System Management

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Example from
the Field

Definition

System management refers to conducting or supervising day-to-day operations associated with developing, implementing, and sustaining a system of care. The management structure developed to support systems of care features positions responsible for carrying out activities, tasks, and functions that promote the vision and mission. In addition to personnel, the management structure includes operational functions that advance systems of care.

Why Use a System Management Toolkit?

Implementing a strong system of care takes much more than simply having a solid infrastructure established. Effectively managing that infrastructure is equally important to ensure all the system of care components are operating smoothly and timely, with consistency, and that high-quality actions and interactions are taking place. As your community develops policies and procedures for managing your system of care, you can use this toolkit to:

• Provide guidance for developing the day-to-day activities of those who are overseeing the system of care.
• Learn from other communities that have been involved in system management.
• Build on the experiences of others.
• Adapt existing products to accomplish your system management tasks.

Systems of Care Principles and Values

Integrating system of care principles and values into the daily operations of system management will set the tone and direction for moving forward. Principles help guide direction and action and lend focus to your system of care work. Principles and values are the foundation on which to build your system of care.

The following are some key ways systems of care principles and values might be evident in your community’s system management structure:

• Meetings are scheduled at times that are convenient for all team members.
• Family members who are not agency employees are reimbursed for attending meetings, covering their time, travel, hotel, per diem, and child care.
• Family members are compensated with salaries comparable or equal to those associated with agency positions of similar scope.
• Consensus is a decision-making goal.
• Staff can follow a flexible schedule for a 40-hour work week.
• Supervision follows a strength-based and individualized approach or is applied through a positive performance process.
• Individuals representing diverse cultures, ethnicities, and ideas manage the system.
• Children, youth, and families are regarded as a community responsibility rather than the responsibility of a single department or agency.
• The use of strength-based, family-driven, community-based care is evident.
• Data and outcomes are collected, analyzed, and consulted to make decisions and manage the system.
• Data are reported to all interested levels of the system, as well as to funders, and the governance body, and are linked to a formalized continuous quality improvement structure.
• Management information systems incorporate data fields that reflect systems of care principles. For example, you might have a data field on the level of family involvement or interagency collaboration.
• Policy, procedure, and practice manuals incorporate and reflect systems of care principles.

Goals for Implementation

• The capacity of existing management structures are strengthened to support and sustain systems of care.
• Innovative approaches are applied to the management of day-to-day activities and reflect the values and principles of systems of care.
• Families are involved meaningfully and represented fairly in day-to-day operations and meetings that address operational issues
• Individuals responsible for day-to-day operations are trained in, and committed to, systems of care values and principles.
• Family members are hired, either as staff or contract consultants, for the systems of care management team.
• The systems of care management team operates with the active and full support of employers and agency administration.
• The systems of care management team has the support of the governance body and other authorizing officials to plan for and implement system change.
• The system managers of partner agencies are trained in, and committed to, the values and principles of systems of care.
• The management structure is adaptable to emerging issues and needs.
• Management information systems track data and outcomes and manage fiscal and service utilization across agencies.
• A smooth, efficient process for developing and implementing individualized multi-agency case plans.
• Clear procedures for developing case plans include a process for utilizing interagency administrative teams, grievance procedures, and confidentiality protocols.

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Example from the Field

Site

New York City

Goal

In its response to a Federal grant announcement released in 2003, New York City’s Administration for Children’s Services proposed developing a system of care focused on the specific needs of families with infants living in Bedford-Stuyvesant, a community in Brooklyn. The CRADLE in Bedford-Stuyvesant: A Systems of Care Initiative was established to create a comprehensive system of care for families with infants and young children who have been abused or neglected or are at risk for maltreatment. A principle-driven framework was created to guide the way services and supports are organized and delivered to children, youth, and families with multiple needs.

Strategy/Approach

What Was Done

To build a safe and supported system management structure, roles and responsibilities were constantly and carefully reviewed and reevaluated for each team member based on current job descriptions and goal-oriented mini-plans. A discussion with each team member led to greater awareness of specific roles and responsibilities, eliminating overlap. New titles created for two team members clarified their tasks not only for them but also for partners. This reevaluation and shift in some assignments were necessary to establish a clear leadership hierarchy with separate lines of authority and responsibility.

Given this strategic focus on key activities, it was imperative to institute processes that kept the team consistently connected and informed so obstacles were quickly identified and brought to the attention of the steering committee as soon as they emerged. In addition to a monthly meeting, the team met for quick check-in meetings at the end of each week to discuss successes and roadblocks in meeting the week’s goals. The team has also used this 30–45 minute check-in to inform one another of priorities for the coming week. Roadblocks that could not be immediately remedied and were not time-sensitive were deferred to the next steering committee meeting for discussion and resolution. Also assigned was a steering committee co-chair, who was a family partner or community member voted upon by the group.

Who Was Involved

The steering committee assessed and ensured efforts were on track with strategic goals and guided the system management work. Recently, steering committee members have been more engaged in analyzing project activities, asking strategic questions, and requesting more data to help them in guiding the project. While the committee always has had a chair, a comprehensive document detailing the role of the chair as well as the steering committee as a whole did not always exist. Eventually, steering committee and chair roles and responsibilities were created, voted upon, and accepted by members.

Team titles began to reflect each person’s responsibilities, i.e., training and development manager, family engagement specialist, and community consultant. While all members of the team are responsible for committing to and carrying out the systems of care guiding principles, each person was assigned direct responsibility for key areas of the system-building process.

The training and development manager was responsible for fostering interagency collaboration by identifying agencies in the community with whom to partner, developing a memorandum of agreement, and coordinating trainings and workshops with community-based organizations and city agencies on issues of relevance to the community. The family engagement specialist was responsible for child and family involvement, which included building family representation on various systems of care committees; coordinating family activities within the community; and serving as the liaison with community groups, parent leaders within neighborhood schools, and other stakeholders. The community consultant was charged with promoting an environment where culturally competent services and supports are provided to families, as well as engaging key community stakeholders such as churches, the police department, and elected officials. The deputy director managed day-to-day activities, which included keeping the team on track with priorities. She led weekly team meetings to discuss priorities, checked on accomplishments, identified roadblocks for activities that were not carried out, and developed strategies for addressing the issue or deciding to bring it to the attention of the steering committee for resolution. The project director had overall responsibility for ensuring the smooth operation of the entire structure.

Monthly one-on-one meetings between team members allowed for focused time to discuss the work, strategies, opportunities, and other issues relevant to accomplishing goals. Activity logs were redesigned to aid in assessing how daily activity was linked to strategic goals and actual outcomes. The logs also provided a place where staff can indicate the follow-up necessary to complete a particular task. This approach to project operations was shared with partners when the opportunity arose so that a strong management infrastructure was developed in the community.

Why This Approach Was Selected

Over the past 6 years, the CRADLE has worked to establish the infrastructure needed to build and sustain a cohesive, principle-based system of care. The CRADLE continues to leverage its unique position within Bedford-Stuyvesant to promote strength-based service provision; sponsor formalized interagency partnerships; and influence policies that directly affect the safety, permanency, and well-being of children in the community.

As the collaborative built credible programs, new partners became involved. Governance structures emerged and changed to accommodate new interagency relationships and implementation phases. A focus on goals provided the tools and language to help partners understand how and why the Community Partnership Initiative was integral to sustaining the system of care principles and the strong foundation the CRADLE had established in the community. The Community Partnership Initiative represents a paradigm shift in the way child welfare work was conducted in New York City. As the infrastructure was further developed through the Community Partnership Initiative, the CRADLE has continued to aid in building and supporting child welfare community partnerships that are family focused and promote integrated services to strengthen the community’s ability to use family strengths, resources, and unique cultural assets to promote safety, permanency, and well-being of children and families. The children and families with whom the partnerships come into contact can access coordinated services that contribute to their social, educational, cultural, and economic development within their neighborhood. The initiative has been involved with communities to create an environment in which people and systems with different strengths and perspectives work together for the safety of children and families.

Systems of Care Principles

The theory of change underlying the system of care approach assumes that family outcomes will improve if high quality care was coordinated effectively at the systems level. As partnerships and programs that actualize the six systems of care principles were implemented, the needs of families will be met more effectively. Over time, the cultures of organizations involved in the initiative will become more collaborative, better informed of families’ service needs, and more accountable. Overall, service systems were expected to deliver a better product and be less isolated, and community assets would grow.

Systems of care principles continue to guide the CRADLE’s actions, including construction of a complex array of service assets that features a strong governance infrastructure to operate the system of care; collectively designed interventions to ensure care was well-coordinated, accessible, strengths-based, culturally competent, and reflective of community needs; involvement of families in all areas of decision-making; connections to policymakers who can facilitate systems change; and accountability mechanisms to keep the system on track at all times.

A connection to broader system reform has advanced the CRADLE toward sustainability. The Community Partnership Initiative in Bedford-Stuyvesant continues to build on the infrastructure established by the CRADLE, and has worked to expand this infrastructure to systems serving other target populations. The CRADLE continues to be an integral component, assuming a leadership role within the partnership of service providers and family members, many of whom are also CRADLE partners. With an eye toward future system of care work, CRADLE staff were strategically placed in each of the four Community Partnership Initiative workgroups in order to infuse system of care principles and build on what the CRADLE learned in facing challenges associated with collaboration and infrastructure building.

Lessons Learned

In building system management, each community must understand its local context and tailor its strategies to the needs it identifies. Building a system of care was an evolutionary process that involved advancing a system toward a common vision that includes core principles.

Moreover, ongoing meetings with team members were necessary for the group to be informed about and record all team activities, both in terms of new relationships among agencies and within the infrastructure itself.

Tools such as evaluation tasks and standards, and a log that documented the daily activities of each team member, help in monitoring staff performance and outcomes. The CRADLE contracted with a consultant who focused on team-building activities and the team was assessed and given a professional development plan. Staff also participated in training on implementing tasks and producing outcomes.

In 2008, the CRADLE experienced a transition in both management and operations when the director was named director of the Office of Community Partnerships. In light of this transition, and as the infrastructure-building work took root in the community, the CRADLE continued its strategic focus on the four community partnership tasks and instituted processes to keep the team connected and informed so obstacles can be quickly identified and brought to management attention.

Example from the Field 2

Site

Dauphin and Northumberland Counties, Pennsylvania

Goal

Implementation of the Locally Organized Systems of Care for Children in Pennsylvania began in 2003. Through the vision of the Secretary of the Department of Public Welfare, the State focused on implementing integrated services, guided by an Integrated Children’s Services Plan, which incorporated the principles of systems of care for each county in the Commonwealth. Over time, the focus shifted from multiple counties to two principal counties: Dauphin and Northumberland.

Strategy/Approach

Who Was Involved

To assist the State, an Integrated Children’s Services Advisory Board was created. The advisory board was composed of State, county, and family partner representatives and ensured the process of integrating services throughout the Commonwealth provided quality supports to children and families Representatives from the Office of Mental Health and Substance Abuse Services, the Department of Public Welfare, and the University of Pittsburgh are committed to the systems of care process and the infrastructure development that will result from a culture change. Each partner was involved in many aspects of the project both as a resource and as a change agent.

What Was Done

In Dauphin County, systems and community partners were actively engaged in various aspects of the systems of care initiative at all levels. Within the county agencies, partners from each department had an opportunity to participate on a practice team. This team assisted in guiding agency collaborations, policy development, and identifying resources as they pertained to the support provided to the children and families of Dauphin County. County agencies and subcommittee chairpersons formed the implementation team, which helped ensure that the project scope remained consistent with the larger initiative and that each subcommittee stayed informed about the activities being implemented as a result of collaboration.

Faith-based, community-based, parent advisory, youth, and outreach subcommittees were composed of community members, school district officials, and representatives of supporting service agencies. Each summer, these subcommittee members and county partner agencies collaborated to design and implement a camp program that was initiated by the faith-based subcommittee, which realized adolescents had a limited number of supports, and violence and substance abuse were on the rise. A task group of community volunteers, local businesses, and partner agencies oversaw the camp’s day-to-day operations and the subcommittee members each contributed resources to the program. The Harrisburg School District provided space for the initial camp site; however, seven summer camp sites now exist throughout the county. Buses were provided for transportation to field trips, breakfast and lunch were offered for each student, and school personnel assisted with hands-on educational support. Penn State University’s 4-H Club, the YMCA, Hamilton Health Center, Harrisburg Police Department, Harrisburg Area Community College, Harrisburg Parks and Recreation, and the Dauphin County Executive Commission on Drugs and Alcohol collaborated to provide camp programming. Goodwill and a local construction company had also provided a 6-week job training program for students 14 years of age or older. Surveys were conducted each year and have revealed that students felt they learned more at the camp than during the school year through one-on-one instruction, entrepreneurial skills development, and peer relationship building.

The Northumberland County structure was made up primarily of agency and parent partners. Subcommittees were the Directors Group, Supervisors Group, and Direct Care Group. Consistent information exchange ensured each group was engaged and informed. Through this initiative, Northumberland County human service partners and education partners collaborated to address the county’s truancy issue by implementing the Parent Truancy Awareness Program. The program educated parents about the impact of truancy on their children’s lives and the life of their community. Through the program, families have voluntarily accessed supports through formal and prevention agencies. Program data had indicated early positive results that hold promise for future, long-term impact.

The county has also engaged the community to address increased gang activity. As a result of a partnership between juvenile probation, adult probation, and children and youth, the county held its first Gang Task Force Meeting and Conference. The purpose was to leverage the relationships developed with the local school districts through the Parent Truancy Awareness Program to assist teachers in identifying the signs of students’ gang activity.

Churches, businesses, and other community members also were invited to the conference. As a follow-up to the conference, the county set up a hotline to report evidence or gang tags in the community and scheduled town meetings to educate larger numbers of community members. The task force grew over 12 months and local police officials reported some gangs had left the county.

Systems of Care Principles

Dauphin and Northumberland counties have designed their services plan to reflect systems of care principles and apply these principles to serving families in a collaborative way. Through Family Group Decision-Making, systems of care activities, and implementation of the Integrated Children’s Services Plan, Dauphin County has engaged both systems partners and community partners to address community issues. For example, in 2003, Northumberland County suffered a death of a child as a result of domestic violence, which sparked a movement to eradicate domestic violence in the county.

Guided by the Integrated Children’s Services Plan, Northumberland County established committees and operations that directly related to systems of care principles: integrated intake, case management, data management, and prevention; Domestic Violence Steering Committee; Family Group Decision-Making Implementation Committee; and the Systems of Care Family Advisory Committee. Each principle was embodied by a team from the county’s children’s services agencies, in addition to parent representation, to ensure families receive comprehensive services. Family Group Decision-Making has made a significant contribution to the success of these efforts. In the first 2 years that the county offered Family Group Decision-Making, 100 conferences were conducted, 20 facilitators were trained, and scores of families were empowered to take control of their lives before accessing formal services. The county conducts informal surveys of families after they participate in a Family Group Decision-Making conference in order to understand the family experience.

Lessons Learned

Committed collaboration has produced promising results for both Dauphin and Northumberland counties, thanks to the patience and hard work of all stakeholders. Although involving community and cross-agency partners from the beginning may have been time consuming, it made long-lasting infrastructure change easier. However, the counties discovered that as long as partners are part of the process, no matter the timeframe, systemic change will occur.

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 the following people for graciously volunteering to be interviewed for the Voices from the Field Section of the toolkit: Rich Weisgal, Contra Costa County, California; Beth Evans, Children & Family Services Administrator, Kansas; and Fred Wulczyn, Chapin Hall Center for Children, New York. 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
• 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)
• Nicole Bossard, Technical Assistance Team Leader, National Technical Assistance and Evaluation Center
• Gary De Carolis (Chair), Senior Consultant, National Technical Assistance and Evaluation Center
• Elleen Deck, Technical Assistance Liaison, National Technical Assistance and Evaluation Center
• Janet Griffith, Senior Fellow, National Technical Assistance and Evaluation Center
• Ethleen Iron Cloud Two Dogs, Technical Assistance Liaison, National Technical Assistance and Evaluation Center
• Caitlin Murphy, Analyst, National Technical Assistance and Evaluation Center