Systems of Care Yakima: Yakima Co. Proposal

ABSTRACT

The Yakima Valley Youth and Family Coalition will implement a single, integrated system of care to provide comprehensive, community-based mental health services and supports for all Yakima County youth, including the Yakama Nation, with SED and their families. Planning and implementation will be anchored with the Partnerships for Success (PfS) Community Planning Process and wraparound care coordination in accord with National Wraparound Initiative standards. We will initially prioritize service to youth age 10-21 with SED and involvement in juvenile justice or child welfare systems, youth experiencing co-occurring challenges related to substance use and youth in transition, with specific focus on Native American and Hispanic youth. We anticipate expanding to preschool and school-age children in Years 5 and 6.

Our system of care will be governed through a multi-agency Governance Team featuring consensus-based decision making with youth and family representatives as full partners.

The Governance Team will be led by the Chairman of the Yakima County Board of Commissioners and will feature five core sub-teams: the Youth Development Team, Family Development Team, Cultural Competence Representative Council, Care Review Team and Program Development Team.

We will implement county-wide Wraparound Care Coordination with full fidelity to the NWI standards and supported through implementation of the Wraparound Fidelity Assessment System (WFAS) under the direct leadership of Dr. Eric Bruns. Development and implementation of our system of care will be organized around the Partnerships for Success (PfS) community planning process, also led by Dr. Bruns. The PfS process will bring our community together to analyze gaps and needs, identify appropriate EBPs, and implement them across the partner agencies of the Coalition. The local evaluation will be closely aligned with the PfS process.

We plan for a total of 8 Wraparound Care Coordinators by Year Two, with at least one within the Yakama Nation, allowing capacity to serve approximately 64 youths and families at any time. Capacity will increase to 12 Coordinators by Year Four. Capacity will also be increased through an integrated system that better defines need and monitors specific targets. The capacity of key services such as intensive home-based services, crisis intervention, school-based day treatment, therapeutic foster care, and expanded respite care are also targets for expansion. Access to key outpatient services including Parent-Child Interaction Therapy and Trauma-Informed Cognitive Behavioral Therapy are already available, but additional capacity will be added as needed. Cultural and racial disparities will be addressed through community involvement in the PfS Community Process to meet the needs of our diverse communities.Table of Contents

Abstract 1

Table of Contents 2

Section A: Understanding of the Project

1. The Importance of Systems of Care 4

2. Children and Youth with Serious Mental Health Needs in the Yakima Valley 5

3. Current Capacity 7

4. Significance of the Proposed Initiative – Gaps and Barriers 8

5. Catalyzing Statewide Change: Collaboration with Federal, State, and Local Initiatives 9

Section B: Implementation Plan

1. Infrastructure Development 10

a. Cross-Agency Infrastructure 10

b. Governance 11

c. System Integration Procedures: Interagency Collaboration 12

d. Replication 15

e. Developing Structures of the System of Care 16

f. Collaboration with Other Child Serving Systems 17

g. Training, Technical Assistance, and Social Marketing 17

h. Capacity and Quality of Services 19

i. Participation in Plan Development 19

j. Interagency Collaboration and Nonfederal Matching Dollars 20

k. Governor’s Letter of Assurance 20

2. Service Delivery 20

a. Access to Services 20

b. Service Components 21

c. Strategies to Implement Key Service Activities 23

d. Care Coordination / Individual Service Plans 26

e. Family Driven Care 31

f. Youth Guided Care 32

g. Cultural and Linguistic Competence 32

3. Sustainability / Linkages with Statewide Transformation Efforts and Other Relevant Federally-Funded Programs 36

a. Linking Coalition Goals / Objectives with Transformation Efforts and Statewide Reform Efforts 36

b. Strategies for Ensuring Project Sustainability after the Sixth Year 37

c. Coordination with Other Federally Funded Initiatives 38

Section C: Project Management and Staffing Plan

1. Capability and experience of the applicant organization 38

a. Capability and experience of the applicant organization 38

b. Staff positions for the project 38

Section D: Evaluation Plan

1. Implementation of the National Evaluation: Commitment and Capacity 40

2. Using National Evaluation Data to Improve the System of Care 40

3. Ability to Collect and Report on Required Performance Measures 42

4. Managing the Project and Assuring Continuous Quality Improvement 43

5. Conducting the Performance Assessment as Specified in Section I-2.6 43

Section E: Literature Citations 44

Section F: Budget Justification, Existing Resources, Other Support 46

Section G: Biographical Sketches and Job Descriptions 57

Section H: Confidentiality and SAMHSA Participant Protection/Human Subjects 74

Appendix 1: Letters of Commitment and Support and Memoranda of Understanding 83

Appendix 2: Governor’s Assurance 112

Appendix 3: Data Collection Procedures and Instruments 114

Appendix 4: Sample Consent Forms 314

Appendix 5: Non-Federal Match Certification 318

Appendix 6: Organizational Chart, Staffing Pattern, Timeline and Management 319

Assurances – Non-Construction Programs 322

Certifications 325

Disclosure of Lobbying Activities 328

Checklist – Survey on Ensuring Equal Opportunity for Applicants 329

Yakima Valley Youth and Family Coalition

Section A: Understanding of the Project

1. The Importance of Systems of Care

In her groundbreaking study Unclaimed Children, Jane Knitzer (1982) documented the failure of child and adolescent service delivery systems to provide adequate and appropriate care to this nation’s children and youth with serious emotional disturbances (SED). At the time, children’s mental health received scant attention, involved little collaboration among child-serving systems, and suffered from a paucity of family involvement (Kutash & Rivera, 1996). Following publication of Unclaimed Children, and the subsequent formation in 1985 of the Child and Adolescent Service System Program (CASSP) of the National Institute of Mental Health (NIMH), there has been a steady growth in the development of children’s mental health services and increased emphasis on the comprehensive, community-based “system of care” model as an alternative to traditional service approaches (CASSP Technical Assistance Center, 1990).

As systems of care emerged, they were defined in terms of, “a comprehensive spectrum of mental health and other necessary services, which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986, 1994). More recently, the definition has evolved based on a growing understanding of the actual experiences of successful system of care communities around the country: “A system of care is an adaptive network of structures, processes, and relationships grounded in system of care values and principles that provides children and youth with serious emotional disturbance and their families with access to and availability of necessary services and supports across administrative and funding jurisdictions” (Hodges, et al., 2007). This definition expands on the original by linking definitional components directly to key areas of implementation including system flexibility, integration, infrastructure, care coordination and collaboration.

The shift in children’s mental health practice has also been described in terms of four major shifts related to: family participation, intensity of services, cultural sensitivity, and the development of community-based service systems (Epstein, et al., 1998). The first shift involves family participation in care. Families were historically viewed primarily as the cause of their children’s problems; now they are increasingly recognized as full partners in treatment, implementation, and system change. A second shift involves a change in the way service intensity is understood. Traditionally, intensive services were equated with restrictive residential and inpatient settings. More recently, services such as Multisystemic Therapy and mobile crisis response have begun to convince practitioners that intensity and restrictiveness are orthogonal and that youth can receive intensive services in natural community settings. The third shift relates to culturally competent service systems, acknowledging cultural differences and committing to develop services that meet the needs of diverse families. The fourth shift involves the development and implementation of community-based services. While noting these advances, Robert Friedman (1990) commented that, “… there are large discrepancies between what the state of knowledge is and what we are actually doing.”

The contemporary system of care model assumes that the needs of children and families are best served through treatment that is driven by families, guided by youth, delivered in the least restrictive, most natural setting possible, and supported by a true partnership between the youth and family and the full array of child-serving systems. The model is based on a framework that mirrors major domains of development and need for children and families including family, mental health, social, educational, health, vocational and recreational.

Worthington, Hernandez, Friedman, and Uzzell (2001) offered further guidance for system change, identifying consistent themes related to positive outcomes. Briefly, their findings revealed that promising practices essential to successful systems of care could usefully be classified according to three functional categories: Engagement—the process of connecting with and maintaining the involvement of children and families in services; Delivery of Clinical Services—service elements that lead to the development of effective family / provider relationships and ultimately promote success; and, Structural and Operational Characteristics—specific features of services that demonstrate system values, including flexibility and a family-driven and community-based orientation. The partners coming together to form the Yakima Valley Youth and Family Coalition (The Coalition) are fully committed to attend to these functional areas through the planning and implementation of this cooperative agreement in order to build a sustainable system to meet the needs of our children and youth with serious emotional disturbance and their families.

2. Children and Youth with Serious Mental Health Needs in the Yakima Valley

Projected age range. The initial priority population for the Coalition will be children and youth age 10 to 21 years. In Years 5 and 6, once efficiencies are realized, we will address early intervention services for pre-school (birth to five) and school-age (six to nine) children.

Prevalence estimate. The prevalence of SED among children and youth in Yakima County is estimated at approximately 7% or 5,000 youth (Washington State DSHS, 2003, The Prevalence of Serious Mental Illness in Washington State). Less than half this number received mental health services. Furthermore, children with SED who manage to access services too often do so at a point when family resources have been exhausted and children are in crisis. Across the Yakima Valley’s current mental health system, the most frequent entry point is through crisis services (about one-third of referrals). Other points include requests from parents or guardians (just under one-third), local police (9%), primary care physicians (7%), and schools (5%).

Racial and ethnic group representation. The 2006 U.S. Census estimates Yakima County’s total population at 233,105, with a white population of 174, 317 (74.8%) and non-white population of 53,200 (22.8%). The Hispanic population is estimated at 92,551 (39.7%). A general breakdown of estimates for other racial and ethnic groups includes: American Indian/Alaskan Native at 9,200 (4.0%), Asian/Pacific Islander at 2,642 (1.1%), African American at 1,745 (0.8%), and other races at 3,870 (1.7%). Most Native American residents are members of the Confederated Tribes and Bands of the Yakama Nation (Yakama Nation), numbering nearly 8,400 enrolled members. While people of color are a minority of overall residents, children and youth of color comprise a majority of school-age: 53% of Yakima’s children are Hispanic, 39% are white, 5% are American Indian/Alaskan Native, 1% are African American, and 1% are Asian/Pacific Islander (Educational Service District 105, 2006).

Other demographic characteristics. The Valley’s children are also particularly disadvantaged compared to children in the rest of the state. According to the Yakima County Disparity Report (Yakima County Department of Community Services, 2007), relative to the rest of Washington State, Yakima’s children are twice as likely to live in poverty, 33% more likely to receive Medical Assistance, and 18% more likely to live in a household where English is not spoken. U.S. Census data indicate that Hispanic youth in Yakima County make up a higher proportion of the total youth population than in the rest of Washington State (42.3% vs. 9.2%), and they suffer even more disadvantages, representing a much higher proportion of youth living in poverty (67.4% vs. 21.2%), being more likely to live in single-parent households (21.8% vs. 16.5%), and making up most of those children who are non-English speaking (92.9% vs. 49.3%). Yakima County youth were also nearly three times more likely than their counterparts in the rest of the State to be arrested for drugs and alcohol (6.08/1,000 vs. 2.60/1,000) or vandalism (6.20/1,000 vs. 2.19/1,000). Similarly, teen pregnancy in Yakima County is 80% higher than the state-wide average. Attempted or completed suicide is almost twice as prevalent among Yakima County youth then in the rest of the state (100.09/1,000 compared to 52.21/1,000).

Service disparities across family and institutional settings for children from racial and ethnic minorities. Child welfare services in Yakima are provided by Region 2 of the State’s Department of Social and Health Services (DSHS) Children's Administration, Division of Children and Family Services (DCFS). Region 2 DCFS served approximately 7,000 (6,949) children through protective case management services in FY2005 – 36.7% of whom were white and 62.7% of whom were children of color (3.1% African American, 17.4% American Indian / Alaskan Native, 45.8% Hispanic, and 1.3% Asian / Pacific Islander), with overrepresentation (compared to their percentage of the child population) of African American and American Indian / Alaskan Native children. This same report showed a similar trend for children receiving behavioral rehabilitative services through child welfare. Of children served, 61.5% of the children came from non-white ethnic groups, with American Indian/Alaskan Native children (30.8%) and Hispanic children (33.3 %) among the groups most served. Once again, roughly the same proportion of non-white children were placed in foster care, representing 67.7% of the 710 children placed in care. American Indian/Alaskan Native children were the largest group (38.9%) receiving foster care services, followed by Hispanic (33.9%), and white (32.3%). Of the 41 children receiving other intensive services, including crisis care services, 51.2% were white, 39.0% were Hispanic, 12.2% were African American, 12.2% were American Indian/Alaskan Native, and 4.9% were Asian/Pacific Islander.

DSHS also reported on utilization of Juvenile Rehabilitation Administration services (JRA, the State’s juvenile justice agency) during FY 2005. Forty-five (45) youth received community placement services that year (services in small group facilities located in communities), 42.2% of whom were white and 57.8% were non-white (28.9% Hispanic, 17.8% American Indian/Alaskan Native, 15.6% African American, and 4.4 % Asian/Pacific Islander). Of youth adjudicated to community supervision and treatment as an alternative to institutional confinement, 40.5% were white, 37.8% were Hispanic, 18.9% were American Indian/Alaskan Native, 8.1 % were African American, and 8.1% were Asian/Pacific Islander. This contrasts with proportions of youth placed in secure confinement with a higher proportion of non-white youth were placed in these settings (68.9% as compared to 31.1% white youth). More Hispanic youth (49.5%) were served in secure placements than any other ethnic group (African American youth represented 10.7% and American Indian/Alaskan Native youth represented 17.2%), much higher than the proportion of Hispanic youth involved in JRA. In addition, African American and American Indian/Alaskan Native youth were overrepresented in secure placements, compared to their proportion of the overall youth population. This stands in stark contrast to the Valley’s mental health systems, where, among children and youth who access and receive public mental health services, youth of color are seriously underrepresented with proportions receiving services approximately half of their proportion in the overall population.

Given these trends, we estimate 145 annual referrals from major child-serving sector as follows:

DCFS (child welfare): We anticipate 50 children a year, including 35% Hispanic, 30% American Indian/Alaskan Native, 20% white, 10% African American, and 5% other;

JRA / County Court (juvenile justice): We anticipate approximately 20 referrals a year, including 50% Hispanic, 20% American Indian / Alaskan Native, 15% African American, 10% white, and 5% other;

Schools: We anticipate 20 children a year, including 55% Hispanic, 35% white, 5% American Indian/Alaskan Native, 3% African American, and 2% other;

Mental Health System (crisis, urgent and routine): We anticipate 45 children a year, including 55% Hispanic, 35% white, 5% American Indian/Alaskan Native, 3% African American, and 2% other; and

Other points of access (law enforcement, primary care, and other medical settings): We anticipate 10 children a year, including 55% Hispanic, 35% white, 5% American Indian/Alaskan Native, 3% African American, and 2% other.

3. Current Capacity

Despite the myriad challenges faced by Yakima Valley youth and their families, the current system of care for children, youth and their families has many strengths that will form a sound foundation for system change and improvement. However, Yakima County’s current capacity to serve youth with SED and their families does not meet the need. An inventory of available services shows the primary building blocks for a system of care are in place, but we are lacking in both capacity and the extent to which current services are integrated, accessible, family-driven, youth-guided, and evidence-based:

Yakima County Department of Community Services (YCDOCS) is the human services arm of County Government and administers programs and services in the areas of mental health, substance abuse, domestic violence, housing and homeless services, community development, employment and training, aging and long-term care, and court and police-based alternatives to incarceration (CIT, Jail Diversion, Drug Court, Family Court).

Mental health services for children, youth, and families are provided through four agencies: Catholic Family & Child Service (CFCS), Central Washington Comprehensive Mental Health (CWCMH), Yakima Valley Farm Workers Clinic’s Behavioral Health Services (YVFW), and Yakama Nation Behavioral Health. In 2006 these agencies served 2892 children and youth – about half of the estimated 5,000 children with SED in our County.

Based on provider-reported data for 2007 (unless otherwise noted), current mental health resources to support the system of care in the Yakima Valley include:

Three (3) child psychiatrists serving evaluation and medication management needs. A fourth child psychiatrist is currently being sought to augment these resources.

Crisis outreach is available24 hours a day, 7 days a week for assessment and stabilization, with 72 hour crisis stays are available.

Inpatient hospitalization (voluntary and involuntary) takes place outside the County at Lourdes Counseling Center – 90 miles from the city of Yakima (21 children and youth were involuntarily detained in 2006).

The Crisis Center served 93 youth through 232 bed days in its Detox Residential Facility.

Foster care, including treatment foster care, is available through DSHS with capacity to serve between 50 and 60 youth.

A group home is opening in Spring 2008 to serve girls in the community using Dialectic Behavior Therapy (DBT). This service is currently available only to girls committed to the state juvenile justice system (JRA).

Evidence Based Programs and Practices

§1 Adolescent Dialectical Behavioral Treatment (DBT)

§2 Brief Strategic Family Therapy (BSFT)

§3 Cognitive Behavioral Therapy

§4 EMDR

§5 Family Integrated Therapy (FIT)

§6 Motivational Interviewing

§7 Multi-Systemic Therapy (MST) §8 Parent Child Interaction Therapy (PCIT)

§9 Strong Families/Familias Fuertes – Parent Training

§10 The Incredible Years

§11 Therapeutic Foster Care

§12 Trauma Focused Cognitive Behavioral Therapy (TFCBT)

§13 Strengthening Families

Collaboration. Yakima Valley child and family serving agencies, the Yakama Nation and Yakima County have an established track record and demonstrated commitment to partnership and collaboration, but we have lacked the infrastructure and resources to truly integrate services across agencies in a family-driven, youth-guided manner. Currently, the partners that have come together for the proposed coalition operate independently and each manages a myriad of contracts, MOUs, and informal agreements with each other. The community is small enough than many successful initiatives have been put in place, including mental health services for children and youth currently provided in schools, juvenile detention, Court programs, and integrated primary care settings. Collaborative forums have been actively supported, although not always sustained, as child serving systems have come together (often under the auspices of the Yakima County Community Services Department) to plan and attempt to meet the needs of children and youth with complex needs in our community.

4. Significance of the Proposed Project – Gaps and Barriers

Overcoming local barriers to a system of care. Many gaps and barriers challenge our system. During the planning process, a group of parents, providers, Yakama Nation, juvenile court representatives, child welfare representatives, county government, Educational Service District, local school districts, Greater Columbia Behavioral Health Regional Support Network (RSN) (the regional mental health authority), and early childhood services representatives identified the following priority gaps and barriers:

Lack of integration and coordination in access, screening, and assessment, with particular lack of coordination at key transition points (across child-serving agencies, between the child and adult mental health systems, youth returning from out-of-county placements);

Family and youth involvement in care is not institutionalized and happens idiosyncratically, and at a system level, families and youth are not seen or treated as partners;

No acute inpatient mental health capacity for children/youth within Yakima County and a lack of community-based short term residential options, necessitating travel out of the county for any family whose child receives inpatient care;

Access to alcohol and other drug use treatment and consultation is limited and there is a lack of integrated treatment for youth with co-occurring needs;

School involvement in the mental health system is limited; while specific contracts and agreements exist, there is a need more coordination with local school districts, including the Yakima School District and the 24 smaller school districts and numerous private and parochial schools served by Educational Service District 105; and

Currently, providers offer a range of support called “wraparound,” none of which are currently implemented with fidelity to the standards of the National Wraparound Initiative.

Moving from collaboration to integration. A related but distinct set of barriers center on cross-system integration. While our community strongly values collaboration – and multiple overlapping cross-agency forums and many examples of successful partnering exist – key agencies and providers face challenges in working together effectively. At best, we are a collaborative system rather than an integrated “system of care.” Factors related to this include:

There is no current family support organization and no formal youth support organization to catalyze efforts to involve parents, caregivers, and youth in the system of care;

Collaboration and integration are not formalized, so successful collaboration requires the ongoing involvement and intervention of high-level stakeholders and agency leaders; and

Diminishing fiscal resources in past years have forced child-serving agencies to restrict intensive treatment to children with only the most intense impairments.

5. Catalyzing Statewide Change: Collaboration with Federal, State, and Local Initiatives

The opportunity to develop a new system of care in Yakima County comes at a critical time in Washington’s statewide efforts to transform its mental health services. The convergence of federal, state, and local initiatives for change within Washington (described in more detail in later sections of this application) has created an unprecedented opportunity for demonstrating transformed practices and developing real-world strategies for sustainability:

Washington’s federal Mental Health Transformation State Infrastructure Grant (SM57468). Washington State is one of six states currently implementing Mental Health Transformation State Infrastructure Grants (MHTSIG), and the State’s goals in the third year of transformation are aligned closely with the goals of Yakima County’s project.

Recent Legislation Developing Systems of Care for Children’s Mental Health Services. Washington State’s legislature in 2007 passed House Bill 2SHB-1088, with both of Yakima’s Republican legislative representatives joining a broad, bipartisan support for the Democratic-sponsored bill. The legislation prioritized expanded access to mental health services and expanded funding in future years for children’s mental health services (particularly empirically-supported practices), established an Evidence-Based Practice (EBP) Institute at the University of Washington, mandated expedited re-enrollment for Medicaid services for youth in the juvenile justice system, expanded pilots for Wraparound Care Coordination, and supported development of integrated screening and assessment protocols.

Multiple Department of Social and Health Services (DSHS) Initiatives. Washington’s state government integrates its services for children and families primarily through three of DSHS’ administrations: the Children’s Administration (CA), which provides child welfare services; the Juvenile Rehabilitation Administration (JRA), which provides juvenile justice services; and the Health and Rehabilitative Services Administration (HRSA), which provides Medicaid, mental health (through the Mental Health Division – MHD), and substance abuse services (through the Division of Alcohol and Substance Abuse – DASA). These administrations have been working together to promote evidence-based practices such as Multisystemic Therapy (JRA in lead), Functional Family Therapy (JRA in lead), Multidimensional Treatment Foster Care (CA and MHD sharing the lead), Parent-Child Interactive Therapy (CA in lead), Trauma-Focused Cognitive Behavioral Therapy (MHD in lead), Wraparound Care Coordination (led by MHD with three joint pilots under 2SHB-1088), Family Integrated Transitions (JRA in lead), and integrated treatment for co-occurring disorders supported by statewide implementation of a standardized screening instrument (DASA leading with the Global Appraisal of Individual Needs – Short Screener, GAIN-SS).

Partnership with Tribal Governments. All of the above efforts have all been carried out in partnership with the 29 federally recognized Tribes located in the State. The Centennial Accord signed in August, 1989, provides a framework for government to government relationships between the State of Washington and each sovereign Tribe. The Confederated Tribes and Bands of the Yakama Nation are a signatory to that accord, and their willingness to join the comprehensive planning process of the Coalition is a tremendous opportunity.

Section B: Implementation Plan

1. Infrastructure Development

a. Cross-Agency Infrastructure

The partners in the Yakima Valley Youth and Family Coalition have come together to implement system of care to realize our vision of: A single, integrated system of care to provide comprehensive, community-based mental health services and supports for all Yakima County youth, including children and youth from the Yakama Nation, with serious emotional disturbances and their families. Services will be available in the community and feature family involvement in all aspects of care and care coordination.

The CMHI represents an unparalleled opportunity for our community:

We will initially prioritize service to youth age 10-21 with SED and involvement in juvenile justice or child welfare systems, youth experiencing co-occurring challenges related to substance use and youth in transition, with specific focus on Native American and Hispanic youth. We anticipate expanding to preschool and school-age children in Years 5 and 6.

Our system of care will be governed through a multi-agency Governance Team featuring consensus-based decision making with youth and family representatives as full partners.

Implementation will be led by an Administrative Team reporting to the Governance Team.

We will implement a county-wide Wraparound Care Coordination capacity in full accord with NWI standards and supported through implementation of the Wraparound Fidelity Assessment System (WFAS) under the direct leadership of Dr. Eric Bruns, Co-Coordinator of the National Wraparound Initiative and Director of the University of Washington Wraparound Evaluation and Research Team (see his letter of support in Appendix 1).

Development and implementation of our system of care will be organized around the Partnerships for Success (PfS) community planning process, also led by Dr. Bruns. The PfS process will bring our community together to analyze gaps and needs, identify appropriate EBPs, and implement them across the partner agencies of the Coalition.

The local evaluation team, led by Dr. Peter Selby of TriWest Group, has evaluated other system of care communities, and will be closely aligned with the PfS process.

We understand that a functional system of care cannot exist without the necessary structures and supports. This infrastructure aligns with the contemporary system of care definition presented on page 1 of this application (Hodges, et al., 2007;) and consists of four critical components:

Network – A set of linkages across people, organizations and communities;

Structures – Specified roles, responsibilities and authorities that define and enable an organization to perform its functions;

Processes – Methods of carrying out organizational activities often involving sequences of inter-related activities; and

Relationships – Trust-based links creating connectedness across people and organizations.

b. Governance

Local leaders including the County Commissioners; Yakama Nation representatives; local parent and youth leaders; mental health, child welfare, and juvenile justice agencies; and the Educational Service District came together in the planning of this proposal and formed the Yakima Valley Youth and Family Coalition Governance Team. The Governance Team is authorized by the County Commissioners. The Team is led by the Chairman of the Yakima County Commissioners, Ronald Gamache. A representative of Washington State’s federal Mental Health Transformation Project and local evaluator TriWest Group will participate in the Governance Team as ex officio members, along with key staff of the Coalition.

The Governance Team will include family members and youth as equal partners in all decision-making throughout the course of the six-year grant period. Initially, due to the realities of our current system, the Governance Team will be made up of a majority of professionals. However, through the formation of a Youth Development Team and a Family Development Team, strong youth and family organizations will be developed enabling youth and families to gradually form the majority of voting members of our Governance Team. The teams will provide training and support so that youth and family members will be fully equipped to advocate in meetings and other settings and to participate as equal partners in the Governance Team. We anticipate asking each of the key partnering organizations to engage and support a youth and family member to participate on the Governance Team. This will help us start off with reasonably equal representation of youth, parents and professionals. Technical assistance from Carolyn Cox, Family Partner for the 3 Rivers Wraparound Program and Jessica Hodges, Youth Participant for the 3 Rivers Wraparound Program, will be critical to this effort, as well as the support of the Statewide Action for Family Empowerment of Washington (SAFE WA). This support is documented in the letters of support provided by each organization.

The Yakima Valley Youth and Family Coalition Governance Team will:

Develop and uphold formal agreements among all Coalition partners;

Hold each other and the broader system of care accountable for meeting high standards of care, including standards for cultural and linguistic competence and family and youth involvement, as well as standards of effective practice;

Ensure that cooperative agreement funds are expended appropriately;

Maintain awareness of and active involvement in Washington State mental health system reform efforts, and ensure that our Coalition is model for effective system reform; and

Collaborate with local evaluator TriWest Group and the University of Washington Wraparound Evaluation and Research Team to monitor clinical and functional outcomes.

Cultural and linguistic competence will be demonstrated by ensuring that members of the governance team are representative of the primary populations that will be served (including Yakama Nation and Hispanic representatives) and by ensuring youth and family participation. Meetings will be held in community settings chosen primarily by youth and family representatives. Additionally, information from all meetings that may be of community interest will be published in local newspapers and disseminated in both English and Spanish.

The figure at right presents an overview of the governance structure, showing the Governance Team and Youth and Family Development Teams, as well as four other core operational teams that will be explained in more detail below: the Administrative Team, Program Development Team, Care Review Team and Cultural Competence Representative Council.

c. System Integration Procedures: Interagency Collaboration. The Coalition will promote system integration by formalizing commitments to the collaborative process through Memoranda of Agreement (MOA) among the community’s child serving agencies and providers. Governance Team members will execute MOA to formalize their commitments. At the system level, the purpose of these MOA will initially be to engage the members in an ongoing, multi-system, strategic planning process that focuses on coordination of multiple funding streams, integration of provider networks, and joint policy formation. Agreements will specify each partner’s role in the system of care, their financial and in-kind contributions, official representation in the governance and service coordination and delivery structure, and staff assigned to carry out each partner’s responsibilities under the agreements. When state or federal agencies are represented, the agreements will address any limits on their representatives’ authority and any special requirements or procedures for consenting to or endorsing the Coalition’s recommendations and decisions. Yakima County already has in place a contract with Greater Columbia Behavioral Health Regional Support Network (GCBHRSN), the regional authority for Medicaid and state funding for mental health services, which is referenced in the letter of support from GCBHRSN provided. In addition, initial MOAs have been secured with Children’s Administration Region 2 and local Juvenile Rehabilitation Administration representatives, all of which are authorized through the letter of support from Secretary Robin Arnold-Williams on behalf of the Department of Social and Health Services that oversees them. MOAs and letters of support from the remaining key partners including Yakama Nation Tribal Council Chairman Ralph Sampson.

With respect to consolidation of funding streams, all partners agree that all federal, state, and local funds targeting services to youth with serious emotional disturbance and their families will be “on the table.” All State Plan and 1915(b) Waiver mental health services for Medicaid eligible children will be covered by GCBHRSN and provided by the participating children’s mental health provider agencies. State mental health funds will be used to provide additional supervision and placement costs, and county funds will be combined with Medicaid and state funds to support expanded implementation of EBPs and culturally specific practices detailed below.

With respect to integration of provider networks, all partners agree that our community’s goal is to integrate currently separate, but overlapping, network development resources and activities to develop a unified process for provider contracting, credentialing, monitoring, and evaluation.

With respect to joint policy formation, all partners agree that the community’s goals are to reduce and ultimately eliminate barriers to access and to promote the system of care core values and guiding principles among all participating entities and at all levels.

System integration will be supported by an Administrative Team. This team will include the Project Director, Family Coordinator, Youth Coordinator, Cultural and Linguistic Competence Coordinator, Social Marketing Coordinator, Technical Assistance Coordinator, State-Local Liaison, Local Evaluators, and administrative support staff. This team will selected by, and will report to, the Governance Team. The Administrative Team’s responsibilities will include:

Support the Governance Team in development of a strategic plan in coordination with Dr. Eric Bruns (Univ. Washington) and the Partnerships for Success model (described below);

Budget, manage, and expend service funds as approved by the Governance Team;

Integrate funding streams to the fullest extent possible under state and federal law;

Manage contracts for service delivery, training, TA, evaluation, and communications;

Use findings from the national and local evaluations to support the Governance Team in directing ongoing and future programs, practices and policies, under the direction of local evaluation team lead Dr. Peter Selby (TriWest Group).

Services Integration. The ultimate measure of integration will be the experience of each youth and family served. The Coalition will promote (and evaluate) an integrated but decentralized care coordination capacity governed by the Coalition, but implemented through each of the four primary partner provider agencies. Through contractual agreements, the Coalition will direct care management and Wraparound Care Coordination for all youth with SED and their families, regardless of referral source or point of entry. We use the term care coordination to make clear that this role involves more than the coordination of “treatment.” A youth and family team’s job is to craft a plan of care that addresses all system of care components. The Coalition will employ a team of bilingual, bicultural Wraparound Care Coordinators to facilitate individualized youth and family teams to plan and coordinate effective service delivery. At least half these team members will be people chosen by the youth and family, including the youth and the youth’s primary family caregiver.

The Plans of Care that are developed by these teams will ensure youth and family safety, as well as the delivery of culturally responsive services through a mix of formal and informal supports aimed at meeting the unique needs of each youth family. This proposal also includes a pool of “flex-funds” that can be used for typically non-reimbursable service items to meet cultural and other individualized needs. To ensure that services are accessible, our policy will be to provide Care Coordination services in the youth and families’ homes, and to arrange for home-based or neighborhood-based support services as much as possible. When families must access services at any distance from their homes, the Care Coordinator will ensure that convenient transportation and childcare are available or arranged.

Mental health services will be provided in settings such as schools, detention and foster homes, which are more accessible to youth and families and conform to service delivery needs in the partner system settings (child welfare, juvenile justice, schools). Structures will be put in place to ensure that agencies work together to support and partner with youth and families Cross-training will be provided across partner agencies to ensure that they understand the services and supports which will be provided as well as each others’ capabilities, limits, and mandates.

Care Review. The proposed Coalition structure includes a cross-system Care Review Team. This group will ensure the protection of consumer rights and adherence to the system of care core values and guiding principles; monitor progress toward achieving individualized Plan of Care goals; and develop recommendations to improve the adequacy, appropriateness, and quality of services and procedures. The Care Review Team will also establish care review protocols and criteria. The intent is not to review every youth’s care, but to select Plans of Care that exemplify the variety of needs being addressed and the typical barriers and difficulties encountered in order to identify and overcome barriers, as well as maintain and build upon best practices. The Care Review Team will interview youth, family members, care coordinators, and others in addition to examining the Plan of Care. The Team, made up of youth, family members and professions will:

Monitor appropriateness and quality of individual Plans of Care;

Monitor fidelity of plans to principles of system of care and the principles of the National Wraparound Initiative;

Ensure that living and service placements for children are in the least restrictive, most normative, clinically appropriate, and most safe environments;

Monitor the degree to which care management and other services enhance the strengths, resilience, and well-being of youth and families; and

Ensure compliance with all federal and state funding rules, including regulations under 42 CFR 438 governing Medicaid Prepaid Inpatient Health Plans, Title rules and regulations for electronic exchange of information and for confidentiality of case records as required by the Health Insurance Portability and Accountability Act (HIPAA).

Access, Financing, Workforce Development and Community Leader Support. To ensure the Coalition’s sustainability, we have been careful to budget the available SAMHSA grant funds for capacity building and not to rely on them for long-term operating costs. We have studied the CMHS report on sustaining systems of care beyond the federal investment (Koyanagi, 2000) and the 2004 Matching for Sustainability report and built our proposal with those lessons in mind. Procedures for flexible funding will include establishing a pool of funds that includes state and local funds through DCFS, JRA, and GCBHRSN, determining how youth and family needs will be identified, and developing policies for how those funds can be accessed. In order to ensure access into services, all partner systems will be educated and informed about how to help youth and family access all available services and supports. Financing will be addressed through the use of in-kind resources from participating agency representatives. Workforce development will include providing internship opportunities for college students in the Wraparound Service Coordination system. Community leader support will include the leadership of the County Board of Commissioners and outreach to leaders in the business and philanthropic community.

d. Replication

Washington State is in the midst of transforming its mental health systems. In her letter of support, Governor Chris Gregoire talks about how the Yakima Valley Youth and Family Coalition aligns with the two major statewide initiatives at the heart of this transformation: the SAMHSA-funded Mental Health Transformation Project (MHTSIG) initiated in 2006 and the legislatively-driven promotion of systems of care under the 2007 House Bill 2SHB-1088. Washington is in the process of a multiyear transformation:

The 2005 Joint Legislative & Executive Mental Health Task Force carried out a statewide review of mental health systems, leading to both a restructuring of responsibilities for regional mental health authorities to comply better with Medicaid managed care requirements under 42 CFR 438, as well as setting the stage for Washington’s successful application for the Mental Health Transformation State Infrastructure Grant awarded in 2006.

Building on earlier SAMHSA Children’s Mental Health Initiatives in King County and Clark County, legislation (2SHB-1088) passed in early 2007 established a statewide infrastructure of prioritized funding, Wraparound Service Coordination pilots, and a statewide center of excellence to ground the fidelity and monitor outcomes for child and family best practices (the Evidence Based Practice Institute at the University of Washington).

In support of replicating this framework statewide, DSHS contracted with TriWest Group (the local evaluator for the Coalition) to review its State Medicaid Plan and recommend strategies for sustaining empirically-supported practices. The Final Report from July 2007 prioritized expansion through Medicaid funding of fidelity-based Wraparound Care Coordination and multiple best practices, including Multisystemic Therapy, Multidimensional Treatment Foster Care, Parent-Child Interactive Therapy, and Trauma-Focused Cognitive Behavioral Therapy.

The Yakima Valley Youth and Family Coalition is aligning with a successful Wraparound implementation and family support organization in the southern part of the Regional Support Network of which Yakima County is a part (Greater Columbia Behavioral Health RSN). The 3 Rivers program in Benton County will partner with our project to replicate the fidelity-based models of 3 Rivers (see the letter of support they have provided), adapted for the unique people and agencies of Yakima County. Yakima County is therefore a natural next step for replication regionally, as well as at a statewide level.

The primary hub for replicating systems of care across Washington State like the system being proposed for Yakima through this reprioritized policy and funding framework is the Wraparound Evaluation and Research Team (WERT) at the University of Washington. In 2004, Washington State was fortunate to become the home of Eric Bruns, PhD, director of the WERT, as well as co-coordinator of the National Wraparound Initiative (NWI). Dr. Bruns has developed the Partnership for Success (PfS) Community Process and Consultation Model as a coordinated system for helping communities plan and develop local systems of care. By aligning the Yakima Valley Youth and Family Coalition with the PfS approach, our community builds on the momentum within the state for implementing systems of care and provides a critical opportunity for comprehensive reform across a diverse region that includes the fourth most populous metropolitan area within the state, the largest Tribal Government (the Yakama Nation), and a vast geography encompassing numerous small towns across the states major agricultural region.

Given the support of these multiple federal and state initiatives, we believe that the Yakima Valley Youth and Family Coalition is poised, in the words of Governor Gregoire, to “provide a vehicle to demonstrate revised practices” and an “opportunity to test real-world strategies for sustainability.” We believe that the diverse coalition assembled for the Yakima Coalition can become a critical tipping point in this statewide transformative effort.

e. Developing Structures of the System of Care: Structural changes necessary to build and sustain a system of care include specifying roles, responsibilities, and authorities that enable the system to perform its functions. Collaborative structures include budgetary authorities that can facilitate flexible, cross-agency, and family-friendly decision making and infrastructure that can facilitate smooth transitions for youth and families across system boundaries and levels of service. More concretely, the clinical network, administrative team, training, performance standards and information sharing capacity are critical elements of system structure. The Clinical network development by the Yakima Valley Youth and Family Coalition will be led by the Program Development Team of the Governance Team and supported by the three community mental health provider agencies within the County (which are the only certified Medicaid providers in the County) and Yakama Nation Behavioral Health. They will participate in ongoing planning with core initiative teams and the Governance Team. This team would be responsible for case review and identifying clinical training needs.

We propose three levels of coordination: (1) clinical/direct service, (2) agency management, and (3) system level. Clinical and direct service coordination will center on Wraparound Care Coordination (with fidelity to NWI principles). The management level, which will include the Project Director, will be responsible for regular reviews and reports on system challenges to provision of coordinated and integrated care to youth and families. It will carry out resource sharing authorized by system level coordinators. System level coordination will include the Governance Team and other agency leads with control over funds. System level members will have the authority to endorse resource sharing and braiding. They will also have the authority to implement policy changes in their respective agencies.

System integration will be supported by a carefully selected Administrative Team. This team will include the Project Director, Family Coordinator, Youth Coordinator, Cultural and Linguistic Competence Coordinator, Social Marketing Coordinator, Technical Assistance Coordinator, State-Local Liaison, Local Evaluators, and administrative support staff. This team will be selected by, and will report to, the Governance Team. The Administrative Team’s responsibilities were noted above, and will include direct participation by Dr. Eric Bruns (WERT/NWI) and Dr. Peter Selby (TriWest Group).

Training capacity will be developed through pooling agency resources and by developing a training schedule that addresses the shared needs of those involved in the system of care. Coalition partners are committed to cross-agency training that includes youth and family members. We have identified a Wraparound Care Coordination trainer and coach, Laura Burger Lucas, whose model has demonstrated fidelity through the Wraparound Fidelity Index, and who has worked closely with Dr. Bruns in the 3 Rivers program described above . Her training model is designed to build capacity by emphasizing training supervisors in order to develop local coaches and champions. All participating agencies will participate in training based on NWI principles in order to build a culture of understanding around the core aspects of our system.

Performance standards will be developed by the Program Development Team with the assistance of Ms. Lucas (wraparound trainer), Dr. Bruns (NWI and PfS model), and Dr. Selby (local evaluator). Standards will be enforced by the Care Review Team on behalf of the Governance Team to ensure that youth and families will have consistently high quality experiences across the system of care.

Management Information System. The County and the local mental health authority (GCBHRSN) currently share the same management information system software, as are the three community mental health agencies. At this time, the Yakama Nation Behavioral Health is not using the system. We will explore with all partners the most effective approaches to communication and information sharing in order to address and resolve problems with that system, to develop reports that can be shared to address the components of the service delivery model, and to resolve data access issues across agencies. The technical assistance of the Mental Health Transformation Project to support these goals was committed through their MOU.

Locations of service are located in communities throughout the county (Yakama Nation, Grandview, Sunnyside, Toppenish, Yakima, Union Gap). The system of care will continue to be based out of these sites with emphasis on providing more services outside of the clinical office in places convenient to youth and families such schools, homes, juvenile justice agency sites, DCFS sites, and other community setting depending on the individual needs of the youth and families.

f. Collaborating with Other Child Serving Systems

The Coalition recognizes that the youth and families we seek to serve receive services from multiple child serving agencies. System representatives from primary care, education, juvenile justice, child welfare and mental health have participated in the planning process leading to this proposal. The mental health system currently collaborates with all these systems through individual contracts and agreements so that mental health services are currently accessed in some community schools, some primary care locations, some child welfare agency sites, and some juvenile justice venues. A primary goal for our Coalition is to move this situation-specific collaboration to a system-wide status that is consistent and institutionalized. Our Governance Structure has authorized a Program Development Team to develop policies, protocols and agreements to support this shift.

For development of this proposal, MOUs and letters of commitments were provided by:

The Yakama Nation Yakima County Juvenile Court

3 Rivers Wraparound United Way of Yakima County

County Department of Community Services Children’s Village (primary medical care)

Washington State Juvenile Rehabilitation Administration, Region 2 (juvenile justice) Educational Service District 105 and the Yakima School District and (education)

TriWest Group (local evaluator) Greater Columbia Behavioral Health RSN

Department of Social and Health Services (DSHS – state department overseeing mental health, substance abuse, Medicaid health and specialty care, child welfare, and juvenile justice services) University of Washington Evidence Based Practice Institute (technical assistance for empirically-supported practice implementation)

Wraparound Evaluation and Research Team and National Wraparound Initiative DSHS Children’s Administration, Region 2, Division of Children and Family Services

SAFE WA local community mental health providers

EPIC – Head Start provider

g. Training, Technical Assistance, and Social Marketing

Training. In order to support the development of an integrated system of care, we will implement training in Wraparound Care Coordination and specific evidence-based practices. We have made a commitment to participate in the Partnership for Success (PfS) Community Process and Consultation Model led by Eric Bruns, PhD, of the University of Washington Evidence Based Practice Institute as a foundation for the planning around our efforts to support the development of the system of care. Through this process, community needs will be assessed and a service array will be developed to address those needs. This process will lead to identification of the most appropriate EBPs for our community and build links with purveyors to participate in training to ensure fidelity.

Coordinated with this broader effort, Wraparound Care Coordination training will be provided through a five-dimension model that incorporates: (1) new techniques for training staff, (2) coaching practices that are outcome focused, (3) supervision skills that support practice change, (4) information management that documents a strength-based assessment, team approach, and an individualized plan of care and outcomes, and (5) agency culture change. Wraparound Care Coordinators and their supervisors will participate in an intensive ongoing coaching process to support fidelity. This training and coaching will be provided by Laura Burger Lucas, a trainer and coach based in Arizona who currently supports the development of Wraparound Care Coordination capacity at 3 Rivers Wraparound Program in a nearby county in the southern part of the Regional Support Network of which Yakima County is a part. Ms. Lucas has worked closely with Dr. Bruns on the 3 Rivers project and has already provided some training to providers in the Yakima network.

We would also seek to provide training in fidelity monitoring and cultural competence. The cultural competency training would go beyond the surface level training that most providers receive to confront underlying issues of racism at both the individual and institutional levels. Training in family, youth and professional partnerships would be emphasized. We would utilize a cross-system training strategy whenever possible to further support our integrated, unified system of care. Given the need to adapt most empirically-supported practices when they are applied cross-culturally, training in cultural competence will begin with assessment of the cultural competence of each empirically-supported practice implemented, following a multi-level approach (Stewart, 2007):

Technical Assistance. The Coalition will seek technical assistance (TA) related to building an efficient integrated administrative structure, MIS, sustainability, working successfully with youth and families as equal partners, maximizing non-federal match, and incorporating youth development strategies into the system of care. Technical assistance in consensus building and team development will be provided to the governance structure. Technical assistance on computer infrastructure development will be sought with the assistance of the Mental Health Transformation Project. Guidance and technical assistance related to integrated systems and service teams and addressing HIPAA concerns will also be sought. As noted above, technical assistance through the Partnership for Success (PfS) Community Process and Consultation Model will help us to understand and identify specific needs and empirically-supported practice models that fit our community. In addition, TA from the Wraparound Evaluation and Research Team and the National Wraparound Initiative, coordinated by Eric Bruns, PhD (see attached letter of commitment) will support in ensuring high quality Wraparound Care Coordination.

Social Marketing. Efforts would target the general community, the health care provider community, and community and political leaders. The project already has the bipartisan support of Yakima’s Congressman Doc Hastings and Senator Patty Murray. Our social marketing plan would most likely follow a developmental progression, starting with awareness of mental health as a common challenge faced by young people in our communities, and moving over time to address stigma and promote access to available referral and treatment services. A social marketing plan will be developed in the first year with their input and will address how the community will be informed about the project’s goals, vision and progress.

h. Capacity and Quality of Services

The Yakima Valley Youth and Family Coalition will first seek to increase system capacity and quality through high-fidelity implementation of Wraparound Care Coordination across our system of care. We plan for a total of eight Wraparound Care Coordinators throughout the county by Year Two, with at least one Care Coordinator within the Yakama Nation. Once trained and in full swing, this will provide capacity to serve approximately 64 youths and families at any time with full fidelity to the NWI standards – representing a tremendous increase in both capacity and quality. Grant-supported capacity will increase to 12 coordinators by Year Four. Capacity will also be increased by setting up an integrated system that better defines need and better monitors attainment of specific targets in order to ensure that resources are more efficiently utilized.

The capacity of key services such as intensive home-based services (many employing evidence-based approaches such as MST, FFT, and FIT), crisis intervention, school-based day treatment, therapeutic foster care (potentially employing the Multidimensional Treatment Foster Care model), and expanded respite care are also targets for expansion. Access to key outpatient services including Parent-Child Interaction Therapy and Trauma-Informed Cognitive Behavioral Therapy are already available through network providers, but capacity will be assessed and additional capacity added as needed. Core to the overall assessment of clinical need and prioritization of clinical system development efforts will be the Partnership for Success (PfS) Community Process. This process will guide the Coalition’s decision making and goal setting in year one and identify targets and strategies for expansion for specific services. Cultural and racial disparities will be addressed at the system level through community involvement in the PfS Community Process to select services and locations for services that meet the needs of our diverse communities. At the service level, the Wraparound Care Coordination model supports cultural competence as it is driven by the youth and family – this approach and the culture that surrounds it will help move our service capacity towards fairness, respect and responsiveness.

i. Participation in Plan Development

State and local child-serving agencies and community leaders. Leaders from the mental health, child welfare, juvenile justice, education and drug and alcohol treatment systems have been meeting regularly as a whole and in workgroups to develop this plan. The Chair of our County Commissioners is leading our process. The Yakama Nation participated in planning and has committed to devote staff resources to fully participate in the comprehensive planning process to be carried out during year one.

Family members and family-run organizations and advocates. Parents, grandparents and kin caregivers of youth with SED participated in planning our Coalition. Partners in the Yakima Valley Youth and Family Coalition are committed to developing strong family-run organizations. Among the first activities in year one will be the establishment of a Family Development Team to support the development of a formal organization and to ensure that family members are able to take their place as full partners from the outset of the project.

Youth. Youth involved in multiple systems, and involved in making the transition from dependence to independence, participated in the planning process for this proposal. Among the first activities in year one will be the establishment of a Youth Development Team to support the development of a formal organization and to ensure that youth are able to take their place as full partners from the outset of the project.

Racial, ethnic and other cultural groups in the community. The Washington State Migrant Council has coordinated with mental health providers in the community for mental health consultation in their Headstart classrooms. Yakima Valley Farm Workers clinic, one of the participants in the project, has an agreement with a local public Spanish-language radio station, KDNA, with a large listener base covering most of central Washington; hour-long live programs are provided on a weekly basis, covering multiple health topics, including mental health and substance abuse. Nuestra Casa and La Casa Hogar, two grassroots organizations serving immigrant women and their children, receive consultations from mental health providers. Casa de Esperanza is a licensed chemical dependency program which is a part of Yakima Valley Farm Workers Clinic. Providers coordinate on a regular basis with South East Yakima Community Center, which serves a multi-racial community in southeast Yakima. We have strong faith-based connections with the Diocese of Yakima which will be built on and expanded to include a broad array of faith-based organizations in year one. As detailed throughout this proposal, the Yakama Nation and Yakama Nation Behavioral Health and the Yakima Valley Farm Workers Clinic Behavioral Health Services are core partners in this proposal and participated throughout the planning process.

j. Interagency Collaboration and Nonfederal Matching Dollars

In our budget justification we project readily meeting our required match amounts, largely through increased funding for EBPs and other mental health services contemplated under 2SHB-1088 (see letter of support from State Representative Dickerson) and by planned development with local bond funds of a new inpatient facility in Yakima County for children and adolescents, estimated to total $6.671 million over the 6 years. The value of interagency collaboration through the Governance Team structure, in-kind clinical supervision for Wraparound Care Coordinators, and additional savings from reduced use of restrictive juvenile justice, child welfare, and out-of-district school system placements is expected to total over $1.835 million over the six years.

k. Governor’s Letter of Assurance

Please see the Letter of Assurance from Governor Christine Gregoire provided in Appendix 2.

2. Service Delivery

a. Access to Services: We will initially emphasize services for a priority population of youth age 10-21 with serious emotional disturbance (SED) who meet any of the following criteria: are involved with the juvenile justice or child welfare systems, have co-occurring SED and substance abuse disorders, are (or are at risk of) receiving care in restrictive out-of-community settings or who are transition to or from these settings, or are in need of short-term, community-based out-of-home respite.

To address the service disparities in the current system, we also specifically commit to serve children and youth of color, particularly Hispanic and Yakama Nation youth and transition age youth (17-21). Youth with a diagnosis of developmental disorder will be eligible if they have a co-occurring mental health diagnosis. Referrals will come from any referral source across the child serving systems and youth will be eligible regardless of their financial or insurance status. Access to services will be managed by a cross-system Care Review Team that can serve as “barrier busters” in providing oversight to resource allocation issues and resolving issues that present barriers to effective cross-system services provision. The Care Review Team will include youth, parents, and a core of agency representatives from the Region 2 Division of Child and Family Services (child welfare), Greater Columbia Behavioral Health Regional Support Network (Medicaid and state-funded mental health), Yakama Nation Behavioral Health, the three local community mental health providers, juvenile court (both juvenile justice and dependency), substance abuse/chemical dependency treatment providers and schools (the Yakima School District and overall Educational Services District 105). The core group will represent the full range of major ethnic and racial minorities within the County (Hispanic, Native American, African American, white) and will be augmented by panel members participating on an as needed basis, representing DSHS Department of Developmental Disabilities, chemical dependency, and DSHS Region 2 Juvenile Rehabilitation Administration (state level juvenile justice agency).

Coordinated but de-centralized access will respond to any request, and will provide resource coordination and referral as needed. Social marketing strategies will raise awareness of centralized access for ease of entry and seek to reduce the stigma of seeking these services. Enrollment procedures will be consistent across the system of care and initial services (such as initial screening, review of need, resource coordination, outreach) will not require formal entry into the public mental health system.

b. Service Components

The Governance Team will pursue multiple strategies to develop an effective, community-based provider network, through the following primary strategies:

Participation in the Partnerships for Success Community Planning Process to (1) establish benchmarks for change; (2) create a realistic profile of current programs, services, and activities; and (3) produce a strategic plan for change within the community.

Development of services or alternatives within available resources to address gaps.

Building of an integrated provider network from the currently separate but overlapping networks used by the major child serving state agencies.

Developing and establishing a quality assurance and improvement process to monitor and promote integration across the system, services delivery, and funding allocations. This system will be organized around the Wraparound Fidelity Assessment System that will be implemented within our community by Dr Eric Bruns of the Wraparound Evaluation and Research Team and National Wraparound Initiative, and supported by the local evaluation infrastructure provided by Dr. Peter Selby and TriWest Group.

Work within the legislative mandates of 2SHB-1088 and the parameters of Washington’s State Medicaid Plan to broaden the range and capacity of community-based services this network offers to address the eight dimensions of service identified in the system of care model (Stroul, 1986). A 2007 review of Washington’s Medicaid State Plan found the plan to support the delivery of Wraparound Care Coordination and the empirically-supported practices noted above (TriWest Group, 2007a). Expanded state funding contemplated under 2SHB-1088 and coordinated strategies for supporting empirically-supported practices under the Medicaid State Plan are currently anticipated for the 2009-2011 funding biennium, taking effect in July 2009. This timing creates a unique and fortunate opportunity to build sustainability for services into Yakima County’s new system of care from the middle of the first year of the grant ongoing, as described in more detail in Section B.3 of this application.

Promoting the adoption of SAMHSA’s system of care core values and guiding principles through an aggressive training and technical assistance program that emphasizes cultural competence and family-driven system and service planning, delivery and evaluation.

Establishment of a Program Development Team to design the system structure, establish policies and standards, identify gaps and needed services, and support implementation.

Development of policies to ensure consistency in service delivery and operations. Policies will provide a process to measure system variables through the local evaluation.

Education of provider clinical staff on the Coalition’s structure, expectations, standards, policies, access points, screening/assessment process, and care coordination model.

Social marketing to understand the system of care and reduce stigma.

Enhancement of cross-agency information sharing, communication, and reporting.

Required Mental Health Services and Supports; Optional Services, and; Non-Mental Health Services. In developing the plan for the Yakima Youth and Family Coalition presented in this application, partners came together to conduct a detailed review of required, optional and non-mental health services. This review incorporated current status and desired status of each services and improvement strategies for each. Due to page limits, we will present an extremely abbreviated summary of the results of this process in response to this question.

Required Mental Health Services:

Diagnostic and evaluation services: Service is available but with little coordination. The Program Development Team will analyze system gaps and resources in order to achieve an integrated and coordinated set of assessment protocols and tools.

Cross-system care management processes: Child Welfare, Juvenile Justice, and Mental Health provide case management under their mandates to serve specific populations within categorical funding streams. An integrated care coordination model will be developed using Wraparound Care Coordination and supported by training, coaching and fidelity monitoring.

Individualized service plan development inclusive of caregivers: Public mental health providers are inconsistent in individualized treatment planning and multiple plans exist across systems. Uniform cross-system individualized care plans will be developed with fidelity to NWI.

Community-based services: The majority of services are provided in traditional office-based settings and are funded by Medicaid, CHIP, and private insurance. Although EBPs are present, few therapist or mental health professionals in this community are trained in evidence based practices. The PfS Community Planning Process will identify and address system gaps and evidence-based models will be adapted to be responsive and sensitive to the local culture.

Emergency Services: Emergency care will be enhanced to feature a coordinated continuum of 24 hour crisis services including: mobile in-home crisis with short-term follow-up; community-based short term residential options; and acute - community-based inpatient services.

Intensive Home-Based Services: Increased capacity for intensive, evidence based services will be coordinated and expanded in each of the mental health agencies and PfS process.

Intensive day treatment services: Currently located outside the county and available only to a few youth. The PfS process will determine needs and appropriate response in this area.

Respite Care: Available to some enrolled treatment foster care youth. In order to build capacity, funding mechanisms for respite care will be identified and we will recruit and train pool of respite providers.

Therapeutic Foster Care: Current capacity within the mental health agencies is approximately 40 beds. The PfS process will determine needs and appropriate response in this area and we anticipate adapting training to local culture and provide to local providers.

Independent Living Skills: Services are focused on foster care youth transitioning to adulthood. In order to increase program capacity to serve all transition age youth we will engage in coordination between child and adult systems and seek alternative funding sources.

Family advocacy and peer support services delivered by trained parent/family advocates: This is a critical area of need for our community. The Youth and Family Development Teams will work with the Program Development Team and state organizations (SAFE- WA) to develop a plan in this area.

Optional Mental Health Services

Screening assessments to determine whether a child is eligible for services: Early Periodic Screening and Diagnoses and Treatment (EPSDT) screen through medical providers are currently required. We will expand relationships with school districts, child care providers and primary care to target infants and children at high risk of mental health problems.

Therapeutic recreational activities: The mental health system is not currently involved in recreational activities. Utilize flexible funding to design individualized recreational options for youth and collaborate with recreational organizations in our community.

Customized suicide prevention and intervention approaches: Mental health providers are required through state regulations to have an individualized crisis plan for all at-risk youth. Youth and Family Teams will facilitate greater individualization and use of natural supports.

Inpatient Hospitalization: No inpatient hospitalization for youth is available in Yakima County. The nearest inpatient facility is 90 miles away, with another hospital utilized in the Spokane area, approximately 200 miles away. Plans are currently underway to develop a small (10 bed) inpatient facility in Yakima.

Non Mental Health Services

Educational Services: All districts provide psychological evaluations to assess need for specialized services and eligibility under IDEA, Sec. 504 and as needed during the IEP process. The IEP will be integrated with the youth’s individualized care plan. Wraparound Care Coordinators will participate in the education planning process and advocate for youth.

Health Services: All mental health providers currently have mental health clinicians working in medical clinic settings. While medical services are readily available, medical case management is not. Medical providers will be involved in the treatment teams for children when significant medical case management issues are identified.

Substance abuse prevention and treatment services: Stronger relationships need to be developed between substance abuse and mental health providers to improve outcomes for dual-diagnosed youth. We will include prevention and dual-diagnosed youth as part of a planning and design team and braid funding as much as possible for flexibility for services.

Out-of-home services such as acute inpatient and residential: Currently not available throughout the county or region. Local providers are currently examining expansion in this area. The PfS process will help our community analyze the needs in this area and develop a strategic plan to address.

Vocational counseling and rehabilitation and transition services offered under IDEA: Currently, coordination is inconsistent and idiosyncratic. We will coordinate mental health services with IEP treatment plans, with the goal of integrating the plan and outcomes from the two systems.

Protection and advocacy, including informational materials: The Coalition’s social marketing effort will coordinate with local NAMI group and SAFE-WA to develop a strategic plan in this area.

c. Strategies to Implement Key Service Activities

Diagnostic and Treatment Planning. A culturally competent Care Coordinator will coordinate strengths-based assessments to identify each youth and family’s strengths and needs, and the resources they have available to meet them, including the family’s formal and informal support systems. Family members will be supported to discover their personal and family strengths and assume an active role in decision making, rather than having services “prescribed” by professionals. All partner agencies will agree to share information (subject to authorization by youth and family) to reduce the need for families to tell their story repeatedly. Based on this, the child and family team will seek the best set of supports and providers from the integrated network to match the child and family’s particular needs, strengths, culture and preferences.

To support these processes, the Program Development Team will identify/develop a common screening and intake assessment protocol to be used across the system of care. Providers will be trained to the process with measurable competencies. The common intake assessment will be built upon proven tools already implemented in Washington’s mental health system, including the GAIN-Short Screen. Assessments will be completed by certified Children Mental Health Specialists (Washington’s mental health system certifies mental health professional as children’s specialists based on specific experience and training requirements).

Community-Based Services. All network providers have committed to providing services in the least restrictive and most ecologically valid method possible. Often, this will involve meeting with the youth and family in their own homes or other community locations. Care plans will also prioritize natural supports in treatment whenever possible. Formal network services will include individual, peer group, and multigenerational family counseling services. Youth and families will have a choice of providers to provide meaningful choices and promote cultural compatibility. Services will be provided at home, clinic, office, school or other appropriate location, and will include consultation with psychologists, psychiatrists, and developmental pediatricians, as well as monitoring and management of medications. Specific services for enhancement across the grant period will be identified directly by community members through the PfS Community Planning Process to be conducted by Dr. Bruns.

Culturally Competent Assessment. As noted above, a culturally competent Care Coordinator will coordinate all assessment activities. In order to ensure that assessment recognizes gender and cultural differences, all network providers will receive training on, and be required to adhere to guidelines that will make each provider responsible for ensuring a culturally competent and gender and age appropriate assessment. Standards and associated training and technical assistance will ensure that relevant environmental, disability and sexual orientation factors are also considered. Whenever possible the assessments will be conducted by a clinician whose gender and ethnicity matches the preferences of the consumer. We will in all cases ensure that assessments include questions and descriptions in each consumer and family’s own words regarding their individualized frame of reference for what is normal or acceptable behavior within their family or community. Given the broad diversity of the people of Yakima Valley, in some cases there will not be a full cultural match between clinician and consumer. For example, while most Hispanic residents in the Yakima Valley have a Mexican American heritage, the overall population represents multiple regions and communities within Mexico, as well as multiple nations and cultures across Latin and South America. To help bridge any remaining cultural gaps, the Coalition will also provide access to consultation for ethnic minority specialists.

Once matched to an appropriate clinician, the following strategies for culturally competent assessment will be employed:

Determination of the language preferences of the individual, family, and key supports;

Assessment of the level of individual and family acculturation versus assimilation;

Incorporation of culturally relevant assessment results into treatment planning and services;

Use of cultural norms in differential diagnosis, assessment, and service planning;

Incorporation of the individual’s natural supports and beliefs into the treatment process; and

Incorporation of traditional cultural practices and alternative medicine interventions.

Training. The Care Review Team will review the credentials, qualifications, and training of all network providers. This review will emphasize the qualifications of each clinician to deliver evidenced-based treatments and appropriately apply DSM-IV diagnostic categories. To ensure high quality care, our proposal includes a substantial investment in training and technical assistance on a variety of topics, coordinated through the PfS Community Planning Process to base these on system needs identified by the community, helping us target appropriate training. Through linkages to purveyors of selected EBPs supported and coordinated through the EBP Institute at the University of Washington, we will ensure fidelity-based training, coaching, and ongoing monitoring is provided to clinicians. Training will also include which DSM-IV diagnoses and cultural modifications are appropriate for each EBP, and follow-up training and consultation by trainers will ensure fidelity to models over time. Overarching Wraparound Care Coordination training will form a basis for shared understanding and practice around a culturally and linguistically competent, family-driven, and youth-guided system of care.

Evidence-Based Practices (EBPs). The Yakima Valley Youth and Family Coalition has entered into an agreement with Eric Bruns, PhD at the Washington State Evidence Based Practice Institute at the University of Washington Division of Public Behavioral Health and Justice Policy to personally lead and conduct the Partnerships for Success (PfS) Community Planning Process. This well-researched process includes activities that aim to strategically enhance community capacity for implementation and sustainability of evidence-based practices.

The term “Evidence-Based Practice” (EBP) is an umbrella term that has several underlying components, but in the final analysis, for a practice or program to be evidence-based, it must be well researched and shown to be more effective than placebo, treatment as usual, or another practice. Typically, for a program or practice to receive evidence-based status, there must be substantial evidence of such effectiveness (e.g., randomized design, multiple studies by different investigators, etc). In addition to proven effectiveness, another important component is how easily the program is implemented. Generally, evidence-based practices come with a manual and significant training. Programs must be practical to implement within a community structure. Finally, there is often a component to ensure fidelity to the model (that is, are people implementing the program in the way it was implemented when it was shown to be effective).

We also believe that successful evidence-based practice (EBP) promotion begins with an understanding of the real world limitations of each specific best practice, so that the understandable stakeholder concerns that emerge can be anticipated and incorporated into the best practice promotion effort. While the Coalition is committed to implement evidence-based practices (EBPs), building on momentum at the state and local level described throughout this application regarding a wide array of possible models, we are very conscious of the factors that too often challenge implementation of such practices. Inherent limitations in the research base for EBPs (for example, a lack of research that addresses the complexities of typical practice settings such as staffing variability due to vacancies, turnover, and differential training) often lead providers, caregivers, youth, and other stakeholders to question the extent to which EBPs are applicable to their communities. In addition, many families and youth are understandably concerned that having policy makers specify particular approaches might limit the service choices available, and many providers are reluctant to implement EBPs due to the costs and risks involved in training and infrastructure-building, processes that require commitments over years rather than months. The challenges of adapting such practice across culture include the need to adapt most empirically-supported practices when they are applied cross-culturally, and our systematic approach to these issues was discussed above.

The Partnerships for Success (PfS) model was specifically designed to help communities select and tailor EBP implementation to their local needs, resources, and cultures. The basic tenets of the Partnerships for Success (PfS) model are described directly below:

Underlying Principles – The model is community based, participatory, based on data-informed decisions, and designed to balance a holistic continuum of approaches.

The Community Process – The process involves three phases: Planning (across four phases, including: mobilization, needs assessment, resource assessment, and strategic plan development), Implementation and Evaluation, and Sustainability.

Expected Outcomes – PfS targets the following outcomes: (1) development of sustainable cross-agency planning entities, (2) creation of local training and coaching consortia to support EBP implementation, (3) increased adoption and implementation of EBP’s, (4) development of data collection infrastructures, (5) significant increases in external grant funding, and (6) leveraging, blending, and pooling of previously “siloed” internal funding sources to support EBP implementation.

While we look forward to the PfS process and identification and implementation of appropriate EBPs in our community, we also have a history to EBP use. EBPs that have been are or currently available in the Yakima Valley include: Multisystemic Therapy (MST), Dialectic Behavior Therapy (DBT), Multi-Dimensional Treatment Foster Care (MDTC), Functional Family Therapy (FFT), Parent-Child Interaction Therapy (PCIT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Family Integrated Transitions (FIT).

d. Care Coordination / Individual Service Plans

Reflecting the individualized needs of each child, adolescent, and family. The Yakima Valley Youth and Family Coalition care coordination efforts will strictly adhere to National Wraparound Initiative (NWI) standards and be guided by the key principles of the Wraparound Care Coordination process. We will be supported in these efforts through training and coaching by Laura Burger Lucas and by technical assistance from Dr. Eric Bruns involving the Wraparound Evaluation and Research Team and NWI standards through the Wraparound Fidelity Assessment System (WFAS).

Care coordination efforts will intentionally and consistently elicit each family member’s ideas, priorities, needs, strengths, and desired outcomes, allowing them to fully explore and express their perspective. These intentional efforts will begin during the engagement and orientation phases of service and continue throughout the entire Wraparound process. Care Coordinators will be mindful of factors that could marginalize or discount family members’ roles in this process and will support the family in working through these concerns when they occur. In particular, coordination efforts will ensure that youth and family members’ perspectives have sufficient impact within the collaborative process and can carry the weight of having the primary influence over decision making. These efforts are especially important in supporting youth in expressing their priorities and perspectives. Coordination efforts will be grounded in the principle that the people who have a long-term, ongoing relationship with a youth should have the greatest influence over the care coordination and service planning process as it unfolds.

Every family is unique in terms of its strengths, culture, needs and goals. The NWI-based Wraparound Care Coordination process is particularly tailored to emphasize these unique features of families and their individual members. Key tasks for the Care Coordinator include thoroughly reviewing each family member’s strengths, including their capabilities, knowledge, skills and insights; gaining their perspective on their needs; respecting and building on their culture, values and beliefs; and exploring their goals and how best to achieve them. In addition, the Care Coordinator will support family members in identifying potential team members drawn from their network of natural supports (such as friends, neighbors, extended family, church members, and others). Emphasizing these natural and enduring family supports adds a level of individualization beyond a more typical array of formal and professional supports. As the Care Coordinator completes these steps, a document will be developed summarizing the family’s needs, vision, cultural attributes, and strengths of each individual family member, as well as the family as a whole. The document will then be reviewed and approved by the family.

With family members’ guidance, the Care Coordinator will contact potential team members from the family’s natural and formal supports, explain the care coordination and service planning process, and encourage their participation as a team member. For those who agree to participate, the Care Coordinator will explore their perspectives on the family’s strengths and needs, as well as learn about the team member’s needs and preferences for meeting. Service planning meetings will be scheduled at a time and place of the family’s choosing, and the meeting itself will be guided by ground rules established by the entire team and that emphasize the importance of promoting family and youth voice and choice. The planning process will be grounded in the family’s strengths (as identified by family members and team members), and a review of the family’s vision will serve as a foundation for setting a team mission – an overarching goal that will guide the team through the planning and implementation phases. A general review of needs will lead to prioritizing a select number of them that will best help the team achieve its mission. These targeted needs will reflect the priorities of the youth and family. Also, as the plan unfolds, it will reflect activities and interventions that draw on the family’s sources of natural support.

Provider Training: The Coalition is committed to common cross-agency training of all provider and targeted cross-agency staff in the Wraparound Care Coordination process. We have identified and established a training agreement with Laura Burger Lucas, supported with additional technical assistance from Dr. Eric Bruns. Ms. Lucas is a parent of a youth with complex multi-system needs and is recognized as an expert in Wraparound Care Coordination, working closely with Dr. Eric Bruns on an implementation in the southern part of the Regional Support Network covering Yakima County. Her training and coaching model has been well researched, and teams that she has trained and coached have received high fidelity scores through the Wraparound Fidelity Assessment System. Training will begin with multiple community sessions for providers and community members to develop a shared understanding. Next, providers will participate in ongoing coaching centered on supervisors, with the trainer working with each supervisor to develop specific practice strategies within the Wraparound Care Coordination model that support the culture of each team and the youth and families they serve.

Individualized Service Plans. A service plan will begin to be developed over the course of one or two meetings with the entire Wraparound team. These meetings will be facilitated by the Care Coordinator. However, the planning process will be grounded in the family’s strengths (as identified by family members and team members), and family members should feel that their voices are being heard, that the chosen needs are ones they have prioritized, and that selected strategies can reasonably help them meet their needs. A review of the family’s vision will serve as a foundation for setting a team mission – an overarching goal that will guide the team through the planning and implementation phases. A general review of needs will lead to prioritizing a select number that will best help the team achieve its mission. The Care Coordinator will guide the team to define what would represent success in meeting each chosen need. The team will discuss how the outcome of goals will be assessed, including identifying specific indicators and a schedule for measuring them. The team will then evaluate the likelihood of effectiveness of each strategy. Also intrinsic in this process is the implication that team members will demonstrate mutual respect for one another, focus more on assets than on deficits, and appreciate the value each person brings to the team. Strategy and resource options will extend beyond formal services; family members’ nominations for natural supports among their interpersonal and community relationships will be prioritized. Action steps – small activities that move strategies forward – will be identified and assigned to specific team members. A particular time frame for completing action steps will be determined. Throughout this phase, the process will focus on the youth and family’s primary role and influence – along with their natural supports and resources – as the key agents for change and most powerful contributor to successful outcomes.

As described previously, addressing safety concerns and potential crises is a key part of developing individualized service plans. The Care Coordinator will review family members’ needs in relation to crises and safety concerns, gather additional input from knowledgeable people (including the referring source), and guide a discussion with all team members on how the team will maintain safety for all family members. Family strengths in the form of supports and resources will play a key role in developing and implementing effective crisis/safety plans, both in terms of prevention and intervention strategies.

Coordination with IDEA. Building on the existing collaborative relationships between the mental health provider network, the Yakima School District and Educational Service District 105 Special Education representatives have participated in our planning process and have committed to serve as core members of our Governance Team. They will also be available to support individual Youth and Family Teams. For each youth, if they have or need an IEP, it will be integrated with the Wraparound Care Coordination Process. Care Coordinators will be trained to participate in the IEP process and advocate for youth and families. Family members will have access to educational training and support to understand and exercise their rights under IDEA (including parts B and H) and have access to educational advocacy services as needed. A Response to Intervention (RTI) framework will guide planning and coordination with IDEA.

Coordination with the Title IV-B Family Preservation and Support Program. DCFS leaders from the Region 2 Children’s Administration office are core members of our proposal planning process and proposed Governance Team, as evidenced by their attached joint MOU and letter of support. That MOU specifically commits DCFS to coordinate and ensure access to the Title IV-B services for eligible youth served, and documents Region 2’s past success integrating such supports in the 3 Rivers Wraparound Program (the program referenced in that letter as the collaborative project in the Tri-Cities). All system of care activities, both at the youth and system level will be closely coordinated with DCFS. In our community DCFS provides a range of services that meet reasonable efforts to prevent children from entering restrictive care settings. Family preservation services are contracted to develop individualized service plans for families in which risk of abuse and neglect has been identified or where families are at risk of disruption due to the developmental, medical, or mental health issues of the children. Currently, DCFS and the RSN coordinate the delivery of services to mutual clients through the co-funding of a care manager, a joint treatment foster care program, and an integrated crisis response system. Strategic planning between the systems also occurs to direct treatment funds to prevent children from entering highly restrictive placements, so there is a solid base on which to build.

Individualized Service Plan Components. The Coalition understands that Individualized Service Plans form a foundation for effective care and must include the following components:

Description of the need for services – During the initial phase of the Wraparound process, the Care Coordinator meets with family members to hear about their experiences and gather their perspectives on what they need. As this phase moves forward, the Care Coordinator meets with identified team members and gains their perspective on the family’s needs and strengths. As needs are identified, efforts are also made to validate, build on, and expand family members’ psychological assets (positive self-regard, hope, self-efficacy, resilience, and others), interpersonal skills, expertise, and knowledge. Needs identification is an ongoing and evolving process, and as progress occurs or challenges emerge, re-evaluation will occur.

Recognition of existing strengths of the child and the child’s family – Recognizing existing strengths of the youth and their family begins with honoring the family’s voice and choice. The act of valuing each child and family’s perspectives, priorities and choices is a fundamental recognition of their strength, commitment and influence over making positive changes for their family. As the Care Coordinator undertakes an exploration of strengths with family members, a thorough and detailed approach can help broaden and deepen an understanding of each family member’s unique assets, skills, and successes. Often inquiring about interests, identifying who has been helpful in the past, or how the family effectively helped themselves can reveal important resources and examples of resiliency and self-efficacy. Obtaining similar input from the family’s natural supports and other team members expands the array of strengths even further. Equally important to this process is creating an atmosphere of mutual respect and appreciation for the value each person brings to the team.

Development of objectives that meet the needs and build upon the existing strengths of the child and the child’s family – As needs are identified and prioritized to a manageable number reflecting the family’s priorities, team members collaborate on identifying objectives that would best reflect success in meeting them. The team also explores ways to define and monitor outcomes for identified goals. Potential strategies are then generated through creative problem solving and guided by identified strengths and resources for the family. The team then evaluates which strategies would be most effective in achieving the family’s goals. Priority is given to the natural supports of the youth and his or her family. Achievable action steps are then developed and assigned, with progress reviewed routinely based on an agreed-upon timetable. In all cases language used will be clear and make sense to youth and family.

Development of customized interventions for the child and the child’s family if the child’s history indicates that the child is at risk for suicide – Crisis and safety planning is a mandatory early component of the individualized service plan. Given the high documented rates of suicide among youth in Yakima County as compared to the rest of the State of Washington, this is a particular concern. Information gathering from the youth and other family members will be customized to determine the immediate level of risk, including whether the youth has a plan for self-harm, the level of lethality of the plan, the level of lethality of past suicide attempts, and whether there are lethal objects available in the household (firearms, dangerous medications, sharp implements, etc.). In addition, key supports – both natural and formal – will be identified and included in the crisis/safety plan. Antecedents will be clarified and roles and responsibilities will be assigned to team members to provide continuous support for the youth. The team can also support the youth to take an active role in his or her mental health care.. However, contingency plans for more intensive levels of care will be explored in order to clarify when these resources need to be used. Routine review of progress and safety will occur on a more frequent basis.

Development of a methodology for meeting these objectives – The Care Coordinator will guide the team in a process to think in a creative and open-ended manner about strategies for meeting needs and achieving outcomes. The Care Coordinator uses techniques for generating multiple options, which are then evaluated by considering the extent to which they are likely to be effective in helping reach the goal, outcome, or indicator associated with the need; the extent to which they are community-based; the extent to which they build on youth and family strengths; and the extent to which they are consistent with family culture and values. The team will establish accountability and will review progress at each meeting, ensuring that there is a process to address concerns or issues that might impede progress.

Provision of non-mental health services – Collaborative relationships and agreements will need to be cultivated with such organizations and services. The Care Coordinator will support the youth and family team in identifying when it is most appropriate to use non-mental health services. These services might range from medical or dental supports through Children’s Village, to substance abuse or chemical dependency treatment through a network provider, to vocational rehabilitation, mentoring, or other informal community services. These services will be given equal weight as more traditional mental health services. Flex funds may be used when the services represent a high enough priority to the team.

Designation of the lead agency responsible for care management/coordination of services – The services plan will be a teaming process made up of staff from across Yakima Valley’s child and family-serving system and natural supports to help each youth and family achieve their needs. The Care Review Team will have lead responsibility for oversight; however we plan to implement a decentralized system where youth and families can access Care Coordination through four agencies and multiple sites across the County. In all cases, the Youth and Family Team will define lead agency responsibility. The lead agency will facilitate each Individualized Care Plan.

Quality Assurance Process. We believe that quality assurance at multiple levels – in terms of fidelity to NWI wraparound principles, maintaining compliance with agency, local, state and federal regulations, and ultimately in terms of making a difference in the lives of youth and families served – is critical to the Coalition’s success. Care Coordinators will be responsible for reviewing with the youth and family team the services being provided at regular intervals. This review will include an assessment, using available data, of progress being made towards goals, including the child and family’s satisfaction with the services. When the team determines that current strategies and services are not working (or no longer working), the steps above will be repeated to identify and access a new set of services. We will be supported in this process by the full application of the Wraparound Fidelity Assessment System under the direction of Dr. Eric Bruns and incorporation of this information through the quality management processes of the local evaluation under the direction of Dr. Peter Selby.

Grievance Processes. Whenever necessary, families will have formal options to discuss or appeal any service decisions directly to the Care Review Team, in addition to the ongoing supports for family voice within the care coordination process. The Care Review Team will determine the most appropriate course of action in partnership with the youth and family. All grievance procedures will be documented and comply fully with county, state, and federal regulations, including fair hearing and Medicaid managed care complaint and grievance provisions under 42 CFR 438. We are committed to ensuring a friendly easy-to-access system that will meet the families concerns with respect and responsiveness, and we will view regular access to and use of the grievance process as a sign of the health of the system.

e. Family Driven Care

Family Partnerships. The Governance Team will include family members as equal partners in all decision-making. Family members have been involved throughout the development of this grant proposal, as evidenced by the letters of support provided by Desiree Lohman and Julie Cruz. In order to nurture and prioritize family partnership, the partnership will fund a full-time Family Coordinator, and one of the first activities of the Governance Team will be to establish a Family Development Team, staffed by the Coalition’s Family Contact, to reach out to, engage, and support family members in taking part in the system of care and moving into leadership positions. Our goal is that the Governance Team be made up of a majority of family and youth members by Year Three. Recent experience in Yakima County with Casey Family Programs’ Kinship Navigator Program demonstrates the impact of supporting and training family members to take a larger role in the service system both as providers and advocates(TriWest Group, 2005).

CMHS-funded Statewide Family Network. The only CMHS-funded network in Washington State is A Common Voice for Pierce County Parents, located in the Western part of the state. This network is part of Statewide Action for Family Empowerment of Washington (SAFE WA), and the Coalition has requested technical assistance and support from SAFE-WA (funds are budgeted to purchase such assistance and a letter of support from SAFE-WA is included). However, given the geographic and cultural differences between communities in Western and Eastern Washington, we are looking to a group in Eastern Washington as our primary source for technical assistance: the family support organization and parent partners of the 3 Rivers Wraparound project. This technical assistance has been previously described.

Financial support for family participation and the family organization. We commit to establish a family support organization in the first year of the grant and support its transition to independent status over the course of the grant period. Each year, our proposed budget contains funds to pay stipends to parents and youth who take part in planning and oversight activities and to support the establishment of this organization. Additional funds are budgeted for youth and family teams to use as needed, including paraprofessional support and childcare for SED youth while parents attend system meetings. The continued availability of these supports will be a key element of our sustainability plan, and all expenditures will comply with the Funding Restrictions for allowable incentives specified in Appendix G of the RFA.

f. Youth Guided Care

“Nothing about us, without us.” The partners of the Governance Team are committed to changing the way the service system works in order to meet the simple, but challenging, standard set forth by the five words of this motto. We believe that youth need and deserve a voice in planning their futures and in planning the care they receive, as well as the systems in which that care is delivered. We took an initial step toward this goal by involving youth in the planning for this application by attending an ongoing meeting of youth in transition and discussing their experiences in the service system and their recommendations for change. We intend to move forward by the immediate establishment of a Youth Development Team as a core function of the Governance Team at the outset of Year One. This Team will provide direct input to the Governance Team and partner in decision-making. The Youth Development Team will also conduct youth support groups, and youth to youth mentoring, as well as community surveys.

The Full-Time Youth Coordinator. While the Coalition intends to conduct a search process for the youth coordinator, we have secured an agreement with an outstanding individual to support the project in this area so that we can begin the process with no delay. Jessica Hodges first became involved in the mental health system at the age of 15 when her family was referred to services. She is now 19 years old and has become a leader in youth development within her community and has presented at a national system of care meeting. Jessica has agreed to support the Yakima Valley Youth and Family Coalition as we begin our effort to change the way we work and support our Youth Development Team.

A Strong Partnership Between Professionals and Youth. Across this proposal we have enumerated multiple ways that youth will be involved in the planning, management, and evaluation of the Coalition’s system of care. In summary, youth will be full partners, involved at every level of the system alongside family representatives and other Coalition partners. We are committed to making the necessary changes to the process to accommodate and sustain youth involvement. As we discussed the observation about youth and long, “boring” meetings among our Coalition partners, everyone agreed that shorter, more focused meetings would be a benefit, not just to youth, but to the system as a whole. The youth at the table through our application development process helped keep our focus on the need to make a real difference in the lives of the youth we serve, and we are confident that their voices will remain strong, be joined by other youth, and help transform our local system of care.

g. Cultural and Linguistic Competence

Compliance with Title VI of the Civil Rights Act. The Yakima Valley Youth and Family Coalition recognizes its obligation under Title VI of the Civil Rights Act and is strongly committed to deliver services and function in full compliance with both the letter and spirit of that mandate. The Yakima Valley Youth and Family Coalition is fundamentally committed to cultural and linguistic competence, and our partners all bring a strong voice to the table in support of this commitment. In particular, the involvement of the Yakama Nation, the diversity of our planned Governance Team, our commitment that at least half of the care coordinators employed will be bilingual and bicultural, and the representation in our provider network of the Yakima Valley Farm Workers Clinic Behavioral Health Services and the Yakama Nation Behavioral Health all represent concrete evidence of the Coalition’s commitment.

Compliance with Cultural and Linguistic Competence Standards. The Coalition will work to provide services that are culturally and linguistically appropriate, and its policies and procedures will strongly reflect our shared belief that cultural or linguistic differences should not pose a barrier to or restrict the full access to services necessary to a family’s well-being, but should instead be a key resource in support of resiliency and health. Washington’s mental health system has made a strong commitment to linguistic accessibility, requiring published materials and supports to be available also in available in Cambodian, Chinese, Korean, Laotian, Russian, Spanish, and Vietnamese, as well as alternative formats for people with visual impairments and people speaking sign language. Our clinical materials and social marketing strategy will reflect the needs of the diverse client and stakeholder population of the Yakima Valley Youth and Family Coalition, and our activities and outputs will be in compliance with Title VI of the Civil Rights Act; DSHS requirements; U.S. DHSS National Standards on Culturally and Linguistically Appropriate Services; and SAMHSA’s Cultural Competence Standards in Managed Mental Health Care Services. Additionally, we will adapt as needed any empirically-supported practices we implement when they are applied cross-culturally, following a multi-level approach (Stewart, 2007) that ensures compliance with the following standards:

Are language and/or culturally-specific variants of the practice available?

Does the practice have external / ecological validity that relates to the specific needs and strengths of the community targeted?

Has the practice been developed with a representative sample?

For a diagnosis-specific practice, does the practice address cultural variants in diagnosis?

Does the practice include orientation, outreach, and engagement strategies that fit with the needs and preferences of the targeted community?

We propose the formation of a Cultural Competence Representative Council made up of individuals from the client and stakeholder population who will participate actively in all phases of program design and service delivery oversight. This group will be integrated into the decision-making process of the project, and will influence the formation and implementation of the Coalition’s structure and functions. This Council will be staffed by the project’s Cultural and Linguistic Competence Coordinator, a full-time commitment that will be created and given the responsibility – and authority – for working with the project’s governance and management structures, stakeholders, service populations, and outside contractors to ensure that culturally and linguistically appropriate practices are followed throughout the local system of care.

Culturally and Linguistically Appropriate Practices in the Individualized Service Plan. The Coalition intends to incorporate culturally and linguistically appropriate practices into the individualized service plans of the families it serves to ensure that the services and strategies offered to improve their lives are designed and implemented within each family’s cultural context. The collaboration model and the Wraparound Care Coordination approach to be implemented will provide a framework for individualized care and acknowledgment of family strengths and experiences within a climate of respect.

During Year One, we will survey the provider network for cultural diversity and language competence. Providers, including non-traditional providers, will be recruited and credentialed in ways that remove barriers to participation. Practitioners that families choose will be added to the provider network, utilizing alternative funding mechanisms when traditional funding requirements otherwise would restrict access. These providers will include traditional healers, with quality standards defined by the cultural groups associated with those healers. For example, for traditional Native American medicine, we will look to the Tribal Government of the Tribe involved for guidance on alternative credentialing approaches, in accord with the priorities articulated in a recent review of Washington’s mental health benefit design with representatives of Tribal Governments, including the Yakama Nation (TriWest Group, 2007b).

Participation in the System of Care. As noted above, the primary mechanism to accomplish this will be the formation of a Cultural Competence Representative Council. This Council is planned to be a permanent component of the system of care to be developed by the Coalition.

Incorporation of Diversity within the Management Plan, Staffing Pattern, Project Organization, and Resources. The Cultural Competence Representative Council will have oversight responsibilities for the implementation of the Cultural and Linguistic Competence Plan, which will include the following steps recommended by Cross (Cross, et al, 1989):

Assess the Environment. Assess the cultural sensitivity of attitudes and existing policies.

Develop Support. Inform, sensitize and clarify values and build a network to support change within the broader community.

Develop Resources. Identify capital and human resources to promote change.

Develop Leadership. Identify system and community leaders to facilitate change.

Mission and Action. Articulate values, mission and goal statements.

Because of Yakima’s large Hispanic population, most of the provider agencies making up the local care system already make efforts to address language needs, and to provide services that are culturally appropriate in nature. This expertise is anchored by the Yakima Valley Farm Workers Clinic Behavioral Health Services. Translation of documents and outreach materials is commonplace, and most of the service agencies provide cultural sensitivity training. All service agencies prioritize bilingual abilities in hiring, and also have diverse boards and advisory committees. Similarly, Yakama Nation Behavioral Health is both experienced and well-versed in the cultural needs of the Tribal community it serves. However, this is simply the foundation of the planned efforts of the Coalition, which seeks to fully incorporate cultural competence into the overall service delivery framework. To that end, the Cultural and Linguistic Competence Plan described above will be integrated as a part of the overall project management plan, facilitated by the Cultural Competence Representative Council, but overseen by the project’s Governance Team. The Plan will incorporate other diversity-related issues such as language, age, gender, and sexual orientation. At all levels of the project, every effort will be made to have representatives of all of the communities served by the project involved in key positions. In-service training will be ongoing with pre and post measures to monitor impact. The Coalition will conduct cultural and linguistic competence self-assessments to guide policies regarding how cultural and linguistic competence will be addressed throughout the proposed project. Cultural and linguistic competence will be woven into every aspect of the proposed system of care from the governance structure (for example, ensuring members are representative of the populations being served) to service delivery (for example, ensuring services provided are in the preferred language of the families being served).

Provider representativeness. We will first assess the cultural and linguistic resources of each provider as part of the Cultural and Linguistic Competence Plan. The Coalition will engage in targeted recruitment for service providers for the project, to include radio, television and newspaper publications that have a large minority following or subscriber rate. Partnerships will be established with additional service providers that represent the minority community and any providers identified by families will be invited to be included in the network, as described above. Current providers are strongly representative of the racial and cultural composition of the community. For example, Yakima Valley Farm Workers’ Board of Trustees is 79% Hispanic and Hispanic employees make up 57% of the agency – similar proportions are found at both Catholic Child and Family Services and Central Washington Comprehensive Mental Health. The Yakama Nation Behavioral Health serves a largely Native American population and incorporates traditional cultural practices along with more commonplace treatment approaches.

Addressing Disparities. The identification of youth of color – particularly Hispanic youth and Yakama Nation youth – as a primary focus of the proposed system of care was a direct outgrowth of our review of current service delivery trends and the identification of these two populations in particular as overrepresented in restrictive child welfare and juvenile justice placements. The Coalition’s broader strategy for addressing disparities related to access to, quality and availability of, and satisfaction with services centers on the Cultural Competence Representative Council – a fully authorized committee of the Governance Team. Staffed by the Cultural Competence Coordinator, this group will participate actively in all phases of the program design and service delivery oversight process. In addition, the Cultural Competence Coordinator (as staff to this Council), will work with the project’s governance and management structures to ensure that any disparities found are addressed.

We recognize that access is not just a matter of making services available, but also relates to the extent to which those services are seen as desirable and appropriate by families. In order to truly address disparities, the Yakima Valley Youth and Family Coalition is undertaking the Partnerships for Success model for community-based service planning so that all facets of our community are involved in planning a service system that balances state of the art EBPs with a holistic continuum of approaches incorporating context, mind, body and spirit.

Service Provision Plans. The NWI-based Wraparound Care Coordination approach provides a strong framework for the development of service plans that reflect the cultural and linguistic context of the youth and family receiving services. While a service plan can call for the provision of culturally and linguistically appropriate services, care must also be taken to ensure that such services are available to be provided. In order to support this process, service requests will include questions about language preference, and if a non-English language or minority clinical staff person is requested, the request will be honored as fully as possible. In addition, case consultation will be sought in all instances when assigned care coordination or treatment staff do not possess the specific competencies required to serve a youth or family. Finally, the Cultural Competence Coordinator (or Coordinators – see below) will have the responsibility and authority to ensure that culturally and linguistically appropriate services are prioritized and monitored during planning and implementation of our system of care.

Cultural Competence Coordinator. The Yakima Valley Youth and Family Coalition will dedicate 1.0 FTE to the position of Cultural Competence Coordinator to lead the project’s Cultural Competence Representative Council and be a part of the Governance Team. We have gone beyond the 0.5 FTE requirement because we recognize the centrality of culture in our lives and are committed to developing a system of care that provides not only access to services, but access to services that are desirable and appropriate for the youth and families we serve. As the Yakima Valley encompasses a unique mix of peoples – including immigrant and U.S.-born Hispanics, as well as the Yakama Nation and many other smaller racial and ethnic groups – we are open to the possibility of hiring not one, but two individuals to work together to fulfill the functions of the Cultural Competence Coordinator. As demonstrated in our budget, we are seeking individuals with a high level of skill and clinical experience who can truly lead our process of enhancing the cultural competence of our service system.

Strategies and infrastructure: A Cultural Competence Representative Council will be made up of individuals from the client and stakeholder population who will participate actively in all phases of program design and service delivery oversight. This group will be integrated into the decision-making process of our overarching Governance Team. The composition, staffing, roles, and responsibilities of this Council have been described in detail throughout this section.

To ensure that culturally and linguistically appropriate practices are prioritized and adhered to throughout our system of care, one planned strategy will be the development of a Cultural and Linguistic Competence Plan.

3. Sustainability and Linkages with Statewide Transformation Efforts and Other Relevant Federally-Funded Programs

a. Linking Coalition Goals / Objectives with Transformation and Statewide Reform Efforts

Multiple linkages with statewide transformation and reform efforts have been enumerated throughout this proposal. Given page limitations, rather than reiterate that detail here, we will focus here on the following linkages with key State Personnel and other State leaders:

Washington’s federal Mental Health Transformation State Infrastructure Grant (SM57468). The primary linkage for this coordination is Ken Stark, Director, signatory to the Memorandum of Understanding (see Appendix 1) executed between Yakima County and the Mental Health Transformation Project. The Coalition has multiple linkages to the Transformation Project through RSN, provider, and child-serving agency leader involvement.

Second Substitute House Bill (2SHB)-1088 for Children’s Mental Health Services. Implementation of 2SHB-1088 has been charged to the State’s Mental Health Division (MHD), and the primary contact is Robin McIlvaine, Senior Program Administrator and Supervisor for Children’s Mental Health. Robin coordinated all interaction with DSHS agencies in the development of this grant application and will continue to be the primary point of contact for ongoing coordination. In addition, the University of Washington Evidence Based Practice Institute under the direction of Eric Trupin, PhD, and the Wraparound Evaluation and Research Team (WERT) within the EBP Institute under the direction of Eric Bruns, PhD, are key actors in the implementation of the mandates of 2SHB-1088. Both Dr. Trupin and Dr. Bruns have provided letters of support for this project and both have committed to be personally involved in that support (see Appendix 1).

Coordination Across the Department of Social and Health Services (DSHS) Initiatives. The letter of support provided by DSHS Secretary Robin Arnold-Williams underscores the alignment of our Coalition with current DSHS initiatives and pledges the support of her administration and division leaders in support of the grant activities. Those leaders include: Doug Porter, Assistant Secretary for the Health and Recovery Services Administration (HRSA), John Clayton, Assistant Secretary for the Juvenile Rehabilitation Administration (JRA), and Cheryl Stephani, Assistant Secretary for the Children’s Administration. Within HRSA, two additional directors will also lend critical support, including: Richard Kellogg, Director, Mental Health Division (MHD) and Doug Allen, Director Division of Alcohol and Substance Abuse (DASA). The primary linkages within the Coalition for coordinating with these state leaders (all of whom have provided letters of commitment, MOUs, and/or contracts) include Bill Wilson, Director, Greater Columbia Behavioral Health RSN (linkages to HRSA and MHD), Ken Nichols, Regional Administrator, DCFS Region 2 (linkages to Children’s Administration); Don Jones, Regional Administrator, JRA Region 2 (linkages to JRA); and Rick Weaver, CEO, Central Washington Comprehensive Mental Health (linkages to DASA as a provider)..

b. Strategies for Ensuring Project Sustainability after the Sixth Year: It is our intent that the Yakima Valley Youth and Family Coalition will endure as an autonomous entity after the end of the six year grant period, preferably as an independent, non-profit entity. While the exact legal structure of the Coalition is subject to decision-making by stakeholders during the planning year of the grant and ongoing as new challenges and opportunities emerge, our focus is on building an enduring infrastructure to support the Coalition’s mission. We have been careful to budget the available SAMHSA grant funds for capacity building and not to rely on them for long-term operating costs. In addition, we have studied the CMHS report on sustaining systems of care beyond the federal investment (Koyanagi, 2000) and the 2004 Matching for Sustainability report and built our proposal with those lessons in mind.

Funding for the administrative positions of the grant will be picked up by the Coalition partners through savings, primarily to state-funded programs. Regarding expanded services, we are very optimistic about the possibility of expanded state and Medicaid funding for children’s mental health services given the mandates of 2SHB-1088 and the opportunities within Washington’s Medicaid State Plan and 1915(b) Waiver. A 2007 review of Washington’s Medicaid State Plan (TriWest Group, 2007) found the plan to support the delivery of Wraparound Care Coordination and the all of the empirically-supported practices noted within this proposal (MST, FFT, DBT, PCIT, TF-CBT, and MTFC). In the case of Wraparound Care Coordination and MTFC, only the treatment components covered by the Medicaid State Plan can be covered, but Washington’s Medicaid benefit has been extended to cover treatment within foster care settings with adequate protections to prevent payment for child welfare activities supported by other federal funding streams (such as Title IV-E funds). Given that the authors of that 2007 review, TriWest Group, have committed to serve as local evaluators for the Coalition, we look forward to making use of their expertise to maximize funding through existing funding streams. Expanded state funding contemplated under 2SHB-1088 and coordinated strategies for supporting empirically-supported practices under the Medicaid State Plan are currently anticipated for the 2009-2011 funding biennium, taking effect in July 2009. This creates a unique opportunity to build sustainability for services into Yakima County’s new system of care from the middle of the first year ongoing.

c. Coordination with Other Federally Funded Initiatives: In addition to the SAMHSA-funded Mental Health Transformation Project (MHTSIG), Washington has several other federal initiatives previously noted in this proposal with which the Coalition will coordinate development efforts, particularly regarding sustainability and reform of state-level policies and regulations. Within the comprehensive framework of the Mental Health Transformation Project and 2SHB-1088, Washington has aligned all of its federal, state, and local initiatives through its Community Mental Health Services Block Grant Plan and Washington’s Mental Health Plan for Children and Adolescents with Serious Emotional Disturbances, and Governor Gregoire has committed to update both of these plans if our Coalition is funded. .

Section C: Project Management and Staffing Plan

a. Capability and experience of the applicant organization: Yakima County and the Yakima County Department of Community Services has a strong track record of successful community partnerships in implementing similar projects with similar populations. There is a 14 year history of coordinated service provision between the county mental health system and the Yakama Nation. Yakima County manages a Public Services grant with the Northwest Community Action Council (NCAC) and has been awarded annually to the county for 7 years consecutively. Yakima County also manages a program with the Yakima Neighborhood Health Services, YWCA Domestic Violence Shelter and the Triumph Treatment Services (Substance Abuse) agencies to provide wraparound services and employment preparedness services to homeless families in Yakima County over the next 10 years. Yakima County also managed a SAMHSA grant for the implementation of the Nurse Family Partnership (NFP) in collaboration with the partnering agencies of Children’s Village (Memorial Hospital, Farm Workers Clinic, and Central Washington Comprehensive Mental Health). This grant ran three years ending in 2007 and there has been a secondary grant award to expand services throughout the County. This grant required bilingual home visiting nurses and an Infant Mental Health Specialist to facilitate client/family service identification and serve as an advisor to the nursing staff in consultation with families. Partner agencies have a strong track record of implementing selected EBPs, collaborating across systems to successfully carry out grant initiatives and representing the populations targeted by the Coalition through diverse staff, Board membership and collaboration with community organizations. Our local evaluator has a strong track record of conducting system of care evaluation (see Section D).

b. Staff positions for the project:

Project Director: A full time County Department of Community Services position responsible for overseeing the development implementation and sustaining of our system of care. We will seek an individual who is experienced with children’s mental health and related service systems and with demonstrated ability to support collaboration and most likely a Master’s level clinical qualification and state certification.

Family Contact: A full time County Department of Community Services position to be filled by a parent or other family member of a child or adolescent with a serious mental health need, who has received or currently is receiving services from the mental health service system. This individual will, among other things, support the function of the Family Development Team and ensure support services for families receiving services through the cooperative agreement. This position will have full inclusion on the Governance Team.

Youth Coordinator: A full time County Department of Community Services position to be filled by a young adult. She will be responsible for developing activities to represent the voice of youth and will support the functions of the Youth Development Team. As a bridge to filling this position and function, we have secured a commitment from Jessica Hodges, a 19 year old alumni of mental health services who is a youth coordinator for nearby 3 Rivers Wraparound, to help our Coalition engage youth, begin the Youth Development Team and hire a Youth Coordinator.

Family Partners: Family Partners will assist families and youth navigating the mental health and related service systems, engaging in advocacy and developing natural supports.

Key Evaluation Staff: The Coalition has engaged TriWest Group to conduct the evaluation. Led by Dr. Peter Selby, their organization brings a strong track record of successful implementation of the CMHI system of care evaluation in a CMHI community now in its sixth year.

Social Marketing-Communications Manager: A half time County Department of Community Services position with a strong track record of developing comprehensive social marketing and communications strategies.

Technical Assistance Coordinator: A half time County Department of Community Services position who can demonstrate experience in working with diverse organizations and stakeholders to identify needs and coordinate training and related events.

State-Local Liaison: This role will most likely be filled by the Project Director who will have full understanding of our Coalition and familiar with state and local mental health systems.

Key staff experience with the population of focus: Key staff for the Coalition will be selected with an absolute requirement of demonstrated experience serving the populations emphasized in this proposal. Key staff will be bilingual in Spanish and English and ideally also bicultural. TriWest Group evaluation staff are includes a recognized expert in cultural competence (Jesús Sanchez, PhD) and a member with extensive direct experience with Spanish-speaking populations (Socorro Martinez-Parham, M.Ed).

Resources for the proposed project: The Yakima County Department of Community Services will be the fiscal and administrative sponsor for the Coalition. The Department is the human services arm of County government and provides program and services in the areas of mental health, substance abuse, domestic violence, housing and homeless services, community development, employment and training, aging and long-term care and court and police based alternatives to incarceration program support treatment. This department is staffed with a Director and Grants Accounting Supervisor, 4 Grant Accountants, 4 Financial Specialist and a financial technician.

Partner provider agencies, responsible for care coordination and provision of direct services have facilities in full compliance with the American with Disabilities Act and all necessary facilities to meet basic services requirement and support the goals of the Coalition. The evaluation team has secure physical office locations, as well as the necessary office and computer equipment and staff support to successfully carry out the proposed evaluation activities. The evaluation team is experienced in working with various agency and provider databases, and it is skilled in the use of current analysis tools.

Section D: Evaluation Plan

1. Implementation of the National Evaluation: Commitment and Capacity: The Yakima Valley Youth and Family Coalition agrees to comply with all of the terms and conditions of the National Evaluation of the Comprehensive Community Mental Health Services Program for Children and Their Families. To carry out that commitment, we have engaged a national evaluation and consultation firm with a proven track record implementing evaluations of SAMHSA grants that make a real difference in the communities they serve: TriWest Group, of Boulder, Colorado. TriWest’s prior work as evaluator for the CMHI grantee in El Paso, Texas (Border Children’s Mental Health Collaborative) has been described as “exemplary” by Brigitte Manteuffel, Ph.D., Vice President & Principal Investigator for the national evaluation through Macro International and as “outstanding” by Michele Herman, Project Officer, Child, Adolescent and Family Branch, SAMHSA (2005 letters submitted to El Paso County Commissioners Court). Under the lead of Peter Selby, PhD, TriWest Group will conduct the local evaluation as a core member of the collaborative oversight process. TriWest will implement the data-gathering and reporting infrastructure necessary to achieve the goals of the local and National Evaluation components in a manner that incorporates contributions of youth and families, and will do so within the context of culturally competent evaluation practices. The specific evaluation activities and procedures TriWest will employ are described below. Additional detail is provided in Section H: Confidentiality and SAMHSA Participant Protection / Human Subjects.

2. Using National Evaluation Data to Improve the System of Care

Improving the service system. Data from the National Evaluation will be used to provide timely feedback and actionable recommendations to the Governance and Administrative Teams. National Evaluation data (such as that from the System of Care Study and the Services and Costs Study) will be used to perform gap analyses to identify needs in the service system. Results will be integrated into regular updates and annual reports to help the partners understand the effects of their efforts, to build on successful strategies, to target areas for improvement, and to improve decision support capacity over the life of the grant and beyond. We will also incorporate this data into the Partnership for Success (PfS) process to be led by Dr. Eric Bruns, of the Wraparound Evaluation and Research Team (WERT) within the EBP Institute at the University of Washington. The role of the evaluation within the PfS process will vary by the project phase:

Planning Phase (9 months). During the planning phase, TriWest will work with Dr. Bruns and the Coalition to define broad targets for change in Yakima Valley (targeted impacts) and factors (risk, protection, and assets) that are most closely associated with the selected targeted impacts. Data from the System of Care Study will be used (supplemented by additional targeted data collection) to help create a realistic profile of current programs, services, and activities in the Yakima Valley related to the targeted impacts identified in the needs assessment. Based on this comprehensive analysis, the Governance Team will produce a strategic plan that indicates how best to address the targets for change within the community. The Coalition will then work with Dr. Bruns, Dr. Selby, and the local evaluation to develop a community prevention/ intervention plan, document program logic, define anticipated outcomes, and be prepared to begin implementation.

Implementation and Evaluation Phase (2 years). Beginning late in Year One and continuing into Year Three, an implementation phase will begin with the definition of program outcomes, most of which will be derived from the National Evaluation data. Evidence-based prevention and intervention efforts will be implemented and responsive to ongoing community needs assessments and fidelity and quality assessment, which will be implemented through the local evaluation, leveraging the data collection of the National Evaluation. Social marketing strategies will also be incorporated, and an initial report on outcome achievement pulling together all of these sources will be produced by the end of the Implementation year. The local evaluation will also monitor training and implementation of selected EBPs will take in a coordinated fashion across this period place.

Sustainability Phase (ongoing). Throughout the six years, evaluation data will be used to track progress and outcomes, as well as to update annual strategic plans based on current needs assessment and outcome evaluation findings. Implementation efforts will continue, supported by both National Evaluation and local evaluation data.

Increasing the quality of service delivery. Coalition partners and TriWest plan to introduce mechanisms to continually improve the quality of service delivery processes and outputs. As described previously, the Coalition will implement a quality assurance and improvement process to monitor and promote integration across the system, services delivery, and funding allocations supported by TriWest. This system will be organized around the Wraparound Fidelity Assessment System (WFAS) to be implemented through the local evaluation infrastructure provided by TriWest, with technical support and guidance by Dr. Eric Bruns of the Wraparound Evaluation and Research Team and National Wraparound Initiative (see letter of commitment from Dr. Bruns in Appendix 1). Data from National Evaluation clinical instruments will be integrated into the eligibility determination and service planning processes, and local evaluation activities will develop a comprehensive service fidelity monitoring and feedback system to improve service planning and delivery at the specific program level. Findings from the National Evaluation will also be integrated into the quality improvement process, for example, by using findings from the System of Care Study to help assess adherence to system of care principles.

Developing systems of care policies in the local community. Members of the Coalition have a strong history of making use of evaluation findings to inform policy decisions, and evaluation efforts will support our goal of a viable system of care. Findings from the National Evaluation (e.g., System of Care Study), coupled with local evaluation findings (e.g., WFAS results), will help refine policies for new service development, provider network management, interagency collaboration, and other issues in a manner consistent with System of Care principles.

Sustaining the system of care beyond the 6-year period of Federal funding. The evaluation will provide accessible information to share with decision-makers for key payers (Medicaid, youth corrections, child welfare, the state legislature), as well as for broader social marketing efforts. TriWest will implement cost analyses to assess the cost effectiveness of new services provided against current costs and service provision, and other comparisons with model programs making use of National Evaluation data will help enhance the credibility of collaborative accomplishments. It is expected that evaluation findings in this area will be useful in engaging current and new payers in the long-term support and sustainability of the Yakima Valley Youth and Family Coalition. As described in earlier sections, TriWest is uniquely positioned to help based on its work in 2007 with the State of Washington’s Mental Health Division (part of HRSA, within DSHS) (TriWest, 2007a) to complete an analysis of its State Medicaid Plan, 1915(b) Waiver, and overall mental health benefits to prioritize strategies for enhancing funding for empirically-supported practices. During that review, TriWest worked closely with the actuarial firm contracted by DSHS for its Medicaid waiver and has developed initial cost models to help develop rates to support these EBPs. National Evaluation and local evaluation data will help refine these estimates to support DSHS as it works to secure funding for Wraparound Care Coordination and treatment-based EBPs during the 2009-20011 biennium.

3. Ability to Collect and Report on Required Performance Measures. TriWest Group has the necessary abilities and experience to report performance on the required measures, and has done so successfully on our current system of care project in El Paso, Texas, which is starting its sixth grant year. The evaluation team proposed for the evaluation of the Yakima Valley Youth and Family Coalition under the lead of Dr. Selby includes clinical and research experience and qualifications to fully complete all aspects of the evaluation, and its key members (Dr. Jesús Sanchez, and Ms. Socorro Martinez-Parham) have participated in extensive training on the complex National Evaluation protocols currently being employed to assess System of Care communities. The evaluation will also recruit, train and support independent, culturally competent, bilingual youth and family evaluation team members. In regard to the use of the CMHS NOMs Consumer Outcome Measures for Discretionary Programs, TriWest will ensure that the Coalition complies with data collection and reporting requirements, as well as data collection and reporting requirements of the National Evaluation. Because NOMs baseline interviews are to be conducted within seven days of service enrollment, compared to within 30 days of enrollment for National Evaluation baseline interviews, NOMs forms will be completed via face-to-face data collection at enrollment and at the required follow-up data collection points (including at discharge), by the clinician working with each service recipient. TriWest will track data collection deadlines, as well as enter data from these forms into the TRAC Web system within seven days of data collection for the NOMs forms and within the guidelines of the National Evaluation for its data collection forms.

Data will be regularly and securely transported to the TriWest office and keyed into electronic form by trained and supervised evaluation support staff. Over the course of the grant period, electronic data collection and transmission will also be implemented, in a HIPAA-compliant manner, to include web-based surveys for local and National Evaluation protocols as appropriate. Data will be maintained in password-protected electronic databases that will be kept on removable media that will be backed up and stored under lock and key. All data collection, entry, storage, analysis, and retention policies will be reviewed and approved by the Institutional Review Board (IRB) prior to implementation.

TriWest is also experienced in working with agency and provider databases, and will make use of services and costs data provided by Coalition partners. TriWest will ensure the accuracy of the extracted data, understand discrepancies, determine limitations that exist, clean and recode the data, and ensure that files are managed and secured appropriately. Evaluation team members are skilled in the use of current database and analysis tools, including Microsoft Access©, SPSS© and Crystal Reports. Summary analyses and recommendations will be distilled through a rigorous internal peer review process involving multiple members of the evaluation team and Coalition partners. We will submit required data and reports to TRAC and the National Evaluation through timely data entry and secure electronic data transfers, with a regular feedback loop to the Coalition’s Governance Team and key managers to share emerging findings and help administrators, clinicians, and other stakeholders use evaluation findings for project management, social marketing, and other decision-making.

4. Managing the Project and Assuring Continuous Quality Improvement: TriWest’s direct participation in the Governance and Administrative Teams for the Coalition will ensure a direct link to management and quality improvement structures. As described above, TriWest will integrate cross-site and local evaluation findings into the quality improvement process nested within the PfS process led by Dr. Bruns. In addition, TriWest will establish linkages at the provider level to share findings from the WFAS to support Care Coordinators through the supervisory process. National Evaluation findings will also be a part of the feedback system aimed at improving the quality of service planning and delivery at the program level.

5. Conducting the Performance Assessment as Specified in Section I-2.6: The local evaluation for the Yakima Valley Youth and Family Coalition will seek to improve the process and outcomes of service delivery by the Coalition at multiple levels. In order to reduce the burden of the evaluation on service recipients and stakeholders, the project will make use of NOMs and National Evaluation data for these activities whenever possible. The local evaluation will address process questions related to the extent to which project implementation matched the implementation plan; deviations from the implementation plan, their causes, and their effects; and services and costs provided by the project. During the project planning period, formative evaluation activities will feature infrastructure development to support the National Evaluation, as well as participant observation, stakeholder focus groups, implementation monitoring, and targeted surveys to support needs assessment, planning, and service delivery infrastructure development. All of this will be integrated with the PfS efforts in collaboration with Dr. Bruns.

A major component of the local evaluation will focus on fidelity tracking for Wraparound Care Coordination across the system of care, using the WFAS, as specified by the National Wraparound Initiative (copies of the Wraparound Fidelity Index are included in Appendix 3). Because a clear link has been established between fidelity, intervention quality and ultimate system and client-level outcomes (Henggeler et al, 1999), local evaluation efforts focusing on fidelity in the context of initiative wraparound teams will both enrich understanding of the relationship between wraparound fidelity and indicators tracked by the National Evaluation. The evaluation will use the WFAS as a springboard to develop a comprehensive process fidelity monitoring system for all evidence-based practices targeted under this grant, working closely with Dr. Bruns through the PfS process.

Outcome aspects of the local evaluation will also address questions related to the effects of evidence-based interventions on participants; program, contextual and individual factors associated with outcomes; and durability of effects. The fidelity tracking approach described earlier, coupled with Coalition partner service data and outcome data collected as part of the National Evaluation protocol, will contribute to a more complete understanding of these questions. Because the longitudinal component of the National Evaluation protocol is comprehensive, the local evaluation will be able to make maximum use of data collected as part of this longitudinal effort to answer important outcome questions while at the same time limiting the evaluation burden on the Coalition, as well as the youth and families it serves.

Section E: Literature Citations.

Cross, Terry L., Bazron, Barbara J., Dennis, Karl W., and Isaacs, Mareasa. (1989). Towards a Culturally Competent System of Care, Volume 1. Washington, D.C.; National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center.

Duchnowski, A. J., Hall, K. W., Kutash, K., & Friedman, R. M. (1998). The alternatives to residential treatment studies. In M. H. Epstein, K. Kutash, & A. J. Duchnowski (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families (pp. 55–80). Austin, TX: Pro-Ed.

Friedman, R. (1990). In Summary of Proceedings: Child and Adolescent Service System Program Technical Assistance Research Meeting CASSP Technical Assistance Center, Georgetown University Child Development Center.

Henggeler, S.W., Pickrel, S.G., & Brondino, M.J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research. 1, 171-184.

Hodges, S., Ferreira, K., Israel, N., & Mazza, J. (2007). System implementation issue brief #1 – Lessons from successful systems: System of care definition. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health.

Knitzer, J. (1982). Unclaimed children: The failure of public responsibility to children and adolescents in need of mental health services. Washington DC: Children’s Defense Fund.

Knitzer, J. (1993). Children’s mental health policy: Challenging the future. Journal of Emotional and Behavioral Disorders. 1(1), 8-16.

Koyanagi, C., & Feres-Merchant, D. (2000) For the Long Haul: Maintaining Systems of Care Beyond the Federal Investment. Systems of Care, Promising Practices in Children’s Mental Health 2000 Series, Volume III. Washington D.C.: Center for Effective Collaboration and Practice, American Institutes for Research.

Kutash, K & Rivera, V.R. (1996). What works in Children’s Mental Health Services: Uncovering Answers to Critical Questions. Baltimore, MD: Paul H. Brooks Publishing.

National Institute of Mental Health. (1990). Summary of Proceedings: Child and Adolescent Service System Program Technical Assistance Research Meeting. CASSP Technical Assistance Center, Georgetown University Child Development Center.

Stewart, D. (February 8, 2007). Adapting evidence based practices to culture and community. Presented at the 2nd Annual Advancing Colorado’s Mental Health Care Conference, Denver, CO.

Stroul, B.A. & Friedman, R.M. (1986) A system of care for children and youth with sever emotional disturbances (rev. ed.). Washington DC. Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

Stroul, B., & Friedman, R. M. (1994). A system of care for children and youth with severe emotional disturbances (Rev. ed.). Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.

TriWest Group. (December 2005). Casey Family Programs Kinship Caregiver Navigator Pilot: Final Pilot Evaluation Report. Seattle, WA: Casey Family Programs.

TriWest Group. (July, 2007). Statewide Transformation Initiative Mental Health Benefit Package Design – Final Report. Olympia, WA: State of Washington, Department of Social and Human Services, Health and Recovery Services Administration, Mental Health Division.

TriWest Group. (July, 2007a). Statewide Transformation Initiative Mental Health Benefit Package Design – Final Report. Olympia, WA: State of Washington, Department of Social and Human Services, Health and Recovery Services Administration, Mental Health Division.

TriWest Group. (July, 2007b). Statewide Transformation Initiative Mental Health Benefit Package Design – Final Report – Analysis and Recommendations for Tribal Governments and their Members. Olympia, WA: State of Washington, Department of Social and Human Services, Health and Recovery Services Administration, Mental Health Division. Downloaded on January 27, 2008, at http://www1.dshs.wa.gov/pdf/hrsa/mh/preliminary_mental_health_benefit_package_design_report__draft__7_6_07.pdf.

US Census Bureau. (2006). ACS Demographic and Housing Estimates: 2006. Data Set: 2006 American Community Survey, Geographic Area: Yakima County, Washington. Downloaded on January 23, 2008 at

http://factfinder.census.gov/servlet/ADPTable?_bm=y&-qr_name=ACS_2006_EST_G00_DP5&-geo_id=05000US53077&-ds_name=&-_lang=en.

Washington State DSHS, 2003, The Prevalence of Serious Mental Illness in Washington State. Report to the Legislature. http://www1.dshs.wa.gov/word/hrsa/mh/2003Prevalence.doc.

Worthington, J., Hernandez, M., Friedman B., & Uzzell, D. (2001). Systems of Care: Promising Practices in Children’s Mental Health, 2001 Series, Volume I1. Washington, D.C.: Center for Effective Collaboration and Practice, American Institutes for Research.

Yakima County Department of Community Services. (2007). Yakima County Disparity Report.

Budget Justification

Section F

Yakima Valley Family and Youth Coalition Project

Six Year Detailed Cost Plan

Budget Conversion Worksheet to SF 424

Cost Element Narratives:

PERSONNEL:

Staffing costs for required key positions were identified into two subcategories: Administrative Team and Project Required Staff.

Administrative Team:

Principal Investigator

Director of Community Services

Assistant Director of Community Services

As the applicant and fiscal agent, Yakima County shall:

1. Be responsible for developing and implementing a system of care under the Child Mental Health Initiative (CMHI) as outlined in the application proposal and aligned with federal and state transformation priorities;

2. Comply with the terms and conditions of the Notice of Grant Award (NOGA);

3. Agree to provide SAMHSA with the data required for Government Performance and Results Act (GPRA);

4. Create an overall Logic Model for system of care services (to be developed by local evaluator);

5. Develop a strategic plan that is reviewed and revised based on program needs;

6. Develop a technical assistance plan for the system of care and establish an interagency team to assist with the assessment, planning, and implementation of training and technical assistance activities;

7. Develop a culturally and linguistically competent social marketing strategic plan that addresses the national Caring for Every Childs’s Mental Health Campaign goals;

8. Develop a Cultural and Linguistic Competence Plan (CLCP) and implement a culturally and linguistically competent system of care;

9. Participate in all data collection and performance measurements requirements;

10. Contract with project participants and monitor outcomes;

11. Participate in required SAMHSA grantee meetings; and

12. Act as fiscal agent to the project and ensure sound accountability.

13. Serves as the bridge between State and the awardee community in efforts to create a single system of care that will be sustained through collaborative and integrated funding investments from State and/or community based and family serving public agencies.

14. Establish interagency involvement in the initiatives structure and process by developing and/or changing interagency agreements and other public policies relevant to the creation of the system of care.

The Principal Investigator and his designates (the Senior Director and Assistant Director of the Department of Community Services) will be responsible for the accountability of these tasks, commitments and actions along with the fiscal and reporting requirements of the grant award.

Based on these outlined functions, the percentages of FTEs per position as outlined in the Six Year Detailed Cost Plan are based on the experience of the Department to operate, staff and support similarly large projects and multi-agency community boards. Primary day-to-day responsibility will fall on the Assistant Director of the Department of Community Services who will supervise the fiscal Grants Management Department’s accounting, billing and reporting as well as the direct oversight of the Project Director to be hired.

Existing Salaries are as follows:

Principal Investigator (County Commissioner) $79,000

Sr. Director – Department of Community Services $94,000

Assistant Director – Department of Community Services $81,780

It is anticipated that in the year of initial award the County will need to establish and fill Governance Team position and hire key required staff positions including advertising, screening, interviewing and performing staffing orientations.

It is also expected that in the initial year the Assistant Director will accompany the project team to the two required grantee meetings to meet with the grantor and facilitate the team.

Later years there is an expectation that the empowerment of the Project Director and the team members will decrease the amount of necessary oversight and so the amount of FTE percentages reflect those factors.

Project Required Staff:

Project Director – Job Description and Salary outlined in Section G. Estimated time to hire 2 months based on an aggressive advertising campaign and input from the newly formed project Governance Team. Salary range based on Yakima County personnel system that is reviewed annually and updated every two years for competitive compensation criteria. D62 – Project Director is eligible for a 5% salary adjustment within the 2nd year of employment once probationary period is satisfactorily completed.

Family Lead Contact – Job description and salary range outlined in Section G. Salary range is determined based on level of community representation and interactions with families. It is expected that this position will be hired with in the first quarter of the first year and be a full time position.

Youth Coordinator – Job description and salary range outlined in Section G. Salary range is determined based on level of community representation and interactions with youth served. It is expected that this position will be hired with in the first quarter of the first year and be a full time position.

Cultural and Linguistic Competence Coordinator – Job description and salary range outlined in Section G. Salary range is determined based on level of community representation, clinical knowledge and experience creating multiracial and multiethnic dynamic cultural and environment and system of care. It is expected that this position will be hired with in the first quarter of the first year and be a full time position with strong input from the clinical/technical staffing of the providers and the committees.

Technical Assistance Coordination - Job description and salary range outlined in Section G. It is anticipated that this position will be hired as a permanent half-time position with benefits and coming onboard within the last quarter of the first year. Input from the TA coordinator provided and the Consultant for EBPs will be used along with Governance Team. Project Director and County to ensure appropriate experience level.

Communications Manager - Job description and salary range outlined in Section G. It is anticipated that this position will be hired as a permanent half-time position with benefits and coming onboard within the last quarter of the first year. This positions salary determination included the level of national, state, regional and local coordination of project public education and communications strategies required.

BENEFITS:

Yakima County has a negotiated benefits package with several unions and extends its rate to all non-union employees and departments. Yakima County Department of Community Services is a non-bargaining department. The 2008 negotiated benefits rate is 32.25% of salary and wage. The benefits include:

Medical 12.46%

Paid Leave 9.91%

FICA 5.18%

Retirement Cont. 3.67%

L&I .81%

Unemployment Ins. .22%

TRAVEL:

Travel is included only for the required attendance at the two annual grantee meeting that are outlined in the RFA. Travel is estimated for the project team ten key staff and representatives listed in Section 2.7 of the RFA. The local evaluator (TriWest Group) will also attend, but these costs are included in the contract with TriWest and are therefore not included here. In year one of the grant award there are two additional staff attending the meetings; the Director and Assistant Director of Community Services. The estimate of the grantee meeting expenses is based on 2 nights of hotel, airfare and meals for out of state travel. Year 1 amounts are estimated at $1,700 per person per trip. Yakima County has adopted the Federal Travel Regulations per diem amounts but requires actual receipts for all expenses. Out years estimates very slightly with year 5 and 6 higher at $1,920 per person for anticipated fuel costs increasing airfare or gas reimbursements.

SUPPLIES:

The new developed staff team for this project will need to establish and lease facilities for office space. This includes purchasing office furnishings and machines, networking the staff to the Counties computer network and installing desk computers, printers and office supplies. Also, staff will need to be accessible to the County, providers staff, each other and so cell phones and PDA devices will be necessary. Seven staff positions were used to estimate the costs as follows:

YEAR 1

Computers, printers and PDA’s = $1,800 per person

Office Supplies - $543 per person

Office Furnishings - $2,088 per person

Cell Phones monthly fees - $83 per person

OUT YEARS 2 – 6

Office Supplies – average $285 to $428 per person PER YEAR

It is anticipated that the supplies will be more in the start up year and that some replacement costs of computer, cell phone or PDA supplies may occur in the later 6th year.

CONTRACTUAL COSTS:

Yakima County will contract with TRIWEST GROUP for the local evaluation, data collection and strategic planning assistance. TriWest will make available two doctoral level research staff (Selby, Sanchez), as well as two masters level clinical staff for local data collection (Martinez-Parham, and one staff member to be recruited). TriWest will bill consultant time on an hourly basis using an all-inclusive hourly rate of $160 (inclusive of travel costs, including required travel to national meetings) in Year 1, increasing by 3.5% annually. The following total hours billed and overall costs are projected by grant year:

Year One – 1,250 hours at $160 per hour - $200,000

Year Two – 1,812 hours at $166 per hour - $300,000

Year Three – 2,334 hours at $171 per hour - $400,000

Year Four – 2,255 hours at $177 per hour - $400,000

Year Five – 1,634 hours at $184 per hour - $300,000

Year Six – 1,052 hours at $190 per hour - $200,000

Budgeted under the Service Analysis and Inventory line, Yakima County will also contract with the University of Washington Wraparound Evaluation and Research Team for the Partnership for Success community planning process at a cost $75,000 a year in Years 1-3, dropping down to $47,000 in Year 4, $12,800 in Year 5, and $25,000 in Year 6 as activities diminish in later years.

Budgeted in part under the Governance Team Development line, Yakima County will also contract with SAFE WA for technical assistance related to the development of a local family support organization and youth support organization at a cost of $5,000 annually.

Yakima County will contract with the four service provider agencies identified in the project narrative for system of care expansion to include Care Coordinators (at least half bilingual, who will receive a bilingual pay differential of $2400 annually in Year 1) and Family Partners serving as client and family advocates. See Section G for job descriptions and salary ranges.

It is anticipated that hiring for the services positions will be done jointly by the Coalition during the last quarter of the first year of the grant to allow for trainings and orientations to occur in year 1. A joint announcement for multiple positions hosted by 4 agencies has not been done before but is a commitment of the Coalition to offer consistent salaries for the project.

Also, Family Partners who are formerly clients of services or family members of clients in services often have barriers to employment full time, with consistent hours and traditional schedules due to many variable in their lives and each persons given capacities. Mentoring and patience and persistence is often required by the Family Partner and other staff to help advocates achieve in these duties. Because of this, we have budgeted for the equivalent of a full time FTE at each provider participating but know that it may more realistically require several part time persons to staff these positions. In year one, we have estimated that 4 persons will be identified and hired as Family Partners by the end of the third quarter of the year. The Yakima Valley Family and Youth Coalition is committed to integrating Family Partners into the new system of care and to work at the pace of the persons hired necessary for them to become successful, either full or part time.

OTHER COSTS:

Advertising – This is estimated based on the experience of the County for required notifications of employment opportunities, committee positions and advocate contracts. All staff are expected to be hired throughout year 1 so costs are requested for that expense. Attrition and turn over will be paid by the employer and be used as match.

Facilities Lease Costs – It is anticipated that 1400 square feet of office space will be needed to accommodate the new seven employee team strategically located near the collaborative sites. Current market rate for office space in the City of Yakima is $15 per square foot. We expect to have space leased by the end of the first quarter of Year 1 as staff begin to come onboard.

Meetings Support and Child Care – Our experience is that when developing grass roots board for Parents of youth with SED and youth with SED that you need to have meetings during convenient hours, and include food and beverages so people can “break bread” together and really be able to voice and contribute their ideas, opinions, solutions and desires. Also, we know that unless child care services that are safe and sanitary are provided you will not get the turnout of parents you want to achieve the diversity of participation you are seeking. So, we have estimated that we will spend approximately $8,000 in food/child care services costs in the first year to support meetings for the establishment and start up of the Governance Team, Youth Development Team, Family Development Team, Cultural Competence Representative Council, Care Review Team and Program Development Team (see the Six Year Detailed Cost Plan). We expect that amount to increase in Years 2 and 3 due to committees and teams and youth programs hitting full implementation. We expect this expense to diminish in the outer years (4-6) as service providers, community partners and agencies should engage and host meetings as part of the sustainability of the processes and community input become integrated.

Audit Costs:

Yakima County expects to incur audit costs for the acceptance of this award on behalf of the Coalition and is charged by the Budget Director by grant based on the Single Audit portion of the State Auditor Invoice annually. Estimated costs will start to incur in Year 2 and continue through Year 6 (and beyond) and the audit cost amount is typical of a grant amount between $1M and $3M based on experience. The current hourly rate of the WA State Auditor’s Office is $79.50.

Grant Accounting and Billing Services:

The Yakima County Department of Grants Management is a separate direct billing function of Yakima County. The Department has an approved billing method by the State Auditor to manage federal, state and foundation grants as we have legislative revenues and entitlements for which to account, bill, report, and provide compliance oversight. Current service costs are estimated to be 4.25% of grant billings in year 1 and 3.3% in years 2-6. Expenses in year 1 are greater due to the initial set up of the grant in the accounting system, establishing the access to the GMS and billing expectations, and establishing the management reports that the Administrative Team wants to use to manage the grant and project for outcomes.

INDIRECT COSTS:

The Yakima County Department of Community Services is charged for the following functions as part of the County Government through its indirect cost plan.

.205 - Facilities use space – Maintenance and Operations cost by square footage

.152 - Liability Insurance – claims history and number of employees

.258 - Technology Services – expensed by number of computers/machines and network usage

.385 - Processing – Auditor and Treasurer’s Offices expenses based on AP, investments.

Cost estimates for these functions in this grant are based on the expectation of existing rates comprising the indirect allocation. These rates are used for all proposed years and will adjust annually.

Match Rationale and Assumptions

Yakima County Department of Community Services

Yakima Valley Family and Youth Coalition

The following table summarizes the projected match amounts by major category of support for each year of grant.

Position Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

State Support

EBP Institute 100,000 103,500 107,123 110,872 114,752 118,769

EBP Expansion 0 685,000 900,000 1,050,000 800,000 800,000

New funding for child inpatient care 0 57,000 58,140 59,303 60,489 61,699

Local Support

Governance Team Participation 144,000 149,040 154,256 159,655 165,243 171,027

Wraparound Supervision 62,880 65,081 67,359 69,716 72,156 74,682

Inpatient Unit Construction 1,000,000 0 0 0 0 0

Additional local efficiencies 0 0 0 100,000 150,000 230,000

Other Support

Private insurance payments for new inpatient unit 0 93,000 94,860 96,757 98,692 100,666

Total Match (including carry-forward) 1,306,880 2,459,501 3,841,238 5,487,542 6,948,875 8,505,717

Required Match 335,000 500,000 667,000 2,000,000 3,000,000 2,000,000

Amount Exceeding Requirements (cumulative) 971,880 1,624,501 2,339,238 1,985,542 446,875 3,717

State support of project will include an agreement to increase the amount of local and State existing funding levels to Yakima County through the RSN via either a direct project allocation and/or the “de-siloing” of current DCFS and JRA cost savings from traditional services. Key components of the match for Year One include:

Evidence Based Practice (EBP) Institute (Years 1 thru 6). This includes the value of EBP Institute staffing dedicated to the Yakima Valley Youth and Family Coalition, over and above the grant funds used to purchase staffing support for the Partnership for Success process. Estimated value is $100,000 every year, and is estimated to increase in value by 3.5% a year.

State support for EBP expansion (Wraparound Care Coordination and Multidimensional Treatment Foster Care) (Years 2 thru 6). Midway through Year One, we are expecting expanded state funding contemplated under 2SHB-1088 to support empirically-supported practices for the 2009-2011 funding biennium, taking effect in July 2009. While the specific practices to be supported have not yet been selected, a recent analysis (TriWest Group, 2007a) recommended expansion of Wraparound Care Coordination and Multidimensional Treatment Foster Care (MTFC). Since most children served are Medicaid eligible, the Medicaid funding base for these services (federal financial participation and state match) cannot be included in the local match calculation. However, the TriWest report authors worked with Department of Social and Human Services (DSHS) actuarial consultants to estimate both Medicaid and State funds for this expansion. Two types of State funds were projected. First, for Wraparound start-up costs were estimated to cover the cost of new teams implemented across multiple years and needing to ramp up to full caseloads. It is expected that the Coalition will implement additional Wraparound capacity with these funds, rather than simply replace funding for the teams contemplated under the grant so the State-funded ramp up period is expected. It is estimated that the first year state portion for the potential expansion (excluding the state portion of any Medicaid costs) will exceed 45%, diminishing by the third year to 25% (state costs not reimbursable as Medicaid mental health services). For MTFC, the TriWest report recommended that room and board costs be paid with only State funds so that children with mental health needs would not be required to access the child welfare system. As a result, half of the daily rate will consist of State funds over and above the Medicaid funding. Total state funding for implementing these EBPs is estimated by year in the match estimate for this line item.

State funding for inpatient care (Years 2 thru 6). We anticipate that most children using the new inpatient unit to be established in Year 1 will be Medicaid eligible, but we expect approximately $57,000 per year by DSHS Division of Alcohol and Substance Abuse funds. These are new funds and will be available from Year 2 onward. These are expected to increase by 2% per year.

Additional match will come from local agency resources (mix of local and state funds) transitioned to cover the infrastructure supported by the grant funds. These include:

Governance Team Participation (Years 1 thru 6). The value of non-mental health staff involved in the Governance Team, the five associated teams (Youth Development Team, Family Development Team, Cultural Competence Representative Council, Care Review Team and Program Development Team), and the Administrative Team, is estimated at 20 hours per month on average, for 12 months, across eight agencies, times $75 per hour (given the senior level of these staff, plus all associated overhead and travel) for a total of $144,000 (184 hours at $75 per hour). This match is available every year, and is estimated to increase in value by 3.5% a year.

Wraparound Care Coordinator Supervision (Years 1 thru 6). Each of the four partner providers is expected to commit 0.25 FTE of clinical supervision time for the two care coordinators and parent partner funded in each agency under the grant. The value of these local commitments is estimated at 1.0 FTE (0.25 FTE times four) at $48,000 per year, plus 31% to cover benefits and operating expenses. This match is available every year, and is estimated to increase in value by 3.5% a year.

Development of child and adolescent inpatient facility (Year 1). Local capital spending from a bond initiative to develop a new child and adolescent inpatient facility within Yakima County is projected to expend $4,000,000 in 2008. Approximately $1,000,000 would be expended in the first three months of Year 1 of the grant period.

Additional local efficiencies (Years 4 thru 6). Additional efficiencies are anticipated for local agencies by year 4, particularly due to reductions in the use of restrictive juvenile justice, child welfare, and school system out-of-district placements. These are estimated conservatively at $100,000 in Year 4, $150,000 in Year 5, and $230,000 in Year 6.

The remaining match will come from other funds, specifically insurance payments for children with SED served in the new child and adolescent inpatient facility. These are estimated at $93,000 a year, available from Year 2 onward. These are expected to increase by 2% per year.

BIOGRAPHICAL SKETCH

NAME

Ronald F. Gamache POSITION TITLE

Principal Investigator

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION AND LOCATION DEGREE

(if applicable)

YEAR(s)

FIELD OF STUDY

Gonzaga University

University of Washington

Washington State University

Certificate 1961-63

1970

2003 General Studies

Public Official

RESEARCH AND PROFESSIONAL EXPERIENCE: Concluding with present position, list, in chronological order, previous employment, experience, and honors. Include present membership on any Federal Government public advisory committee. List, in chronological order, the titles, all authors, and complete references to all publications during the past three years and to representative earlier publications pertinent to this application. If the list of publications in the last three years exceeds two pages, select the most pertinent publications. DO NOT EXCEED TWO PAGES.

Professional Accomplishments:

Yakima County Farm Bureau President (1990-1992)

State Farm Bureau Vice President (1992-1999)

Heritage University Board Member (2000-present)

Yakima County District #2 Commissioner (2001 to present)

Current Yakima County Board and Commission Appointments:

Chairman – Yakima County Board of Commissioners

Yakima Conference of Governments

Yakima County Emergency Services Council

Yakima Count District Health Council

Joint Urban Planning Committee

Yakima County Law Library Board

Yakima County Development Association

SW Central WA Resource Conservation Board

BIOGRAPHICAL SKETCH

NAME

Kimberlee Holt Tully POSITION TITLE

Assistant Director, Department of Community Services

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION AND LOCATION DEGREE

(if applicable)

YEAR(s)

FIELD OF STUDY

Central Washington University

Western Washington University

Management Concepts Inc. (MCI)

Certificates 1984-86

1986-89

2000-05 General Studies

Accounting

Grants Management

Western Washington University – BA in Accounting and Computer Science 1989

Defense Contract Audit Agency – 1989-1997 - Auditor in Charge/Fraud Investigator

Certified Procurement Official for Department of Defense – 1990 – 1997

DCAA – Audit Institute - Federal Procurement and Regulations Certificate – 1990

Outstanding Team Awardee – Garland, TX Branch 1996

Washington State Auditor’s Office – Auditor in Charge 1997-2000

Outstanding Team Awardee – Yakima SAO Branch Office 2000

Yakima County Department of Grants Management – Manager 2000-2004

Job reclassification based on increased departmental responsibility to Senior Manager 2005

Certified Grants Fiscal Manager (CGFM) – Recipient 2004

Certified Grants Fiscal Manager (CGFM) – Pass Through Agency (PTA) 2005

Yakima County Department of Community Services – Assistant Director 2007 to present

Current Appointments:

Fiscal Manager to Homeless Network of Yakima County

Fiscal Advisor to the Yakima County Affordable Housing Committee

Fiscal Advisor to the Yakima County Asset Building Coalition

Fiscal Manager to the Yakima County Veterans Advisory Board

BOCC representative for Yakima County to the County Veterans Coalition – State Board

BIOGRAPHICAL SKETCH

Peter M. Selby, Ph.D. Principal, TriWest Group

EDUCATION/TRAINING

INSTITUTION AND LOCATION DEGREE

(if applicable)

YR(s)

FIELD OF STUDY

Univ of Guelph, Ontario, Canada

Univ of Maryland, College Park

Univ of Maryland, College Park B.A.

M.A.

Ph.D. 1989

1992

1995 Psychology, English

Clinical/Comm Psychology

RESEARCH AND PROFESSIONAL EXPERIENCE:

University of Washington, Children’s Hospital & Regional Medical Center Seattle, WA (1995-1998)

Clinical Assistant Professor: Provided training and supervision to Master’s level clinicians, psychiatry residents, and psychology doctoral interns. Conducted assessment and intervention with children, adolescents and their families. Provided behavioral consultation to schools and other child-serving entities. Provided statewide case-level and system-level consultation and training to JRA residential and parole facilities, as member of a multi-disciplinary University-based team. Consultation included assessment and intervention with emotionally and behaviorally disturbed youth, cultural competency, outcome tracking, and inter-system linkages and transitions.

Seattle Children's Home, Seattle, WA (1998-1999)

Director, Community Behavioral Health & Research: Responsible for community-based, outpatient and outreach-oriented clinical service operations of a mid-sized behavioral health provider agency. Introduced outcome-based, family-centered assessment, treatment planning and intervention model. Successfully bid for and implemented King County MST demonstration project in context of State’s Community Juvenile Accountability Act.

TriWest Group, Seattle, WA (2000-present)

Principal and Senior Consultant providing consultation in the human services, emphasizing program evaluation, juvenile justice, behavioral health, and managed care. Projects include:

§ Border Children’s Mental Health Collaborative, El Paso, TX (October 2002-present)

Project lead for multi-year evaluation of SAMHSA children’s system-of-care grant.

§ New Mexico Children, Youth and Families Department, Santa Fe NM (2000- 2006)

Lead investigator on contract to conduct an eight-year evaluation of New Mexico’s Title IV-E Waiver program serving children in state and tribal foster care systems.

§ Boulder County IMPACT Program, Boulder, CO (October 2001-present)

Project lead on contract to develop and implement a uniform outcome tracking system across 17 community-based programs that serve youth in Boulder County.

§ Pueblo of Zuni Community Health Dept., Zuni, NM (October 2002- present)

Project lead for contract to develop strategic plan, provide technical assistance for: implementation, and conduct multi-year evaluation of the Pueblo of Zuni OJJDP Safe Start Program to address the impacts of violence on young children.

§ Puget Sound Educational Service District, Burien, WA (October 2002–September 2006)

Project lead for evaluation of the Safe Schools/Healthy Students grant initiative for Greater Pierce County.§ Governor’s Juvenile Justice Advisory Committee, Olympia, WA (July 2003–June 2005):

Project lead for multi-site evaluation of the Juvenile Violence Prevention initiative for Washington state.

§ King County Superior Court, Juvenile Court Services, Seattle, WA (2004-present)

Project lead for design and implementation of three-year Seattle-King County Juvenile Justice Intervention Services Expansion Evaluation.

§ King County Superior Court, Juvenile Court Services, Seattle, WA (2003-present)

Project lead for three-year evaluation of Seattle-King County Reclaiming Futures Initiative.

§ Colorado Division of Youth Corrections, Denver CO (2003- present) Project lead for evaluation, consultation and training initiatives to reduce use of secure detention and enhance use of targeted evidence based intervention for youth in the juvenile justice system.

§ North Thurston Public Schools, Lacey, WA (October 2005–present)

Project lead for evaluation of the Safe Schools/Healthy Students grant initiative for Thurston/Mason Counties.

Additional Professional Qualifications

§ NASMHPD/NIMH Research Fellow, (9/97 – 11/98)

§ Postdoctoral Fellow, Child and Adolescent Community Psychiatry, Univ Of Washington (10/95 – 6/96)

Selected Publications and Presentations

Trupin, E. W., & Selby, P. M. (1997). Development of an assertive community-based intervention for youth in contact with the juvenile justice system. The 9th Annual Research Conference Proceedings, A System of Care for Children’s Mental Health: Expanding the Research Base. Tampa, FL: University of South Florida, Florida Mental Health Institute, Research and Training Center for Children’s Mental Health.

Selby, P. M., Trupin, E. W., McCauley, E., & Vander Stoep, A. (1998). Preliminary outcomes of an assertive community-based intervention for youth in contact with the juvenile justice system. The 10th Annual Research Conference Proceedings, A System of Care for Children’s Mental Health: Expanding the Research Base. Tampa, FL: University of South Florida, Florida Mental Health Institute, Research and Training Center for Children’s Mental Health.

Coursey, R.D., Keller, A.B., Selby, PM, et al. (2000). A psychological view of people with serious mental illness. New Directions for Mental Health Services, 88(4), 61-72.

Selby, P. M. (2003). State detention system trends and best practices in juvenile detention alternatives. Colorado Division of Youth Corrections Annual Conference, Vail, CO.

Selby, P.M., Tomaka, L., & Sanchez, J. (2004). Wraparound Fidelity in Children’s Mental Health. Presented at the System of Care Communities Conference, Dallas, Texas.

Selby, P.M., Bartsch, D., & Huff, T. (2004). Using the CANS-MH to Promote Positive Mental Health in the Pierce County Safe Schools/Healthy Students Project. Presented at the First Annual CANS Conference, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Selby, P.M. (2005). Juvenile Justice Intervention Services. Evaluation results presented at the Bridging the Gap Juvenile Justice Symposium, King County, WA.

Selby, P.M. (2005). Wraparound Fidelity in Children’s Mental Health. Presented at the Division of Youth Corrections Statewide Best Practices Conference, Vail, Colorado. BIOGRAPHICAL SKETCH

Jesús Sanchez, Ph.D. Senior Staff Consultant

EDUCATION/TRAINING

INSTITUTION AND LOCATION DEGREE

(if applicable)

YEAR(s)

FIELD OF STUDY

University of California, Irvine

University of Colorado, Boulder

University of Colorado, Boulder B.A.

M.A.

Ph.D. 1986

1989

1992 Social Ecology

Clinical Psychology

RESEARCH AND PROFESSIONAL EXPERIENCE:

University of Colorado Multicultural Center for Counseling and Community Development, Boulder, CO (1989-1990): Long-term and brief individual outpatient psychotherapy and intake assessment with university students.

Indiana University School of Medicine Psychology Training Consortium, Indianapolis, IN (1990-1991)Indiana University Medical Center (APA Accredited Internship)

Pre-doctoral internship in Clinical Psychology. Duties included diagnostic interviewing, psychological assessment, individual and group psychotherapy, and consultation in outpatient psychiatry, Veterans Administration Medical Center inpatient chemical dependency treatment, and state hospital adolescent inpatient treatment.

University of Colorado Counseling and Career Services, Boulder, CO (1991-1993)

Provided direct services to university students, faculty, and staff, having primary responsibility for intake diagnostic interviewing, treatment planning, short-term psychotherapy, and final disposition of cases. Engaged in outreach activities, consultation, and liaison work with other units on campus. Co-coordinated the delivery of intake and psychotherapy services; provided clinical supervision to masters-level trainees. Provided ethnic diversity consulting; planned and delivered training workshops focusing on diversity issues.

John A. Martinez, Ph.D., Denver, CO (1992-1993)

Independent contract position to provide consultation and direct services, including psychological assessment, diagnostic interviews, mental status examinations, and group and individual psychotherapy with clients with co-morbid physical disorders (primarily involving chronic pain), most of whom were monolingual Spanish speakers.

Mental Health Center of Boulder County, Lafayette, CO (1993-1994)

Clinical position involving diagnostic interviewing, psychological assessment, case management, and psychotherapy with children, adolescents, adults, and families.

Sunspectrum Outpatient Rehabilitation, Thornton, CO (1994-1996)

Clinical position as part of an interdisciplinary team providing consultation, diagnostic interviewing, psychological assessment, and psychotherapy to individuals with co-morbid physical conditions, including monolingual Spanish-speaking medical rehabilitation patients.

Mental Health Corporation of Denver, Denver, CO (1996-1999)

§ Program Manager, Access Center. Provided clinical and administrative supervision of a multidisciplinary staff at the agency’s single point of access to services. Supervised a triage and intake team, a hospital liaison team, a team of service providers to homeless shelters, and a citywide mobile response crisis team. Provided liaison with other mental health system entities and worked with a variety of interagency and statewide workgroups and committees. Position also involved participation in a number of agency committees and workgroups, including a workgroup that developed cultural competence guidelines for the organization.

§ Access Project Coordinator. Designed a coordinated system of access to agency services.

§ Staff clinician. Conducted assessment and direct individual and group psychotherapeutic treatment of adults with severe and persistent mental illness.

Colorado Mental Health Institute at Fort Logan, Denver, CO (1999-2000)

Staff Psychologist on an interdisciplinary team in an adult inpatient unit, providing diagnostic evaluations and psychological testing, evaluations and court testimony for involuntary commitment, consultation, and treatment at the group and individual level. Participated on the unit’s management team and in a hospital-wide committee on cultural diversity.

TriWest Group, Boulder, CO (March, 2000-Present)

Senior Staff Consultant specializing in human services research and clinical system development consultation. Recent and current projects include:

§ Partnerships for Health Initiative, Denver, CO (October, 2005-present)

Team leader for an eight-year independent evaluation of an effort of The Colorado Trust to support 13 community health partnerships to improve the coordination of health services at the community level, with an emphasis on addressing Healthy People 2010 focus areas.

§ City of El Paso Social Services Dept., El Paso, TX (October 2005-present)

Project lead to provide independent evaluation of a Hogg Foundation-funded project to recruit and train older adults as peer counselors to other older adults in the community.

§ Advancing Colorado’s Mental Health Care, Denver, CO (March, 2005-present)

Assistant project coordinator for a project involving management and coordination of a five-year grants program aimed at improving the integration of mental health services and facilitating coordinated care across systems. Advancing Colorado’s Mental Health Care is a joint effort of the Caring for Colorado Foundation, the Colorado Health Foundation, The Colorado Trust, and The Denver Foundation.

§ Border Children’s Mental Health Collaborative, El Paso, TX (February 2003-September, 2005; May, 2007-present)

Project lead to provide independent evaluation of SAMHSA-funded system of care project to provide mental health services to border-area children through the County of El Paso, Texas.

§ Governor’s Juvenile Justice Advisory Committee, Seattle, WA (July 2003-June, 2005)

Project team member to provide independent cross-site evaluation and technical assistance to funded juvenile violence prevention grant program.

§ City of El Paso Social Services Dept., El Paso, TX (March 2003-September, 2005)

Project lead to provide independent evaluation of a SAMHSA-funded targeted capacity expansion project to provide mental health services to homebound, nursing home eligible older adults in the community.

§ Colorado Dept. of Human Services, Division of Youth Corrections, Denver, CO (July 2001-September, 2006)

Project team member on a multi-year, 22-site evaluation of Colorado’s SB94 community-based juvenile justice alternatives program.

§ Casey Family Programs, Austin, TX (July 2001-September 2002)

Project team member for planning and evaluation of the Casey Family Programs’ Region 6 Community Building Through Family-Centered Teams Initiative.BIOGRAPHICAL SKETCH

Socorro Martinez-Parham, M.Ed., CSW Staff Consultant

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION AND LOCATION DEGREE

(if applicable)

YR(s)

FIELD OF STUDY

University of Texas at El Paso

Licensed Professional Counselor, TX B.A.

M.Ed.

LPC 1994

1997

1998 Psychology

Guidance & Counseling

Counseling

RESEARCH AND PROFESSIONAL EXPERIENCE:

University of Texas at El Paso, Department of Psychology (June 1992-July 1994)

Research Assistant, Social Cognition Laboratory

El Paso Community Mental Health/Mental Retardation Center, El Paso, TX (October 1994-January 1996)

Caseworker I, Helping Kids Cope Program

Provided drug prevention and intervention services to at-risk children and adolescents in individual and group settings. Created and provided drug awareness presentations to community youth and parents.

El Paso Community Mental Health/Mental Retardation Center, Child and Adolescent Mental Health Program, El Paso, TX (August 1996-December 2003)

§ Utilization Management/Utilization Review Agent (June 2003-December 2003)

Provided clinical supervision and training to unit staff. Conducted intakes for Early Intervention population and oversaw treatment and service planning for all children served in the unit. Oversaw child and adult admissions to the El Paso Psychiatric Center.

§ Early Intervention Supervisor, Clinical Social Worker V (July 1997-May 2003)

Provided clinical and administrative supervision to caseworkers assigned to provide services to children under six. Conducted intakes and assessments for early intervention population. Worked closely with community providers in order to promote and expand program.

§ Intake Specialist, Caseworker II (February 1996-July 1997)

Conducted intake assessments and linked children and adolescents with serious emotional disorders to community providers.

§ Counselor Intern (August 1996-May 1997)

Provided individual and family counseling to children and adolescents with serious emotional disorders.

Texas Dept. of Mental Health/Mental Retardation, Austin, TX (1999-2001)

Committee Member, Infant Mental Health Work Group

Worked with representatives from TDMHMR and Texas Early Childhood Intervention administrators to adopt a collaborative definition of infant mental health and to develop protocols for seamless transition between programs.

TriWest Group, El Paso, TX (January 2004 to present)

Evaluation Consultant

Consultation in human services, with an emphasis on training and evaluation in mental health services and child welfare. Current projects include:

§ Border Children’s Mental Health Collaborative, El Paso, TX (January 2004-present)

Assist in coordination and implementation of the evaluation component for El Paso County’s SAMHSA-funded system of care project which provides comprehensive, community-based and culturally competent services to youth with serious emotional disturbances and their families.

Foreign Language Skills

Spanish: Fluent speaking, proficient reading and writing.

Presentations

Martinez-Parham, S. (1999, March). Positive Discipline. Presented at the Annual Together for Children Conference, El Paso, TX.

Section G Job Descriptions

PROJECT DIRECTOR:

Responsible for overseeing the development of an ongoing comprehensive strategic plan for creating, implementing and sustaining the proposed system of care, organizational structure, hiring of personnel and providing leadership in all facets of the development of the system of care including guiding the establishment of inter-agency collaborations with other child serving agencies, families and the Yakama Nation.

This full time position will be filled with an individual with knowledge of the children’s mental health and related service system, with demonstrated experience in planning and building service systems, management policy analysis and strategic thinking: of leadership experience and demonstrated fostering of collaborative partnerships.

Yakima County Pay Range: D62 – Project Director ($68,300 - $89,900)

Educational or Experience Expectation: Bachelors or Masters Degree in project related field as well as at least 6 years of experience large system projects and programs as well as supervision and management of staff.

Role and Responsibilities:

Participate as a member of the Yakima Valley Family and Youth Coalition Administrative Team, responsible for the implementation and management of all program design policies.

Establish and implement mental health program policies and procedures.

Create an environment of embracing project system design, services attitudes and culture changes.

Revise procedures as state or GCBH requirements change.

Coordinate with support staff to ensure procedures are being followed for openings, closings, filing, confidentiality, etc.

Coordinate with Records and Registration staff to ensure access and review standards are being met according to the contract requirements.

Oversee the preparation for any program or licensing audits.

Establish HIPAA policies and fulfill the role of HIPAA officer to ensure confidentiality of consumer information and records.

4. Complete other administrative responsibilities as Project Director.

Assist in the development and management of the mental health and designated program budgets.

Assure all contract guidelines are met and reports completed as required.Establish and implement a continuous improvement process. Oversee the Quality Assurance/Quality Improvement process according to WAC and GCBH requirements in cooperation with other mental health program managers and supervisors.

Assist in interviewing personnel and make recommendations for hiring to the Yakima County Department of Community Services Director.

5. Provide opportunities for professional growth and supervision for staff.

Works closely with Yakima County Department of Community Services Assistant Director regarding program and fiscal project administration.

Conduct annual staff evaluations and establish individual training plans.

Provide supervision to staff in a manner which encourages professional growth and follows quality ethical practice guidelines.

Schedule and facilitate administrative team meetings and support of the project Governance Team and subcommittees.

Organize cultural and clinical training as identified within the project training plan.

6. Pursue program development in areas of need within the community.

Assist in the development of grants or proposals for new or continued mental health and other related services.

Submit application for project sustainability and participate in fundraising.

7. Maintain positive working relationships with referral sources and other local, county, state and regional agencies, including HRSA, State and Medicaid Authority, the Mental Health Division, the Division of Alcohol and Substance Abuse, the Division of Child and Family Services, Juvenile Rehabilitation Administration and Greater Columbia Regional Support Network..

8. Maintain records per County policy.

9. Participate in regular supervision, clinical manager meetings, and consultation as required by County policies.

10. Perform other duties as assigned.

Section G Job Descriptions

LEAD FAMILY CONTACT:

Responsible for developing, set up or work with a family run organization that represents the culture and linguistic background of populations being served. This position will have full voting inclusion on the governing body of the project.

Yakima County Pay Range: – Client Representative ($36,500 - $45,400)

Educational or Experience Expectation: This position is to be filled by a parent or family member of a child who has or currently is receiving services from the mental health service system.

Role and Responsibilities:

Participate as a member of the Yakima Valley Family and Youth Coalition Administrative Team, Governance Team and subcommittees responsible for the planning, development, implementation and management, evaluation, sustainability and transformation of all service delivery and support of families and Children in the project.

Maintain records and receipts per County policy.

9. Participate in Family Support Committee meetings as required by the County Administrative Team, Project Director or Human Resources Department.

10. Perform other duties as assigned.

Section G Job Descriptions

YOUTH COORDINATOR:

Responsible for developing activities to represent the voice of youth who have serious mental health service needs with staff who are charged with the programming and implementation of the system of care.

Yakima County Pay Range: – Youth Representative ($32,580 - $41,000)

Educational or Experience Expectation: This position is to be filled by a young adult who has either been a client of the mental health services system or family member of a client either in services or alumni of services. High School or equivalent

Role and Responsibilities:

Develop programming for young people to facilitate their involvement in the development of the system of care.

Maintain records and receipts per County policy.

4. Participate in Family Support Committee meetings as required by the County Administrative Team, Project Director or Human Resources Department.

5. Perform other duties as assigned.

Section G Job Descriptions

CULTURAL AND LINGUISTIC COMPETENCE COORDINATOR:

Is responsible for implementation of the cultural and linguistic competence that belongs to all users and parties to the system of care. This position is a Team Leader and has the responsibility for assisting leadership, management staff, families, youth, contractors, and all other system partners in ensuring cultural and linguistic competent practices in all aspect of the system of care.

Yakima County Pay Range: – Project Manager ($53,800- $71,400)

Educational or Experience Expectation: Bachelors + 5 years or Masters +3 years

Role and Responsibilities:

Participate as a member of the Yakima Valley Youth and Family Coalition Administrative Team, Governance Team and subcommittees responsible for the planning, development, implementation and management, evaluation, sustainability and transformation of all service delivery and support of families, children and clinicians in the project.

Incorporate all the Cultural and Linguistic Competence Elements into the project as outlined in the Appendix K of the grant RFA.

Maintain records and receipts per County policy.

4. Participate in all project Committee meetings as required by the County Administrative Team, Project Director or Human Resources Department.

5. Perform other duties as assigned.

Section G Job Descriptions

TECHNICAL ASSISTANCE COORDINATOR:

This position serves at the central point within the Team and System of Care for strategizing and assessing the technical assistance needs of the community and as the primary link with the Technical Assistance Partnership (TAP) for accessing the appropriate technical assistance.

Yakima County Pay Range: – Project Training Coordinator ($35,952 – $42,905) this is expected to be permanent part-time (.50) position.

Educational or Experience Expectation: 2 year degree +3 years of related experience in determining training needs and evaluating training resources, medias and mediums.

Role and Responsibilities:

Develop with partners and the TAP a project technical assistance plan for the system of care

Assess continuously the technical assistance needs of the system of care.

Organize and implement training activities to address developmental needs of the system of care.

Establish an interagency team to assist the assessment, planning, implementation of training and technical assistance activities.

Maintain records and receipts per County policy.

7. Participate in all project Committee meetings as required by the County Administrative Team, Project Director or Human Resources Department.

8. Perform other duties as assigned.

Section G Job Descriptions

COMMUNICATIONS MANAGER:

This position is responsible for developing a comprehensive social marketing/communications strategy for the community, including a social marketing plan, public education activities and overall project outreach activities. This position also coordinates activities with the national campaign contractor.

Yakima County Pay Range: – Project Communications Coordinator ($35,952 – $42,905) this is expected to be permanent part-time (.50) position.

Educational or Experience Expectation: 2 year degree +3 years of related experience in public relations, communications, politics and federal campaigns.

Role and Responsibilities:

Develop with partners a social marketing/communications plan for the system of care that aims at reducing stigma, bringing about social awareness of the needs of clients and families and provides for family education.

Assess the communication needs of the system of care national campaign and implement the plan by understanding the informational needs of the audiences and develops messages, materials, and activities that are in compliance with Title VI of the Civil Rights Act.

Provide support to a family organization associated with the system of care to implement outreach strategies for families and children and youth with serious mental health needs who are from racial and ethnic groups represented in the community to be served.

Maintain records and receipts per County policy.

6. Participate in all project Committee meetings as required by the County Administrative Team, Project Director or Human Resources Department.

7. Perform other duties as assigned.

Section G Job Descriptions

WRAPAROUND CARE COORDINATOR:

Responsible for facilitating the wraparound care coordination process for children, youth and their families through care coordination and youth and family team processes in accordance with the standards of the National Wraparound Initiative.

Contractor Estimated Pay Range: $31,487 plus benefits

Educational or Experience Expectation: Care Coordinators must possess a B.A. or B.S. degree in Social Work, Psychology, Nursing, Occupational Therapy, or a B.A. or B.S. in an unrelated field with experience in human services, preferably Case Management. Individuals must be able to successfully complete wraparound care coordination training.

Role and Responsibilities:

The Care Coordinator maintains a caseload of 8-9 families with a minimum of 14 hours of service contact per month per family to include weekly face-to-face contacts with the youth and family.

The Care Coordinator must assemble a Youth and Family Team within two (2) weeks of enrollment by interviewing the family, identifying family members/natural supports/agency representatives and other significant persons. The Care Coordinator assesses the youth’s/family’s strengths and needs and provides assistance with any immediate needs, as well as begins the development of a Crisis Plan.

The Care Coordinator coordinates the meeting of the Youth & Family Team and develops the initial individualized care plan based on the identified strengths and needs, including a comprehensive 24-hour Crisis Plan. The Plan should reflect the best possible fit with the culture, values and beliefs of the family.

The Care Coordinator must monitor the provision and quality of services provided to the family through the Youth & Family Team and is the liaison when new services/resources need to be sought or developed. The Care Coordinator seeks community resources first with the assistance of the Team and modifies the plan whenever services or resources need to be added and/or deleted.

The Care Coordinator provides or arranges for transportation for his/her clients to appointments, crisis/respite services, etc., if needed.

The Care Coordinator provides or secures support and crisis/emergency services for the youth/family.

The Care Coordinator completes all the necessary paperwork and monitoring tools.

The Care Coordinator collaborates with other necessary individuals the youth and family may have contact with and invites them with adequate notice to Youth & Family Team and Plan of Care meetings, and provides them with copies of the completed care plan.

Section G Job Descriptions

FAMILY PARTNER:

This position will perform a wide range of activities to assist families and youth navigating the mental health and related service system and engaging in advocacy and developing natural supports. Peer support services may include but are not limited to providing support to individual families involved in Wraparound Care Coordination and providing support be sharing of the peer counselor's own life experiences.

Contractor Estimated Salary Range: $12.00 per hour

Educational or Experience Expectation: This position is to be filled by a parent or family member of a child who has or currently is receiving services from the mental health service system.

Role and Responsibilities:

Provide awareness to families of available community resources and programs for children and adolescents.

Participate with facilitator and the family in forming and maintaining effective Child and Family Teams.

Help promote the individual family culture in the Child and Family Team.

Represent Parent/Family voice in family activities at the agency.

Link parents with other parents in community.

Offer a shared connection to families by establishing a collaborative partnership.

Participate in Child and Family Team activities and training.

Establish and maintain positive and effective working relationship with internal staff and external resources.

Coordinate parent support group meetings and activities.

Assist families in strengthening connections within their community of natural and informal supports.

Consult with Care Coordinators on issues related to supporting and strengthening family/community connection.

Maintain records and receipts per County policy

Perform other duties as assigned.

Section H: Confidentiality and SAMHSA Participant Protection/Human Subjects.

Confidentiality and Participant Protection:

Risks to the project participants may include the potential effects of factors related to their diagnosis, including danger to self or others, and of their system involvement, such as in the child welfare or juvenile justice systems. Because their status can make this group of participants particularly vulnerable, they are also at risk for exploitation by others. Notwithstanding their pre-existing strengths and needs, this project is not expected to pose an additional significant risk to participants that would be greater than that normally expected as a result of participation in a treatment program administered by qualified mental health and other human services professionals, specifically risks related to confidentiality and the hassle of participation.

This project will take place in the context of an existing and expanded service program, with interventions that are documented and accepted models of care with at least some level of evidence base. Any probability of harm or discomfort expected to be encountered by study participants will generally be consistent with that encountered during the routine provision of services by qualified mental health and other human services professionals. No experimental treatment or random assignment to services will be used. In addition, the instruments to be used for evaluation data collection purposes were either used in the model program or are commonly used in clinical practice, and are well-suited for use by service providers working with the study population.

In the first year, before any services are provided or any person is enrolled in the evaluation, the specific procedures to safeguard providers and clients will be finalized with input from providers, family members and the evaluation team. The project will then work with an Institutional Review Board (IRB) through TriWest Group IRB #1 (OHRP IRB identification number IRB00004195, under Federalwide Assurance number 00007004), which is currently overseeing three SAMHSA evaluations, including the El Paso, Texas Border Children’s Mental Health Collaborative under the CMHI project) so that participant protection is ensured. This process will ensure that procedures offer protection validated at multiple levels of the project and the IRB.

Protection against risks to confidentiality will be implemented at multiple levels. At the interagency level, the different participating entities will sign confidentiality agreements. Under the provisions of Title 42 of the Code of Federal Regulations, Part II, agencies will maintain the confidentiality of mental health and alcohol records, and authorized personnel will share data only as permitted by consenting participants and applicable state and federal regulations. All electronic and paper files will reside at agency sites or, for evaluation data, at a secure TriWest Group office to be secured within the grantee community post-award. Only trained and authorized agency staff and evaluation team members will have access to these data, which will be stored securely and protected by passwords when in electronic form (in accord with the requirements of the Health Insurance Portability and Accountability Act – HIPAA), and kept in locked files when in paper form. Agency databases will be maintained by each participating agency, according to their own policies and procedures governing the protection of data, and in accordance with relevant state and federal requirements.

Evaluation data collection activities will be coordinated by trained, doctoral-level research staff, and data will be maintained in a secure location. All data collection staff will be familiar with general standards for confidentiality and participant protection, as well as all data collection protocols for this project. Documentation of informed consent will be obtained from all participants, and no children will participate in any project or evaluation activities without the written consent of the parents or guardians legally authorized to provide such consent. Because the documentation of informed consent will identify participants by name (through their signatures), and because it will need to include the unique identification number of the participant for whom it was signed (in order to track compliance with informed consent requirements), documentation of informed consent will be kept securely separate from any participant data in locked files, to be accessed only by authorized agency and evaluation staff. Only aggregate analyses of data will be conducted and reported for evaluation purposes. The project will obtain IRB approval, as required, prior to the initiation of any evaluation activities involving human participants.

Limits to confidentiality include the need to reveal the names of evaluation participants when there is a direct reason required under the law, such as the duty to comply with child abuse reporting requirements and duty to protect in situations involving imminent risk of harm to self or others. Participants will be informed of these confidentiality limitations as part of the informed consent process (see the sample consent forms provided in Appendix 4 for that specific language).

Adverse effects: This is not expected to be applicable, beyond the normal risks of adverse consequences inherent in the provision of intensive mental health services. The proposed activities do not involve an experimental or novel intervention and all participants will be able to access all components of the existing system of care.

Typical clinical issues such as medication monitoring, changing mental health status and decreases in functioning may at times call for a proactive response. Extensive safety planning will be a major emphasis in order to help providers, youth and their families to proactively plan for potential crises. Safety plans will be developed as needed. An extensive crisis and safety planning process will help all team members to respond and assist participants.

In the case of a mental health emergency, clinical staff will be knowledgeable of emergency policies and program-specific clinical policies and procedures. In the event of a clinical emergency, the safety of the person in question is paramount. A clinical staff person will be made aware of the situation and immediately assess for imminent danger. If it is determined that the immediate safety of the person in question or others is in question, the appropriate emergency first responder personnel, such as the police are to be contacted.

Staff is mandated to report suspected child abuse or neglect to Washington Department of Social and Human Services, Children’s Administration, Division of Child and Family Services, Region Two office, located in the service area of the grant and a primary Coalition partner.

The purpose of this program is to integrate the system of care to provide comprehensive, community-based mental health services and supports for all Yakima County youth, including children and youth from the Yakama Nation, with serious emotional disturbances and their families. As part of that program, all current outpatient and other services within the community will be available, as well as new services implemented under the grant. However, placement in an out of home placement such as a hospital or RTC (residential treatment center) might also benefit the youth in the event that intensive community supports cannot support the individual in the community. If that type of placement becomes necessary, it will feature a high level of family involvement with specific focus of linking with community-based care and facilitating transition to (or back to) the community.

Target population and exclusions: The primary population for this project will be children and youth ages 10 – 21 that have a diagnosable behavioral, mental health, emotional or socio-emotional disorder, are not functioning successfully in family, school and/or community, and who require, or are at risk of needing, multi-agency intervention. Due to the high prevalence of Hispanic youth, particular emphasis will be placed on providing care to children and youth of color, and Yakama Nation youth. In addition youth age 17-21 making transition from child to adult systems will be prioritized.

The project will emphasize providing care to:

Children and youth involved with the juvenile justice or child welfare systems

Children and youth with co-occurring SED and substance abuse disorder

Children and youth who are, or are at risk of, receiving care in restrictive out-of-community settings

Children and youth who are transitioning back community from out-of-community residential settings

In Years Five and Six of the initiative period, with efficiencies realized through providing community-based services to children and youth in our primary population described above, we will enhance early intervention services to better meet the needs of children and their families in the following groups:

Children age birth to five (5) who have a diagnosable behavioral, mental health, emotional or socio-emotional disorder and, without early identification, diagnosis and treatment will be at risk for failure in family, school and community settings.

Children age 6 – 10 who have a diagnosable behavioral, mental health, emotional or socio-emotional disorder and, without early identification, diagnosis and treatment will be at risk for failure in family, school and community settings.

The inclusion of pregnant women, other youth or adults with mental disabilities, or in institutions, or prisoners and individuals who are likely to be particularly vulnerable to HIV/AIDS would occur to the extent that these conditions were co-occurring with the primary conditions being served, or if these individuals are family members of the youth served by the project. Otherwise the project is not seeking to serve those populations.

We are not excluding any qualifying youth in need of the services provided by this project. The program is only designed to provide services to those youth and their families.

Voluntary or required participation: Youth will be selected through a referral process initiated by mental health or other referring child-serving systems, including child welfare, juvenile justice, courts, or schools. Project staff will be trained to administer assessments to screen for eligibility. All eligible youth in need of the services developed by this project will be selected.

Participation for those youth referred by non-court agencies will be voluntary. A court may mandate youth to participate in services provided in conjunction with this grant, but not in the specific activities of the evaluation. Youth admitted to this program may be at risk for out-of-home placement and may have been unsuccessful in a less intensive and structured program. As a last resort, court orders can often provide youth with a forced opportunity for treatment and, as a result, create an opportunity for positive outcomes. Participation in the evaluation is voluntary. Clients will not be required to participate in the evaluation in order to be eligible for services. Under no circumstances will participation be coerced.

Youth and their caregivers who participate as participants in the evaluation will receive compensation in the form of gift certificates to area merchants in the amounts of $20 per interview. No participant incentives will exceed $20 per individual, in accord with SAMHSA requirements. This will be provided as compensation for the one to two hours necessary to complete data collection interviews for the GPRA NOMs and the National Evaluation at baseline and at the 6-month follow-up interviews.

At the time of intake, participants will be given written information in their primary language (English, Spanish, or translated as needed into other languages) regarding the study, including its voluntary nature. This will include a clear statement that service eligibility is not dependent on study participation. See the sample consent and assent forms in Appendix 4 to view this language. Evaluation and clinical staff will be trained in the use of the consent forms and will be available at any time during the course of the client’s involvement in services and the evaluation to answer questions and reassure clients of the voluntary nature of the study, as well as ongoing availability of services whether or not the client participates in the study.

Data collection procedures: Data will be collected from all youth service recipients and their families who agree to participate in the evaluation. The primary population for this project will be children and youth ages 10 – 21 that have a diagnosable behavioral, mental health, emotional or socio-emotional disorder, are not functioning successfully in family, school and/or community, and who require, or are at risk of needing, multi-agency intervention. Due to the high prevalence of Hispanic youth, particular emphasis will be placed on providing care to children and youth of color, and Yakama Nation youth. In addition youth age 17-21 making transition from child to adult systems will be emphasized.

In Years Five and Six of the initiative period, with efficiencies realized through providing community-based services to children and youth in our primary population, we will enhance early intervention services to better meet the needs of children and their families in two groups: (1) Children age birth to five (5) who have a diagnosable behavioral, mental health, emotional or socio-emotional disorder and, without early identification, diagnosis and treatment will be at risk for failure in family, school and community settings, and (2) Children age six (6) to 10 who have a diagnosable behavioral, mental health, emotional or socio-emotional disorder and, without early identification, diagnosis and treatment will be at risk for failure in family, school and community settings.

Study procedures consist of the administration of study questionnaires by trained interviewers via interview format to youth service recipients and their family members. The administration of study questionnaires via interview format will take place at locations convenient to participating families, such as their homes, project offices, or a location of the family’s choice in which confidentiality can be preserved. Being representative of the target population from which it will be drawn, the study sample will include Spanish-speaking families. In cases where non-English speaking participants will be included, the data collection procedures will be conducted in the participant’s language of fluency by a trained evaluator (in the case of Spanish-speaking participants and families), or with the assistance of a trained interpreter (in cases where the participant and family’s language is other than English or Spanish).

Baseline NOMs data will be gathered within seven (7) days of a youth’s enrollment into the project (within 30 days for National Evaluation baseline data). Follow-up data, using the same set of instruments, will be gathered at 6, 12, 18, 24, 30, and 36 months.

Youth and their caregivers who participate will receive compensation in the form of gift certificates to area merchants in the amounts of $20 per interview.

No specimens (e.g., urine, blood) will be collected or analyzed as part of this evaluation.

TriWest will ensure that the Yakima Valley Youth and Family Coalition complies with data collection and reporting requirements for the National Evaluation, as well as participate in the local evaluation. TriWest will also ensure that the Yakima Valley Youth and Family Coalition complies with data collection and reporting requirements of the NOMs. Because data collection deadlines for NOMs are different than those for the National Evaluation (e.g., NOMs baseline interviews are to be conducted within seven days of service enrollment, compared to within 30 days of enrollment for National Evaluation baseline interviews), NOMs forms will be completed via face-to-face data collection at enrollment and at the required follow-up data collection points (including at discharge), by the clinician working with each service recipient. To ensure the collection of valid and reliable data and at the proper points in time, clinicians will be required to undergo training on the administration of the NOMs forms and the National Evaluation forms, with annual refresher sessions to review data collection issues that have arisen and have been resolved during the preceding quarter. To ensure the completion of NOMs forms and the National Evaluation forms within the required deadlines, and to confirm the completion of the forms, TriWest will track data collection deadlines and also enter data from these forms into the TRAC Web system within seven days of data collection for the NOMs forms and will follow the guidelines provided by the National Evaluation for those data collection forms. Face-to-face interview protocols for NOMs and National Evaluation instruments will follow guidelines specified by TRAC and the National Evaluation for each individual instrument.

An Enrollment and Demographic Information Form will be completed for all families in the system of care. All eligible families who agree to participate in the Longitudinal Outcome Study will be interviewed using the following measures, depending on respondent and data collection point:

Child Information Update Form

Achenbach Child Behavior Checklist 1½–5

Achenbach Child Behavior Checklist 6–18

Behavior and Emotional Rating Scale–Parent

Behavior and Emotional Rating Scale–Youth

Caregiver Information Questionnaire

Caregiver Strain Questionnaire

Columbia Impairment Scale

Delinquency Survey–Revised

Education Questionnaire–Revised

Family Life Questionnaire

Global Appraisal of Individual Needs Quick–Substance Related Issues

Living Situations Questionnaire

Revised Children’s Manifest Anxiety Scale

Reynolds Adolescent Depression Scale

Substance Use Questionnaire–Revised

Vineland Screener (ages 0–2.11, 3–5, 6–12)

Youth Information Questionnaire

At follow-up points the following instruments will also be completed for families in the study.

Cultural Competence and Service Provision

Multi-Sector Service Contacts–Revised

Youth Satisfaction Survey for Families

Youth Satisfaction Survey

Ensuring privacy and confidentiality: Service providers and TriWest Group agree to maintain the confidentiality of mental health client records in accordance with the provisions of Title 42 of the Code of Federal Regulations, Part 2. Personnel will only share client data as prescribed by State and Federal regulations, unless the client has signed a specific consent agreement.

Use of Data Collection Instruments. Data collection instruments will be used in several ways. (1) NOMs and National Evaluation data instruments will be used to provide data for TRAC and to the national evaluator for cross-program analysis and support for federal level initiatives. (2) Data from the NOMs and the National Evaluation will also be used by the local evaluation for ongoing project feedback and support and reporting, including the Partnership for Success process. Those efforts will primarily focus on ongoing continuous quality improvement monitoring. (3) Reports will be developed using the evaluation’s Access data base to provide feedback about program progress in terms of youth and families served. (4) Reports will also be developed to report on outcomes of the program for youth and families. (5) Data of particular interest to the local level such as services system and program-specific process and outcomes data will be reported to the project and the programs through programmed reports. (6) The evaluation will use the data to complete additional analysis related to emerging questions and outcomes refined to address those questions.

Data Storage. Data will be maintained in secure locations. NOMs Data will be entered directly into the password protected TRAC web-based system by trained and qualified TriWest evaluation staff following TRAC guidelines. Only evaluation staff will have access to that system and other evaluation data bases for data entry, retrieval and reporting. That NOMs data will also be uploaded to an evaluation data base once it is retrievable from TRAC. The evaluation database will be a password-protected Microsoft Access data base installed on a password-protected evaluation computer and backed up nightly on removable media. All paper data will be kept at the TriWest evaluation office in a locked file cabinet.

Data for the National Evaluation will be provided to the national evaluator in the secure manner specified by the national evaluator. Data for the National Evaluation will also be entered into the secure evaluation database. Paper copies of the completed data forms will be filed in a locked file cabinet. The evaluation’s Access data base will be backed up regularly on removable media.

Data collected for the local evaluation will be saved and stored in the same manner as described for the NOMs and the National Evaluation data.

Access to Data. Access to the evaluation data base will be limited to authorized evaluation staff and will be password-protected. Any information sharing including data collection will only be done with the informed consent for release given by the participant.

Identifiers. A unique evaluation identification number will be used on all data collection instruments. Only the evaluation staff will have the list that matches these numbers with names. Identification numbers unique to the TRAC and National Evaluation will also be cross referenced to participant names by the evaluation staff. When reports are written, data will be aggregated so that only the whole group is referred to, not any individual person or family.

Record Confidentiality. We agree to maintain the confidentiality of alcohol and drug abuse client records in accordance and compliance with the provisions of Title 42 of the Code of Federal Regulations, Part II.

Obtaining and documenting consent: Participants in the project will be informed about the purpose of the project. This includes:

To collect information about the needs of youth, their demographic information, referral sources, referral types and services provided, and

To monitor changes over time.

Participant data will not be identified with people’s names, but rather with unique identification numbers. While a tracking system will be used that will cross-reference record identification numbers with identifying information, this information will be kept separate from any participant data, and will be safeguarded through the use of a password-protected electronic file, on removable media, kept in a locked file cabinet in the TriWest evaluation office.

Because the documentation of informed consent will identify participants by name (through their signatures), and because it will need to include the unique identification number of the participant for whom it was signed (in order to track deadlines for follow-up interview purposes and to maintain consistent data), documentation of informed consent will be kept securely separate from any participant data, to be accessed only by authorized evaluation staff. Any paper data records, removable media containing electronic records, and documentation of informed consent will be kept in locked cabinets, in locked offices. Any electronic data files kept by TriWest Group will be kept on a secure computer and will be password-protected.

Participants will be provided with documentation of informed assent and consent at the time of enrollment into the project, clearly articulating that their participation in voluntary. Consent forms will describe the project, and the type and purpose of their participation. A description of how data collected will be used will be included, as well as the types of MIS data that will be obtained and used, as applicable. The documentation of informed consent will also detail the steps used to keep data private, including data-sharing safeguards among participating agencies, and how only aggregate data results will be reported. The name and contact information of the principal evaluator, Peter Selby, PhD, will also be included should questions arise at any time after the interview. Documentation of informed consent for the evaluation of the project will also specifically list the types of data that will be collected, the types of respondents from whom it will be collected, and how it will be used.

Consent forms will also:

State that participation is voluntary and will not affect the right of participants to receive services outside of the project or without participation in the evaluation;

Explain the voluntary nature of participation as applying for the duration of involvement in the project, and that it includes the right to end participation in the project at any time without penalty or any adverse consequence;

Describe the possible risks from the project (as described previously in this section);

Describe plans to minimize these risks.

Informed consent is predicated on the assumption that the information is understood. Interviewers and/or clinicians will read the assent or consent for youth and the consent for legal guardians and other family members, or they arrange for an interpreter should one be needed to ensure that the youth and family members are fully aware of the procedures to which they would be giving assent/consent. Assent and consent forms will be available in Spanish and English. Any questions or further explanation will be provided to the youth or family member as it comes up during the informed consent process.

Youth and family members will be provided with documentation of informed assent and consent at the time of enrollment into the project. The documentation will be in the form of a copy of the signed assent or consent form. Interviewers and/or clinicians will read the assent or consent for youth and the consent for family members or arrange for an interpreter should one be needed to ensure that the youth and family members are fully aware of giving assent/consent. Assent and consent forms will be available in Spanish and English. Any questions or further explanation will be provided to the youth or family member as it comes up during the informed consent process. Sample youth assent and consent and family consent forms are provided in Appendix 4.

All consent forms are subject to approval and revision by the properly constituted IRB convened for this project. If additional consents became necessary, they will be submitted to the IRB for approval prior to implementation.

Participant involvement in the project is voluntary and includes the right to end participation in the project at any time without penalty or other adverse consequence, including the right of participants to receive needed services outside of the project. Participation in the evaluation is voluntary and will not affect the right of youth or family members to participate in project services or receive services outside of the project.

Risks and benefits: Risks associated with this program are minimal and are far outweighed by the benefits that youth and their family members will experience with the interventions provided by this program.

Beyond the general risks associated with receiving mental health and other services, the risks of participating in the proposed program are primarily related to confidentiality and the burden of participation in the evaluation. These confidentiality and evaluation risks are minimized by the voluntary nature of participation in the program and the many safeguards just described.

Weighing against these risks are two primary benefits. First, the project will offer youth in need of services for co-occurring mental illness and substance abuse disorders and/or multi-agency services access to specific services that are currently not available. Second, this project is expected to result in the development of knowledge about services of this type that will impact the local service system, as well as systems of care around the country.

Protection of Human Subjects Regulations

Institutional Review Board approval through TriWest Group IRB #1 (OHRP IRB identification number IRB00004195, under Federalwide Assurance number 00007004) will be obtained prior to enrolling any participants in the proposed project evaluation.

Appendix 1

Letters of Commitment and Support

Memorandums of Understanding

1. Julie Cruz, Grandparent

2. Tribal Council Chairman Ralph Sampson, Yakama Nation

3. Dawn Grosz, Director, Parent Program, Statewide Action for Family Empowerment (SAFE WA)

4. Sharon Madsen, Program Director, Carolyn Cox, Family Partner, and Jessica Hodges, Youth Participant / Volunteer, 3 Rivers Wraparound Program

5. Senator Maria Cantwell

6. Senator Patty Murray

7. Congressman Richard “Doc” Hastings

8. State Representative Mary Lou Dickerson

9. Ken Stark, Director, Washington State Mental Health Transformation Project

10. Secretary Robin Arnold-Williams, Department of Social and Health Services (DSHS)

11. Don Jones, Regional Administrator, DSHS Juvenile Rehabilitation Administration, Region 2 Office

12. Kenneth Nichols, Regional Administrator, DSHS Division of Children & Family Services Region 2 Office

13. Eric Bruns, PhD, University of Washington, Dept. of Psychiatry & Behavioral Sciences

14. Ken Trull, Juvenile Court Services Manager, Superior Court for the State of Washington for the County of Yakima, Juvenile Court Division

15. Superintendent Jane Gutting, Educational Services District 105

16. List of Additional Letters of Commitment

§ Desiree Lohman, Parent

§ Superintendent Yakima Public Schools

§ Kathleen McDonald, CEO, EPIC Head Start

§ Diane Patterson, Director, Children’s Village

§ Lynn Sloan Biggs, Senior Director, Yakima Field Office, Casey Family Programs

§ Lance Stephens, President, United Way of Yakima County

§ Eric Trupin, PhD, University of Washington, Evidence Based Practice Institute

§ Steven Hill, Senior Director, Yakima County Department of Community Services

§ William Wilson, Director, Greater Columbia Behavioral Health Regional Support Network

§ Darlene Darnell, Director, Catholic Child and Family Services, Diocese of Yakima

§ Rick Weaver, President/CEO, Central Washington Comprehensive Mental Health

§ Janis Luvaas, Program Director, Yakima Valley Farm Workers Clinic

Appendix 3: Data Collection Procedures and Instruments

Data collection procedures specified by TRAC and the National Evaluator will be employed. At the time of enrollment, a baseline assessment of the child and the child’s family will be administered. Follow-up assessments will occur at periodic intervals (e.g., every 6 months for up to 3 years) while children are receiving services and after these services have terminated.

The following data collection instruments are included:

Data collection for the SAMHSA required Government Performance and Results Act (GPRA) will include the following CMHS NOMs forms. Both are included in this appendix.

Adult Consumer Outcome Measures for Discretionary Programs

Child Consumer Outcome Measures for Discretionary Programs (Child or Adolescent Respondent Version or Caregiver Respondent Version).

Data collection instruments required for the National Evaluation include the following. The instruments are grouped by the study within the National Evaluation.

Cross-sectional Descriptive Study - All families in the system of care in all communities will complete the Enrollment and Demographic Information Form

Longitudinal Child and Family Outcome Study - All eligible families in the Cross‑sectional Descriptive Study will complete the following measures, depending on respondent and data collection point.

Child Information Update Form

Achenbach Child Behavior Checklist 1½–5

Achenbach Child Behavior Checklist 6–18

Behavior and Emotional Rating Scale–Parent

Behavior and Emotional Rating Scale–Youth

Caregiver Information Questionnaire

Caregiver Strain Questionnaire

Columbia Impairment Scale

Delinquency Survey–Revised

Education Questionnaire–Revised

Family Life Questionnaire

Global Appraisal of Individual Needs Quick–Substance Related Issues

Living Situations Questionnaire

Revised Children’s Manifest Anxiety Scale

Reynolds Adolescent Depression Scale

Substance Use Questionnaire–Revised

Vineland Screener (ages 0–2.11, 3–5, 6–12)

Youth Information Questionnaire

Service Experience Study - All families in the Longitudinal Child and Family Outcome Study will complete the following measures at follow-up points only (every 6 months from 6 to 36 months):

Cultural Competence and Service Provision

Multi-Sector Service Contacts–Revised

Youth Satisfaction Survey for Families

Youth Satisfaction Survey

Local Evaluation - An assessment of the fidelity of the Wraparound model will be completed using the Wraparound Fidelity Index 4, which includes the following forms:

Demographics Form

Wraparound Facilitator Form

Caregiver Form

Youth Form

Team Member Form

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