funding and sustaining family-centered treatment … and sustaining family-centered treatment for...

Funding and Sustaining Family-Centered Treatment for Women with Substance

Use Disorders

Developed for the Center for Substance Abuse Treatment under Contract with Johnson, Basin and Shaw

Authored by: Kimberly Dennis, M.P.A., Nancy K. Young, M.S.W., Ph.D. & Sidney L. Gardner

Children and Family Futures, Inc.

A Program of the

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatmentand the

Administration on Children, Youth and FamiliesChildren’s Bureau

Office on Child Abuse and Neglect

Outline of Presentation

Family-Centered Treatment for Women with Substance Use Disorders

Funding Family-Centered Treatment for Women with Substance Use Disorders

Shields for Families Funding Family Centered Treatment by Kathryn Icenhower, Ph.D., LCSW

Principles

Family-centered treatment is comprehensive Women define their families Treatment is based on the unique needs and

resources of individual families Families are dynamic, and thus treatment must be

dynamic Conflict is inevitable, but resolvable Meeting complex family needs requires

coordination across systems

Principles

Substance use disorders are chronic, but treatable Services must be gender responsive and specific

and culturally competent Family-centered treatment requires an array of

staff professionals as well as an environment of mutual respect and shared training

Safety comes first Treatment must support creation of healthy family

systems

Women’s Treatment With Family Involvement

Services for women with substance

use disorders. Treatment

plan includes family issues,

family involvement

Goal: improved outcomes for women

Women’s Treatment With Children

Present

Children accompany women to treatment. Children

participate in child care but

receive no therapeutic

services. Only women have

treatment plans

Goal: improved outcomes for women

Women’s and Children’s Services

Children accompany women to treatment.

Women and attending

children have treatment plans and

receive appropriate services.

Goals: improved

outcomes for women and

children, better

parenting

Family Services

Children accompany women to treatment;

women and children have

treatment plans. Some

services provided to other family members

Goals: improved

outcomes for women and

children, better

parenting

Family-Centered Treatment

Each family member has a treatment plan and receives individual and

family services.

Goals: improved outcomes for

women, children, and other family members; better

parenting and family

functioning

Continuum of Family-Based Services

Inter-related Components

CommunitySupport

Clinical Support

Clinical Treatment

Clinical Treatment ServicesAddress Medical and Biopsychosocial Issues

Outreach and engagement

Screening

Detoxification

Crisis intervention

Assessment

Treatment planning

Case Management

Counseling and

education

Trauma services

Medical care

Pharmacotherapy

Mental health services

Drug monitoring

Continuing care

Clinical Support ServicesSupport Recovery and Maintenance

Life skills Parenting and

child development

education

Family programs

Educational remediation and

support

Employment readiness services

Linkages with legal and child

welfare systems

Housing support

Advocacy

Recovery community

support services

Outreach and engagement

Screening

Detoxification

Crisis intervention

Assessment

Treatment planning

Case Management

Counseling and education

Trauma services

Medical care

Pharmacotherapy


Drug monitoring

Continuing care

Clinical Support ServicesSupport Recovery and Maintenance

Life skills

Parenting and child

development education

Family programs

Educational remediation and

support

Employment readiness services

Linkages with legal and child

welfare systems

Housing support

Advocacy

Recovery community

support servicesOutreach

and engagement

Screening

Detoxification

Crisis intervention

Assessment

Treatment planning

Case Management

Counseling and

education

Trauma services

Medical care

Pharmacotherapy


Drug monitoring

Continuing care

Housing

Family-strengthening

Services

Child Care

Transportation

TANF Linkages

Recovery Support

Workplace Prevention

Vocational & Education Services

Faith-based Organizations

Children’s Clinical Treatment Services

Screening

Intake

Assessment

Medical care and services

Residential care (in residential settings)

Case management

Case planning

Substance abuse education and

prevention

Mental health and trauma services

Therapeutic child care and development

Children’s Clinical Support Services

Screening

Intake

Assessment

Medical care and services

Residential care (in

residential settings)

Case management

Case planning

Substance abuse

education and

prevention

Mental health and trauma services

Therapeutic child

care and developm

ent

Child Care

Mental health and

remediation services

Prevention services

Recreational services

Educational services

Advocacy

Recovery community

support services

Purpose

To identify strategies to Increase funding flexibility Maximize revenues Optimize the efficiency of existing resources

Funding Family Centered Treatment

By…

Detailing Federal and State funding sources that could support treatment services for women and their families

Highlight the experiences and insights of SHIELDS for Families

Provide concrete, next-step starting points

Prerequisite to Funding Strategies:

Taking Stock of Your Program and Community

Understand Existing Funding Streams

How they flow into their communitiesHow they are currently allocated among

different service providersHow they might be better allocated to meet

needsWhat is needed to tap into those existing

resources


Who are my clients and what are their needs?● Changes over time● “Financing for what?” Understand and correctly

prioritize clinical treatment and support services● Use case reviews, surveys or focus groups to

find out what services were most/least useful, and needed but not received


What services do we currently provide to meet parents’ needs, and where do we fall short? What about others in the community that serve

our parents? Comparing parents’ priority needs with existing

program services Parents are typically involved with other

community service systems

What funding and other resources in the community are currently used to fund these services? Are those resources sufficient to achieve

intended outcomes? How can the agency’s resources be combined

with others to achieve greater impact?



What funding and other resources in the community are currently used to fund these services? Create an inventory of what other resources and

services already exist in the community and the total level of public and other dollars flowing into the community to support those services

Identify who controls these resources


To what extent can we tap into these existing sources? What partnerships need to be established? Identify potential collaborators Initiate discussions about which service

providers have the capability and capacity to offer which services

Develop an interconnected service delivery system that reflects family and community needs


Should we—can we—offer services ourselves? If the resource mapping identifies significant

unmet service needs, providing services in-house may best meet family needs


Should we—can we—offer services ourselves? Internal planning and decision-making considers:

• Do we have the appropriate facilities, technology, licensing, qualified staff, and prior experience

• How will we accommodate budget/program growth• Do we use our own staff, employ additional staff, or

bring in outside contractors?• What are the expected savings, benefits, and

outcomes

Increasing Funding Flexibility Maximize Revenues Optimize the Efficiency of Existing Resources

Strategies to Create Unified Financing

Increasing Funding Flexibility

Decategorization A Federal- or State-level strategy used to reduce or

eliminate categorical funding stream constraints

Pooled or Blended Funding Formally combine a portion of funds from several

agencies or sources into a single funding stream

Braided Funding Used to obtain or weave together multiple funding

sources to create and support comprehensive services

Wraparound A process in which clients receive a full range of

services to meet their needs

Increasing Funding Flexibility

Leveraging Maximize Federal funding by taking advantage of

Federal programs that provide matching funds contingent on State/local/private spending

Refinancing Maximizing use of Federal entitlement funds to pay for

services financed with State/local funds

Administrative Claiming Making use of available child welfare and Medicaid

administrative funds

Strategies to Maximize Revenues

Strategies to Optimize Efficiency of Existing Resources

Redeployment Move funding from higher cost remedial services to

lower cost prevention and early intervention

Reinvestment Identify cost savings generated by effective programs

and reinvesting those savings

Redirection Identify the least effective programs and redirect

resources to more effective programs with documented results

Primary Federal Funding Types

Entitlement Programs Open-ended, uncapped appropriations to all individual

who meet eligibility criteria (Medicaid, Title IV-E) Formula or Block Grants Capped appropriations to States or localities based on

established formulas (SAPTBG) Discretionary Grants Capped appropriations for specific programs under

competitive awards (PPW, Regional Partnership Grants) Direct Payments Capped appropriations to individual beneficiaries (SSI,

Section 8)

Primary Federal Sources for Adults

Substance Abuse Prevention &

Treatment Block Grants - SAPTBG

Temporary Assistance for

Needy Families -TANF

Medicaid Workforce Investment Act

Community-Based Child Abuse Prevention Program

Child Welfare Services IV-B, Subparts I & II

Developmental Disabilities Basic

Support and Advocacy Grants

Community Mental Health Services Block

Community Services Block

Grant

Maternal and Child Health Block

Grant- Title V

Social Services Block Grant

Community Prevention

Incentive Grants –Title V

Family Violence Prevention and

Services

Housing Opportunities for

Persons with AIDSHIV Care formula

Grants

Project for Assistance in

Transition from Homelessness

Residential Substance Abuse

Treatment for State Prisoners

Primary Federal Sources for Children and Youth

Substance Abuse Prevention &

Treatment Block Grants - SAPTBG

Temporary Assistance for Needy

Families - TANF

Community-Based Child Abuse

Prevention ProgramChild Abuse and

Neglect State GrantsChild Welfare Services IV-B, Subparts I & II

Promoting Safe and Stable Families IV-B,

subpart 2

Child Care and Development

Fund/child care and Developmental Block

Grant

Medicaid/Early and Periodic screening,

diagnostic, and Treatment Program

State children’s Health Insurance Program (SCHIP)

Individuals with Disabilities Education

Improvement Act (IDEA)

Developmental Disabilities Basic

Support and Advocacy Grants

Community Mental Health Services Block

Community Services Block Grant

Maternal and Child Health Block Grant-

Title VSocial Services Block

Grant

Chafee Foster Care independence

Program

Juvenile Accountability Incentive Block

Grants

Community Prevention Incentive

Grants – Title V

Family Violence Prevention and

ServicesHIV Care formula

Grants

Details for Each Funding Source

Responsible Federal Agency General Description/Overview Type of Funding How Funds are Managed Eligible Populations Use of Funds How Substance Abuse Treatment Providers can

Leverage These Funds Important Restrictions Special Notes

Guiding Principles and Specific Steps

Ensure family’s needs drive the funding search Map and track funding streams Develop collaborative relationships at all levels Ensure funding is diversified Customize the approach and prioritize targets Promote the connections between funding and

outcomes Work to change the rules and the priority given to

substance abuse treatment funding

Requirements for Sustainability

• Products• The program or initiative to be sustained

• Financial• The potential of revenue source

• Political and Community Support• Outcomes to justify investment

To Order a Copy or Obtain Website Address for White Papers

Contact: Larisa Owen, M.B.A.Director of Technical Assistance Services

4940 Irvine Boulevard, Suite 202Irvine, CA 92620

714.505.3525www.ncsacw.samhsa.gov

[email protected]

Administration for Children and Families

Regional Partnership Grantee Conference:Advancing Clinical and Collaborative Practice

Washington, D.C., January 15-16, 2009

Presented by Kathryn Icenhower, PhD, LCSWSHIELDS For Families, Inc.Los Angeles, CA

“FUNDING AND SUSTAINING FAMILY CENTERED TREATMENT FOR WOMEN WITHSUBSTANCE USE DISORDERS”

Successes and Challenges in Sustainability at the Exodus Program

FUNDING AND SUSTAINABILITYSuccesses and Challenges

Shields is a non-profit agency serving the Compton and Watts communities of South Central Los Angeles. We have approximately

300 employees with an annual budget of $21 million. SHIELDS provides programs in multiple sites, including:

8 Substance Abuse Programs10 Mental Health Programs

Community Assessment Center3 Youth Programs

5 Child Development ProgramsFamily Preservation

Family SupportPartnership for Families

Prevention InitiativeVocational Services Center

Adoption SupportFederal Healthy Start Program

Partnership for Families126 Units of Low-income Housing

Transportation

SHIELDS for FamiliesExodus Program

Exodus Program

The Exodus program is located at Keith Village, an 86 unit apartment complex in

Compton, California. Services on-site include: treatment program, child development center,

youth program, vocational services center. Facility also houses two play grounds, a

community room and a Laundromat. Keith Village was purchased in 1994 and the

Exodus program has been in operation for twelve years. A maximum of 45 families are

enrolled in the program.

Exodus Program

Originally funded through the Federal Center for Substance Abuse Treatment’s (CSAT) perinatal initiatives in 1994, the

Exodus program provides comprehensive care for women and their children including: counseling, child development, vocational

services, mental health, medical care, family support and family reunification. Annually, approximately 60 women and 250 children

are served with an average length of stay of 12-18 months.

Exodus Program

Currently, 45 moms with approximately 170 children are enrolled in the program.

Services are six days a week (Monday thru Saturday) from 8:30 a.m. to 5:00 p.m. Average length of stay is 18 to 24 months.

Families are allowed to remain in housing one year post completion in order to transition back to the community

Completion rates have remained at 70% or higher since the program was implemented. Family reunification rates are 85%.

SHIELDS for Families

Funding Family Centered Treatment:

How We Did It

The Dollar Didn’t Drive Us:We Drove the Dollars

We knew that the program was:•Needed in the community, •Requested by our consumers•Supported by our evaluation results•Essential in furthering our mission.

•We developed the model and started searching for funding.

The Dollar Didn’t Drive Us:Success #1: Funding for the Initial Program

Applied twice to get the money, first to CSAP then to CSAT.

We knew it would work, so we didn’t change the model, we kept trying.

Finally funded by CSAT in 1994. The Pregnant and Postpartum Women’s grant enabled us to provide a wide range of services to women and their children. Also received a SAMHSA grant to provide specialized services to children in the program. However….we did not want to do traditional residential treatment – too costly and restrictive. We wanted a model that allowed the entire family unit to participated in services –housing and treatment combined.


Challenge #1:Funding for Housing

We knew that CSAT funding was not enough, especially for the housing component.

Funding for Housing

To address this challenge:SHIELDS began looking at services in a different manner….we began exploring alternatives in order to implement the model we had developed.

We realized that we could provide the housing ourselves. After exploration, we set up a separate non-profit housing corporation.

Loans were acquired to purchase the facility through the State of California and the Community Development Division of a Bank.

Funding for Housing:

Success #2: What we Know Now

Alternative sources of funding for Housing include:

HUD – Continuum of Care, Section 8 State Sponsored Loan ProgramsCorporation for Supportive HousingCommunity Development DepartmentsSpecialized Non-Profit LendersTax CreditsNew Market Tax Credits


Challenge #2: Don’t Put All Your Eggs in One Basket…

Don’t Put All Your Eggs in One Basket…

1. We needed more money than our CSAT grant

2. We had five years to find funds to continue services.

When we implemented Exodus, we knew two things:


What we realizedOur families needed extensive services that

were not available anywhere in the community.

Challenge became twofold1. Eliminating the dependency

on the CSAT funding (one funding source)

2. Finding a way to address the special concerns of our families.


Continuing our philosophy of looking at treatment in a different manner, we

starting looking at two things:

The services we needed to offer to meet our families needs…

What funding was available from anywhere that could pay for them…


SERVICES WE NEEDED:

Substance Abuse Treatment ServicesMental HealthChild DevelopmentYouth ServicesCase ManagementVocational ServicesEducational ServicesHealth PromotionFamily Support/ReunificationLegal ServicesFood ServicesTransportation


Funding Available:

Providing Family Centered Treatment required a paradigm shift in how we thought about funding…The first step in looking at funding availability was the identification of all the potential systems that are families were a part of…..


Funding Available:This included the following systems:

Substance Abuse TreatmentChild WelfareMental HealthVocational RehabilitationDevelopmental DisabilityPublic Health/HealthPublic Social ServicesCriminal/Juvenile JusticeEducation


Funding Available:

The second step was looking at the funding available through these systems and what services they might be able to finance.


Funding Available:

Traditional treatment sources of funding:

Block grantMedicaidCenter for Substance Abuse TreatmentCenter for Substance Abuse Prevention


Mental Health Funds: Funding for prevention, case management, treatment for children and adults Center for Mental Health ServicesMedicaid, EPSDT

Child Welfare Funds: funding for prevention, case management, treatment for children and adults

Administration for Children and FamiliesBlock GrantTitle IV-ESafe and Stable Families

Health funding: funding for case management, support services, parenting, child care:

Maternal and Child Health Block GrantHealth Resources Services AdministrationMedicaid


Public Assistance Funding: funding for case management, treatment, child care, transportation

TANF/Responsibility to Work Funds

Criminal Justice Funds: funding for prevention, case management, treatment for children and adults

Juvenile JusticeProbationAdult SystemPatriot ActSecond Chance Act

Vocational Services: funding for supportive services, financial literacy, job readiness and training

Department of LaborDepartment of RehabilitationTitle IV-ESafe and Stable Families


Education System Funds: funding for educational classes, certificate programs, trade programs

ADA Adult School SystemCharter SchoolsCommunity CollegesTrade Schools

We also needed to look for other resources to cover needs outside those systems……

Food and Transportation: FEMAFederal transportation funds


Challenge #3: Accessing Funding and Services….Moving Mountains

Moving Mountains

Five years of funding through CSAT was racing by rapidly….After identifying the systems and funding that might be available….the challenge facing us now was

to identify what funds we could access and what resources we could obtain through existing systems.

First, we looked at what was available through existing resources in the community. If the

service existed, we worked to establish collaborative relationships….

”win-win” situations.

If no or limited resources were available, we sought funding through SHIELDS. This included becoming mental health and child welfare providers during our

initial five years of funding.

Moving Mountains

Additionally, key to obtaining our on-going funding was advocacy for our program as well as others.

In California: Nine programs facing the loss of CSAT funds.

We joined together to form the California Perinatal Treatment Network. We worked together to lobby for continued funding from the State of California.

We were successful in obtaining this funding in 1999 and continue to receive an annual allocation for our

core treatment services.


Success #3: Long Term Integrated Funding and Services for

Exodus….Where we are now

Where We Are Now

Exodus has been in operation for 14 years…9 years beyond the end of our original CSAT

funding. Our current budget is approximately twice that of our initial grant.

Services are funded by the following sources:

Where We Are Now…

Substance Abuse Treatment Services:Federal Block Grant, State General Funds,

TANF

Mental Health:Medicaid, County General Funds, MHSA, TANF,

PSSF

Child Development:Proposition 10, EPSDT, Treatment funds, PSSF,

County Health Department, HRSA; Services accessed on site through Regional Center

Youth Services:EPSDT, United Way, Federal Block Grant, PSSF;

Services provided on site from local schools.

Where We Are Now…

Case Management:PSSF, Treatment Funds, HRSA, EPSDT

Vocational and Educational Services:PSSF, United Way, Proposition 10; Services

accessed on site through three Unified School Districts (ADA), Community Colleges, Department of Rehabilitation

Health Promotion:CSAT, HRSA, Los Angeles County Health

Department, Proposition 10; Services accessed through local Health Providers for on-site classes and resources.

Family Support/Reunification:PSSF, IV-E Waiver

Where We Are Now…

Legal Services:PSSF, Proposition 10; Services accessed

through local legal clinics

Food Services:FEMA, Treatment funds, United Way

Transportation:CalTrans, PSSF, Treatment funds, TANF

Where We Are Now…

Additionally, SHIELDS is certified to complete applications for all public benefits for our families….

And…now we are trying to replicate the model with the implementation of Tamar Village…targeted towards women in the county jail system

Where We Are Now…

QUESTIONS AND ANSWERS

The EndSHIELDS For Families, Inc.12714 South Avalon, Suite 300Los Angeles, CA 90061ph (323) 242-5000, fx (323) 242-5011www.shieldsforfamilies.org

Kathryn Icenhower, PhD, [email protected]

Presented by the SHIELDS for Families IT Department

funding and sustaining family-centered treatment … and sustaining family-centered treatment for...

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