A SYSTEM OF CARE:
- incorporates a broad, flexible array of effective services and supports for a defined population
- is organized into a coordinated network
- integrates care planning and management across multiple levels
- is culturally and linguistically competent
- builds meaningful partnerships with families and youth at service delivery, management, and policy levels
- has supportive policy and management infrastructure.
An important CSoC goal is the reduction of costly, highly restrictive out of home placements through the creation and maintenance of coordinated and effective community based services. CSoCs also create partnerships with public and private providers of services that target children, youth and their families in a multi-agency, multi-disciplinary system of services.
Recent estimates indicate the following percentages of these youth in Louisiana need behavioral health services:
- 40% of those placed in Office of Community Services (OCS) foster homes
- 70% of those in Office of Juvenile Justice (OJJ) out of home placements
- 20% of children and parents served in their home by OCS
- 50% of children and parents served in their home by OJJ
It is widely acknowledged that the needs of these children and families are currently being served through a fragmented service delivery model that is not well coordinated, is many times inadequate to meet the families’ needs and is usually difficult to navigate. Further, state departments are not currently pooling resources and leveraging the ‘smartest’ financing to provide a coordinated system of behavioral health services to this population. This too often results in Louisiana’s children with the highest level of need often detained in secure or residential settings, which are proven the highest cost services with the poorest outcomes.
CSoC efforts have been shown to provide solutions to common problems found in states and communities throughout the nation, including:
- Lack of home and community-based services and supports
- Patterns of utilization – racial/ethnic disparity and disproportionality
- High cost
- Administrative inefficiencies
- Poor outcomes
- Rigid financing structures
- Deficit-based/medical models, limited types of interventions
(Source: Pires, S. (1996). Human Service Collaborative, Washington, D.C.)
GOALS, VALUES AND POPULATION OF FOCUS
In a recent planning retreat, over forty agency and stakeholder leaders agreed as follows on the goals, values and population of focus for the Louisiana Coordinated System of Care.
Values and Principles:
Population of Focus:
Louisiana’s Coordinated System of Care will initially serve children and youth that have significant behavioral health challenges or co-occurring disorders that are in or at imminent risk of out of home placement. Out of home placements are defined as the following:
Goals of System of Care Implementation include:
- Reduction in the current number and future admissions of children and youth with significant behavioral health challenges or co-occurring disorders in out of home placements.
- Reduction of the state’s cost of providing services by leveraging Medicaid and other funding sources as well as increasing service effectiveness and efficiency and reducing duplication across agencies.
- Improving the overall outcomes of these children and their caretakers being served by the coordinated system of care.
Currently 5 regions have been chosen to implement the CSoC in the state with the remaining regions coming on board at a later date. Families Helping Families of Jefferson has been selected to be the Family Support Organization for the Jefferson Parish Coordinated System of Care. Support for and by family members within the system of care has emerged as a core strategy for improving the children’s mental health system of care. The system of care approach has fundamentally changed the relationships that families of children and youth involved in child-serving systems have with the agencies within those systems. Increasingly, collaboration and partnership between families and service providers have been recognized as the threads that link successful programs, policies, and practices. The development of youth involvement in mental health systems of care closely follows the growth and acceptance of family peer-to-peer support and the broader family empowerment movement, as well as the growth of consumer-provided services. A recent literature review sponsored by the University of South Florida (USF) Research and Training Center for Children’s Mental Health provides an excellent survey and synthesis of available evidence for the approach. A recent national survey of family organizations found that education, advocacy, and peer-to-peer support are key to family support. Another review of family peer-to-peer support models provided a useful conceptualization of the key mechanisms underlying the effectiveness of this approach.
They identified four key areas:
- Social support helps caregivers feel a sense of belonging and being valued, and also provides new resources, both tangible and intangible.
- Peer-to-peer support providers serve as links to broader social networks, in which peer-to-peer support connects caregivers to community resources, people, or institutions and thus serves as a relationship or social network bridge-builder.
- Social comparison occurs when caregivers are better able to maintain and build self- esteem in the context of receiving support from a peer who has been through a similar experience, as opposed to situations where unintended negative consequences emerge as supports or services are received from someone who has not experienced similar challenges. Because of similar experiences, the peer can understand what the caregiver is going through, but avoid the potential negative consequences of threatening comparisons.
- Empowerment appears to be supported through the peer-to-peer interaction as caregivers see the peer-to-peer support provider as a model of success and as they learn strategies and access resources to help deal with their child’s and family’s situation.
In Louisiana’s Coordinated System of Care, family involvement, support and development, at all levels of the system, will be structured to support family involvement and engage the diversity of families affected by the system of care, including families of children involved in the child welfare or juvenile justice systems. Regions are expected to be thoughtful about the different structures and Family Support Organizations (FSOs) in their Region in order to understand how they will affect different stakeholders’ experiences, level of involvement and attainment of system goals. Through local FSOs, family members will participate in the wraparound planning process and provide support and training to families being served by the CSoC.
In general, an important component of meaningful family support is that it is delivered by family peers, defined as follows: a family member of a child or youth with significant behavioral health challenges or co-occurring disorders served by multiple, public child-serving systems for at least one year.
By featuring family members as full partners working within the system of care, the Louisiana Coordinated System of Care hopes to stimulate behavioral change across the system and support development of family-friendly policies and procedures within the provider agencies and among community partners. Emphasizing FSOs as system partners will support full family involvement in systems of care becoming the rule, rather than the exception.