Building Effective Service Systems for Children and Families Presentation by: Sheila A' Pires Human

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Building Effective Service Systems for Children
and FamiliesPresentation bySheila A.
PiresHuman Service CollaborativeWashington,
DCThe Presidents New Freedom Commission for
Mental HealthSeptember 11, 2002Chicago,
Illinois
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The Total Population of Children and Families Who
Depend on Public Systems Pires, S.
(1996). Human Service Collaborative, Washington,
D.C.

• Children and families eligible for Medicaid
• Children and families eligible for the State
  Childrens Health Insurance Program (SCHIP)
• Poor and uninsured children and families who do
  not qualify for Medicaid or SCHIP
• Families who are not poor or uninsured but who
  exhaust their private insurance, often because
  they have a child with a serious disorder
• Families who are not poor or uninsured and who
  may not yet have exhausted their private
  insurance but who need a particular type of
  service not available through their private
  insurer and only available from the public sector

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Examples of Sources of Behavioral Health Funding
for Children and Families in the Public Sector

• Child Welfare
• CW General Revenue
• CW Medicaid Match
• IV-E (Foster Care and Adoption Assistance)
• IV-B (Child Welfare Services)
• Family Preservation/Family Support

• Medicaid
• Medicaid In-Patient
• Medicaid Outpatient
• Medical Rehabilitation Services
• Medicaid Early Periodic Screening, Diagnosis and
  Treatment (EPSDT)

• Other
• WAGES
• Childrens Medical Services/Title V - Maternal
  and Child Health
• Mental Retardation/Developmental Disabilities
• Title XXI - State Childrens Health Insurance
  Program (SCHIP)
• Vocational Rehabilitation
• Local Funds

• Education
• ED General Revenue
• ED Medicaid Match
• ED Block Grant
• Special Education
• Part C, Early Interv.

• Substance Abuse
• SA General Revenue
• SA Medicaid Match
• SA Block Grant

• Mental Health
• MH General Revenue
• MH Medicaid Match
• MH Block Grant

• Juvenile Justice
• JJ General Revenue
• JJ Medicaid Match
• JJ Block Grant

Pires, S. (1995). Examples of sources of
behavioral health funding for children families
in the public sector. Washington, D.C. Human
Service Collaborative
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Current Systems Problems Pires, S.
(1996). Human Service Collaborative, Washington,
D.C.

• Patterns of utilization
• Cost
• Administrative inefficiencies
• Poor outcomes

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Efficacy of Services(Barbara Burns Research at
Duke University) Pires, S. (1996).
Human Service Collaborative, Washington, D.C.

• Most evidence of efficacy Intensive case
  management, in-home services, therapeutic foster
  care
• Weaker evidence (because not much research done)
  Crisis services, respite, mentoring, family
  education and support
• Least evidence (and lots of research) Inpatient,
  residential treatment, therapeutic group home

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Categorical vs. Non-Categorical System Reforms
Pires, S. (1996). Human Service
Collaborative, Washington, D.C

• Categorical System Reforms

Mental Health
Child Welfare
Juvenile Justice
Etc.
Child Welfare
Shared Population Focus
etc.
Non-Categorical Reforms
Mental Health
Juvenile Justice
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Customizing Care for Children with Serious
Emotional/Behavioral Disorders and Their Families
- Operational Characteristics Pires,
S. (1996). Human Service Collaborative,
Washington, D.C.

• Collaboration across agencies at policy,
  management and service levels
• Partnership with families
• Cultural and linguistic competence
• Blended, braided, or coordinated financing
• Shared governance and liability across systems
  and with families
• Shared outcomes across systems, reflecting
  community values
• Organized pathway to services and supports
• Interagency/family services planning and
  monitoring teams

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Customizing Care for Children with Serious
Emotional/Behavioral Disorders and Their Families
- Operational Characteristics(continued)
Pires, S. (1996). Human
Service Collaborative, Washington, D.C.

• Single plan of care
• One accountable care manager
• Cross-agency coordination
• Individualized services/supports wrapped around
  child and family
• Home-and community-based alternatives
• Broad, flexible array of services and supports
• Integration of clinical treatment services and
  natural supports, linkage to community resources
• Integration of evidence-based treatment
  approaches
• Cross-agency management information systems

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Local OwnershipState CommitmentPires, S.
(1996). Human Service Collaborative, Washington,
D.C.
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Financing Strategies to Support Improved Outcomes
for Children Friedman, M. Center for
the Study of Social Policy

• First Principle Program Drives Financing
• Redeployment Using the Money We Already Have
• The cost of doing nothing
• Shifting funds from deep end treatment to early
  intervention
• Moving across fiscal years
• Refinancing Generating New Money by Increasing
  Federal Claims
• The commitment to reinvest funds for families and
  children
• Foster care and adoption assistance (Title IV-E)
• Medicaid (Title XIX)

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Financing Strategies to Support Improved Outcomes
for Children (continued) Friedman,
M. Center for the Study of Social Policy

• Raising Other Revenue to Support Families and
  Children
• Donations
• Special taxes and taxing districts for children
• Fees and third party collections including child
  support
• Trust funds
• Financing Structures which Support Service Goals
• Seamless services financial claiming invisible
  to families and children
• Funding pools Breaking the lock of agency
  ownership of funds
• Flexible dollars removing the barriers to
  meeting the unique needs of families
• Incentives Rewarding good practice

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Finance the art of passing currency from hand to
hand until it finally disappears.
n

Robert W. Sarnoff, son of David Sarnoff and head
of NBC
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For Further Information Contact

• Sheila A. Pires
• Human Service Collaborative
• 1728 Wisconsin Avenue, NW
• Washington, D.C. 20007
• [phone]
• sapires_at_aol.com