Transformation Transformation Connecting to state initiatives Connecting to state initiatives Influencing policy Influencing policy Building for sustainability Building for sustainability “Barrier busting” “Barrier busting” Giving family and youth a voice Giving family and youth a voice Modeling SOC values Modeling SOC values Building a broad based community system and ensuring the understanding by all that the funding is for the children, families and youth Building a broad based community system and ensuring the understanding by all that the funding is for the children, families and youth

10 Critical Characteristics of SOC Governance Balanced-true sharing of responsibility, power and authority Balanced-true sharing of responsibility, power and authority Inclusive-with significant and authentic decision making roles for all who desire a role Inclusive-with significant and authentic decision making roles for all who desire a role Broad-many places available to be a part of decision making for family, youth state and community partners Broad-many places available to be a part of decision making for family, youth state and community partners Defined-roles concise, clear and understandable Defined-roles concise, clear and understandable Simple Simple

11 Governance Characteristics (continued) Culturally and linguistically competent Culturally and linguistically competent Clear communications flow and work flow and easily explainable to all stakeholders with diagram Clear communications flow and work flow and easily explainable to all stakeholders with diagram Efficient and effective Efficient and effective Clear roles and procedures for decision making Clear roles and procedures for decision making Responds quickly but also accommodates a more deliberate approach when needed Responds quickly but also accommodates a more deliberate approach when needed

12 STAKEHOLDERS MEETING EVERY OTHER MONTH Full Partnership Facilitator Agenda  2 Framed Major Challenges  Work Group Meet  Work Group (Some) Report Progress  Agency Pitch – Networking Memorandum of Agreement WG Odd Number Group PD, PI, Community Leaders, Lead Family, Family Member, Youth, Policy Makers, Lead Evaluator Role  Frame Major Strategic challenges to go to full partnership  Set agenda for full partnership meeting  Model SOC principles  Barrier busting  Conscience of SOC, Cultural competency, family inclusion, collaboration  Help the PD  Model Change  Do It 1 st  High Standard of Care/Quality Administrative Team  Grant Requirements  Grant Administration  Staffing  Budget  Quality Decisions  Broad SOC Community Strategy  Intake System  Social Marketing  Referrals to Community Services  Participation in Child & Family Teams  Family Involvement Coordinating Committee Standing or Ad Hoc OK Send a Work Group Out Broad Based Governance System

13 Avoiding Governance Pitfalls This is not a mental health project! It is a challenge for MH to not own it to the exclusion of others This is not a mental health project! It is a challenge for MH to not own it to the exclusion of others Make sure all the system development work is not done by SOC employees-partners must share equally in “building” and “carrying the load” Make sure all the system development work is not done by SOC employees-partners must share equally in “building” and “carrying the load” Fiduciary agency is not the “lead agency”. The fiduciary agency should have no additional decision making beyond it’s assigned role in the governance system Fiduciary agency is not the “lead agency”. The fiduciary agency should have no additional decision making beyond it’s assigned role in the governance system

14 Avoiding Governance Pitfalls Input is not involvement! Beware of: “we got their input, we will put it together”, “we will run it by them”, “they should feel engaged, they participated in a focus group” Input is not involvement! Beware of: “we got their input, we will put it together”, “we will run it by them”, “they should feel engaged, they participated in a focus group” Avoid advisory groups Avoid advisory groups For care teams, coordinators, wrap supervisors stationed in partner agencies, dual supervision takes extra time, communications and coordination For care teams, coordinators, wrap supervisors stationed in partner agencies, dual supervision takes extra time, communications and coordination

15 Governance and System Management Track 1 – Early Developmental Stages Michelle Zabel University of Maryland

16 Regional Care Management Entities A CME is a structure that serves as a “locus of accountability” for youth with complex needs and their families. A CME is a structure that serves as a “locus of accountability” for youth with complex needs and their families. Provide Supports to Youth and Families: Provide Supports to Youth and Families: Child Family Team Facilitation using Wraparound Service Delivery Model Child Family Team Facilitation using Wraparound Service Delivery Model Care Coordination using Standardized Assessment Tools Care Coordination using Standardized Assessment Tools Care Monitoring and Review Care Monitoring and Review Peer Support Partners Peer Support Partners

17 Regional Care Management Entities Provide System Level Functions: Provide System Level Functions: Information Management & Web-based Information System Information Management & Web-based Information System Provider Network Recruitment and Management Provider Network Recruitment and Management Utilization Review of Service Use, Cost, and Effectiveness Utilization Review of Service Use, Cost, and Effectiveness Evaluation and Continuous Quality Improvement Evaluation and Continuous Quality Improvement Cross-System and Jurisdiction Financing Cross-System and Jurisdiction Financing Populations to Be Served: Populations to Be Served: 1915(c) Psychiatric Residential Treatment Facilities (PRTF) Demonstration Project Medicaid Waiver 1915(c) Psychiatric Residential Treatment Facilities (PRTF) Demonstration Project Medicaid Waiver SAMHSA funded SOC grants – MD CARES and Rural CARES SAMHSA funded SOC grants – MD CARES and Rural CARES Child Welfare’s Place Matters Group Home Diversion using Resource Coordinators Child Welfare’s Place Matters Group Home Diversion using Resource Coordinators Other Out-of-Home Diversion using Care Coordination Other Out-of-Home Diversion using Care Coordination


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