katie a.: effective approaches to implementation challenges of the core practice model cmhacy...

Katie A.: Effective Approaches to Implementation Challengesof the Core Practice Model

CMHACY Presentation

Agenda• Engagement & Assessment– Workshop– Families

• Planning & Implementation– Workshop– Families

• Monitoring and Adapting– Workshop– Families

• Transition– Workshop– Families

Ice Breaker: Clock ActivityMake a Clock Stand up and meet as many different people as you can. For each person, get an appointment on the hour.

**Remember- you must be theirs at the same time they are yours**

Check-In

• “We’re doing that already.”

• How is the CPM different?

• Model

Engagement & Assessment

Core Practice Model Overview

Engagement & Assessment

Core Practice Model Overview• Implementing the CPM in our

Community-Based Outpatient Program

–Brief background

–Needs of youth/families we serve

• Engagement

• Hope and Motivation

• Natural Supports & Successful Outcomes

Engagement & Assessment

Four Phases 1. Engagement & =

Assessment

2. Planning & = Implementation

3. Monitor & = Adapting

4. Transition =

1. Intake & Assessment

2. Treatment Planning

3. Treatment

4. Discharge Planning

Review of CPM

Phases and Activities1. Engagement & Assessment

• Intake meeting & engagement• Orient family to services• Stabilize crises/Safety Planning• Engage Community Partners• Strength Needs Cultural Discovery• Create Family Vision• Identify Priority Needs

3. Monitoring and Adapting

• Child Family Team meetings• Monitoring and Adapting• Functional Assessment & Crisis Plan• Prepare for Transition• Engage Natural Supports• Strength Needs Cultural Discovery• Update Individualized Plan

2. Services Planning & Implementation

• Initial Child Family Team meeting• Interventions and strategies • Strengths Needs Cultural Discovery• Utilize Family Vision • Identify Natural Supports• Create the Treatment Plan• Create the Individualized Plan

4.Transition

• Transition Child Family Team Mtg• Transition to Natural Supports• Prepare family for success• Linkage• Create Relapse Prevention Plan• Utilize the FIT Transition Plan

Engagement & AssessmentCPM Meetings & Documents

Engagement• Engagement is the KEY– Youth & families– Community Partners

• Challenges with Engagement– Historical racism and historical trauma

• Common Principles– Family-Centered– Strength-Based– Team-Based– Needs-Based

Engagement & Assessment Initial Meeting - Intake

• Orienting to services: Program explained clearly in a way the family understands – including what to expect

• Role Clarification & team-based approach

• Answer questions so the family feels comfortable making an informed decision regarding services

• Gain commitments

• Confidentiality & Mandated Reporting

• Complete brief Functional Assessment & Crisis Plan

• Brief Assessment for Provisional Dx

Engagement

Planning

Implementation

Transition

Engagement & Assessment

Introducing Services• Individual Therapy/Family Therapy– EBPs

• Collateral Services– Not if, but when– Minimum should equal how often we see the

youth

• Psychiatric Services• Child Family Team meetings (CFTs & ICC-CFTs)• Intensive Home-Based Services• Case Management Services

Engagement & Assessment

SNCD• Strength, Needs, and Cultural Discovery

–What

–When

–Why

–How – Activity

Planning & Implementation

Vision• Working within a team environment,

providing culturally relevant and trauma-informed system of supports and services that is responsive to the strengths and underlying needs of families being served jointly by child welfare and mental health.

• Commitment?

Planning & Implementation

Family Vision• What is the Family Vision? This will drive

your plan!– How do you envision life being when things are

going well?

• Family Vision Example:– Joey will be off of probation, graduated from

Middle School, and the family will be together.

• Commitments: Each Child and Family team member makes an individual commitment to helping the family achieve their vision

Planning & Implementation

Teaming

Planning & Implementation

CFT Priority• All families will receive the following:– Initial CFT – At least 1 Implementation CFT– Transition CFT

• Katie A. Sub-Class Requirements– ICC-CFTs every 90 days minimum– CPS SW invited

• Facilitator AND Therapist attends– Family Partner Invited

Planning & Implementation

Initial CFT• Purpose: Get all team members together, discuss 1-2 priority

needs, review the family vision and develop the Treatment Plan and FIT Plan

• Challenges: – Time: this can be a very long meeting– Special needs of youth and family– Siblings (small children)

• Solutions:– Prepare board– Bring snacks– Bring coloring books/art supplies– Problem identified– Family Vision identified– Needs identified – Utilize SNCD to help prepare meeting– Facilitator & Therapist must attend– Family Partner invited– Other relevant team members invited (Child Welfare, etc.)

Planning & Implementation

What are Needs Statements?

Planning & Implementation

Writing a Priority Need• Example: – Problem: Excessive fighting, intimidation of others, and

destruction of property at school.

– Family Vision: The youth will be off probation and the family will be celebrating youth’s 8th grade graduation together. Everyone living together and able to spend time together.

– CANS/Needs: Mother selects “legal”, youth selects “anger control” They agree on both.

– Priority Need 1 (Anger Control): Youth will learn to express her feelings in a safe manner.

– Priority Need 2 (Legal): Youth will be able to attend school regularly and meet all requirements for school conduct.

Planning & Implementation

Individualized Plans• Integrated Plans:– Treatment Plans vs FIT Plans

Monitoring & Adapting• Working within a team environment,

providing culturally relevant and trauma-informed system of supports and services that is responsive to the strengths and underlying needs of families being served jointly by child welfare and mental health.

• Still the Vision?

Trauma is RealThe Impact is Real

• ReMoved

Simply removing a child out of immediate danger does not in itself reverse or eliminate the wa y that he or she has learned to be fearful. The child’s memory retains thoughts and memories that can elicit ongoing fear and anxiety.

Trauma-Informed: It Takes Commitment

• A trauma-informed youth and family service system is one in which all parties involved recognize and respond to the impact of traumatic stress on those within the system – including youth, caregivers, and service providers.

• Programs and agencies within such a system infuse and sustain trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies.

• They collaborate with all those involved, using the best available science, to facilitate and support the recovery and resiliency of the youth and family.

Monitoring & Adapting CFTs

• Monitoring and Adapting…

• Follow-up on the plan developed at Initial CFT– Still the Needs?– Still the Vision?– Gain commitment

• Differences will exist, but in general, CFT meetings should be predictable and consistent in:– Length– Frequency– General agenda format

Monitoring and Adapting

Evaluating Progress• Problem: Excessive fighting, intimidation of others, and destruction

of property at school.

• Family Vision: The youth will be off probation and the family will be celebrating youth’s 8th grade graduation together. Everyone living together and able to spend time together.

• CANS/Needs: Mother selects “legal”, Youth selects “anger control” – They agree on both.

• Priority Need 1 (Anger Control): Youth will learn to express her feelings in a safe manner. – Goal 1: Youth and caregiver will report that youth expressed her feelings

safely for 3 weeks in a row with no incidents of property destruction.

• Priority Need 2 (Legal): Youth will be able to attend school regularly and meet all requirements for school conduct. – Goal 2: Youth will meet all school conduct requirements for 2 consecutive

months.

Transition• Transition CFT:

– Should schedule a minimum of 1 Transition CFT to develop a Transition (Discharge) Plan

– First Transition CFT should be scheduled preferably 2 months prior to estimated D/C date

Transition• During Transition Phase:– Update SNCD to reflect lessons learned and successes

made– Provide linkage to needed services or resources– Update Crisis Plan to utilize if needed after D/C

– Review skills learned and Relapse Prevention Plan– Schedule a celebration that matches the youth/families

culture, values and traditions– Provide youth/family a Resource Binder with info re:

• Skill worksheets• Completed work• Resources• Plans

Outcomes & Case Examples

• Ebony (Family and Executive Team)

• Stephanie (Supervisor)

• Tamieka (Direct-Care)

Review of CPM

Phases and Activities1. Engagement (Assessment)

• Intake meeting & engagement• Orient family to services• Stabilize crises/Safety Planning• Engage community partners• Strength Needs Cultural Discovery• Create Family Vision• Identify Priority Needs

3. Implementation (Treatment)

• Child Family Team meetings• Monitoring and Adapting• Functional Assessment & Crisis Plan• Prepare for Transition• Engage Natural Supports• Strength Needs Cultural Discovery• Update Individualized Plan

2. Planning (Treatment Planning)

• Initial Child Family Team meeting• Interventions and strategies • Strengths Needs Cultural Discovery• Utilize Family Vision • Identify Natural Supports• Create the Treatment Plan• Create the Individualized Plan

4.Transition (Discharge Planning)

• Transition Child Family Team Mtg• Transition to Natural Supports• Prepare family for success• Linkage• Create Relapse Prevention Plan• Utilize the FIT Transition Plan

Questions?

THANK YOU!!!!• For further information or training: – Stephanie Kelly, LMFT• skelly@youthsolutions.org• 916-417-4783

– Tamieka Paveglio• thilliard@youthsolutions.org• 916-869-3225

– Ebony Chambers• echambers@youthsolutions.org• 916-240-5936