The Connecticut Experience

Bridging Silos: Building Stronger Systems of Care to Improve Child OutcomesGrantmakers for Children, Youth and Families ConferenceOctober 10, 2012JUDITH1Bridging Silos: Building Stronger Systems of Care to Improve Child OutcomesIntroductionsWhy Systems Building?Foundation Case StudiesConnecticutColoradoSmall-Group Discussion3-Part DiscussionConcluding CommentsIntroductionsJudith MeyersPresident and CEO, The Childrens Fund of ConnecticutDeidre JohnsonProgram Officer, The Colorado TrustPhillip ChungAssistant Director of Research, Evaluation, and Strategic Learning, The Colorado TrustJennifer SchroederPresident, The Implementation Group

Why Systems Building?System: a set of interrelated parts that interact and function together to produce a common outcome (Coffman & Parker, 2010)Systems building: the process of improving the individual parts, and more importantly, how these parts interactGoal of systems building: improve the continuum of quality care for children and familiesThe Connecticut ExperienceJudith Meyers, Ph.D.President and CEOChildrens Fund of ConnecticutJUDITH5

Framework: Vision of a Comprehensive System for Childrens HealthEvery child in Connecticut will receive high quality health promotion and prevention services within a family-centered medical home, and will have timely access to community-based services and supports as needed, where needed, to assure optimal development.Childrens Fund of CT: StrategiesDevelop FrameworkFund Communities and Provide TA: Systems DevelopmentCommunity PlansDemonstrations/ReplicationsPractice ChangeEPICWorkforce DevelopmentResearch & Dissemination of FindingsPolicy Reform7Child Health Services Building BlocksFamily SupportServicesUniversalSelectiveIndicatedCare CoordinationMedical Home[Accessible, Continuous, Comprehensive, Coordinated, Family-Centered, Compassionate, Culturally Effective]ChildHealthServicesDevelopmental ServicesMedical ServicesHome Based ServicesPrt C (B-to-3)Title VDesired Outcomes for School ReadinessFamily Capacity and FunctionEmotional / Social / Cognitive DevelopmentPhysical Health & Development.Early Care and EducationPrograms.All integrated in such a way as to promote outcomes.Components all working together to share responsibility for outcomes.How components of system are integrated is critical. Building blocks Universal/selective (available to all and accessed by some)/IndicatedLinkage dependent on Care Coordination and Service Integration permeating all components. Integration towards a common goal. 8Systems Development: Support for CommunitiesPurpose: Promote full integration of child health in comprehensive community early childhood planning and implementationGrants to communities Public/PrivateProvide Technical Assistance Results based accountability frameInformation, webinars, intensive supportChild Health System PerformanceHealth Related Indicators for School Readiness Inventory of Community Resources resources/How well services are integrated across/embedded in child serving systemsEngaging child health providerAccessing and using data

The four-step process outlined in the guide involves:Determining the major child health issues experienced by young children in your communityIdentifying and collecting data consistent with a Results-Based Accountability frameworkEngaging child health providers in working with your community to promote school readinessEvaluating the effectiveness of your health collaborative in reaching the its population results and system objectivesEach step in the process is supported by a straightforward set of tools that identify key measurements, provide comparative performance benchmarks and data sources that are either publicly available or collectable with simple surveys. The Tool Kit also provides survey drafts, a template for creating an inventory of available services as well as evaluation methods and interpretation guides to identify a communitys health resource strengths and weaknesses. In addition, it describes and provides checklists and information on a variety of support resources. Finally, there are easy-to-use survey tools designed to elicit information from parents and caregivers and health care providers. The Tool Kit is intended for use by communities working to develop comprehensive early childhood plans to achieve school readiness for all children.

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Systems Development: Model Demonstration/Replicationfor Key ComponentsChild FIRST (Child and Family Interagency Resource, Support, and Training) - evidence based early childhood home visiting intervention, embedded in a system of care

Child FIRST (Child and Family Interagency Resource, Support, and Training) is an evidenced based early childhood home visiting intervention, embedded in a system of care that works to decrease the incidence of serious emotional disturbance, developmental and learning problems, and abuse and neglect among the most vulnerable young children and families. Multiple Funders/Investors national, state, localRandomized Controlled study evidence-based results demonstratedComponents - Collaboration among local early childhood and family service providers Home-based interventionUsing learning collaborative approach to replication gone from 1 site demo to 6 sites to 9 sites to statewideThe Department of Health & Human Services (HHS) recently approved Child FIRST as a national evidence-based home visiting model through its HomVEE (Home Visiting Evidence of Effectiveness) initiative. A randomized, controlled trial (published in Child Development in January/February 2011) demonstrated the effectiveness of the Child FIRST model showing markedly improved outcomes in child mental health and language, parental stress and depression, protective service involvement, and access to community-based services. The Child FIRST model is being replicated in communities across Connecticut with the support of the Robert Wood Johnson Foundation and a number of public and private funders. 10Practice ImprovementEducating Practices in the Community (EPIC)Brings timely information and training to child health professionals to change their practicesSample modulesScreening - Developmental/Behavioral Health/AutismCollaborative Health CareOral healthCare CoordinationHearing LossEarly Childhood Mental Health WorkforceInfant/toddler mental health competenciesEPIC - Practice-based for entire office teamEmphasis on practice change using clinical information, tools, resources Topics for which there are resources to address

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Research and DisseminationAdvancing Policy ReformGovernance - state and local

Standards that define quality

Research, evaluation and data development

Financing sufficient to assure the delivery of high quality programs and practices in a comprehensive manner based on adopted standards; infrastructure support; Medicaid

Provider and practitioner support to assure the quality of services and the development of workforce with the capacity to meet the needs (competencies)

Public/private partnershipsGovernance who gets to set policy guidelines, articulate cross-agency agreements, manage finances, and track results and performance of the system and its component parts (local collaboratives as hubs) SR legislation/how funding flowsStandards that are aligned across the system and that define effective practices and programs - regulationsMonitoring in order to track program performance and results based standardsResearch, evaluation and data development Financing sufficient to assure the delivery of high quality programs and practices in a comprehensive manner based on adopted standards Provider and practitioner support to assure the quality of services and the development of workforce with the capacity to meet the needs (competencies)Allow for state agencies to create pooled resources that communities can use flexibly to meet local priorities based on plans and accountability for results. (no fiscal cost). Blend policies, procedures and funding across education, child welfare, public health, mental health, social services. (CT BHP is example that it can be done)Streamline reporting and evaluations of state-funded programs to achieve consistency in accountability, decrease cost, and increase time efficiency at the local level (no fiscal cost) 9 state agencies involevdEstablish a formal multi-year commitment from legislators and agencies to ensure that implementation can be accomplished rather than shifting priorities within short time periods (no fiscal cost)Expand local community access to state data across agencies, disaggregated by community, in order to reduce the need for communities to develop their own data collection processes and ensure implementation of community RBA plans largest barrier to community planningMedicaid and private insurance reimbursement for some of these services such as: care coordination; translation services, bilingual providers, early childhood mental health services able to be provided without a diagnosis; treatment for parent/child dyads not requiring the child to be the identified patient (0-3).Include language to promote public/private partnerships

13Challenges for FundersCollaboration with other funders Lack of alignment across systemsLack of capacity dollars, experience in systems buildingLack of dataFor rural communities systems change at the local level is difficult to effect without regional collaboration.Engaging health providers

The Colorado Experience: The Colorado Trusts Early Childhood Health Integration strategyDeidre JohnsonProgram OfficerThe Colorado TrustDEIDRE15Early Childhood Health IntegrationGOALTo better integrate healthinto Colorados broader early childhood development systemas a means of improving health outcomes for more than 700,000 children.

DEIDRE

16Colorado Early Childhood CouncilsIntroduced in Colorado in 1997

Multi-sector partnerships working to coordinate services in local communities: Early LearningFamily Support and Parent EducationHealthSocial Emotional and Mental Health

Goal: Improve child outcomes by creating a system of care that is more effective and easier for families to navigate.30 Councils representing 55 of Colorados 64 counties17Early Childhood Colorado Framework

18Selected Child Health OutcomesAccess to preventive oral/medical health care Assuring Better Child Health and Development Cavity Free at Three

Enrolling children in health insurance

Access to a Medical Home approach

Immunizations

Physicians and dentists accepting Medicaid/CHP+

Access to timely, appropriate prenatal care

Increased knowledge of the importance of health/wellness

Increased number of environments providing early identification and mental health consultation

19Conceptual FrameworkContext - Improving the political environment that surrounds the system so it produces the policy and funding changes needed to create and sustain it.Components - Establishing high-performance programs and services within the system that produce results for system beneficiaries. Connections - Creating strong and effective linkages across system components that further improve results for system beneficiaries.Infrastructure - Developing the supports systems need to function effectively and with quality.Scale - Ensuring a comprehensive system is available to as many people as possible so it produces broad and inclusive results for system beneficiaries.

~ J. Coffman (2007)

20Timeline21

Early Childhood of La Plata CountyDeveloped and implemented the Community Access and Referral Enrollment System (CARES) a sliding fee scale program to increase access to medical, dental and mental health care services by offering discounted care to the underinsured. (www.laplatacares.org)

Created an Early Childhood Community Resource Guide an online, bilingual asset/inventory database of resources available in La Plata County for children from birth to age 8

Created a Pediatric Health Care Home Coalition to increase communication and collaboration among medical and non-medical early childhood service providers , decrease duplication and increase early intervention.

22Phase II - GoalsDemonstration of effective systems-building activities that further advance health integration accomplishments achieved during the first three years.Active and sustained engagement of health partners. Active and sustained coordination of health integration activities within the Early Childhood Council.Demonstrated planning for sustainability of health integration activities beyond the completion of the Phase II health integration grant.

23Lessons Learned & Advice for FundersDefining systems, systems building and systems outcomesDealing with different developmental stages and varying local resources Grantee readinessProgram Implementation vs. Systems-BuildingLanguage matters when working across systemsEngaging health providersAligning and collaborating with state level partnersPlanning and technical assistance Iterative approach

Small-Group DiscussionPart 1 (10 minutes): How integrated vs. silod are the systems in the communities you serve?Part 2 (10 minutes): How would you measure success in systems building in the communities you serve?Part 3 (10 minutes): As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?

09000018765432159004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?260900098765432158004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900088765432157004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900078765432156004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900068765432155004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900058765432154004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900048765432153004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900038765432152004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900028765432151004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?0900018765432150004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 1: How integrated vs. silod are the systems in the communities you serve?Part 1 Report-BackPart 1: How integrated vs. silod are the systems in the communities you serve?

Part 2 Small-Group DiscussionPart 2: How would you measure success in systems building in the communities you serve?

09000018765432159004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?380900098765432158004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900088765432157004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900078765432156004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900068765432155004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900058765432154004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900048765432153004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900038765432152004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900028765432151004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?0900018765432150004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?Part 2 Report-BackPart 2: How would you measure success in systems building in the communities you serve?

Part 3 Small-Group DiscussionPart 3: As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?09000018765432159004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkAs a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?500900098765432158004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900088765432157004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900078765432156004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900068765432155004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900058765432154004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900048765432153004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900038765432152004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900028765432151004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?0900018765432150004987654321039876543210987654321021987654321098765432100HoursMinutesSeconds10-minute Small-Group WorkPart 2: How would you measure success in systems building in the communities you serve?As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?Part 3 Report BackPart 3: As a funder, how can you increase the likelihood the communities you serve will reach the systems building success indicators you described?What are some of the challenges in reaching success indicators?How would you communicate your role in supporting systems building work to both your grantees and your Board?Contact InformationJudith Meyers, President and CEO of The Childrens Fund of Connecticut (meyers@adp.uchc.edu)Jennifer Schroeder, President, The Implementation Group (jen@theimplementationgroup.com)Deidre Johnson, Program Officer, The Colorado Trust (Deidre@coloradotrust.org)Phillip Chung, Assistant Director of Research, Evaluation and Strategic Learning, The Colorado Trust (Phillip@coloradotrust.org)

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