1. Overview of Systems of Care Susan Steckel, MSSW Early Connections Network Director Tennessee Department of Mental Health Tennessee Prevention Advisory Council Meeting, January 25, 2011

2. System of care is, first and foremost, a set of values and principles that provides an organizing framework for systems reform on behalf of children, youth and families. Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

3. HISTORY of SYSTEMS of CARE… The Systems of Care framework grew out of the work of the Child and Adolescent Service System Program (CASSP) in the field of children’s mental health. CASSP emerged in the mid 1980’s as a result of national recognition that the needs of youth with serious emotional disabilities were not being adequately met. In 1986, Stroul and Freidman proposed a system of care philosophy as a solution to these systemic problems. This framework is based on a set of guiding values and principles that establishes a foundation upon which to build systems of care.

4. Core Values and Principles Family-driven, child-centered and youth- guided Culturally and linguistically competent Individualized and Community-based Evidence Based Practice Interagency collaboration Continuous Quality Improvement (CQI)

5. A SYSTEM of CARE Is… Education Families Child welfare Mental health and substance abuse professionals Early childcare providers Primary health care Faith-based organizations Other community organizations and governmental agencies A community partnership among families, youth, schools, and public and private organizations. Partners may represent:

6. A system of care incorporates a: broad, flexible array of services and supports for a defined population organized into a coordinated network integrates care planning and management across multiple levels culturally and linguistically competent builds meaningful partnerships with families and youth at service delivery, management, and policy levels, has supportive policy and management infrastructure. Definition of a SYSTEM of CARE Pires, S. (2010). Building systems of care: A primer. 2nd edition. Washington, D.C.: Human Service Collaborative.

7. Characteristics of Systems of Care as Systems Reform Initiatives FROM Fragmented service delivery Categorical programs/funding Limited services Reactive, crisis-oriented Focus on “deep end,” restrictive Children out-of-home Centralized authority Creation of “dependency” TO Coordinated service delivery Blended resources Comprehensive service array Focus on prevention/early intervention Least restrictive settings Children within families Community-based ownership Creation of “self-help” Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

8. Planning Decision Making & Oversight at the Policy Level System Management Benefit Design/Service Array Evidence-Based Practice Outreach and Referral System Entry/Access Screening, Assessment & Evaluation Decision Making & Oversight at the Service Delivery Level –Care Planning –Care Authorization –Care Monitoring and Review Care Management or Care Coordination Crisis Management at the Service Delivery & Systems Levels Utilization Management Family Involvement, Support & Development at all Levels Youth Involvement, Support & Development Staffing Structure Staff Involvement, Support & Development Orientation and Training of Key Stakeholders External and Internal Communication Provider Network Protecting Privacy Ensuring Rights Transportation Financing Purchasing/Contracting Provider Payment Rates Revenue Generation and Reinvestment Billing and Claims Processing Information Management Quality Improvement Evaluation System Exit Technical Assistance and Consultation Cultural Competence Pires, S. (2002).Building Systems of Care: A Primer. Washington, D.C.: Human Service Collaborative. Potential System of Care Functions

9. What is the EARLY CONNECTIONS NETWORK? A six-year federally funded early childhood System of Care initiative in Middle Tennessee to serve young children birth-5 years with social, emotional, and behavioral needs in Cheatham, Dickson, Montgomery, Robertson and Sumner Counties.

10. What is the EARLY CONNECTIONS NETWORK? The ECN will be administered by the Tennessee Department of Mental Health and operated locally through a broad based public-private partnership of the Division of Special Populations, Tennessee Voices for Children, Centerstone of Tennessee, Centerstone Research Institute, families, and local and regional stakeholders.

11. Build a System of Care for young children (ages 0-5) with social, emotional and behavioral needs; Bring together families, caregivers, teachers, providers, governmental agencies and natural supports in the promotion of healthy development; Strengthen community based, family-driven and culturally and linguistically competent efforts to prepare children for school and for life; Have a special focus on working with the children and families of military service members. What is the PURPOSE of the ECN SYSTEM of CARE?

12. Develop a System of Care for young children with social, emotional and/or behavioral needs and their families in Cheatham, Dickson, Montgomery, Robertson and Sumner Counties. Provide child-centered, family-driven, high-fidelity Wraparound to young children and their families. Reduce the stigma associated with early childhood mental health needs. Increase community awareness of the importance of responding to those needs early and effectively. Improve outcomes for young children with significant behavioral or relational symptoms related to trauma, parent/child interaction difficulties or impaired social emotional development. Provide training for providers, families and community members about evidence- based practices to effectively address early childhood mental health and social emotional needs. Develop a seamless early childhood System of Care using a public health model for replication in other areas of the state. What are the GOALS of the ECN SYSTEM of CARE?

13. Wraparound is a practice approach for the planning and provision of services and supports that can be applied to any population of children and families with or at risk for intensive service needs – not just to those with the most serious and complex problems. Wraparound puts system of care values and principles into practice for service planning and provision. What is WRAPAROUND?

14. Children (ages 0-5) living in Cheatham, Dickson, Montgomery, Robertson or Sumner Counties. Children must have significant behavioral or relational symptoms or be identified as being at imminent risk for developing a mental health or serious emotional disorder. Children with impaired functioning at home, school and community that requires involvement with multiple service agencies. Children at risk of placement to a higher level of care (inpatient hospitalization, residential treatment or state’s custody for treatment). Parent or caregiver willing to participate in the wraparound process. Who is ELIGIBLE?

15. The ECN will be building the local infrastructure for the ECN from October 2010 – October 2011, through the development of public- private partnerships led by local families and stakeholders. Many agencies and individuals are needed to build and support the ECN as a successful System of Care for early childhood mental health. Working together through a broad-based governance structure, agencies and individuals will provide oversight of and make decisions about all aspects of ECN planning, implementation, and sustainability. How can I get INVOLVED?

16. Governance partners will be involved in: Strategic system planning Facilitating state and local collaborative partnerships Identifying community needs and working to resolve system- wide barriers Access to effective and age appropriate services for infants and young children Enhanced interagency collaboration Promotion and practice of System of Care values and principles Continuous Quality Improvement (CQI) Goal is to begin enrolling families in Wraparound October 2011 How can I get INVOLVED?

17. Contact information for the EARLY CONNECTIONS NETWORK: Susan (Sukey) Steckel, MSSW Early Connections Network Director Tennessee Department of Mental Health 425 5 th Avenue, North 5 th Floor, Cordell Hull Building Nashville, Tennessee 37243 615.253.8377 or 615.943.1141 Susan.Steckel@tn.gov THANK YOU!