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Agenda• Introduction • Overview of BBI Framework • The Plummer Home for Boys: A
Transformational Journey • What Families Need • Questions
The Building Bridges Initiative (BBI): Advancing Partnerships. Improving Lives.
Best Practice Framework for Residential Interventions for New York State - Webinar/ Overview of Building Bridges Initiative July 10, 2015 Presented by: Gary M. Blau, Ph.D., Chief, Child, Adolescent and Family Branch, Substance Abuse and Mental Health Services Administration
BBI Mission Identify and promote practice and policy initiatives that
will create strong and closely coordinated partnerships and collaborations between families, youth, community- and residentially-based treatment and service providers, advocates and policy makers to ensure that comprehensive services and supports are family-driven, youth-guided, strength-based, culturally and linguistically competent, individualized, evidence and practice-informed, and consistent with the research on sustained positive outcomes.
• Family Driven & Youth Guided Care • Cultural & Linguistic Competence • Clinical Excellence & Quality Standards • Accessibility & Community Involvement • Transition Planning & Services (between settings
& from youth to adulthood)
BBI Core Principles
BBI Critical Elements for Success
•Residential-specific research shows improved outcomes with shorter lengths of stay, increased youth and family involvement, and stability and support in the post-residential environment (Walters & Petr, 2008).
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BIG STEPS AND SMALL STEPS
• All count – Create an action step based on what you learn today!
• A number of family-driven & youth-guided practices have been identified that support better outcomes – How do you engage and support youth and families??
• How do you track outcomes??
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Examples of Where BBI is happening?
• Comprehensive State initiatives (DE, IN, MA, WA; NH – initially 6 residential programs, CA – initially 4 regions)
• Initial State level activities (AZ, FL, GA, LA, NM, ND, OK, SC, WV; in CA & MD – Provider associations leading)
• County/City level initiatives (City: NYC; Counties: Monroe/ Westchester, NY & Maricopa, AZ)
• Many individual residential and community programs across the country
Key Elements of Different BBI Initiatives • CA (4 large pilots): Wraparound/Family
Search & Engage/Finding Support System in Community/Family & Youth Advocates
• NH: Open and Honest Examination of ALL CURRENT PRACTICES/willing to transform all practices against FD & YG Care
• MA (statewide for CW & MH): Total Transformation/Family & Youth advocates/Flexible Service Models - Follow into Community
Indiana, Damar, Inc., Dr. Jim Dalton, CEO Our Job is not to cure kids but rather to help kids
and their families negotiate the basic tasks of everyday life.
“Residential treatment” should be oriented not
so much around removing problems kids bring to care but toward establishing conditions that allow children and families to manage symptoms and crises more effectively at home and in the community.
•Recidivism/Readmissions Post Discharge From Residential
• 68% in one state (2009) for all licensed residential programs after one year vs. Damar Services (BBI implementer) with ranges from 3-11%
Example of a Critical Issue
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“You never change things by fighting existing reality. To change something, build a new model that makes the
old model obsolete.”
- Buckminster Fuller
BBI Products & Resources • BBI website (www.buildingbridges4youth.org): Please visit the
website and review all of the BBI documents available to support work with children, youth and families.
• BBI Self-Assessment Tool (SAT) and the SAT Glossary: Residential programs, the youth and families they serve, and their community program counterparts now have a useful tool available to assess their current activities against best practices consistent with the BBI JR Principles. ▫ The SAT: designed to be used with groups of residential and
community staff, advocates, families and youth to facilitate discussion on how program and community efforts to implement best practices can be most effectively supported.
▫ The SAT Glossary provides a definition of terms used throughout the SAT.
▫ Will be available on the BBI website with additional information about how to use the SAT.
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BBI Products & Resources • Family Tip Sheets - Short and Long Versions: The BBI Family
Advisory Network, comprised of family members and advocates who have had children in out-of-home care programs, have developed both short and long versions of the Family Tip Sheet.
• The Family Tip Sheets support family members by identifying important issues that family members might consider relative to their child’s residential experience and information they may want to explore with their residential provider.
• It is recommended that both versions be distributed to family support/advocacy organizations; residential and community programs should also provide new and existing family members with copies of both documents.
• State and county policy makers and associations may want to distribute both versions of the Family Tip Sheet to programs they oversee or to their member organizations.
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BBI Products & Resources • Youth Tip Sheets - Short and Long Versions: The BBI Youth Advisory
Group has completed both short and long versions of the Youth Tip Sheet, entitled: Your Life – Your Future: Inside Info on Residential Programs from Youth Who Have Been There. The Youth Tip Sheets offer both words of support and a framework for guiding youth to ask questions that will help them be informed partners in their own care. Both the short and long versions of the Youth Tip Sheets can also be used as part of an admission packet. ▫ The Youth Tip Sheet – Short Version is for youth who may be
considering a residential program and/or those about to enter or who are already in a residential program. Ideally, a youth advocate or youth mentor would review the Youth Tip Sheet with the youth individually.
▫ The Youth Tip Sheet – Long Version will interest youth who wish to gain a more in-depth understanding of how they can ‘take charge’ of their own treatment and recovery and can be used by advocates, providers, families and policy makers to ensure that residential and community programs serving youth, and their families, are truly youth-guided.
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• Documents & articles to support field (including system of care communities), example include: ▫ Tip Sheets for Working with Families and Youth ▫ Tip Sheet: Working with and Supporting Siblings ▫ Cultural and Linguistic Competence Guidelines for
Residential Programs ▫ Handbook and Appendices for Hiring and Supporting Peer
Youth Advocates ▫ Numerous documents translated into Spanish (e.g., SAT;
Family and Youth Tip Sheets) ▫ Engage Us: A Guide Written by Families for Residential
Providers ▫ Promoting Youth Engagement in Residential Settings
Go to BBI website: www.buildingbridges4youth.org
BBI Products & Resources • Examples of BBI Documents available on BBI website: BBI Fact
Sheet on Child Welfare; Fiscal Strategies that Support the Building Bridges Initiative Principles; Cultural and Linguistic Competence Guidelines for Residential Programs; Engage Us: A Guide Written by Families for Residential Providers; Promoting Youth Engagement in Residential Settings
• BBI Calendars of Events: Over the past five years many national associations and organizations have highlighted different aspects of the BBI in conference keynote addresses, half- and full-day pre-Institute events and conference presentations.
• Articles about BBI: National publications have featured articles about BBI in their publications. Recent publications included the National Council for Community Behavioral Health, the national Teaching-Family Association, and the special issue of Child Welfare on residential care and treatment, the journal of the Child Welfare League of America.
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Recently released BBI documents – available: www.buildingbridges4youth.org • BBI Guide: Finding and Engaging Families for
Youth Receiving Residential Interventions: Key Issues, Tips, and Strategies for Residential Leaders
• BBI Tip Sheet: Youth Advisory Councils • BBI Tip Sheet: Working with and Supporting
Siblings • BBI Report: Building Consensus on Residential
Measures: Recommendations for Outcome and Performance Measures
New Book: Residential Interventions for Children, Adolescents and Families: A Best Practice Guide
There are several options for ordering: • toll free phone: at 1-800-634-7064 • fax: 1-800-248-4724 • email: [email protected] • website: www.routledgementalhealth.com (20% discount w/ web orders using
code IRK71; free global shipping on any orders over $35) Orders must include either: the Title: Residential Interventions for Children,
Adolescents and Families: A Best Practice Guide OR the ISBN: 978-0-415-85456-6 Note: As a federal employee, Gary Blau receives no royalties or any other
remuneration for this book. Any royalties received by Beth Caldwell and Bob Lieberman will be used to support youth and family empowerment consistent with BBI.
BBI web-based training programs available summer 2015
• Cultural and Linguistic Competence in Residential • Best practices in Medication for Residential • Recommended 1st Best Practice Steps for Residential Leaders focused
on Sustained Positive Outcomes • Overview of Best Fiscal, Policy and Practice Strategies for Residential
Programs for State Leaders focused on Sustained Positive Outcomes • 1st Best Practice Steps in Family-driven Care for Residential • 1st Best Practice Steps in Youth-guided Care for Residential • Hiring and Supporting Residential Family Peer Advocates • Hiring and Supporting Residential Youth Peer Advocates • Successful Strategies for Tracking Long-term Outcomes
BBI documents available summer 2015
•Guide: Wraparound Interventions for Residential & System of Care Communities
•Fiscal and Policy ‘How-to” Guide for States/Communities for Funding Residential Transformation
Endorse the BBI Joint Resolution • Go to BBI web site
(www.buildingbridges4youth.org) • Read BBI Joint Resolution (JR) • Email Dr. Gary Blau
([email protected]) or Beth Caldwell ([email protected]) that you would like to endorse BBI JR
• Be put on list serve to receive BBI newly developed documents
• Be first to be invited to BBI events
BBI Intensive Training Program August 5, 6 & 7, 2015
Boston, MA
To register for the training, go to:
https://www.ffcmh.org/bbi/training/register
To receive regular updates about BBI and the August BBI Training event – endorse the BBI Joint Resolution on our BBI website: www.buildingbridges4youth.org
NH Contact Information
NFI North Array of Services Jennifer Altieri 603-586-4328 [email protected] Becket Family of Services Susan Beck, Executive Director 603-726-1552 [email protected]
MA Contact Information
Janice LeBel, PhD, ABPP Director of Program Management, Child &
Adolescent Services Massachusetts Department of Mental Health 25 Staniford Street Boston, MA 02114 Phone: 617-626-8085 [email protected]
CA Contact Information
Dr. Michael J. Rauso, Division Chief Department of Children and Family Services Resource Management Division 425 Shatto Place, Suite 303 Los Angeles, CA 90010 (213) 351-5861 [email protected] William P. Martone, Former/Long-term President & CEO Hathaway-Sycamores Child and Family Services 210 South De Lacey Ave. Suite #110 Pasadena, CA 91105 626-395-7100 [email protected]
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Damar Contact Information
Dr. Jim Dalton, President and COO Damar Services, Inc. www.damar.org (317) 856-5201
BBI Contact Information • Gary M. Blau, Ph.D. [email protected] 240-276-1921 • Beth Caldwell [email protected] 413-644-9319
www.buildingbridges4youth.org
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• James Lister, Executive Director • Lauren Frey, 3P Consulting LLC
Plummer Home
Massachusetts DCF Data
• On December 31, 2014 there were 8,272 children and youth in foster care in Massachusetts.
• On December 31, 2014 there were 1,976 children and youth in congregate care settings in Massachusetts.
• In 2014, 808 youth aged out of care in Massachusetts o (420 were 17.9 to 18 years old, the remainder were 19 to 22).
• 555 of these youth had a goal of Another Planned Permanent Living Arrangement (APPLA)
• 437 of these youth aged out of foster care
• 221 of these youth aged out of congregate care.
Overview of Plummer
• Types of programs
• Transformation process
• Model of intervention
• Permanency work
• Assessments: internal and standardized
• Stepdown process
Plummer Programs
• On Point: Diversion for Youth with JJ Involvement
• Intensive Foster Care
• Group Home: Adolescent Males, age 14 - 18
• Pre-Independent Living: Males, age 18 - 21
• PYRAMID: Community-Based Supported
Apartments for Youth age 18 - 21
Plummer’s First Program Improvements
• Additional staff and staff support • Tutoring • Building improvements • Mentors • Family vehicles • Work program • Music program • Sports, camping and adventure-based activities • Chores and allowance
Plummer’s First Look at Data
Review cases of 41 youth discharged in 2009, 2010, and 2011 plus those in residence at Plummer Home in December 2011
• Service plan goals upon referral to Plummer: Almost half had goals of APPLA/Independent Living (IL). Slightly more than 1/3 had goals of reunification.
• Status at discharge from Plummer:
Most went to higher or locked levels of care. About 1/3 went AWOL, signed out or left “to stay with a
friend”. Less than 15% were discharged to family/kin.
What Did the Data Tell Us?
• Better Programming ≠ Better Outcomes
• For most youth:
o No clear goal to exit the system to reunification, adoption, or legal guardianship
o Inadequate progress toward an exit to family o No safe and stable parenting or network of family
connections at discharge
Plummer Challenges Traditional Residential Approach
• Permanency work is not prioritized or measured. • A committed adult mentor or “connection” is the
best we can hope for. • Youth given a choice of being parented or not. • Youth prepared to live independently of family.
Plummer Transformation
Sparked by staff frustration with the status quo and guided by a strategic plan for change
Shifted from a traditional group home to a permanency-focused program: – Youth-engaged: with youth voice, about youth
needs – Family-driven: with family involvement, toward
family outcomes
Vision: The Dream
ADOPTED 2009 A community committed to providing all children the support necessary to successfully navigate to a healthy adulthood.
PROPOSED 2015 Every young person has a family unconditionally committed to nurture, protect and guide them.
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The Plummer Model of Intervention
Plummer’s Current Data
August 1, 2013 to April 30, 2015: – Average length of stay in group home = 8.1 months – 28 youth discharged from Plummer Group Home:
– 25% were reunified with birth parents – 25% went to pre-IL with family connections
Plummer’s Current Data
18 youth reside in group home and pre-IL: – All are receiving permanency services toward
reunification, adoption, or legal guardianship concurrently with preparedness and community.
– 13 have a State permanency goal of APPLA: 5 youth with a goal of APPLA will be discharged
to family this summer (4 reunification, 1 youth-specific foster home)
What Helped Us Make the Shift?
• Strong vision and strategic planning
• Setting priorities: finances and staff roles
• Solid collaboration with State partners
Plummer Assessments: Standardized and Internal
Child and Adolescent Needs and Strengths (CANS) Youth Connections Scale (YCS) Plummer intervention model rating scale:
– Permanency: Every youth has a safe and emotionally secure parenting relationship and a life long, legal family.
– Preparedness: Every youth has the skills and support to meet his or her
physical, emotional, educational and economic needs.
– Community: Every youth has a safe place to live, a sense of belonging and a
chance to positively contribute to his or her community.
Plummer Permanency Approach
• Family search and engagement o Importance to the youth o Immediate, persistent, ongoing o Involvement in treatment and teaming
• Youth preparation for permanency
o Individual time with permanency social worker o Group work with peers o Family contact/communication prioritized
• Youth-engaged teaming
o Realistic, individualized permanency plans o Measurable benchmarks
Life After Plummer
• Focus on stepping toward family, not stepping down
• Priority on having a parent other than the State and
being parented, concurrently with placement
• Emphasis on family relationships, even when moving to supported apartment
Youth Transitioning From Residential: Permanency, Preparedness, Community
Youth and Caregiver Perspectives: Romere and Khadijah
Romere and Khadijah’s Story
What are the challenges of being 18 and transitioning from a group home?
How did Plummer’s program help with preparedness?
How important was permanency work?
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RESOURCE
http://aacrc-dc.org/sites/default/files/paper13final.pdf
Redefining Residential: Strategic Interventions to Advance Youth Permanency Lister, James, Lieberman, Robert E., Kari Sisson. AACRC. April 2015.
For More Information
James Lister, MBA Executive Director, Plummer Home www.plummerhome.org [email protected] Lauren Frey, MSW, LICSW 3P Consulting LLC www.3PLLC.net [email protected]
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The Building Bridges Initiative (BBI): Advancing Partnerships. Improving Lives.
Best Practice Framework for Residential Interventions for New York State Webinar/ Family-driven Care July 10, 2015 Presented by: Karen Anne Johnson, Family Advocate, FDC. FPC, SCO Family of Services, Briarwood, NY
• Family Driven & Youth Guided Care • Cultural & Linguistic Competence • Clinical Excellence & Quality Standards • Accessibility & Community Involvement • Transition Planning & Services (between settings
& from youth to adulthood)
BBI Core Principles
What’s it all about?
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What is Family Driven? Family Driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. This includes: • Choosing culturally and linguistically competent
supports, services, and providers; • Setting goals; • Designing, implementing and evaluating programs; • Monitoring outcomes; and • Partnering in funding decisions.
Source: Federation of Families for Children’s Mental Health
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Why is it important?
Residential-specific research shows improved outcomes with shorter lengths of stay, increased family involvement, and stability and support in the post-residential environment (Walters & Petr, 2008).
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• Give a very warm, empathetic, non-judgmental reception for the family member – at the door.
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Hire Family Partners/Advocates MOST IMPORTANT STEP: • Hire multiple family partners/advocates • Have senior family partner as part of executive
team & provide supervision to all family partners
• Have family partners (AND FAMILY MEMBERS) as part of EVERY organizational work group/ committee/task force
• Have family partners share offices with other staff – spread throughout the organization
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Hire Family Partners/Advocates •They serve as co-trainers in staff
orientation and ongoing training programs
•They serve as part of hiring groups to hire staff
•They serve as part of evaluation teams to evaluate each individual staff
•“Nothing about us without us!”
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2ND MOST IMPORTANT STEP: Develop Strategic Plan to Successfully Engage Families and Operationalize Family-driven Care
Go to the BBI website (www.buildingbridges4youth.org),
download, review and plan to use the BBI Self-Assessment Tool as part of your strategic plan
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As part of Strategic Plan Have all leadership team members read and read and
read: • Residential Interventions for Children, Adolescents and
Families: A Best Practice Guide: Chapters on Family-driven Care and Clinical Strategies for Engaging Families
• BBI Family Tip Sheets (long and short versions) & BBI Engage Us: A Guide Written by Families for Residential Providers (www.buildingbridges4youth.org)
• Massachusetts Department of Mental Health Creating Positive Cultures of Care Guide Chapters ▫ Successfully Working with Family Partners ▫ Embracing Family-driven Care
• A variety of other materials to support increased understanding and improved knowledge-base
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Priorities for Board/Leadership Full implementation of Family Driven, BBI principles: • Permanency – • Family Search & Engage – • Wraparound/Child & Family Teams – • Best Practice Clinical Engagement Skills (i.e. variations
of Functional Family Therapy/ Multi-systemic Therapy)
• Clear expectations for all disciplines of staff to work interchangeably in residential, home & community
• Focus on Building Memories with Families
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Priorities for Board/Leadership Ensure executive team members: • Have open door policy for family members • (at least one) meets/greets every new family • (at least one) interviews every family
individually at discharge and again – 6 months post discharge
• (and all agency staff) represent the cultures/ethnicities/races & speak the languages of the youth and families served
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Examples of Practices you would see: • Every Staff is ‘Director of First Impressions
• Families can come to program 24/7 • Families can go to every part of the program –
spending time in their child’s room and classroom and activities
• Clinical and direct-care staff work in the families’ homes
• Support groups/educational offerings for families happens in the communities- not on campus
• Families decide dates/times/locations for treatment team meetings – encouraging at home/in community
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Examples of Practices you would see: • Lose the words ‘home –visits or -passes’
• Families called everyday to share child strengths – calls are not just about challenges/problems/issues
• Youth ENCOURAGED to call different family members multiple times daily
• Create opportunities (e.g., weekend camping; recreational trips) for families to spend time with & be proud of their children/to create positive memories
• Support siblings • Gather tickets/freebies for families to use with
children (maybe with a staff for support)
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BBI Contact Information • Dr. Gary Blau [email protected] 240-276-1921 • Beth Caldwell [email protected] 413-644-9319 • Karen Anne Johnson [email protected] 917-232-9269
www.buildingbridges4youth.org
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