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By Howard Shiffman, MA

It isn’t often that you get the chance to spend a day with the executives who are “leading the charge” for improving service delivery for children and youth in the child welfare system. That was exactly my good fortune at the 2015 CWLA National Conference. I had the opportunity to lead the session, Changes, Challenges & Collaborations: Responding To Health Care Reform In Child Welfare & Behavioral Health, and facilitate a thoughtleader discussion on where the field is heading. The thoughtleaders?

  1. Alan M. Vietze, Deputy Director, Children’s System of Care, New Jersey Department of Children and Families
  2. Cheryl Fisher, Senior Director, Foster Care and Child Welfare, Cenpatico
  3. Stephen Yerdon, CEO, Devereux Massachusetts
  4. Rich Weisgal, Senior Child Welfare Specialist, Health and Social Development Program, American Institutes for Research
  5. Eileen Elias, Director, Disability Service Center and Senior Policy Advisor on Mental Health and Disabilities, JBS International and Chair, CWLA Mental Health Advisory Board

And what was their thinking about the direction of the child welfare field in the decade ahead? The session started with a discussion about what makes the foster care population so unique. Children and youth in foster care experience a high rate of trauma, a good deal of transiency, higher rates of psychotropic medication use, and higher rates of hospitalization and readmissions.

According to Eileen Elias, there is a high prevalence of psychiatric conditions in foster care youth. She cited data from the National Institute of Mental Health, which found that nearly half (47.9%) of youth in foster care have clinically significant emotional or behavioral problems; and data from the Casey Family Programs, which estimates that over one-half of children entering foster care exhibit life-time rates of behavioral or social competency problems that warrant mental health services. Those unique characteristics of children in foster care – with the overlay of health care reform – is shaping a new model for “best practice” in the field. I took away five important lessons from our discussion:

  1. Child welfare and behavioral health organizations need to “integrate” – Many organizations (but not all) need to realize that they can no longer “go it alone,” and efforts at some form of collaboration and integration services are a much needed component in tomorrow’s strategic plan. To continue meeting the challenges of a market driven by health care reform, collaborations are occurring in many forms. The discussion of models included funding integration; shared policy and program decision making; consolidation of services and/or staff; sharing administrative functions like training; co-location of primary health with behavioral health care; and mergers and acquisitions to consolidate organizational structures.
  2. New services are essential to meet new payer and consumer needs – According to Alan M. Vietze, successful new service models will be “in touch” with the community they serve; must have a layering and a sequencing vision of fundamental services to sustain a system of care; and should integrate existing community services. As an example, he pointed to the successful transformation of residential placement into out-of-home treatment.
  3. Service delivery needs to be seamless – According to Cheryl Fisher, this will likely happen through some type of managed care or coordinated care model. It was interesting to learn that managed care programs focused on children in foster care are grappling with some common problems – comprehensive medical history not readily available, duplication of services, repeated immunizations and high utilization of behavioral health services and psychotropic medications. Their solution? Ms. Fisher noted an increased investment in technology to support the ongoing (and growing) communications and support between both child welfare and mental health providers and mental health.
  4. Outcomes improvement is possible through coordination – Service provider organizations need to think about positioning in a system that is focused on coordination of care – social, behavioral, and medical. According to Stephen Yerdon, this brings some fundamental challenges – developing an outcome oriented and fiscally efficient integrated delivery system, an infrastructure that can support this new care coordination model, and the funding for development.
  5. Cross training of stakeholders is key to successful launch of “integrated” and “coordinated” service delivery – There is a growing need for a collaborative infrastructure, which would foster informed sharing of information and the cross training of staff from various parts of the health care system. Rich Weisgal expanded on this as a “culture challenge” that requires leaders to bridge the culture gap among different stakeholders and types of provider organizations.

After this discussion, it is obvious to me that the organizations that are willing to venture outside of their comfort zone will be the ones that ultimately find their place in the marketplace and achieve the competitive advantage over their competition. Innovation is the organizational ingredient required to better serve our children – a goal worth pursuing.

For more of our recent coverage of new developments in the child welfare field, check out these resources in the OPEN MINDS Industry Library:

  1. Oklahoma Governor Signs Foster Care Reform Bill
  2. SAFY Awarded $44 Million Contract For South Carolina Community-Based Family Support Services
  3. Florida Auditor Cites Documentation Problems With Child Welfare Lead Agency Contracts
  4. Illinois Awards Vander Weele Group $5.2 Million Early Intervention Monitoring Contract
  5. 5% Of Child Deaths In Texas Were Caused By Abuse Or Neglect
  6. For 11% Of Children In Foster Care, Inadequate Housing Was Factor In Removal From The Home
  7. Advocates File Contempt Motion Against Mississippi Child Welfare System Over Failure To Meet System Transformation Goals
  8. Feds To Strengthen Child Welfare Reporting Requirements & Impose Financial Penalties For Non-Compliance

And, I hope you’ll join me on June 17 for my session, Care Management & Children’s Services: What Are The Emerging Market Models?, with John S. Lyons, Ph.D., Senior Policy Fellow, Chapin Hall at the University of Chicago; and Cheryl Fisher, M.Ed., LPC, Sr. Director, Foster Care and Child Welfare at Cenpatico, at the 2015 OPEN MINDS Strategy & Innovation Institute.

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