PATHWAYS TO WELL-BEING: California s Integrated Training Plan for Children, Youth and Families

PATHWAYS TO WELL-BEING: California s Integrated Training Plan for Children, Youth and Families Shared Management Structure Community Team Presentation DRAFT 7/29/16 Vision Public social service agencies in California, partnering organizations, service providers, tribes, and community-based groups will receive timely, effective and uniform training that supports integrated service delivery systems which are most effective in assuring the wellbeing of children, youth, and their families. Mission In accordance with California s shared approach to integrated practice among the child welfare, behavioral health, and juvenile probation systems, this integrated training plan will establish unified content and encourage integrated training delivery for parent-, child-, and youth-serving agencies and their community-based partners. Guiding Principles This integrated training plan (ITP) addresses the need for consistency of information regarding policy and practice expectations across all relevant public agencies, partnering organizations, and families involved in the delivery, monitoring, and receipt of cross-system services for children in care. Further, in recognition of the value of sharing leadership with parents and youth, the integrated training plan seeks to provide families and other community partners with the same information as that received by professional staff in order to support equity and shared responsibility for improving well-being outcomes for children. To that end, this training plan embraces the following principles for training content and delivery: 1. Consistency: Upholding consistency as an essential component of fairness in service delivery. 2. Cultural Responsiveness: Mutual respect for cultural values and norms, and openness to learning and understanding diverse perspectives. 3. Meaningful Parent and Youth Leadership: Support for the meaningful leadership roles of parents and youth in the curriculum development process and in the delivery of training as co-trainers to ensure deep understanding of the value of youth and parent experiences in accessing and receiving services. 1

4. Engagement of Resource Families: Inclusion of kin and non-related caregivers in the development of curriculum and in the delivery of training for topics pertinent to caregiving. 5. Advocacy: Promotion of training and support for parents, youth, and other partners (which may include certification) to assist families with self-empowerment, resiliency, well-being, and navigation of the child welfare, behavioral health, and juvenile probation systems. 6. Promotion of Conjoint Training Audiences: Promotion of conjoint trainings and access to training resources for the child welfare, behavioral health, and juvenile probation workforces, partnering agencies, community-based organizations, and families to build trusting relationships and enhance shared understanding, skills, values, and collaboration in the case management and service delivery processes. 7. Collaboration: Advancement of collaborative processes with parents, youth, and families, partnering agencies, and the systems of child welfare, juvenile probation and behavioral health. 8. Teaming: Promotion of team-based approaches with parents, youth, and families, the staff of child welfare, behavioral health, and probation agencies, and other involved organizations and individuals to ensure the development of plans for integrated service delivery and provide consistent, quality case management and necessary services to address children s behavioral health or other needs and to improve their outcomes for safety, permanence and well-being. 9. Evidence-based Practice: Promotion of the use of evidence-based and evidenceinformed practices appropriate to the target populations and their social contexts, with emphasis on values, principles and practices. 10. Trauma-informed Practice: Emphasis on skillful responses to the prevalent and pervasive influences of trauma on children s and adults behavioral health and overall development, and the effects of secondary trauma on staff. 11. Implementation Science: Application of methods and principles derived from implementation science research to successfully enact the training plan and to sustain fidelity to the shared practice model across participating groups in order to achieve measurable, positive outcomes for children, youth, and parents. Coordinating Organizations and Affiliates The following organizations and affiliates are responsible for the development, approval, and timely revision of this training plan: 1. Mental Health and Substance Use Disorders Division, California Department of Health Care Services (DHCS) 2. Child and Family Services Division, California Department of Social Services (CDSS) 3. California Social Work Education Center (CalSWEC) 4. Shared Management Structure s Community Team, a 24-member stakeholder team which oversees the state s implementation of recent legal settlements and drives the delivery of collaborative care in California 2

5. Pathways to Well-Being Workgroup, a subcommittee of the Statewide Training and Education Committee (Pathways Workgroup) DHCS and CDSS will provide oversight for the development and implementation of this Integrated Training Plan and orchestrate connections for the Pathways Workgroup and Shared Management Structure s Community Team with other state, county, and partnering agencies to support the plan s development and use. CalSWEC convenes the Pathways Workgroup and serves as Co-Chair (with CDSS) of the Statewide Training and Education Committee. The Pathways Workgroup will contribute expertise in content development, training delivery, and knowledge of existing training products for topics related to the integrated training plan. The Pathways Workgroup includes members of the Shared Management Structure s Community Team or their designated participants who will contribute expertise and experience as advocates, service providers, and service recipients involved in the public child welfare, behavioral health, juvenile probation or other affiliated system. The full body of the Statewide Training and Education Committee will be asked to approve the training plan before it is formally submitted to DHCS and CDSS. Goals of the Coordinating Organizations 1. Develop a shared, integrated training plan that specifies a series of essential topics for the practice areas of public child welfare, behavioral health, juvenile probation and other affiliated systems concerning the well-being of children, youth, and families. Topic areas shall support practices that build on existing strengths, enhance protective factors, and foster the health and well-being of children, youth, and parents through social, emotional, and behavioral development. a. Topics will encompass knowledge, skills, and values for professional staff from governmental or community-based organizations, as well as educational materials for parents, youth, caregivers, and other service providers or community-based support persons that promote a strength-based approach to help each of these groups understand and participate in the public child welfare, behavioral health, or juvenile probation systems as related to children in care, basics of case management, and principles of behavioral health treatment. b. As applicable, the plan will include recommendations for conjoint audiences, training sequencing, training standardization, and modalities for training delivery. 2. Establish and execute a vetting process for the development of documents that explain and constitute the integrated training plan. The vetting process will include 3

identification of stakeholder groups whose comments will be solicited, and provide suggested options by which the members of the stakeholder groups may provide commentary (such as emails, tracked changes, on-line surveys, focus groups, etc.). 3. Develop or identify existing learning objectives for each of the foundational topic areas. Many learning objectives can be used in their current form or adapted from existing sources, such as the California Common Core 3.0 for child welfare social workers or training resources developed by the behavioral health and juvenile probation systems. Learning objectives for the foundational topic areas shall reflect shared theories, principles, values, and practice behaviors for serving California s children, youth, and families. The identification and development of learning objectives will begin after inception of the vetting or approval process for the training plan. A vetting process similar to that used for the training plan will inform the finalization of learning objectives. 4. Identify existing, available training materials that cover topic areas in the integrated training plan. 5. Promote the sharing of information about training resources on the websites of the entities represented in the Pathways Workgroup, the Community Team, and other groups participating in the plan. 6. Articulate a dissemination plan for training resources and related information, such as announcements for training events and sources for technical assistance. 7. Identify gaps in the coverage of foundational topics specified in the integrated training plan and advocate for resources for the development of training products to fill those gaps. 8. Revise the training plan to reflect new training needs. 9. As applicable, issue recommendations to CDSS, DHCS, CWDA, CBHDA, CIBHS, CalSWEC, or other partners regarding goals 1-8. Ongoing Communications Among Coordinating Organizations and Affiliates The Community Team and the Pathways Workgroup host in-person meetings or web conferences, respectively, on a regular basis. It is expected that this Integrated Training Plan will be a focus of attention for each of these groups during their regular convenings. The Community Team and the Pathways Workgroup will each provide one or more liaisons to the other group to communicate updates, commentaries, and other advisements as needed for the development of the Integrated Training Plan via in-person or conference call briefings, or by email correspondence. Communications from DHCS and CDSS to the Community Team and the Pathways Workgroup can be provided by the DHCS and CDSS members in these groups. 4

Guidance for Implementation and Evaluation of the Integrated Training Plan (ITP) In addition to implementing the complement of training specified in this plan, agencies should devise measures for outcomes regarding cross-agency collaborations, stakeholder partnerships, and conjoint trainings. Parents, youth, resource families, and tribal partners should be surveyed periodically to learn about their experiences with training and services provided by or through the agency. Information regarding agency performance should also be formally obtained from other stakeholders and partners, particularly in relation to the successes and challenges involved in cross-agency collaborations and how training content and delivery can be adapted to improve processes and outcomes. (Adapted from the California Core Practice Model Organizational Factors Matrix Draft 7-7-15) Integrated service delivery can be prone to program drift, given its inherent complexities and the competing agendas that are present. Leaders must be attuned to the policypractice feedback loop and design and implement integrated outcome and tracking systems that will indicate where measures of success are present or lacking. Evaluation of the implementation of the ITP is advocated to assess and strengthen its role in relation to the policy-practice feedback loop. The next section provides guidance for designing an effective evaluation process of the Integrated Training Plan (ITP) as a central component of the shared approach to integrated practice. Introductory considerations for evaluating the implementation of the ITP The ITP is a Flexible, Multi-Component Intervention Designed to Expedite and Support Policy and Practice Changes Organized by four tiers, the ITP Includes a constellation of training topics that will be delivered in a manner consistent with eleven guiding principles to conjoint audiences consisting of professional (echelons from line staff to agency director) and lay representatives across the spectrum of collaborating partners in each county. The specific topics and delivery tier (from introductory training to intensive technical assistance) will be customized to address each county s needs. The ITP Will be Implemented in Non-equivalent Settings Training recipients will include providers from multiple systems that approach parent, child, and youth services from distinct paradigms and disciplinary perspectives. 5

California s child welfare and county behavioral health agencies are highly diverse, including myriad organizational structures and community partners forming provider systems operating in demographically dissimilar county jurisdictions ranging from rural and frontier counties to Los Angeles (population greater than 10,000,000). A Complex, Multi-Component Evaluation Design Evaluation of the ITP will occur at multiple levels, utilize mixed methods and employ several classes of evaluation questions and a wide range of indicators designed to document accomplishments and to provide rapid feedback identifying modifications to content and delivery needed to improve implementation. Beginning as soon as possible, pre-implementation baseline measures should be collected to support the assessment of change over time. These data will also inform planning by identifying and clarifying local training and technical assistance needs. Remaining sensitive to existing local evaluation, standardized core evaluation questions relevant to any context should be articulated to assess the overall worth and merit of the ITP, however county or region-specific evaluation strategies designed to produce timely and actionable results are critical to answer the questions, What works, under what circumstances, and for whom? Fiscal and programmatic monitoring processes and evaluation strategies assessing program coverage, and the delivery of training and technical assistance will provide a foundation for intensive evaluation to measure outcomes. ITP outcomes will include practice changes at multiple levels and the adoption, implementation, monitoring and enforcement of policies designed to institutionalize elements of the shared approach. Integrated practice must be rigorously assessed to determine whether and how the ITP contributed to the systems transformation envisioned. Agencies are encouraged to utilize existing performance and outcome measures to assess and inform the implementation of this training plan, e.g., External Quality Review Organization for Medi-Cal Specialty Mental Health Services (EQRO). Assessment should include indicators of successful processes and qualitative measures. Leadership: Management and Supervision Implementation requires coordination across multiple organizational levels and partnering agencies. Administrators, managers, and supervisors in collaborating agencies should be advised of the purpose and scope of the Integrated Training Plan, and mentored on key concepts and skills related to the shared approach to integrated practice. Annual performance reviews of administrators, managers, supervisors, and direct service staff should align with the principles of the Integrated Training Plan; the values, principles, and 6

behaviors of the shared approach to integrated practice; and the training requirements of their respective positions. (Adapted from the California Core Practice Model Organizational Factors Matrix Draft 7-7-15) Collaborative leaders recognize that decision making nearly always involves partners, and that key decisions are not made without consultation and dialogue. Complex integrated care delivery requires a collective wisdom available only when leaders from partner organizations have high levels of trust and accessibility. Matrix or Co-Supervision models are often necessary, but require great communication and attention. Four key areas of collaborative leadership development are encouraged for Directors, Managers, and Supervisors in the partnering agencies: 1. Training and Technical Assistance 2. Information and Data Management 3. Oversight, Accountability, and Performance Management (including the measurement of processes and outcomes) 4. Core Practice Model Fidelity (including a policy-practice feedback loop ) Specific topic areas for Directors, Managers, and Supervisors are listed in the 4 th Tier of the Topic Areas for Integrated Training section below. Workforce Development Guidance for staff recruitment, selection, and orientation Hiring procedures should align with California s shared approach to integrated practice among the child welfare, behavioral health, and juvenile probation systems. Departments of human resources should be oriented to the shared approach and be called upon to suggest tools for recruiting, interviewing and hiring staff who are committed to improving well-being outcomes for children, youth, and parents. (Adapted from the California Core Practice Model Organizational Factors Matrix Draft 7-7-15) In addition to testing and screening for knowledge and skills required for specific positions, candidates should also be vetted for attributes and skills needed to enact the shared approach with fidelity. Such qualities and abilities shall include, but not be limited to, cultural responsiveness; sensitivity to the concerns and perspectives of LGBTQ and genderexpansive youth, trauma-informed practice skills; receptivity to sharing leadership with parents and youth; and enthusiasm for teaming with professionals from other disciplines, family members, and other persons in family support networks. Candidates should also demonstrate openness to evidence-based practices and interest in continual learning. These 7

attributes and skills should be included and reinforced in orientations for new staff and in ongoing training for existing staff. Guidance for recruiting and supporting diverse Parent Leaders In order to qualify as a Parent Leader, individuals are expected to have lived experience as a parent or caregiver who has navigated one or more relevant parent-, child-, or youth-serving systems. Ideally, the local pool of Parent Leaders should reflect the diversity of the parent client population of the relevant local public agencies. At a minimum, Parent Leaders should receive training, including guided practice, to achieve positive results and build research-based competencies required for meaningful work with parents and caregivers. Competencies should include advocacy, empowerment, cultural responsiveness, and parent leadership. Trainings for Parent Leaders should support a teambased framework as indicated in California s shared approach for integrated practice for the public systems of child welfare, behavioral health, and juvenile probation. Certification attesting to lived experience and competencies in Parent Leadership consistent with California s integrated practice approach may partially fulfill the qualifications for serving as a Parent Leader. Guidance for developing Youth Leaders Youth Leaders are expected to have lived experience receiving service from child welfare, behavioral health or juvenile probation. The role of the Youth Leader is to ensure that the strengths, needs and preferences of youth are represented throughout the service process, as well as to ensure that the roles and responsibilities of other members of the team are understood. Youth Leaders mentor and support youth to advocate on their own behalf so that they are able to voice their own needs and goals and propose or select formal services and informal supports that enable them to promote and sustain their well-being. Youth Leaders must demonstrate excellent communication skills as they work closely with youth to design and monitor service plans, and to resolve problems or issues that a youth may face. As role models, Youth Leaders inspire change by encouraging, motivating and supporting the development of leadership ability in youth they serve. Additionally, Youth Leaders should be able to represent the perspective of youth served by the system of care and meaningfully contribute in forums designed to inform policy development, evaluation of programs or services, or other stakeholder processes. Youth Leaders should receive training, as necessary, to successfully carry out their roles in designated positions. 8

Audiences for Conjoint Trainings Caregiver and care recipients Biological and kin caregivers, resource parents, youth, transitional age youth Caregiving service providers Foster family agencies (FFAs); family preservation providers; short-term residential placement providers Professional staff (state & county) Behavioral health, child welfare, juvenile probation, CDSS, DHCS, and county behavioral health, child welfare, and juvenile probation associations Court affiliates Judges, attorneys, Court Appointed Special Advocates (CASAs) Community affiliates & advocates Parent and youth organizations Children s informational supports Resource families Faith-based leaders Community-based organizations and community resources Law enforcement First Five Health affiliates Regional Center services Public Health nurses Managed Care Organizations Behavioral Health Plans Substance Abuse Treatment services Education affiliates Education Liaisons Special Education Local Plan Areas (SELPAs) Teachers Head Start/Early Head Start County Offices of Education 9

Training Standardization, Sequencing, and Modalities [placeholder] Training Delivery This integrated training plan is designed for conjoint delivery, i.e., the delivery of trainings to audiences comprised of staff and individuals from the broad array of participating agencies. Conjoint delivery aims to strengthen collaborative relationships and build common understandings about the concerns of youth and families, the missions and mandates of participating organizations, particularly public child welfare, mental health and juvenile probation agencies, and the promotion of healthy development and child well-being. Agencies that host training events are requested to invite participants across the relevant spectrum of collaborating partners. One of the primary delivery vehicles of this shared training will be the Regional Information and Transformation Exchange convenings, which consist of regular cross system training events coordinated by the Statewide Training and Education Committee. Co-Training In addition to the utilization of professional trainers and subject matter experts, agencies are requested to engage qualified Parent and Youth Leaders as co-trainers. The perspectives of Parent and Youth Leaders can enhance topic areas and strengthen the connection between training and practice. Products Related to the Integrated Training Plan: 1. Explanations of the Integrated Training Plan for professional and lay audiences 2. Learning Objectives 3. Inventory of existing, available resources that support the Integrated Training Plan 4. Clearinghouse websites with resources for the Integrated Training Plan, information regarding sources of technical assistance, announcements for training events, and links to partnering agencies. Vetting Processes Vetting is needed for four different types of training products: 1. This Integrated Training Plan. 10

2. Documents for partnering agencies and groups which provide brief explanations of this Integrated Training Plan, possibly customized for particular audiences. 3. Existing training resources developed by: a) agencies partnering in this Integrated Training Plan; or b) entities external to the partnering agencies. 4. Learning objectives for the foundational topics identified in this Integrated Training Plan. It is envisioned that the vetting of the Integrated Training Plan would occur first, followed by vetting related explanatory documents for statewide or regional distribution (if any), existing training resources, and, after a longer period of development, learning objectives for foundational topics. A general description of vetting processes associated with this Integrated Training Plan includes the following actions: 1. The Community Team and Pathways Workgroup will determine when drafts of the Integrated Training Plan, learning objectives for foundational topics, and related supporting documents are ready for vetting by partnering agencies and groups, and the timelines involved for the steps of the vetting process and for product finalization. 2. The Community Team and Pathways Workgroup will identify stakeholders, content experts, and designated staff from the child welfare, behavioral health, and juvenile probation training systems from among their respective memberships or from external groups who have interest in reviewing drafts and providing structured feedback. Review and feedback by these groups will assist in the development of the Integrated Training Plan, learning objectives, and related documents. 3. Drafts of the shared training plan, learning objectives, and related documents will be made available online to vetting audiences for their review. 4. Feedback from the vetting groups may occur through a variety of structured modalities which are considered most conducive for engaging particular targeted audiences, as agreed by the Community Team and Pathways Workgroup. Modalities may include email correspondence, tracking changes in documents, webinars, focus groups, and online surveys. 5. Explanations about the expectations for participating in the vetting process will be communicated to interested parties in the identified vetting groups. 6. Comments from the vetting groups will be synthesized and serve as the basis for modifying the draft Integrated Training Plan and related documents. 11

Vetting sequence for this integrated training plan 1. Pathways Workgroup prepares draft Integrated Training Plan. 2. Draft Integrated Training Plan is presented and distributed to members of the Community Team (CT) and STEC. a. Comment period: 1 month after each presentation date 3. Pathways Workgroup revises document based on comments from CT and STEC. a. Editing period: 2 weeks after the end of the last comment period 4. The Integrated Training plan is distributed to members of DHCS, CDSS, CPOC, CWDA, and CBHDA. a. Comment period: 1 month 5. Pathways Workgroup revises document based on comments from the agencies listed in item #4. a. Editing period: 1 month 6. Pathways Workgroup submits final Integrated Training Plan to CDSS & DHCS for formal approval. Dissemination of the Integrated Training Plan [placeholder] 12

Topic Areas for Integrated Training 1 st Tier -- Foundations: Building a Common Framework The Foundation Series is intended for all participating service agencies and systems, with the expectation that staff, advocates, supervisors, and managers receive the full complement of foundation courses, except where noted. Foundation courses would be ½ day or a full day, depending on the content. Collaboration Across Systems For each overview, subtopics include: 1) purpose/goals/underlying theory of the system/sector; 2) role of the sector in the landscape of human services; 3) descriptions of the populations served and their needs, with reference to overlap with other sectors; 4) intention of staff role(s) and rationale for key practices; 5) experiences of consumers served by the system; 6) how the system incorporates the principles of the integrated training plan. 1. Introduction to the California s Child Welfare Core Practice Model & Child Welfare Overview (including ICWA) 2. Behavioral Health Overview [includes Continuum of Care, Mental Health Services Act, & Substance Abuse] 3. Juvenile Justice, Courts, and Juvenile Probation Overview 4. Caregiving Overview (includes resource family approval and alternative caregivers [kin, foster parents, foster family agencies, residential programs]) 5. Health Care Overview (includes public health and the Regional Centers) 6. Education Overview (includes IEPs) Integrated Practices 1. Collaboration and Integrated Practice (policy, management and practice levels) 2. Family and Youth Engagement 3. Child and Family Teaming; Sharing Leadership 4. Trauma-informed Practice & Services 5. Cultural Responsiveness & Social Justice, including LGBTQ competency and best practices 6. Sharing Data, HIPAA, Privacy, & Consent (for relevant audiences) 7. Documentation in a Cross-System Environment (for relevant audiences) Promoting Safety, Security, and Well-being 1. Basics of Child and Youth Development 2. Positive Youth Development and Transitional Age Youth 3. Approaches to the Prevention of Child Abuse and Neglect 4. Access to Specialized Mental Health Care Services (Early and Periodic Screening, Diagnosis & Treatment (EPSDT)) 5. Sexual Health 6. Sexual Orientation, Gender Identity, and Gender Expression (SOGIE) 13

7. Commercial Sexual Exploitation of Children (CSEC) 8. Psychotropic Medications 2 nd Tier -- Applications: Deepening Knowledge, Skills, and Values Some topic areas may have broad relevance across sectors that are collaborating in the delivery of services. Other topic areas may have particular relevance to staff members scope of work, and the specific needs of families. 1. Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS) 2. Therapeutic Foster Care (TFC) 3. Medi-Cal Eligibility, Claiming, & Billing Practices 4. Wraparound principles 5. Prevention in Behavioral Health 6. Parent Leadership 7. Youth Empowerment 8. Treatment Foster Care 9. Collaborating with Native American Families and Tribal Communities 10. LGBTQ Competency and Best Practices 11. Adoptions 12. Prudent Parenting 13. Quality Parenting Initiative 3 rd Tier -- Skill-building: Coaching and Supervision Training by itself is usually not sufficient to improve the quality of a particular service or the quality of a staff member s performance. The transfer of knowledge and skills from the training environment to the work setting requires timely practice and mastery on the job under the guidance of a coach or supervisor. 4 th Tier Leadership for Directors, Managers and Supervisors Training Content for Directors, Managers and Supervisors should include, but not be limited to: 1. Shared Decision Making, Governance and Management Techniques 2. Conflict Resolution 3. Cross System Team Building 4. How to Identify and Foster Roles for Advocates, Partners and Persons with Lived Experience 5. Communication in a Cross System Environment 6. Creating and Sustaining Collaborative Fiscal Strategies 14