Care Coordination & Child and Family Team Putting the pieces together for families

provided by Better Days Ahead2 Goals of this training: 1. To understand how Care Coordination relates to wraparound and providers. 2. To learn who might provide care coordination to you and your family. 3. To learn who the members are of a CFT. 4. To begin to learn the terminology and the method used for CFT. 5. To decide upon your next steps.

What is Wraparound? Wraparound is a philosophy used by care coordination (a type of program) for delivering services and supports by “wrapping them around” an individual child and family. The Child and Family Team (CFT) method is used by care coordination to provide wraparound. provided by Better Days Ahead3

What is Care Coordination An exciting new method of doing business which involves care coordinators and addresses the underlying needs that lead to big behavior. provided by Better Days Ahead4

What is a Care Coordinator? A care coordinator is an individual hired by a care coordination agency to facilitate a child and family team process that addresses needs by wrapping services and supports around an individual child and family. provided by Better Days Ahead5

Care Coordination in Monroe County Waiver Intensive Case Management (ICM) Supportive Case Management (SCM) Youth and Family Partnership (YFP) Receives federal funding. Receives state funding. Receives county funding. Highest need mental health service for children and families. Higher need mental health services for families than SCM, but lower than Waiver or do not qualify for Waiver. Families and children with less intensive needs than ICM, but still need more services than just therapy. Families that have children w/mental health needs that meet the specific program criteria. A high level of service. provided by Better Days Ahead 6

How Does Care Coordination fit with my referral to Waiver, ICM, SCM or YFP? Waiver, ICM, SCM and YFP are all programs designed to meet specific guidelines as designated by the Federal, State or County Office of Mental Health and which use the wraparound philosophy as part of a care coordination program for delivering those services. provided by Better Days Ahead7

Who provides Care Coordination in Monroe County? provided by Better Days Ahead8  Hillside’s Waiver  St. Joseph’s Villa’s Waiver  St. Joseph’s Villa’s ICM  St. Joseph’s Villa’s SCM  Youth and Family Partnership

provided by Better Days Ahead9 What is a Child and Family Team? A child and family team is a group of people chosen by the youth and family with the aid of the care coordinator to assist with the planning process. The family drives the process of choosing the members of this team.

provided by Better Days Ahead10 What is the role of the CFT? Identify the strengths of the family Determine needs, including immediate ones Discuss the culture of the family and how it will fit into the planning process Meet as needed to plan for success of the family

provided by Better Days Ahead11 Who are the members of the CFT? The youth and family The care coordinator Current service providers with approval from the youth and family Natural supports Others as determined by the team to address the need

provided by Better Days Ahead12 What is a Natural Support? A natural support is a person that can continue to support the child and family team even after formal supports go away. These are usually non paid persons.

provided by Better Days Ahead13 Who are Natural Supports? Natural supports include, but are not limited to the following:  Extended family members  Friends or neighbors  Religious leaders or others in the religious community  Sports coaches or other players  School personnel  Mentors

provided by Better Days Ahead14 The CFT Process CFT process is strength-based, individualized, and needs driven. CFT is a four phase process. CFT process is based on the premise that all behavior is communication of an unmet need; therefore the bigger the behavior the bigger the unmet need.

provided by Better Days Ahead15 CFT is a different process Old ProcessCFT Process Driven by what’s not workingDriven by what’s working Families were sometimes considered dysfunctional Families are considered to be functioning as well as they can Behaviors result from bad choicesBehaviors result from unmet need Professionals are the experts about everything Families are the experts about their family Service driven processNeeds driven process Services provided as available Needs drive services tailored to the family Provided services to help familyEmpowers family and teaches skills

provided by Better Days Ahead16 CFT is based on Wraparound CFT therefore follows the 10 principles of wraparound:  Family voice and choice  Culturally competent  Team based  Individualized  Natural supports  Strength based  Collaborative  Unconditional care  Community based  Outcome based

provided by Better Days Ahead17 The four phases of CFT Phase One : Engagement and Team Preparation You are introduced to your care coordinator and given the opportunity to get to know one another. Your care coordinator will begin with strengths, needs and a cultural discovery process. CFT meetings with the entire team don’t happen until phase two.

provided by Better Days Ahead18 The four phases of CFT Phase Two: Plan development Your care coordinator schedules an initial meeting that is convenient for you, your family, your natural supports and any necessary providers. The team will develop a hypothesis (a best guess about what the unmet need is for your child and family) and begin the planning process. The process used is called brainstorming which means to think quickly and creatively and not disregard any ideas for any reason.

provided by Better Days Ahead19 The four phases of CFT Phase Three: Plan implementation and fine tuning Team meetings are held to ask the question: How is the plan working? Adjust, fit, and fine tune the plan to meet the goal s.

provided by Better Days Ahead20 The four phases of CFT Phase Four: Plan completion and preparation for a change in care Check for “good enough” so you will know when you are done with the formal team process. Celebrate success! Say good bye. This is as important to finishing the process as getting to know each other was to the beginning of the process for our families. Often youth lose workers with no opportunity for closure. Take time to say goodbye.

provided by Better Days Ahead21 Today’s next step options Do nothing further and just wait for care coordination to start. Be connected with a family mentor from Better Days Ahead who can meet with you individually and teach you even more about the process and help prepare you for the start of care coordination.

provided by Better Days Ahead22 And then what? If you choose to just wait then nothing will happen until you are contacted by your care coordination agency. Some have an intake coordinator; some have paperwork that must be completed before the team process can begin.

provided by Better Days Ahead23 What if I choose a family mentor? We need permission today to contact you within the next week. That person can: Teach you more about the care coordination process. Work with you to identify natural supports. Assist you with getting needs met until care coordination begins. Continue as a support once care coordination begins if you so desire.

provided by Better Days Ahead24 Final comments or questions?