Coordination of Services and Service Array

View an
Example from
the Field

Definition

Coordination of services refers to the centralized process by which multiple services and supports, often provided by multiple agencies, are synchronized to address the needs and strengths of each child, youth, or family. This process commonly follows a strength-based child and family team approach to develop a service plan. Coordination of services for families involved in child welfare may occur through methods such as Family Group Decision-Making, Team Decision-Making, wraparound, case management, and care coordination.

Service array refers to the range of service options, including methods for coordinating services available to address holistically the individual needs of children, youth, and families, as determined by a thorough assessment, within a geographic area. Services may include family preservation and case management services, out-of-home placement, and permanency planning. The service array consists of the network of all local public, private, faith-based, and nonprofit community-based organizations designed to ensure the safety, permanency, and well-being of children, youth, and families.

The service array, including child and family team processes, must be supported by available funding, policies and a strong service provider network to serve children and families in their home community, as illustrated in the following visual developed by Portland State University (2004).

Why Use a Coordination of Services and Service Array Toolkit?

This toolkit outlines how to integrate a comprehensive array of services and supports to actualize your system of care, as well as the processes necessary to individualize services for a particular child and family. This toolkit addresses three questions you might have:

• How do we tailor services for each child and family?
• How do we use a strength–based approach in assessments and service delivery?
• How do we integrate a robust array of services and supports to ensure we serve children and families within their home community whenever possible?

Systems of Care Principles and Values

Incorporating systems of care principles and values into the daily operations of coordinating services and service array development will set the tone and direction for moving forward. Principles help guide actions and lend focus to systems of care work. Principles and values are the foundation on which you build your system of care.

The following are a few ways systems of care principles and values might be evident in your community's coordination of services and service array:

• Services and supports directly address the needs and strengths of the child, youth, and/or family.
• Services and supports are accessible to the children, youth and families of focus.
• Families and youth are actively engaged in coordinating services and developing service plans.
• Culture, race, class, and gender factor into the design and implementation of services or support.
• Service providers use strength–based, culturally competent needs assessments to guide case planning.
• Children, youth, and families are not subject to multiple interviews or invasive, exhaustive questionnaires from multiple sources.
• Individual service plans include service providers who represent diverse agencies and organizations.
• Establishing and using community–based services.
• Serving children, youth and families within the context of their home whenever possible.
• When children and youth must be placed out of their homes, placements are in close proximity to their homes, so that children are kept in the same communities and schools whenever possible.
• Service outcomes and utilization data are regularly tracked, provided to front line staff, supervisors, administrators and policy makers, and used to determine if services should be changed, created, or eliminated.
• Service outcomes and utilization data are used to inform policymakers and drive budget decisions and service system reform.
• Service coordination is essential for case planning and service delivery for all children, youth, and families in the target population.
• The community, agency funders, and key leaders support the array of services available and methods for coordinating services.

Below is an example of how systems of care principles envelop the entire process of serving children, youth and families. As the graphic demonstrates, system of care principles influence the actions of service providers, system partners and all activities involved within a system of care (DeCarolis, Southern, & Blake, 2007).

Goals for Implementation

• A comprehensive set of services and supports are available and accessible to the population of focus.
• The interagency network of service providers works on behalf of all children and families in the population of focus.
• Each child, youth, and family actively/meaningfully participates in coordinating services as part of the case plan.
• All children, youth, and families receive a comprehensive, strength–based, culturally sensitive, family–friendly, and family–driven assessment that is accepted by all participating agencies prior to development of a case plan.
• All service providers and the family are part of the service planning process to produce one individualized, multi–agency service plan per family, regardless of the number of agencies involved.
• Flexible funds are available to purchase services that meet the unique needs of a child, youth, or family, and may fall outside the normal or traditional menu of services offered.
• Services and supports are arranged for a child, youth, or family to optimize efficient and effective delivery.
• Models for coordinating services such as Team Decision–Making or Family Group Decision–Making are recognized as part of the broader service array available to children, youth, and families in the system of care.
• Agencies that fund services allocate revenue to the system of care to support, purchase, or develop services for the population of focus, including methods for coordinating care.
• Agencies and organizations support the service array and service coordination methods fiscally and through policies and procedures.
• These are only a few examples of goals some communities have established. Your community's goals might be very different.

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Example from the Field

Site

Medicine Moon Initiative to Improve Tribal Child Welfare Outcomes through Systems of Care, Spirit Lake, Standing Rock, Fort Berthold, and Turtle Mountain Reservations, North Dakota

Goal

To develop a culturally competent, locally administered tribal system of care for child welfare-involved families that integrates natural and cultural supports into the child welfare service array and includes cultural well-being as part of the quality improvement process.

Strategy/Approach

What Was Done

To enhance culturally competent services, expand the service/support array, and develop a culturally appropriate quality improvement process, the Medicine Moon Initiative conducted seven group interviews with elders and community members from the four reservations and seven groups of Dakota, Lakota, Mandan, Hidatsa, Arikara, and Chippewa tribal people. The goal was to identify cultural supports, values, and protocols that could improve the cultural appropriateness of services, identify values that can be used to enhance child welfare practice, and identify elements/indicators that can be used as part of the development of a culturally relevant quality improvement process.

Who Was Involved

The approach involved multiple key stakeholders including, community members and elders from each tribal group from the four reservations; child welfare staff; Native American Training Institute Medicine Moon Initiative staff; a University of North Dakota graduate and intern; a local community member who facilitated the meetings; and the Medicine Moon Initiative evaluation team.

Time Frame

The initial conceptualization of the cultural interview process began in September 2004 and interviews were completed in December 2005.It took approximately 15 months to develop and conduct the group interviews.

Why This Approach Was Selected

• Recognition that cultural well-being and identity are protective factors for Native American children and youth.
• In a survey, many Native American families reported they did not know their cultural values and history, which helped identify training needs for Native American parents and foster parents.
• Many Native American children and youth are in the North Dakota State child welfare system; it is difficult to find cultural information and/or cultural supports for these children and Native American families.
• Many reservation-based child welfare practitioners, whether they are Native American or not, do not know what cultural supports, values, and protocols are available in the communities where they reside or practice.

Systems of Care Principles

The principle of strengths-based care is incorporated because it recognizes culture as a strength of Native American communities. To be culturally competent, one must be aware of the necessary competencies. It was necessary to involve community members who are knowledgeable about how community-based strengths can be utilized. Accountability to Native American children and families must include identification of issues of cultural well-being. Enhancement of services and supports to Native American children and families that can be sustained over time is also critical to the system of care because they are ingrained in the community.

Lessons Learned

Facilitators

Additional training had to be provided to local community facilitators; they had difficulty staying focused on the purpose of the interview when some of the elders reminisced or socialized. Adequate time should be allocated to address cultural issues because they frequently will be discussed in a story or another indirect way. Facilitators need to be patient, be communicators, and have basic knowledge of cultural protocols.

Barriers

While valuable information was gained, the group was not as diverse as it could have been as everyone was from the same community and many were related. Unforeseen circumstances prevented a large turnout in one group. Initial resistance by some child welfare staff involved in the process, partly due to cultural identity issues, was a barrier.

What Might Have Been Done Differently

The Medicine Moon Initiative central staff might consider conducting more interviews and consulting with community members about who should be interviewed instead of relying solely on the child welfare staff. Another round of interviews could be used to validate the findings from the first set of interviews.

Example from the Field 2

Site

Clackamas, Umatilla/Morrow, and Washington Counties, Oregon

Goal

To improve permanency outcomes for children in the care and custody of child welfare by integrating systems of care values into child welfare practice, engaging families more inclusively at all levels, and increasing interagency partnership.

Strategy/Approach

What Was Done

While some aspects of family involvement in service planning and interagency cooperation were identified as strengths in the Child and Family Services Reviews, areas needing improvement included permanency outcomes for children and the service array. Building on a decade of statewide practice improvement through a strength-based system of care and wraparound implementation in all county branches, as well as use of Title IV-E waiver funds, the State Department of Human Services participated in the Children's Bureau Improving Child Welfare Outcomes through Systems of Care demonstration initiative. This grant program focuses on strength-based practice through family decision meetings, increased attention to child safety through family engagement, and increasing interagency and community involvement through local and State advisory boards.

Local child welfare branches conduct a 30-day, 4-month and/or 8-month case review to ensure services are appropriate to meet a child's safety, permanency, and well-being needs and a viable plan is in place. Systems of care funds are used to meet the individual needs of the child (e.g., mediation, adoption preparation services, skills training, and therapeutic supports). Children in substitute or in-home care are eligible for these funds as long as there is funding and the service request meets the safety and attachment, permanency, or well-being needs of the child.

In Washington County, there were gaps in the advisory board membership. To enlist new members, the coordinator provided an overview of systems of care principles and child welfare goals and objectives. This put members on an equal footing and raised awareness of the goals. As a result, membership increased from three to five participants to 25–30 members. Parent leaders now sit on the board and are more actively involved, as are other community leaders.

Members are committed to continuing what is working well in the county and refining areas that need improvement. This collaboration has evolved to discussions of increasing strength-based and family-involved practice.

The development of parent leaders and parent partners in the child welfare system is a key component of the grant. A contract with a local community agency provided consultation, training, and support to parent leaders at the participating sites. Areas of training and consultation included parent engagement strategies for both project and child welfare staff, presentations for parent leaders at monthly meetings, semi-annual training on parent leadership/shared leadership, and weekly support groups for parent participants.

Who Was Involved

The State Department of Human Services applied for the grant in cooperation with Portland State University's Graduate School of Social Work as the local evaluation contractor. Paring down the number of participating sites to three (Clackamas, Umatilla/Morrow, and Washington counties), the State refocused its effort by hiring county system of care coordinators to develop and improve family involvement, build family leadership in the grant program, and improve advisory board participation in order to maintain and sustain innovations through sustainable cross-agency commitment. Permanency facilitators in each county identified internal barriers to permanency and made recommendations for practice changes.

Time Frame

The work began in November 2005 with the addition of systems of care coordinators. Many aspects of the work are ongoing and predated this grant, but the coordination and refocusing aspects of the grant program were directed toward improved permanency outcomes.

Why This Approach Was Selected

Child and Family Services Review results provided some impetus, as did other evaluations of State practice and its outcomes. Integrating previous systems of care practice to increase child safety demonstrated that increased engagement of families in all aspects of child welfare practice improves child safety, permanency outcomes, and caseworker satisfaction.

System of Care Principles

System of care practice encourages family involvement, a strength-based approach to planning and service delivery, and an interagency team approach to service planning, delivery, and evaluation. These values are integrated into practice by developing family leadership, partnerships at local and State levels, and increasing interagency partnership in county and State advisory boards.

Lessons Learned

Facilitators

A chain of communication and "command" from the State advisory board to the local advisory boards and including staff and families were essential. Permanency facilitators were initially helpful in identifying strategies to improve outcomes, but because they lacked reporting mechanisms and support, demonstrating effectiveness was a challenge. Practice change must be addressed in policy if it is to be sustained. Communication of effectiveness and efficacy is essential to elevate practice improvement from a value to an outcome and eventually into policy and system change.

Barriers

Initially, too many counties were participating with insufficient oversight and lines of communication. This was addressed by refocusing the target of the grant on three sites (four counties), increasing communication and accountability at the State and local levels, and identifying clearer expectations and reporting mechanisms.

What Might Have Been Done Differently

More discussion among line staff, supervisors, and administrators at the county branches and at administrative levels in the State office would have helped to ensure everyone was committed to the goals of the grant and understood their individual roles in achieving them.

Acknowledgements

The National Technical Assistance and Evaluation Center for Systems of Care would like to thank the numerous individuals whose hard work and dedication made this toolkit a possibility. Thank you to the Children's Bureau staff, specifically Bethany Miller and Pamela Johnson (retired), Federal Project Officers, for their guidance and support throughout the writing and editing process. A special thank you goes to Susan Franklin, Gary Ander, and Beth Evans for graciously volunteering to be interviewed for the Voices from the Field Section of the toolkit. Many thanks to the representatives from the nine Systems of Care grant communities of the Improving Child Welfare Outcomes through Systems of Care demonstration initiative who willingly shared sample products and tools which have been highlighted in the Resources Section. Finally, we thank the members of Infrastructure Toolkit Workgroup, who all brought their expertise to the table:

• Susan Franklin, Program Manager, Jefferson County, Colorado, Department of Human Services
• Beth Evans, Children and Family Services Administrator, Kansas Department of Social and Rehabilitation Services
• Angela Braxton, Parent Leader, Kansas
• Susan Franklin, Jefferson County, Colorado
• Peggy Taylor, Evaluator, Kansas
• Angela Mendell, Casework Supervisor, Bladen County, North Carolina
• Marie Parrott–Withers, Parent/Provider, North Carolina
• Helen Spence, System of Care Outreach Coordinator, Foster/Adoptive Parent
• Ervin Talley, Community Member, Bedford–Stuyvesant, New York City, New York
• Kamelia No Moccasin, Oglala Lakota Tribe
• Paula Loud Hawk (deceased), Caseworker, Lakota Oyate Wakanyeja Owicakiya Pi Okolakiciye (Helping Children of the Lakota People)

Resources

Bruns, E. J., Koroloff, N., Schutte, K., & Walker, J. S. (2004). Organizational and system support for wraparound: An introduction. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Children's Behavioral Health, Portland State University.

DeCarolis, G., Southern, L., & Blake, F. (2007). Improving child welfare outcomes through systems of care: Building the infrastructure: A guide for communities. Fairfax, VA: National Technical Assistance and Evaluation Center for Systems of Care.