Flexible Funds for Customized Goods and Services

Flexible funds for customized goods and services have been recognized as an essential component of effective systems of care. The May 2013 Joint Bulletin issued by Centers for Medicare & Medicaid Services (CMS), Substance Abuse and Mental Health Services Administration (SAMHSA), Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions, states:

The experience of the CMHI and the PRTF demonstration showed that a number of other home and community-based services have significantly enhanced the positive outcomes for children and youth. These services include: intensive care coordination (often called wraparound service planning/facilitation), family and youth peer support services, intensive in-home services, respite care, mobile crisis response and stabilization, and flex funds.”

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Considerations in System of Care Expansion: Expanding Early Childhood Systems of Care

Efforts to develop SOC's through SAMHSA’s Comprehensive Community Mental Health Services for Children and Their Families Program (known as the Children’s Mental Health Initiative – CMHI) have evolved over time. Initially, the focus was primarily on school-age and older children. The language of the authorizing legislation for this program does not preclude serving young children and their families. However, there were perceived barriers, such as the requirement of a diagnosis to be eligible for services when the early childhood field hadn’t yet universally accepted the practice of diagnosing young children. Further, the individualized, Wraparound approach to service/care planning and delivery was not seen as applicable to young children and their families.

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System of Care Implementation Readiness Assessment Tools
Many states, tribes, territories, and communities have recognized a need to assess readiness for System of Care (SOC) implementation.  There are at least three tools that have been developed that can assist in planning and implementation processes by identifying areas of strength and challenge as well as potential technical assistance needs.  These include the System of Care Practice Review—Revised, the Self- Assessment of Strategies for Expanding the System of Care Approach and the System of Care Readiness and Implementation Measurement Scale.
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Intensive Care Coordination Using High Quality Wraparound for Children with Serious Behavioral Health Needs
Approximately one in 10 children in the United States has a serious emotional disorder,1 and mental health conditions represent the most costly health condition among children.2 Nearly three million children in Medicaid – about 10 percent of the Medicaid child population – use behavioral health care, yet their cost of care comprises an estimated 38 percent of all Medicaid expenditures for children.3 A variety of options in Medicaid and under the Affordable Care Act(ACA), such as health homes and 1915(i) home and community‐based services,4 provides an opportunity for states to improve the quality and cost of care for these children.
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Developing Structure and Process Standards for Systems of Care Serving Children and Youth with Special Healthcare Needs
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Effective Strategies for Expanding the System of Care Approach
This report presents the findings from a study on effective strategies for expanding the system of care approach that was undertaken as part of the national evaluation of the federal Comprehensive Community Mental Health Services for Children and Their Families Program. The study and report benefitted from the input and assistance of many people. The directors of children’s mental health in the nine states that participated in the study not only allowed themselves to be interviewed, but also enlisted others to be part of the study. In total, 52 individuals were interviewed, and the authors are most appreciative of their time and contributions.
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Effective Strategies Checklist – Children and Youth with Developmental Disorders and Challenging Behaviors
Children and youth who have intellectual disabilities or developmental disorders are at elevated risk for co-occurring psychiatric or behavioral problems. These young people pose a serious challenge for administrators, program directors and clinicians, especially when they present with aggressive or disruptive behaviors. When appropriate community services have not been organized, these youth can be among the most difficult and costly to serve. Across the country, their families report relentless stress, partly because it is very difficult to obtain the help they need. This paper provides resources and strategies that have improved outcomes and lowered costs, while diminishing risk for institutionalized placements, referrals to juvenile justice and child welfare.
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Strategies for Expanding the System of Care Approach ~ Issue Brief
This issue brief summarizes the findings from a study on effective strategies for expanding the system of care approach that was undertaken as part of the national evaluation of the federal Comprehensive Community Mental Health Services for Children and Their Families Program. This study could not have been conducted without the input and assistance of many people. The directors of children’s mental health in the nine states that were included in the study not only shared their perspectives, but also enlisted others to participate. In total, 52 individuals were interviewed, and the authors are most appreciative of their time and contributions.
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Return on Investment in System of Care for Children With Behavioral Health Challenges
Calculating return on investment is not without challenges. These challenges are addressed in the document, and a number of recommendations are provided to strengthen the capacity of states and communities to produce and use return on investment data related to system of care and to get existing information in to the hands of policymakers. Recommendations for strengthening capacity include developing a guide for states and communities for analyzing return on investment; conducting pilots in selected states; and providing methods for states to estimate costs, expenditures, and financing opportunities. Widespread dissemination of available information on return on investment is recommended, with a particular emphasis on state Medicaid agencies and policymakers across the multiple child-serving agencies that share responsibility for financing and providing children’s behavioral health services.
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Family Roles in System of Care Communities
This chart outlines the roles that families play in system of care communities and levels of readiness for roles (initiation, solution-focused, and expanding interests) in each area of involvement.
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Building Systems of Care ~ A Primer
Introduction: In the eight years since the first edition of Building Systems of Care: A Primer, there has been considerable growth in the system of care movement, with more states, tribes, territories, and communities understanding system of care concepts and embarking on or expanding system of care development. This is partly due to federal leadership and grant making. Communities in every state have had federal system of care grants through the federal Center for Mental Health Services or the Children’s Bureau. Growth also is due to a concomitant strengthening of the family movement and the burgeoning growth of the youth movement, with strong family-run and, increasingly, youth-run organizations supporting system of care development. System of care development also has benefited from expansion of evidence-based and effective practices that reinforce family-driven, youth-guided, and home and community-based system of care concepts. Growth also is the result of the natural progression of system change efforts. It has been said that it takes an average of 17 years for an effective practice in the health care field to “take hold.” It has been a little over 20 years since the system of care movement began. At this moment in time, we are seeing system of care values, principles, and concepts taking hold across child-serving systems at federal, state, and local levels in ways that were not seen in earlier years. Increasingly, the system of care framework is being applied to many different populations of children, youth, and families, from birth to 3-year-olds to transition-age youth and even to adult populations. New technologies have emerged for implementing system of care concepts, some of which draw on related fields such as managed care and public health. All this is by way of saying that an update to the original Primer is in order—to capture the sense of growth, new technologies, and expanded applications of the system of care concept.
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New Roles for Families in Systems of Care
Executive Summary: Since Knitzer’s 1982 wake up call to the mental health community, family members have gained knowledge, skills, and access to influence systems of care so our children with mental health needs receive better services and we get supports to raise them to be strong and healthy. We have found and developed our voice. We have become strong partners and assertive leaders in developing a better system of care for our children. We now serve as collaborators, advisors, providers, planners, administrators, evaluators, as well as advocates. Our work provides information and assistance to other families and professionals. We have begun to help one another coordinate the system of care and provide pre-service training to personnel who will be serving our children and families. The diversity and scope of our activities demonstrates the impact families have had on the systems of care emerging around the country.1
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Family Guide to Systems Of Care
This bilingual family guide was first printed in December 1998 with the support of the Child, Adolescent and Family Branch of the Center for Mental Health Services, part of the Substance Abuse and Mental Health Services Administration. One of the most popular print publications of the Caring for Every Child’s Mental Health Campaign, the Family Guide is intended to inform caregivers and families about how to seek help for children with mental health problems. Information is provided on what caregivers and families need to know, ask, expect, and do to get the most out of their experience with systems of care. The content and format of the guide was determined by families from across the country, and it was written by a diverse team of experts led by the Federation of Families for Children’s Mental Health. The initial text for the guide was developed by Families and Communities Equal Success of Stark County, OH. Rhode Island Parent Support Network of Warwick, RI, field-tested the guide’s content, relevance, usefulness, and format.
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Family-Centered Community Building
One strategy for transforming tough environments into family-strengthening neighborhoods is family-centered community building. This brief suggests strategies for using this process to seek wholesale change by directly involving families in low-income communities instead of imposing external solutions.
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Voices: Families as Partners in System Reform
On May 11, 2004, the first ever Rhode Island Children’s Behavioral Health Summit, Voices: Families as Partners in System Reform, took place at the Crowne Plaza Hotel in Warwick, Rhode Island. Over 150 participants – from federal and state lawmakers to youth, family members, volunteers, and social service providers – listened and learned together in plenary sessions, over lunch and in five intense workgroups around the Summit theme. What emerged from the day, specifically from the five workgroups, was a call to action in the form of recommendations to DCYF and its partners. An important outcome of this event was also a renewed commitment from all sectors to further develop policies, practices, and services that are community based, family centered, and culturally competent.
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Family Driven Care in America: More Than a Good Idea
Family-driven care has advanced in the child and youth mental health system in America and next steps are needed to further develop the ability of families to become true partners in treatment planning, service and system development, enhance research as to the effectiveness of these activities and reform policies and practices to reflect needs of families.
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