1、1,THE SKILL BUILDING CURRICULUMModule 7 Service Array and Financing,Developed by: Sheila A. Pires Human Service Collaborative Washington, D.C.In partnership with: Katherine J. Lazear Research and Training Center for Childrens Mental Health University of South Florida, Tampa, FL Lisa Conlan Federatio
2、n of Families for Childrens Mental Health Washington, D.C.,Primer Hands On-Child Welfare,2,Medicaid is the primary source for health/mental health care for children in child welfare. Most states (86%) are applying managed care approaches to their Medicaid programs.,Why Focus on Medicaid Managed Care
3、?,Health Care Reform Tracking Project 2003 State Survey. Research and Training Center for Childrens Mental Health, University of South Florida, Tampa, FL,3,Children in Child Welfare in Medicaid Managed Care,HMO Enrollment: 245,313BHO Enrollment: 174,584 _ Total Enrollment: 419,897,Source: CMS/MSIS S
4、tate Summary Data, FY 2003,53% - 72% of foster care population is enrolled in Medicaid managed care ,Pires, S. (2006). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,4,State Coverage of Child Welfare Population in Medicaid Managed Care,26 states include the child welfa
5、re population in Medicaid managed care 22 with mandatory enrollment 4 with voluntary enrollment,Source: Health Care Reform Tracking Project 2003 State Survey,Pires, S. (2002). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,5,NRCOI Framework for a Full Service Array in
6、Child Welfare,Assessment of Current Practices in the Jurisdiction as They Relate to Building Specified, Needed Child Welfare Capacities. Assessment of Current Leadership and Systemic Culture in the Jurisdiction as They Relate to Building Specified, Needed Child Welfare Capacities. Assessment of Curr
7、ent Services in the Jurisdiction as They Relate to Building Specified, Needed Child Welfare Capacities. Assessment of the Need for Other Services Not Currently Available in the Jurisdiction as They Relate to Building Specified, Needed Child Welfare Capacities.,“Collaborative, strategic, population-f
8、ocused process, guided by set of tools, to identify array of practices, services, and supports needed in a SOC for child welfare populations”,Preister, S. 2005. Assessing and enhancing the service array in child welfare. University of Southern Maine: National Child Welfare Resource Center for Organi
9、zational Improvement,6,Purposes of NRCOI Framework,Create a service directoryPrepare for the CFSR, the Statewide Assessment, and in developing the PIP re the service arrayMeet CAPTA requirement to conduct annual inventoryHelp define array of services needed in SOC when specific target population has
10、 been chosenIdentify gaps and strategies to improve service arrayCan lead to better collaboration among providers and a better functioning community collaborative,Examples Pulaski, Co., Virginia Nebraska 14-county rural area,Preister, S. 2005. Assessing and enhancing the service array in child welfa
11、re. University of Southern Maine: National Child Welfare Resource Center for Organizational Improvement,7,PRIMER HANDS ON- CHILD WELFAREHANDOUT 7.1 National Child Welfare Resource Center for Organizational Improvement: Service Array Frameworkwww.nrcoi.org,Primer Hands On - Child Welfare (2007),8,Daw
12、n Services & Supports,2005 CHIOCES, Inc., Indianapolis, IN,9,Programs Addressing Safety - Abuse-Focused Cognitive Behavioral Therapy (AF-CBT) - AMEND, Inc. (Abusive Men Exploring New Directions) - Child Parent Psychotherapy for Family Violence (CPP-FV): Domestic Violence Rated - Project Connect - Ch
13、ild Parent Psychotherapy for Family Violence (CPP-FV) Trauma Treatment Rated - Project SafeCare - Domestic Abuse Intervention Project (DAIP) - Nurturing Parenting Programs - Project SUPPORT - Intensive Reunification Program (IRP) Motivational Interviewing (MI) - Nurturing Program for Families in Sub
14、stance Abuse Treatment and Recovery - Parent-Child Interaction Therapy (PCIT) - Self-Motivation Group (SM Group) - Shared Family Care (SFC) - Supported Housing Program (SHP) - The Community Advocacy Project - Triple P Positive Parenting Program Programs Addressing Permanency HOMEBUILDERS - Intensive
15、 Reunification Program (IRP) - Project CONNECT - Shared Family Care Programs Addressing Well-Being 1-2-3 Magic: Effective Discipline for Children 2-12 - Abuse-Focused Cognitive Behavioral Therapy -Alcoholics Anonymous (A.A.) - AMEND, Inc. (Abusive Men Exploring New Directions) - Child Parent Psychot
16、herapy for Family Violence (CPP-FV): Domestic Violence Rated - Child Parent Psychotherapy for Family Violence (CPP-FV): Trauma Treatment Rated - Community Reinforcement + Vouchers Approach (CRA + Vouchers) - Community Reinforcement Approach - Domestic Abuse Intervention Project (DAIP) - Eye Movement
17、 Desensitization and Reprocessing (EMDR) - Intensive Reunification Program (IRP) - Motivational Interviewing (MI)Nurturing Parenting Programs - Nurturing Program for Families in Substance Abuse Treatment and Recovery - Parent-Child Interaction Therapy (PCIT) - Parenting Wisely - Project CONNECT - Pr
18、oject SUPPORT - Self-Motivation Group (SM Group) - Shared Family Care (SFC) - STEP: Systematic Training for Effective Parenting - Supported Housing Program (SHP) - The Community Advocacy Project - The Incredible Years Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) - Triple P Positive Parenting
19、 Program,Examples of Evidence Based Practices Related to CFSR Outcomes,California Evidence-Based Clearinghouse at: http:/www.cachildwelfareclearinghouse.org,10,Examples of Other Services Youd Want to Provide Based on Practice/Family Experience & Outcomes Data,Family Group Decision Making Wraparound
20、Integration of natural helping networks Intensive in-home services (not just MST) Respite services Mobile response and stabilization services Independent living skills and supports Family/youth education and peer support,Pires, S. 2005. Building systems of care. Human Service Collaborative. Washingt
21、on, D.C.,11,Examples of What You Dont See Listed as Evidence-Based Practice (though they may be standard practice),Residential Treatment Group Homes Day Treatment Traditional office-based “talk” therapy,Pires, S. 2005. Building systems of care. Human Service Collaborative. Washington, D.C.,12,Exampl
22、es from Hawaiis List of Evidence Based Practices,HA Dept. of Health, Child & Adolescent Division (2005). Available from: http:/www.hawaii.gov/health/mentalhealth/camhd,13,PRIMER HANDS ON- CHILD WELFAREHANDOUT 7.2Examples of Potentially Harmful Programs and Effective AlternativesSource: Dodge, K., Di
23、shion, T., & Lansford, J. (2006). “Deviant Peer Influences in Intervention and Public Policy for Youth,” Social Policy Report, Vol. XX, No. 1, January 2006. As published in Youth Today: The Newspaper on Youth Work, Vol. 15, No. 7. www.youthtoday.org,Primer Hands On - Child Welfare (2007),14,Challeng
24、es to Financing and Implementing Evidence-Based/Promising Practices,Financing & Infrastructure needed for: Training ConsultationCoaching Provider Capacity Development Fidelity Monitoring Outcomes Tracking,Pires, S. 2005. Human Service Collaborative. Washington, D.C.,15,How to Finance/Implement Evide
25、nce-Based and Promising Practices,Adopt a Population Focus: Who are the populations of families and youth for whom you want to change practice/outcomes? Adopt a Cross-Systems Approach: What other systems serve these children and families? Who controls potential or actual dollars? Which systems now s
26、pend a lot on restrictive levels of care with poor outcomes or on deficit-based assessments not linked to effective services - opportunities for re-direction? Identify Incentives and Supports to finance/implement evidence based practices,Pires, S. 2005. Human Service Collaborative. Washington, D.C.,
27、16,Examples of Incentives to Various Systems Serving Children and Families,Medicaid: slowing rate of growth in inpatient, emergency room, residential treatment and pharmacy costs Child Welfare: meeting Adoptions and Safe Families Act outcomes; reducing out-of-home placements Juvenile Justice: creati
28、ng alternatives to incarceration Mental Health: more effective delivery system Education: reducing special education expenditures,Pires, S. 2005. Human Service Collaborative. Washington, D.C.,17,Examples of Cross-System Partnerships to Finance and Implement Evidence-Based and Promising Practices,Pir
29、es, S. 2005. Human Service Collaborative. Washington, D.C.,District of Columbia Multi Systemic Therapy (MST), Mobile Response, In-Home,Medicaid Rehab Option to pay for MST, Intensive Home-Based Services (Ohio model), Mobile Response and Stabilization Services (NJ model),Child Welfare provided match
30、and paid for initial training, coaching, provider capacity development;,Mental health/child welfare to share costs of outcomes tracking,Juvenile Justice also to pay match, training costs as well,Medicaid HMO expressing interest in Mobile Crisis,18,Service Array Focused on a Total Population,Family S
31、upport Services Youth Development Program/Activities Service Coordination Intensive Service Management Wraparound Services Family Group Decision Making,Pires, S. & Isaacs, M. (1996, May) Service delivery and systems reform. Training module for Annie E. Casey Foundation Urban Mental Health Initiative
32、 Training of Trainers Conference. Washington, DC: Human Service Collaborative.,Core Services Prevention Early Intervention Intensive Services,Universal Targeted,19,Driven by family/youth-preferred choices; Understands the needs/help-seeking behaviors of youth/families; Embraces principles of equal a
33、ccess/non-discriminatory practices; Designs/implements services and supports that are tailored or matched to the unique needs of children, youth, families, organizations and communities served; Recognizes well-being crosses life domains; Understands that cultural competence must be defined and requi
34、red for Evidence Based Practices (EBP), and that Practice Based Evidence (PBE) must be taken into consideration as a critical component of EBPs in communities of color.,Lazear, K. J Primer Hands On Human Service Collaborative, Washington, DC. 2006,Characteristics of a Culturally and Linguistically C
35、ompetent Service Design & Practice,20,Families and Youth Provide Valuable Services and Supports,As technical assistance providers & consultants Training Evaluation Research Support Outreach,As direct service providers Foster Parents Mentors Service Coordinators Family Educators Specific Program Mana
36、gers (respite, etc),Adapted from Wells, C. (2004). “Primer Hands On” for Family Organizations. Human Service Collaborative: Washington, D.C.,21,Family and Youth Roles in Building Evidence-Based Practice (EBP),Advocate for ethical, culturally sensitive research Participate in the development and anal
37、ysis of research to support EBP Assist in data collection to support EBP Educate families, family leaders and youth about EBP,Wells, C. & Pires, S. (2004). “Primer Hands On” for Family Organizations. Human Service Collaborative: Washington, D.C.,22,Examples of Strategies to Address Lack of Home and
38、Community-Based Services,Support family and youth movements Engage natural helpers and culturally diverse communities Implement a meaningful Medicaid rehab option Write child and family appropriate service definitions Collapse out-of-home and home and community-based budget structures Re-direct doll
39、ars from out-of-home to home and community-based Implement flexible rate structures (e.g., bundled rates/case rates) Implement pilots or phase in system change,Pires, S. 2005. Building systems of care. Human Service Collaborative. Washington, D.C.,23,Implement capacity-building grants Implement perf
40、ormance-based contracts Develop practice and implementation guidelines Train providers, judges, families, etc. use training resources across systems Implement quality and utilization management Apply for federal demonstration grants Collect data on child and family outcomes, family/youth satisfactio
41、n, and cost/benefits Educate key constituencies (e.g., legislators, Governors Office, State Insurance Commissioner),Pires, S. 2005. Building systems of careHuman Service Collaborative. Washington, D.C.,Examples of Strategies to Address Lack of Home and Community-Based Services,24,Examples of Sources
42、 of Funding for Children/Youth with Individualized Needs in the Public Sector,Pires, S. (1995). Examples of sources of funding for children & families in the public sector. Washington, DC: Human Service Collaborative.,Medicaid Medicaid In-Patient Medicaid Outpatient Medicaid Rehabilitation Services
43、Option Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT) Targeted Case Management Medicaid Waivers TEFRA Option,Substance Abuse SA General Revenue SA Medicaid Match SA Block Grant,Juvenile Justice JJ General Revenue JJ Medicaid Match JJ Federal Grants,Mental Health MH General Revenu
44、e MH Medicaid Match MH Block Grant,Child Welfare CW General Revenue CW Medicaid Match IV-E (Foster Care and Adoption Assistance) IV-B (Child Welfare Services) Family Preservation/Family Support,Education ED General Revenue ED Medicaid Match Student Services,Other TANF Childrens Medical Services/Titl
45、e V Maternal and Child Health Mental Retardation/ Developmental Disabilities Title XXI-State Childrens Health Insurance Program (SCHIP) Vocational Rehabilitation Supplemental Security Income (SSI) Local Funds,25,Major Child Welfare Funding Streams,Child Welfare Services Title IV-B Foster Care & Adop
46、tion Assistance Title IV-E Social Services Block Grant Temporary Assistance to Needy Families (TANF) Medicaid Title IX State and local general revenue,Pires, S. (2006). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,26,Advantages and Drawbacks of Specific Child Welfare
47、 Financing Streams,Pires, S. (2006). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,27,Creating “Win-Win” Scenarios,System of Care,Child Welfare,Alternative to out-of-home care high costs/poor outcomes,Juvenile Justice,Alternative to detention-high cost/poor outcomes,M
48、edicaid,Alternative to Inpatient/Emergency Room-high cost,Special Education,Alternative to out-of-school placements high cost,Pires, S. (2006). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,28,Thinking Across Systems Serving Children, Youth and Families,Pires, S. (200
49、6). Primer Hands On Child Welfare. Washington, D.C.: Human Service Collaborative.,29,Financing Strategies to Support Improved Outcomes for Children, Youth and Families,FIRST PRINCIPLE: System Design Drives Financing,Friedman, M. (1995). Financing strategies to support improved outcomes for children. Washington, DC: Center for the Study of Social Policy.,30,What Are the Pooled Funds?,Wraparound Milwaukee. (2002). What are the pooled funds? Milwaukee, WI: Milwaukee Count Mental Health Division, Child and Adolescent Services Branch.,
