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Page.Volume VII: A Compilation of Lessons Learned from the 22 Grantees of the 1997 Comprehensive Community Mental Health Services for Children and Their Families Program
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Family Involvement/Family Empowerment
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INTRODUCTION | |
Designing systems of care to
serve children and adolescents with serious mental, emotional, and behavioral disorders
and their families within the context of the environment in which many of our
child-serving systems operate can be an extremely daunting task. Eleanor Roosevelt
described what could be the "root" of the problem this way:
Consequently, we should not be surprised that many of the programs developed for children and their families do not work. Far too many of them are categorical, not culturally relevant or competent, and more important, they fail to take into consideration the specific or individualized needs of children and families. In some instances, the program design is more heavily directed toward meeting the needs of the system or organization rather than the child and his/her family. The 22 Grantees of the 1997 Comprehensive Community Mental Health Services for Children and their Families Program have accumulated rich and colorful experiences in the design, development and implementation of community-based, family-focused and culturally competent systems of services for children and adolescents with mental, emotional and behavioral disorders and their families. This Federal grant program is a national effort to help communities establish systems of care that ensure the availability of appropriate services that include these principles for children and families. Funded and administered by the Child, Adolescent and Family Branch of the Federal Center for Mental Health Services, it supports the development of activities that will ultimately become "best practices" in the field of children’s mental health. Thus far, more than 31 communities have been selected to participate in this work. A Compilation of Lessons Learned from the 22 Grantees of the 1997 Comprehensive Community Mental Health Services for Children and Their Families Program is part of an ongoing effort to document lessons learned from the implementation of the Federal grant program. It is produced by the National Resource Network for Child and Family Mental Health Services at the Washington Business Group on Health. Also funded by the Comprehensive Community Mental Health Services for Children and their Families Program, the National Resource Network was established in 1994 to provide field-based technical assistance to these sites. The Program assists the service sites in strategic planning for implementing their vision of a comprehensive system of care based on shared values and principles that include services that are family-driven, individualized, focused on strengths, culturally competent, coordinated across child-serving systems, and most importantly effective for the community and the children and their families. The sites were asked to document their "Lessons Learned" in implementing the federal grant programs. An author from each of the 22 original services sites writes each story from their own experience "on the front line and in the trenches." They are shared with the reader in the hope that others who are working toward a community-based, family-focused, culturally competent system of care can benefit from their efforts, and move toward success more quickly. The collection covers five important areas: 1) family involvement/empowerment, 2) cultural competence, 3) systems of care, 4) evaluation, and 5) managed care.
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| top | FAMILY INVOLVEMENT/FAMILY EMPOWERMENT | |
| In the area of Family
Involvement/Family Empowerment, several of the stories discuss the importance of
involving families from the very beginning of system design and development. The Wichita,
Kansas site very clearly describes their learning curve in support of their family
advocacy program. It points out the expectations of key stakeholders in the site who were
involved in supporting a fledgling effort. Along the same lines, the South Philadelphia
Family Partnership speaks of multi-level family involvement, at both the individual case
level and the system level, ensuring that family involvement is not "tokenism"
but truly includes family participation and power. The Hawaii Ohana Project notes the importance of family involvement and how it is supported, and also describes how family members play key roles as trainers, data collectors and direct service providers. The four counties in rural Maine also plowed new ground in their state by adding parent advocates to the service provider team. These individuals work side-by-side with case managers and receive the same training as other professionals. The Maine project offers the reader specific pointers on how to maintain this type of relationship and build trust among new partners. Project ACCESS in Alexandria, Virginia emphasizes the importance of early, active involvement by a family organization. This early involvement assisted staff in addressing the many administrative issues that may prohibit full family involvement such as childcare, transportation, meeting schedules, etc. The Parent in Residence program at East Carolina University is an integral part of the North Carolina Pitt and Edgecombe-Nash Public Academic Liaison (PEN-PAL) project which ensures integration of a family perspective in all training and technical assistance activities. Finally, the Napa and Sonoma County sites present the impact of hiring family members as staff persons on systems change. They explain that hiring parents is not enough. Such efforts should be coupled with a commitment to change practice. From their experience, they note that total systems overhaul can occur when professional staff and family members work side by side. Specific Family Involvement Lessons Learned:
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| top | CULTURAL COMPETENCE | |
| The Charleston, South Carolina
project has written very useful lessons learned on Cultural Competence called "The
Never Ending Journey Towards Cultural Competence in the Charleston Village: If It
Doesn’t Feel Like Help, It Isn’t." The Charleston project reminds us in
clear, useful terms that cultural competence is not just a training session, but a roadmap
for how our work should be conducted as we build and implement responsive systems of care. A unique perspective regarding cultural competence issues encountered by a Native American site as they build a system of care is presented in the K’e Project story. This brief interview with the executive director highlights the impact of cultural differences. An example highlighted in the story is the requirement that all documents be completed in two different languages. The project reminds readers from non-Western cultures to be aware of federal rules, especially Medicaid, when beginning a project. Specific rules such as timelines for completion of assessments and other interventions are very difficult in a culture that has a different language, in rural communities and where other cultural differences exists that make adherence to western culture rules difficult. Specific Cultural Competence Lessons Learned:
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| top | SYSTEMS OF CARE | |
| Several projects wrote about various aspects
of building systems of care in their community, as well as the issues that must be
addressed in order to be successful. The Southern Consortium, comprised of three rural
southeastern Ohio communities, outlines the positive outcomes they experienced when they
stationed a mental health worker in each of the juvenile court offices to serve as a
liaison to those courts. Stark County, Ohio offers an example of how they built upon the
unique county-based infrastructure in Ohio to build their system of care. Their experience
suggests that in order to be successful and sustainable, the system of care must be folded
into the community’s existing governance and infrastructure. The Wraparound Milwaukee
project illustrates the importance of using positive outcomes for the children and
families served to achieve buy-in from key decision-makers. These efforts can be used to
develop sustainable approaches to working with local systems in providing a
community-based, family-focused system of care. The project in Bronx, New York provides lessons learned in working with the local schools and families within the community-based system of care. The site used a Mobile Community Support Service to realize their success in the Mott Haven community. The North Dakota Partnership project also illustrates the importance of building inter-agency relationships in the development of a community-based system of care. Comprehensive training for staff and families at all levels is noted as a key feature in their success. The Santa Barbara, California project lists several barriers they encountered in building a community-based, family-focused system of care; corrective strategies for each barrier are detailed such as, build on the strength of the child and family, use family to family support, and communication is enhanced by regular meetings of all child serving agencies in the community. In the same vein, the Lane County, Oregon project identified barriers to achieving a sustainable system of care and gives the reader examples of actions that worked best for them. The Access Vermont project, located in one of the most rural states in the country, offers the reader a model for building systems of care in rural communities. The project highlights their success with a wide array of providers including domestic violence programs, child-care centers, and youth service bureaus, as they built their system of care. The Baltimore, Maryland project also illustrates the importance of involving the non-traditional mental health provider in their system of services. They developed their partnership with the Baltimore Police Department Eastern District to form the East Baltimore Community Oriented Policing Services Program, an exciting initiative which focuses on children who experience urban violence and their families. The State of Rhode Island’s contribution involves a Service Coordination Training curriculum. This four-day, 12-module training program has become one of the critical mechanisms through which the basic values that underlie the system of care movement in Rhode Island are reflected and reinforced. Specific System of Care Lessons Learned:
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| top | EVALUATION | |
| The Community Wraparound Initiative in
Broadview, Illinois lesson learned focused on evaluation. They share suggestions on how to
make evaluation an integral part of the system of care such as including the
identification stakeholders and how to use evaluation data to improve the system of care.
KanFocus provides an even more comprehensive look at the importance of evaluation and
offers additional recommendations for effectively using data as an effective navigational
tool for systems change. Specific Evaluation Lessons Learned:
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| top | MANAGED CARE | |
| Five counties in California formed a single
uniform project known as the "California V". This project describes how they
took the California System of Care and expanded it to the broader population covered by
the Medicaid carve out for behavioral health care. They illustrate how the system of care
approach to service delivery subsumes and surpasses the managed care goals by adding an
emphasis on individualized services, family involvement, cultural competence, and consumer
cost outcomes. By incorporating the system of care into the managed care goals, the
overall system brought greater effectiveness and "humanness" to the service
delivery system. The Dona Ana County Child and Adolescent Collaborative, located in New Mexico, shares its experience concerning the impact of managed care on systems of care development. The site poignantly points out the difficulties that have been experienced in trying to merge the values of systems of care with the need to contain costs in a managed care environment. They further note how these experiences have taught the participants to be more creative. Specific Managed Care Lessons Learned: A Compilation of Lessons Learned from the 22 Grantees of the 1997 Comprehensive Community Mental Health Services for Children and Their Families Program is not an exhaustive review of programs that work, but rather it is intended to be a resource for communities who are involved in developing and redefining systems of care to meet the needs of their children and families. The sites have all been successful in their individual communities, building the partnerships necessary to assure successful systems of care. Findings from national and local evaluations of these programs suggest positive outcomes for children and youth with serious emotional disturbance and their families when children are cared for in their homes and communities. Highlights from these evaluations are:
Children and adolescents who have received care through the projects from 1993 to the present have:
These data can be found in the Comprehensive Community Mental Health Services for Children and Their Families Program’s Ten Key Findings, May. For more information, please contact the Center for Mental Health Services at (301) 443-1333.
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| top | REFERENCES | |
| Kahn, A., & Kamerman, S.B. (1992). Integrating services. Integration: An Overview of Initiatives, Issues and Possibilities. National Center for Children in Poverty, Columbia University School of Mental Health. |
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