Innovation in Monroe County Jody Levison-Johnson Director Child & Family Service Quality & System Development Coordinated Care Services, Inc. Technical Assistance Coordinator Monroe County ACCESS Presentation to the Building Bridges Innovative Practices Workgroup July 19, 2007

Monroe County, New York Upstate New York Upstate New York City of Rochester and surrounding area City of Rochester and surrounding area County Population: 735,343 County Population: 735,343 City Population: 219,773 City Population: 219, school districts 19 school districts County driven system County driven system

Monroe County context Phase V funded system of care community (2005) Phase V funded system of care community (2005) Collaborative efforts prior to cooperative agreement funding primarily between: Collaborative efforts prior to cooperative agreement funding primarily between: –Office of Mental Health (mental health) –Child & Family Services (child welfare) –Office of Probation-Community Corrections (juvenile justice) –Coordinated Care Services, Inc.

Coordinated Care Services, Inc. – History Management services organization Management services organization Originally incorporated in 1984 Originally incorporated in 1984 Administered NYS demonstration project on local management & financing of mental health services Administered NYS demonstration project on local management & financing of mental health services –Service planning –Evaluation –Community-wide information system –Alternative financing strategies including capitation plan for adults with serious and persistent mental illness Reorganized in 1992 to become CCSI Reorganized in 1992 to become CCSI

Coordinated Care Services, Inc. – Current Departments: Departments: –Child & Family Service Quality & System Development –Adult Service Quality & System Development –Evaluation & Services Research (including Data Analysis) –Cultural & Linguistic Competence –Financial Services

Coordinated Care Services, Inc. – Current Contract manager for the Monroe County Office of Mental Health Contract manager for the Monroe County Office of Mental Health Project Management/Administration for several Monroe County initiatives including: Project Management/Administration for several Monroe County initiatives including: –Family Access & Connection Team (integrated entry point to care) –Youth & Family Partnership (care coordination) Technical assistance and consulting across NYS and in other communities in key service areas Technical assistance and consulting across NYS and in other communities in key service areas

The First Step Integrated and Innovative Care Coordination

The impetus Silos which led to: Silos which led to: –Confusion –Frustration –Duplication –Complication –Competition Family Voice: Keep it simple Family Voice: Keep it simple

The mandates Family safety Family safety Permanency Permanency Community safety Community safety Personal safety Personal safety Emotional health and well-being Emotional health and well-being Family voice and choice Family voice and choice

Youth & Family Partnership Innovative cross-system wraparound initiative using child and family team process Innovative cross-system wraparound initiative using child and family team process Created prior to receiving SAMHSA funding Created prior to receiving SAMHSA funding Redeployed staff Redeployed staff –Mental Health –Child Welfare –Juvenile Justice Initially 25 child/family pilot Initially 25 child/family pilot Comprehensive evaluation to demonstrate outcomes Comprehensive evaluation to demonstrate outcomes Expanded to serve 100 children and families Expanded to serve 100 children and families

YFP Program Model Cross-trained care coordinators carry out requirements of each department Cross-trained care coordinators carry out requirements of each department Serve as facilitator of child and family team process Serve as facilitator of child and family team process –Identify strengths –Identify and prioritize needs –Brainstorm options (traditional and non- traditional responses) –Family driven/youth guided –Respect for family culture

Successes Development of learning organization Development of learning organization Paved the way for future collaboration Paved the way for future collaboration Provided foundation for SOC grant application Provided foundation for SOC grant application CQI processes in place CQI processes in place Significant County cost savings Significant County cost savings Family satisfaction Family satisfaction Family functional improvements Family functional improvements

YFP outcomes Improvements in Functioning

YFP outcomes Family Satisfaction Y1Y2Y3 Family reported overall satisfaction 76%82%86% Family reported improvement 81%88%81% Family would recommend YFP 80%91%84%

YFP outcomes Fiscal

Challenges Integration of roles & staff re-training Integration of roles & staff re-training Adjustment in family thinking Adjustment in family thinking Moving from paternalistic to fiduciary Moving from paternalistic to fiduciary Real collaboration = real conflict Real collaboration = real conflict Working in a vacuum Working in a vacuum Fidelity Fidelity Providing the right types of support Providing the right types of support

The Next Step Integrated and Innovative Residential Care

The impetus Youth and families in YFP needing: Youth and families in YFP needing: –Stabilization –Time away –Focused intervention –Intensity of milieu County placement rates remaining high County placement rates remaining high

The mandates Family safety Family safety Community safety Community safety Personal safety Personal safety Emotional health and well-being Emotional health and well-being Family voice and choice Family voice and choice Community team Community team

CFT Driven Residential One provider agreed to serve as pilot/demonstration site One provider agreed to serve as pilot/demonstration site Concurrent enrollment in residential care and community-based care coordination Concurrent enrollment in residential care and community-based care coordination Child and family team drives plan of care including all service and support decisions Child and family team drives plan of care including all service and support decisions Emphasis on short-term stay for a specific purpose Emphasis on short-term stay for a specific purpose Attempting to turn residential inside-out Attempting to turn residential inside-out

Successes County-Provider partnership County-Provider partnership Testing new waters collaboratively Testing new waters collaboratively Placements closer to home Placements closer to home Active connection between youth and families while in placement Active connection between youth and families while in placement Foundation for planned efforts to redefine residential Foundation for planned efforts to redefine residential Families have experienced success Families have experienced success

Challenges Staff role changes and re-training Staff role changes and re-training Adjustment in family thinking Adjustment in family thinking Moving from paternalistic to fiduciary Moving from paternalistic to fiduciary Real collaboration = real conflict Real collaboration = real conflict Working in a vacuum Working in a vacuum Fidelity Fidelity Providing the right type of support Providing the right type of support

Challenges (continued) Regulations and requirements of funders and accreditors Regulations and requirements of funders and accreditors –Unbundling of services –Balancing value of treatment milieu with individualized care

Questions and Comments

Contact Information Jody Levison-Johnson, LCSW Director Child & Family Service Quality & System Development Coordinated Care Services, Inc. and Technical Assistance Coordinator Monroe County ACCESS 1099 Jay Street, Building J Rochester, NY (585)