Positive Approaches Journal, Volume 10, Issue 3
Durgin | 42-57
Volume 10 ► Issue 3 ► November 2021
Pennsylvania System of Care: Improving Services and Supports for
Youth and Families with Behavioral Health Challenge
Mark B. Durgin
Introduction
The PA Care Partnership philosophy of System of Care (SOC) builds and promotes equality and trust by including youth, caregivers, providers, and systems that serve children and young adults based on the individual community's strengths and culture. A SOC is achieved by strengthening the collaboration of the commonwealth and county efforts in a statewide approach to build behavioral health supports and services for children, youth, young adults, and their families. A seamless system of care builds effective community-based services and supports that meet youth and families' needs to assist with behavioral health challenges.
Pennsylvania's Department of Human Services, Office of Mental Health and Substance Abuse Services (OMHSAS) has been the recipient of four (4) Substance Abuse and Mental Health Services Administration (SAMHSA) grants that have allowed the commonwealth to build an infrastructure to implement a statewide approach to SOC to serve children, youth, young adults, and their families who have, or need effective community-based services and supports to assist with behavioral health challenges, since 2009.
Through a SOC philosophy, the PA Care Partnership builds and promotes equality and trust by including youth, caregivers, providers, and systems that serve children and young adults based on the individual community's strengths and culture. Adopting this philosophy doesn't mean that communities throw out the programs, services, and supports that they already have in place. A SOC is not a thing, a service, or a program—it is an organizational construct anchored in partnerships—between families, youth, government agencies, private providers, and communities. This makes the System of Care flexible and adaptable enough to work almost anywhere.
A system of care is defined as a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families that:
- Build meaningful partnerships with families and youth
- Organize into coordinated networks
- Address Cultural and linguistic needs
In order to help families function better at home, in the community, and throughout life.1
The mission of the PA Care Partnership is to strengthen the collaboration of the commonwealth and local efforts in weaving behavioral and mental health supports and services into a seamless system of care for children, youth, and their families. This is achieved through the development of local and state leadership teams focusing on the SOC values, providing training inviting multiple systems (Child Welfare, Juvenile Justice, Mental Health, Education, Early Childhood, etc.) to attend training, and through including youth and family with lived experience in decision making.
The vision for the PA Care Partnership is for every youth and family in the commonwealth to be able to access and navigate a unified network of effective services and supports, which are family and youth-driven, community-based, culturally competent, and meet their individual needs. Pennsylvania's SOC model has evolved into a sound philosophy and flexible approach to promote equity and trust among youth, caregivers, child-serving systems, and provider partners based on the individual community's strengths and culture. The goal of a System of Care is to modify the way that youth, families, government, and counties interact with each other so that:
- Youth/young adults and families with lived experience are central to the design, implementation, and operation of services and support working in equal partnership
- Youth and family organizations support individual youth/young adults and families and participate fully in policy and funding decisions
- All child-serving system partners collaborate, share resources, and coordinate with each other and with youth and families
- Natural supports are equally as valuable as formal supports (i.e., paid services)
- Communities engage and transform to become welcoming and supportive of all youth, young adults, and families
The SOC concept is not new to Pennsylvania. There are currently five (5) System of Care grants operating in Pennsylvania, funded through SAMHSA. The current grants are the PA Care Partnership, the Philadelphia System of Care, Allegheny County System of Care, Behavioral Health Alliance of Rural PA, and the Luzerne-Wyoming System of Care. Although these grants have different initiatives from the PA Care Partnership, the core function and values remain similar. These grants work in concert to address the needs of Pennsylvania’s youth and families to build a more robust, equitable, and service-driven SOC.
The SOC not only builds
upon but strengthens our state's strong history with our Child and Adolescent
Service System Program (CASSP). Both are comprehensive approaches that support
children and adolescents with complex behavioral health challenges and their
families. They seek to ensure that services and/or treatment are planned
collaboratively with the family and all agencies and/or systems involved in the
child's or adolescent's life.
Essential to an effective SOC is having system partners working together. System partners help families function better at home, in school, community, and throughout life.2 Systems vary throughout the commonwealth and may include a combination of public agencies, private organizations, and the faith-based community. Your county may have more or fewer systems, but typical system partners might include:
- Mental health services
- social services
- educational services
- health services
- substance abuse services
- vocational services
- recreational services
- juvenile justice services
- early childhood services
- domestic violence services
- autism and intellectual disability services
The challenge—and opportunity—comes in de-siloing systems that don't typically work together, such as mental health and juvenile justice (court system). When youth and family-serving systems are integrated effectively, mechanisms are established to manage and coordinate care in a person-centered approach that meets the needs of youth and family's social, emotional, and physical health. In addition, this integration taps into the natural and community support available to youth and families.
A SOC, however, expands the role of youth and families as decision-makers at the individual, county, and state levels to ensure they receive the most beneficial, culturally, and linguistically competent services and supports. This is achieved by having youth and family as part of county and state leadership teams, employed as peers, as part of behavioral health treatment and planning processes. As a result, systems work more effectively, allowing communities to respond and adapt to challenges nimbly to improve outcomes for youth and families. Information related to outcomes is detailed below.
The PA Care Partnership has worked with the following counties: Blair, Carbon, Chester, Crawford, Delaware, Erie, Fayette, Greene, Lackawanna, Lawrence, Lehigh, Luzerne, Monroe, Montgomery, Northumberland, Philadelphia, Pike, Venango, and York.
Counties working with the PA Care Partnership Grant:
- Collaboration between county system partners agencies, youth, family, and providers
- Education of partners (youth, family, child welfare, juvenile justice, mental health, education, early childhood, intellectual disabilities, etc.)
- Support and enhance services and supports for youth, young adults, and families
- Partnership with natural and community supports
- Creation of policy and funding decisions, including youth and family's full support and engagement with lived experience
- Education and support families and youth to be equal at meetings and training
- Collaboration of partners who share resources and coordinate with one another and with youth and families
- Community engagement and transformation to become welcoming and supportive of all youth, young adults, and families
- Enhancement or increase services and support for youth in the target population with guidance and support to implement required youth and family services and support the planning process
Core Values
An effective SOC relies on the adoption of a core set of values that easily adapts to the realities of any community, including the kinds of challenges that come with stretched resources and decreased budgets. In adopting these core values, systems work more efficiently and save community resources by preventing or reducing entry into higher levels of care or out-of-home placement. Moreover, youth and families have an equitable role in making decisions about their own care leading to better outcomes.
The PA Care Partnership has developed eleven (11) Core Values, which are the foundation of a system of care. Additionally, the values have been vetted and approved by the Technical Assistance Network, part of the University of Maryland School of Social Work, the national technical assistance provider for SOC grants. These values transition the SOC toward a public health framework by focusing on treatment for individual children with serious behavioral health conditions and addressing promotion, prevention, early intervention, and education to improve total health—physical, oral, developmental, and behavioral health.
The System of Care values guides and direct how to implement the philosophy throughout the Commonwealth of Pennsylvania.
- Youth-driven is having youth included in decisions that affect their care and well-being. Youth are supported in various ways by sharing their experiences and opinions to be leaders at the county and state levels.
- Family-driven means families have a primary decision-making role in caring for their children, and opportunities are provided for leadership positions at the county and state levels.
- Home- and Community-based builds on the community's strengths where the family lives, providing community-based high-quality services accessible to families.
- Strength-based & Individualized Practices & Processes identify and build on the youth and young adult's individual strengths and concerns. Family plans are created by teams of people to which they are connected.
- Trauma-informed means that every part of an organization or program understands the effects of trauma on the individuals they serve and promotes cultural and organizational change in responding to those they serve.
- Culturally and Linguistically Competent is the integration and transformation of knowledge, behaviors, and attitudes from and about individuals or groups to enable all team members to work effectively in cross-cultural situations.
- Connected to Natural Helping Networks are personal associations and relationships, independent from formal services, developed in the community that enhance the quality and security of a family or person's life.
- Data-driven, Quality, and Outcomes-Oriented Decisions are made using concrete information about what is happening, rather than personal stories or gut feelings to identify high-risk children and youth.
- County Leadership Team and Governance Boards are comprised of representatives from child-serving and transitional age systems, family members, and youth partners.
- Multi-System Integration ensures that services and supports are integrated at the system level, linking child and transition-aged serving agencies and programs across administrative, funding boundaries, and mechanisms.
- Youth and Family Services and Supports Planning Process facilitates integrated services and supports planning among youth, families, and key child-serving systems.
The Pa Care Partnership provides or sponsors a variety of training to the counties currently involved with the grant as well as to systems, providers, community agencies, youth, and families across the commonwealth. These trainings focus on the values of SOC to address multisystem integration, trauma-informed, cultural and linguistic competence, and being youth and family driven.
Trainings and Technical Assistance including:
- Trauma Workshops Through Lakeside Global Inc. – 2–4-hour workshops focusing on becoming trauma-aware/trauma-informed
- Coach Approach to Adaptive Leadership – Developed for health and human services, this training focuses on changing conversations, empowering others, and creating a culture of collaboration and support.
- Family Roadmap Training – Trains family members using guides and curricula to break up big, overwhelming problems into tasks they can handle.
- Youth and Young Adult Roadmap Training- trains youth, youth adults, and providers to help people break up big, overwhelming problems into tasks they can handle.
- Wellness Recovery Action Planning (WRAP) is a simple and powerful process for creating and maintaining wellness, developing a daily wellness plan, identifying setbacks, and gaining support.3
- System of Care: A Comprehensive Toolkit for County Implementation - A toolkit created by the PA Care Partnership to implement a System of Care with or without funding.
- System of Care Orientation – Helping counties, systems, partners, youth, and families implement a System of Care.
- System of Care Values
- Youth Engagement
- Family Engagement
Evaluation is a significant component for the grant implementation to report outcomes to SAMHSA and help counties and the commonwealth fully understand the impact of the supports and services. There is discretion on the types of services and supports which can be implemented. However, the services selected must have multiple encounters over time and be youth and family driven.
For the PA Care Partnership grant, counties have used the following:
- High fidelity wraparound enhanced services for transition-age youth
- Enhanced supportive living programming
- Juvenile treatment courts
- Intensive behavioral health services (IBHS)4
o IBHS support children, youth, and young adults with mental, emotional, and behavioral health needs.
o IBHS offers a wide array of services that meet the needs of these individuals in their homes, schools, and communities
- Family based5
o The Family based team is composed of:
§ A Master’s level mental health professional who functions as the primary therapist
§ A Bachelor’s level mental health worker who provides support and case management services
§ Through weekly individual and family therapy sessions, the team works with the youth and their family to identify barriers to communication, conflict resolution, bonding and areas of family life that have an impact on and are impacted by the child’s mental health issues
- Family peer support6
o This is a 5-day comprehensive training using the Family-Run Executive Director Leadership Association (FREDLA) Parent Peer Support Provider Practice Model.
o This Practice Model provides a framework for the essential functions of a Family Peer Support Specialist, offering core competency training and practicing of skills across the 6 phases of family peer support: Connect, Discover, Support, Empower, Prepare and Take Care.
- Youth peer supports7
o Youth and Young Adult Peer Support Services for young people are provided by Certified Peer Specialists (CPS) who have lived experience with mental health and related challenges.
o CPS are individuals trained to share their own stories of recovery and resiliency.
o They engage and inspire Transition Age Youth (TAY), ages 14-26, to plan for what is important to them in their everyday life.
- Peer-driven case management8
o Behavioral Health Case Management with either Youth or Family Peer Support imbedded in the program.
Through our evaluation data, we have enrolled 293 youth in the longitudinal evaluation. 94% of youth enrolled have two or more services involved, and 92% have mental health services involved at intake.
Data collected as part of the grant provided the following information:
- 13% of youth have experienced a traumatic event, series of events, or set of circumstances.
- 25% of youth had attempted suicide at intake.
- As a result of supports and services, the following positive outcomes were noted.
o 11% increase in overall health (Youth were asked to rate their overall health)
o 18% increase in daily functioning (Youth were asked how well they were functioning in daily life in the past 30 days, regarding the following categories: Handling Daily Life, Getting Along with Family, Getting Along with Friends, Doing Well in School/Work, Ability to Cope, Satisfied with Family Life)
o 5% decrease in psychological distress (Youth were asked how they were feeling in the past 30 days, regarding the following categories: Nervous, Hopeless, Restless or Fidgety, Depression, Effort, Worthless)
o Noted decreases in illegal substance use (-3%), tobacco use (-3%), and alcohol use (-1%)
o 5% increase in youth remaining in the community
o 2% increase in youth/family perception of care, with
91% reporting positive perception. (Youth were asked what they thought about
the services they received in the past 30 days, the people who provided it, and
the results)
In closing, Pennsylvania has had a long history of implementing SOC philosophies across the commonwealth. While counties and the commonwealth may vary in implementing a SOC, foundationally, they all have the same core values of being youth and family-driven, culturally and linguistic competent, and trauma-informed. In Pennsylvania, we must support the role of youth and families as decision-makers at the individual, county, and state levels to ensure they receive the most beneficial and culturally and linguistically competent services and supports. Through a SOC philosophy, systems, providers, community partners, youth, and families build and promote equality and trust. Children and young adults receive the services and support based on the individual community's strengths and culture.
Other Resources
Behavioral Health Alliance of Rural PA,
Luzerne-Wyoming System of Care
Trauma Workshops Through Lakeside Global Inc.
Coach Approach to Adaptive Leadership
System of Care: A Comprehensive Toolkit for County Implementation
High Fidelity Wraparound
References
1. System of Care Definition and Philosophy. National Technical Assistance Center for Children’s Mental Health website. https://gucchd.georgetown.edu/products/Toolkit_SOC_Resource1.pdf. Accessed November20, 2021
2. System of Care: A Comprehensive Toolkit for County Implementation: Enhancing Your Strengths to Build a System of Care. Pennsylvania Care Partnership website. https://www.pacarepartnership.org/uploads/PA_Care_Partnership_Toolkit_-_ELECTRONIC_VERSION_FINAL.pdf. Published August 2020. Accessed November 20, 2021
3. What is WRAP? Wellness Recovery Action Plan website. https://www.wellnessrecoveryactionplan.com/what-is-wrap/. Accessed November 20, 2021
4. Intensive Behavioral Health Services. Pennsylvania Department of Human Services website. https://www.dhs.pa.gov/HealthChoices/HC-Providers/Pages/BHProvider-IBHS.aspx. Accessed November 20, 2021.
5. Family-based Services. PA-Mentor website. Family-Based Services | Pennsylvania (pa-mentor.com). Accessed November 20, 2021.
6. Free Family Peer Support Specialist Training. Mental Health Partnerships website. Free Family Peer Support Specialist Training | Mental Health Partnerships (MHP). Accessed November 20, 2021.
7. Youth/Transition Age/Young Adults. Montgomery County, PA website. Youth/Transition Age/Young Adults | Montgomery County, PA - Official Website (montcopa.org). Accessed November 20, 2021.
8. Family, Parent, and Caregiver Peer Support in
Behavioral Health. SAMHSA website. Value of Peers
Infographics: Parent Support (samhsa.gov). Accessed November 20, 2021.
Biography:
Mark B. Durgin joined OMHSAS as a contractor in 2016 as the Director of Pennsylvania Care Partnership. Mark holds a B.S. in Criminal Justice from York College of Pennsylvania, focusing on parole and probation. In addition, Mark has over 20 years of professional experience in Pennsylvania's child-serving systems, working with youth and families at a county and state level.
Contact Information
Mark Durgin