TCOM Conversations

We Appreciate You

Two weeks ago was our 16th Annual TCOM Conference; we would like to thank everyone that participated.

With our first virtual conference completed, we would like to take the time to thank every one of our friends, attendees, speakers, and sponsors who made this year’s event a truly special one!
We are delighted that we had a record number of participants of 550 for the 16th Annual TCOM Conference! We had 7 countries and 32 states represented this year, and we feel grateful that we were able to connect with so many that we normally don’t get the chance to. We are so appreciative of your attendance, collaboration, and your passion for the TCOM Collaborative.


From each and every one of us at the Praed Foundation, we would like to say thank you to all our fantastic speakers and keynotes. We know that working around these new technological methods of presenting was not easy. All your effort and hard work did not go unnoticed, and we are very appreciative of the time that you put into your presentations. Many of us were moved by the stories you shared, and we were truly grateful for your time.


The current pandemic has caused all of us to adapt and innovate– and we appreciate your patience with us as our team adjusted our planning and scheduling for this year’s conference. Importantly, we would like to thank our Planning Committee for all their work on this year’s conference, and the TCOM Team members who offered their time as moderators and contributed to the backend to make this conference run as smoothly as we could.

Special Thanks to our Sponsors!

A special thank you also goes out to our Sponsors. Without their support, we would not have the Annual TCOM Conferences. Thank you to Casey Family ProgramsMagellan HealthObjective Arts, and Opeeka.

If you attended this year’s TCOM Conference, you will still be able to go through the presentation materials and recordings in the Socio App. Thank you again for attending the 2020 TCOM Cloud Gathering.

Recap from TCOM 2020 Virtual Cloud Gathering Conference

The 16th Annual TCOM Conference, A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World has officially ended. We hope you were able to learn and grow from this year’s sessions; the TCOM Team feels grateful that we had the opportunity to connect and collaborate with each of you.

If you attended this year’s TCOM Conference, you will still be able to go through the presentation materials and recordings in the Socio App.

As a thank you for attending the TCOM 2020 Cloud Gathering, we will be sending each of you a Swag Pack in December 2020. To get a sneak peak of what you will be receiving, click on this link: Swag Pack for TCOM 2020 Conference: Virtual Cloud Gathering

We feel so fortunate that you helped make this year’s conference the success that it was, and we hope you can join us at our home base for next year’s conference in Lexington, Kentucky, October 6 – 8, 2021.

TCOM 16th Annual Conference: Are You Registered?

We are just days away from A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World Conference!

Right now, we have our All Access Pass Sale (20% off from our regular registration) available until Sunday, November 8th, 2020. Starting Monday, November 9th, only the 3-Day Regular Registration and Single-Day options will be available to register for.

If you have already registered for this year’s conference, please take a look at our Online Event Page and our Registration Page for frequently asked questions.

We look forward to hosting our 16th Annual TCOM Conference, and collaborating with you soon.

Keynote Spotlight: Meet Liz Kromrei

Liz Kromrei, LCSW, MSSW, CPS Director of Services
Liz Kromrei, LCSW, MSSW, CPS Director of Services

We are thrilled that Liz Kromrei is joining us for the TCOM 2020 Cloud Gathering Conference!

Liz Kromrei is a Licensed Clinical Social Worker, with an MSSW from the Steve Hicks School of Social Work at the University of Texas at Austin.

She has more than 35 years of post-graduate social work experience in the field of child welfare, the vast majority in the state-administered Texas child welfare system. As the CPS Director of Services, she currently manages four areas: Medical Services, Behavioral Health Services, Federal/State Support Services, and Federal/Program Improvement Review. 

Be sure to join us virtually to hear Liz discuss “CANS Assessments in the Texas Child Welfare System: A Road Trip” on Friday, November 13th, 2020 from 11:50 – 12:35PM EST during our TCOM 2020 Cloud Gathering Conference.

Speaker Spotlight: Charlane Oliver

Charlane Oliver, co-founder of the Equity Alliance

We are very excited and honored that Charlane Oliver will be using her voice to present at our TCOM 2020 Cloud Gathering Conference!

Hailed as a “Now Generation Activist” by The Tennessean and a 2019 Woman of Influence by the Nashville Business Journal, Charlane Oliver is an award-winning community advocate, respected movement builder, public relations strategist and rising star among Music City’s political scene. She is the co-founder and executive director of The Equity Alliance, a nonprofit that works to build political power among black voters and end voter suppression in a state with one of the lowest voter participation rates in the nation.

As a trusted voice on voting rights issues, her work has been featured in The New York Times, The Washington Post and throughout Tennessee. She has graced the coveted stage at the inaugural TEDxNashvilleWomen and has been a featured guest on various local television broadcasts and national podcasts.

Her organization led a statewide coalition that registered 91,000 Black and brown Tennesseans to vote for the 2018 midterms, increased Black voter turnout by 413 percent, and was responsible for endorsing and electing the most diverse and progressive Metro Council in the city’s history.

Previously, Charlane served as the community liaison and on the communications team for U.S. Congressman Jim Cooper, where she led one of the most successful voter registration initiatives in Congress called Project Register.

With over 15 years of professional experience in nonprofit management, civil service and communications, Charlane has garnered numerous accolades and awards. A native of Little Rock, Arkansas, Charlane has a bachelor’s degree from Vanderbilt University and holds a Master of Public Administration from the University of Tennessee-Knoxville.

Be sure to join us virtually to hear Charlane for our Master Lecture on Wednesday, November 11th, 2020 from 11AM – 1PM EST, and Roundtable from 3PM – 5PM EST on November 11th during our TCOM 2020 Cloud Gathering Conference.

Keynote Spotlight: Meet Dr. Michael Cull

Michael Cull, PhD
Michael Cull, PhD

We are ecstatic that our own Dr. Michael Cull is joining us for the TCOM 2020 Cloud Gathering Conference!

Dr. Michael Cull is an Associate Professor in the Department of Health Management and Policy at the University of Kentucky. His work focuses on quality improvement and system reform efforts in child welfare jurisdictions. Dr. Cull has specific expertise in applying safety science to improve safety, reliability, and effectiveness in organizations. His approach leverages tools like organizational assessment and systems analysis of critical incidents, including deaths and near deaths, to build team culture and help systems learn and get better.  

Attendees who tune into Dr. Cull’s presentation will leave with the following knowledge:

  1. Understand systemic threats to workforce wellbeing   
  2. How an approach to system-level resilience can support helping professionals 
  3. Specific strategies and tactics that support workforce resilience through collaborative work 

Be sure to join us virtually to hear Dr. Cull discuss “Reconsidering Resilience” on Wednesday, November 11th, 2020 from 11:50 – 12:35PM EST during our TCOM 2020 Cloud Gathering Conference.

Keynote Spotlight: Meet Dr. Khaled El Emam

El Emam, Khaled, Ph. D.

We are proud to introduce Dr. Khaled El Emam, and grateful he can join us this year for our TCOM 2020 Cloud Gathering Conference.

Dr. Khaled El Emam is a professor at the School of Epidemiology and Public Health at the University of Ottawa and a Senior Scientist at the CHEO Research Institute. He is also a co-founder and Director at Replica Analytics, which is a spin-off company from his research. As an entrepreneur, Khaled has founded or co-founded five other companies involved with data management and data analytics, and in many cases, these have been based on his research work. 

Previously, Khaled was a Senior Research Officer at the National Research Council of Canada. He also served as the head of the Quantitative Methods Group at the Fraunhofer Institute in Kaiserslautern, Germany. He held the Canada Research Chair in Electronic Health Information at the University of Ottawa from 2005 to 2015. He has a Ph.D. from the Department of Electrical and Electronics Engineering, King’s College, at the University of London, England. 

Attendees who tune into Dr. Khaled El Emam’s presentation will leave with the following knowledge:

  1. Explain what data synthesis is, how it works, and how to evaluate the quality of synthetic data. 
  2. Recognize use cases as well as data use and analysis scenarios where synthetic data can provide a practical solution 
  3. Recognize the typical messy data characteristics which make machine learning (and data synthesis) challenging 

Be sure to join us virtually to hear Dr. Khaled El Emam discuss “The Promise, Applications, and Challenges of Generating Synthetic Health Data” on Friday, November 13th, 2020 from 11:00 – 11:45AM EST during our TCOM 2020 Cloud Gathering Conference.

Keynote Spotlight: Meet Dr. Jei Africa

Dr. Jei Africa, PsyD, MSCP, CATC-V, Director of Behavioral Health and Recovery Services (BHRS) at the County of Marin

We are thrilled to introduce to you Dr. Jei Africa, one of our keynote speakers for this year’s TCOM 2020 Cloud Gathering Conference.

Dr. Jei Africa is an innovative thought-leader, strategist and clinician who is passionate about integrating effective culturally responsive practices into the core functioning of County health services.  
 
For over a decade, Dr. Africa served as the Director of the Office of Diversity and Equity with the San Mateo County Health System where he led agency-wide efforts addressing health equity that received State recognition. He spearheaded the development of the first-ever multi-disciplinary behavioral health LGBTQ+ community center, led the health system’s change efforts to enable the collection of SOGI data for all patients, and was instrumental in the opening of a transgender health clinic. Prior to that, he was Clinical Director at Community Overcoming Relationship Abuse and Manager of Youth Treatment Services at Asian American Recovery Services. In addition to his professional work, Dr. Africa was appointed to serve as a founding member of the San Mateo County LGBTQ Commission (2014-2017), and currently volunteers with Alliance for Community Empowerment (ALLICE), an all-Filipino organization that provides free education on healthy relationships (2007-present).  
 
Jei Africa holds a Post-doctoral Master of Science degree in Clinical Psychopharmacology, a Doctorate of Psychology in Clinical Psychology and a Master of Arts degree in Clinical Psychology from Alliant International University/California School of Professional Psychology. Dr. Africa received a Bachelor of Social Science degree from the University of the Philippines (Manila), in Behavioral Science.  
 
He currently serves as an adjunct faculty member at the USC Sol Price School of Public Policy and at the Mabuhay Health Clinic, a free student-run clinic affiliated with the University of California-San Francisco (UCSF). He was a member of the National Partnership for Action to End Health Disparities Regional Health Equity Council (RHEC) IX, previously served as a Senior Research faculty member at the California School of Professional Psychology at Alliant International University and a fellow with the California Health Care Foundation (CHCF) Leadership Institute. 

Jei was recognized as one of the 100 Most Influential Filipinos in the United States (2009), and received the California Statewide Cultural Competence Professional Award (2009) for his leadership, professional contributions, and service promoting health equity and cultural competence. He was celebrated as one of the 2012 LGBT Local Heroes by KQED and Union Bank at the Castro Theater. In 2015, the California Psychological Association awarded him with the Distinguished Humanitarian Contribution Award for his exemplary work in promoting equity and social justice. He received both the Health Equity Changemaker Award from the New Leaders Council of Silicon Valley and the Bay Area Municipal Election Committee (BAYMEC) Service Award in 2017.  

Dr. Africa is the first openly transgender county behavioral health director in the state and in the US. 

Attendees who tune into Dr. Jei Africa’s presentation will leave with the following knowledge:

  1. The psychological framework of radical hope as a tool to respond to current global crises 
  2. Narratives of social movements founded on love and justice 
  3. Understand the purpose and significance of storytelling and self-reflection as an essential leadership skill 

Be sure to join us virtually to hear Dr. Jei Africa discuss “Emerging from the Crisis: Radical Hope, Justice and Love” on Thursday, November 12th, 2020 from 11:00 – 11:45AM EST during our TCOM 2020 Cloud Gathering Conference.

Transitions: How does managed care use the Child and Adolescent Needs and Strengths (CANS) tool?

By: Barbara Ann Dunn, ACSW, LCSW, Director, Program Innovation and Outcomes, Magellan Healthcare

Transitions

Using Child and Adolescent Needs and Strengths (CANS) algorithms for access and transition decision support is particularly helpful when celebrating successes. It’s not always appropriate to use the algorithms to screen people for discharge from programs. Screening divides those who get certain services and those who don’t; however, it may not be appropriate for use in the same way for discharging. The CANS needs items get a youth into a program, while strength-building creates lasting progress. It is possible for a youth to be ready for discharge when they still have needs. If youth and their families have built coping skills and a supportive environment, they may be ready to leave formal services. We should celebrate that success.

At one point in our Louisiana program, half the youth discharging from wraparound still met the criteria for wraparound eligibility. This was not a failure to make progress; youth were making progress, and CANS scores were better at discharge, particularly in the area of increased linkage to natural supports. We took this as evidence of families and youth transitioning out of formal wraparound and having confidence in their own skills and natural supports, and needing less intensive professional supports.

The other side of the coin are youth in a program having a reassessment CANS and not meeting the criteria to continue in the program. Managed care makes a difference during this assessment, because care managers can include clinical information in the scoring and advocate for planned transitions.

A care manager in our Louisiana program compares the CANS to other material in the request for wraparound, such as the Independent Behavioral Health Assessment and other information in our clinical system. At times as the managed care organization, we have information in patient repositories the provider does not, such as data on a hospitalization, a crisis call, medications or even a complicating physical health claim.

Advocating for planned transitions throughout work with families and youth prepares them for the coming day. The best way to achieve this preparation is to build self-efficacy through intentional building of strengths. When the time for transition comes, whether to a lower level of care or less-intensive service, or to no formal services at all, family and youth confidence in their strengths is what will win the day. From our experience, if we use the greatest change in strengths as the most impactful for transition, we will focus on building the following for a successful planned transition:

  • Natural supports
  • Resilience
  • Resourcefulness
  • Optimism
  • Family strengths

A final note on transitions — in behavioral healthcare, a discharge from a program can be seen as a success. That may be purely based on utilization and length of stay and not on actual success. The CANS is a functional outcomes measure, i.e., it measures how a youth and family is functioning in real life. As value-based programming expands, the CANS will be used for evidence of discharge success. Let’s all embrace this. Managed care organizations value the work you do fully, and we cannot do it without measurement of functional outcomes.

We come to the end of this blog series. I hope you have a better understanding of how managed care should work in the behavioral healthcare system. I am not a spokesperson for all of managed care; I can only speak to what Magellan Healthcare has done and plans to do with the CANS. We all have functions in the behavioral health system, and we work best when we understand the reasons behind those functions, because at the end of the day, we have common goals and work better together.

Looking forward to seeing you at the TCOM Gathering in the Clouds Nov 11-13, 2020!

Barbara Ann Dunn, ACSW, LCSW

TCOM Conference Program Chair 2020

Appropriate and Effective: How does managed care use the Child and Adolescent Needs and Strengths (CANS) tool?

By: Barbara Ann Dunn, ACSW, LCSW, Director, Program Innovation and Outcomes, Magellan Healthcare

Appropriateness and Effectiveness

An appropriate service should be effective. These two Key Decisions are inextricably linked and are often the basis of medical necessity. Evidence-based practices assign a defined appropriate population and a set of measures demonstrating effectiveness and provide a good example of how the community at large and managed care can agree. More work may be required, however, to come to agreement on how the Child and Adolescent Needs and Strengths (CANS) is used to identify the appropriate population. In my first post on Access, I mentioned that in the best of all worlds, there would be two or three years of data on youth in a program using the CANS, the data could drive identification of youth with better outcomes, and then algorithms would be created for decision-making for youth access to programs. Matching a population to a service in managed care requires use of data to achieve meaningful outcomes.

One of the strengths of managed care is the capacity to collect, measure and analyze data. It is required for external reviews and accreditations, waiver applications and healthcare effectiveness. Using the CANS to identify appropriate and effective services for multisystem-involved youth should be standard in Medicaid managed care. Presentation of CANS data with other measures on provider reports and dashboards can be enabled by integrating CANS applications into existing systems and web portals. It would seem simple then to identify youth populations making progress with a level of care and prove treatment effectiveness. There are overarching populations in which we have been able to achieve such results, providing further validation of algorithms.

There are also times when specificity eludes the data, since “community-based” includes many interventions, and even “evidence-based practices” are at times practiced without fidelity measurement. Managed care relies on partnerships with providers and researchers to best understand effective treatment of youth populations. In one of our studies, we created a Family Functioning Scale and a Coping Scale with items across both domains. Both had a high correlation (Chronbach’s alpha) with a change in depression, at 0.89 on the Family Functioning Scale and 0.81 on the Coping Scale (where 1 is a perfect correlation or predictor of positive outcome).[1] It’s not clear what interventions were used with the families, but it is clear those interventions helped the families improve functioning and the youth reduce feelings of depression.

Which brings us to the final proof of appropriateness and effectiveness: the effectiveness for individual youth.

On an individual level, managed care looks to service providers to identify the salient needs and strengths in the plan of care. This could occur when a care or treatment plan is authorized, during wraparound coaching or as part of an audit process. One practice for Magellan Behavioral Health of Pennsylvania is a mid-treatment review. The paired CANS and treatment plan are reviewed with the treatment team to consider effectiveness. Without the pressure of authorization, the care manager and treating provider can use the CANS to focus on the individual and family needs, including the clinical formulation, i.e. the theory behind the CANS score. Managed care looks at the evidence of CANS use for clinical formulation. It is a care manager’s joy when the CANS is used well in the clinical formulation, because most of them were once providers and came to managed care to make a difference on a broader scale.

For the most part, the Pathways Model, with items mapped as pathways, targets and outcomes, has been the most advantageous model we’ve seen. It fits well in many treatment plan formats, allowing providers to use their own treatment plan templates. The Pathways Model (Figure 1) nestles comfortably into a functional behavioral assessment approach. The structure works for the novice CANS clinician as well as for the advanced. A wonderful description of this model in case conceptualization can be found in the Praed Foundation training archives “PsychoCANSalysis”.[2]

Figure 1: Types of Needs Based on the Pathways Model2

The Foundational Why Wheels (Figure 2) tool has been of particular assistance when a team is unable to sort out the pathways, targets and outcomes.[3] In this model, the most pressing needs are determined by brainstorming for drivers of these needs. The top two or three pressing needs each get a Why Wheel. CANS items are then mapped to the behavior and drivers. The resulting map of drivers reorients the team to targets of intervention and outcomes expected. When laid out visually as drivers, a compelling picture can help a family connect actions to reactions and causes to effects. The model as used by Multisystemic Therapy has a well-established track record.

Figure 2. Foundational Why Wheels3

Standardized assessment is an established best practice for measuring appropriateness and effectiveness. The CANS in practice excels at both. When the practice is done well, youth and families flourish and successfully complete their programs. We will look at this in the final blog on Key Decision 5, Transitions.


[1] Dunn, B. (2015) Lessons Learned: The TCOM Partnership of Funder, Manager Care, and Provider. TCOM Conference Presentation. Nov 2015

[2] Fernando, A.D. (2013) PsychoCANSalysis: Making Room for Case Conceptualization in Treatment Planning with the CANS. 9th Annual CANS Conference. Retrieved from TCOMTraining.com.

[3] Cardenas, J., Fernando, A.D., & Hilley, L. (2014). What, Why, and How: Collaborative Treatment Planning. 10th Annual CANS Conference, Chicago, IL. Nov. 13, 2014.

TCOM Annual Conference: Group Rates Available

Meeting Each Other Where We Are: Collaboration in a COVID-19 World

Group rates are available for this year’s virtual conference (November 11th-13th, 2020)! Save 30% off the All Access Pass when you register a group of five people or more. Feel free to reach out to us at communications@praedfoundation.org for details.

For registration and to view the conference agenda, please click here.

TCOM Annual Conference: Early Bird Registration Extended!

We’re extending Early Bird ticket sales to September 13th! Regular registration will begin at 12:00am on Monday, September 14th.

Our conference will be virtual this year, and continuing education credits can be awarded. You can find our registration site and draft conference agenda here.

We hope you’ll join us!

–The TCOM Team

From Access to Engagement: How does managed care use the Child and Adolescent Needs and Strengths tool?

By Barbara Ann Dunn, ACSW, LCSW, Director, Program Innovation and Outcomes, Magellan Healthcare

Engagement

In my last post we looked at Key Decision 1 (Access) and how managed care uses the Child and Adolescent Needs and Strengths (CANS) to enable access to services. Key Decision 2, Engagement, is about bringing people from access — opening the door — to becoming equal partners in the helping system.

Engagement is built on respect and understanding that youth and family are experts in their own lives and need to captain their own ships. Engagement uses a fully person-centered discovery and planning process. Person- and family-centered treatment planning is a collaborative process where care recipients participate in the development of treatment goals and services provided, to the greatest extent possible.[1] We can all agree the principles of wraparound or Child and Adolescent Service System principles; managed care has a specific, although sometimes unwelcomed role.

Managed care organizations (MCOs) are tasked with operationalizing engagement. This can sometimes look like a checklist rather than family-driven care, as operationalization includes timeframes and standards for everything: forms, consents, plans, child and family meetings, authorization, and even how often helpers and family are required to meet. Figuring out how to balance competing demands of engagement and the activities required for services requires a tremendous amount of consideration and care. Fortunately, the CANS offers a place where engagement and operationalization converge.

The CANS anchor items help to operationalize and engage through a common language that is easy to understand, providing scalability for action, and enabling transparency necessary for family-driven planning. Transparency is at the heart of truth-telling, i.e. rating CANS items accurately; respectful truth-telling enables powerful family-driven planning. The common language helps with this:

  • A needs definition is one of the following: no need, prevention, action or action right now.
  • A strengths definition is one of the following: a centerpiece strength, a useful strength, a strength to be built or no identified strength.

The CANS asks the hard questions and opens the door for families to explore the answers together. Sometimes, a standardized assessment uncovers what a family cannot articulate without being prompted by the right questions. When family members voices are heard and accepted, engagement is possible.

Engagement stems from creating a shared vision, and a shared vision needs a shared language. The CANS socializes the language of needs and strengths, functioning, and action across family and systems. A skilled facilitator will use the CANS in the background while assessing needs and strengths, and the family and youth self-assess on relevant items using the anchor items. In the Magellan of Wyoming Care Management Entity, the strengths, needs and culture discovery (SNCD) is the first step in the wraparound process, creating a shared vision with the family and youth.

If you’re wondering which comes first, the SNCD or the CANS – the SNCD, or the family and youth story in their own words, always comes first. Then, the family care coordinator introduces the CANS language on needs, strengths and action-based scoring. This facilitates consensus and understanding of needs and strengths, plan steps, and desired outcomes. The group can then work together to develop the plan of care.

Just using the CANS is not enough. When a facilitator discusses CANS ratings with the family, a guide booklet that defines the process and terms can help the family validate the ratings. This helps create transparency, but it is only the beginning. I recall one provider years ago completing the iconic paper bubble form in pencil after reviewing the referral material. When he met with the family, he gave them an eraser and allowed them to rescore anything they didn’t agree with. That eraser was a powerful tool for engagement.

Sometimes tension accompanies disagreement, and when there is disagreement, there is no shared vision. This may be an indication that the family is not ready to engage. The CANS facilitator is trained on how to recognize readiness for change and approach differences in ratings. Family desires or their readiness to engage can come up against operational requirements which may involve certain CANS scores for eligibility or timeframes to be met. MCOs should have care coordinators assist when the engagement process is derailed by the operationalizing of engagement.

In some cases, the operationalizing of engagement must be modified based on what happens through actual engagement. The engagement process, including the initial CANS and first plan of care, for the Magellan of Wyoming CME was originally operationalized to 30 days based on waiver requirements. For many families who needed immediate crisis assistance, 30 days was not enough time to complete all the tasks of engagement. Authorizations were at risk. Providers and families were stressed. Magellan Healthcare proposed re-operationalizing engagement to better match the phases of wraparound with a different payment model. Magellan would pay for a 14-day “pre-engagement” period, rolled into waiver rates, and the waiver tasks of engagement would be sequentially stretched to 46 days for the SNCD, CANS and plan of care. In all, the tasks of engagement would be allocated 60 days, better matching the wraparound phases. To test if this improved the rates of families engaging, we tracked disengagement. Family engagement was baselined at 16% disengaged and tracked quarterly, revealing a range of 13%-16%. CANS tracking additionally demonstrated increased needs identification and quarter-over-quarter increases in youth showing improvement (historically 50% and tracked quarterly ranging from 51% to 64%).

Proper operationalizing of engagement allows for family and youth to participate as fully as possible in using the CANS for reflection, self-advocacy and self-direction. From there, how do we link family and youth to appropriate and effective services? In my next post, we will look at Key Decisions 3, appropriate services, and 4, effective services.


[1] https://www.samhsa.gov/section-223/care-coordination/person-family-centered


Different Models using the CANS with Family Support and Advocacy

By: Janet Hoeke, Founder and Owner of WillowTree Mosaics

Recently a friend asked me to join their Wraparound care coordination team as part of the child and family team in the role of family support. The CANS wasn’t used in Idaho when my child was dealing with his serious emotional disturbance, so this was my first exposure to a process I have been advocating for over the last 4 years. Joining this team, I had only an advocate’s notion of what to expect.

I have become close with this family and have come to admire their tenacity, love, and welcoming spirit. There are 8 children, three are adopted, and of the 8, three have significant physical, mental and/or emotional challenges. My “support” for the family has often felt more like listening helplessly and praying for answers I couldn’t supply. When one child’s emotional disturbance peaked last year, tumbling the family into crisis, I sat with them in the hospital, helped them figure out what documents they needed, advocated for alternatives other than discharge back to the home with no supports, and helped them process the onslaught of information, differing opinions and navigation of a system of care that was still being implemented.

This year, their needs are different. Life happened and not just COVID-19 issues. Their entire HVAC system, washing machine, and handicap accessible van all died, permanently, in the span of a couple of months without the financial resources to replace them. These are not the things I had the ability to fix either.

These challenges would never have come up in the system of care I experienced with my son as the old system was solely focused on “what’s wrong with your child” and how to we “fix” them. So, I was pleasantly surprised when the Wraparound coordinator brought up the family’s needs at our very first meeting. This was a real acknowledgement that no single individual has the answers to help this family navigate these intense needs – especially with the temperatures set to soar into the 100s in the coming weeks, but that together we could collaborate, acknowledge that the child’s needs are not the only needs that impact the child and family’s ability to heal, and there is strength in our process. 

Within a week, we had accessed a donated washer, picked it up and delivered it to the family, and found an HVAC company willing to go take a look at the problem and at least partially fix the HVAC system so one child wouldn’t experience additional health issues due to the heat. We don’t have a solution to their transportation issues yet, but we are still working on it. Did these things therapeutically impact their child’s needs? No, not directly, and I dare say, in the past model I experienced with my child, these family needs that have a dramatic impact on a family’s ability to provide care and support and manage their own emotional health, would never have been acknowledged, or identified, much less addressed. Were they therapeutically important anyway? Yes, they were.

Experiences like this are taking place all across this country and our world thanks to the CANS. At this year’s TCOM virtual conference, we are having a roundtable discussion on “Different Models using the CANS with Family Support and Advocacy.” We are all at different stages of incorporating family support, peer support, and advocacy, and our models for discussing the child’s and family’s needs and strengths are very different.

In preparation for the roundtable we have discussed successes and challenges of using CANS data within a peer model to drive services without crossing the line into “what you aren’t supposed to do” in your role. What barriers are there to successful family/peer/advocacy roles with the CANS and teaming. How do funding mechanisms, value-based decision making, different models of family and peer support partners, and identification of the various roles in the teaming process impact outcomes for the child and family? What do you do when a member of the team throws down credentials or some other “fact” to overpower another team member?

As facilitators of this year’s roundtable discussion, we are curious about your experience and we would love for you to take a quick couple minutes to fill out a survey that will help set up the conversation we will have at our roundtable.

We hope you will join us at this year’s TCOM virtual conference November 11-13.

TCOM Annual Conference: Early Bird Registration Now Open!

Meeting Each Other Where We Are: Collaboration in a COVID-19 World

We hope you’ll join us for our virtual conference on November 11th-13th! Connection is more important now than ever. We look forward to our community coming together. Early bird registration is now open, and continuing education hours are available (if seeking CEs, please add this to your registration when prompted).

We hope to “see” you soon!!

How does managed care use the Child and Adolescent Needs and Strengths (CANS) tool?

By: Barbara Ann Dunn, ACSW, LCSW, Director, Program Innovation and Outcomes, Magellan Healthcare

The Child and Adolescent Needs and Strengths (CANS) is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. I am often asked “How does managed care use the CANS?” Those of you who ascribe to Transformational Collaborative Outcomes Management (TCOM) likely recognize that managed care plays an increasing role in using clinical decision support tools and value-based programs The CANS offers a common language to look at resource needs and make the balancing of resources more transparent.

John Lyons frames the use of the CANS as part of “Five Key Decisions:” access, engagement, appropriateness, effectiveness and transitions. This framework on CANS use may be helpful for understanding how managed care uses decision support tools, and the CANS in particular, as the CANS has bonus options beyond the usual clinical decision support tools. With this and upcoming blog posts, I’ll discuss each of the five key decisions. This first post on the Access dimension of the Five Key Decisions will not only demystify managed care, but also help you to advocate for the transformational system that youth and families need.

Access

Access refers to screening for a target population, such as using CANS algorithms for matching needs to services. This identifies youth who will benefit from a certain level of care or service, as well as those who will not. We know from early research that youth with lower needs than the level of care is designed to address, such as residential, will have poorer outcomes.[1]

When it comes to using the CANS as an eligibility tool for 1915 Medicaid waiver eligibility or services, there are apprehensions. Do service gatekeepers using the CANS over-report needs? With 11 other wraparound programs, Magellan Healthcare joined the national analysis led by the University of Washington that addressed this question. Systems using the CANS for eligibility did report more needs than systems not using it for eligibility. However, an independent care manager audit found under-reported needs when compared to the needs identified in the standardized Independent Behavioral Health Assessment tool. In other words, the gatekeepers were not found to be over-reporting needs nor focusing on meeting the eligibility algorithms, but on assessing the youth and family needs and strengths. This is the right thing to do.

In the best of all worlds, there would be two or three years of data on youth in a program using the CANS before anyone creates or uses an algorithm for targeting access. That data would drive identification of youth with better outcomes. Then, algorithms would be created for decision-making on youth access to programs. Unfortunately, that can take more time than the funding permits, particularly when a Medicaid Waiver requires an eligibility tool from the start.

Sometimes the algorithm is borrowed from other states, then stakeholders consider the target populations along with the CANS items, and the result is put into waiver or program requirements. This happens before the managed care organization (MCO) is involved. Usually, there is a request for proposal process that multiple MCOs respond to with their solution for the requirements set forth in the waiver and program design. The state or jurisdiction will select the proposal best meeting the rubric set forth. The selected MCO then implements the program based on the waiver and other state requirements but doesn’t often have input into the algorithm creation.

The MCO can, however, validate that an algorithm is capturing the target population using the CANS profiles, outcomes data and other information about youth in the program. This data is then presented to the state or jurisdiction to discuss potential changes to the algorithms.

One Magellan experience with the algorithms in Louisiana followed the process above, yet youth were not being fully identified for the high-risk waiver. Investigation of the CANS data found that the youth with the highest risk of inpatient and residential services were actually two populations, and one was being missed in the high-risk algorithm. Using the CANS profiles of youth at actual high risk and demonstrating that this new algorithm met the Louisiana regulations for youth at risk of inpatient services, Magellan proposed a second algorithm using select CANS risk items at a level of a 3. The state brought the justification to the Centers for Medicare & Medicaid Services, which approved. As youth were reassessed, they were screened into the high-risk waiver.

MCOs, with their advanced analytics capabilities, can provide valuable insights to state and local agencies to inform ongoing adjustments to algorithms to ensure that youth have access to the appropriate level of care.

In my next post on the second Key Decision, engagement, we will discuss moving people from access to being “equal partners in the system” (John Lyons). Check back soon.


[1] Lyons, J.S. & McCollough, J.R. (2006). Monitoring and managing outcomes in residential treatment: Practice-base evidence in search of evidence-based practice. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 257-251.

Voice to Vote

By: the TCOM Team

Let’s all vote and help those who need our help to vote as well. Everyone should have a voice in creating our national shared vision.

Over the past decade, a many of us have participated in a number of strategic planning processes that played off 2020 representing perfect vision (e.g. Vision 2020).   Frankly none of those planning exercises anticipated the three crises that now confront us—a deadly pandemic, the resultant economic collapse, and a tragic and dramatic awakening of how far we need to go to achieve racial justice.  We find ourselves in a moment unlike any that we have experienced before.   

An important focus of the TCOM group is the use of collaboration as a core component of creating a shared vision to guide our work.   In the U.S. democracy, collaboration and visioning begins through all of us exercising our civic duty to vote.    This is one important way for ALL of our voices to be heard.   While no single vote may make much difference, the collective vote establishes a great deal about the direction that we take as a state or a nation in solving problems.

Although there is not a lot of science addressing these issues, we believe that a large percentage of people who work in the helping sectors (and might be reading this blog) already routinely exercise their right and responsibility to vote.    For example, Mizrahi and Abramowitz recently opined that ‘Voting is Social Work’   in discussing the National Social Work voter mobilization campaign:

Sadly, many of the people we help are much less likely to vote. In some states, there are barriers for some people with mental health challenges or criminal histories to vote, but these barriers are not consistent across states.    Sometimes these barriers are a form of voter suppression. The people we help may need our help in overcoming these barriers. We think collectively there are things that we can do.   

If you are a behavioral health provider, the National Voter Registration Act of 1993 requires provider agencies to make voter registration opportunities available at the time of enrollment in care, renewal of care, or if the individual has changed addresses.

Given housing instability among those we serve, it is important to remain diligent to this barrier to voting.

RESOURCES

There are resources that can help us help.  The National Alliance of the Mentally Ill (NAMI) offers very useful information about the laws in each state.

The following sites can help with felony disenfranchisement. 

The American Bar Association provides resources for people with disabilities, minority voters and adults under guardianship.   

Additional resources include   NAACP Voter Registration  and When We All Vote 

WHAT TO DO:

The first step of course is to register.  A great resources is Vote.org 

Here you can found out whether you or someone you are working with currently registered and, if not, they can register through this site.    You can also use this site to request an absentee ballot to allow them to vote by mail if that is their preference and available in their state.

We are asking that each of us at our local level who are working with individuals with behavioral health challenges or adults with children in the foster care system, or young adults who are transitioning out of care.    Perhaps someone on your agencies staff can facilitate voter registration and assist people in knowing when and how to vote when that time comes.

Many states require advance registration to participate in future elections so now is the time to begin to make sure everyone is registered to vote.    We realize that for some absentee and vote by mail approaches have been politicized, for us, it is simply a matter of public health.    Many people we serve have co-existing conditions that place them at particular risk from covid-19 infection.   In addition, BIPOC people are more likely to have polling options reduced resulting in longer lines.  Personal safety during the pandemic is a priority for all of us.

If you have ideas or strategies that you develop or are using, please share so that we can learn from each other how to ensure that everyone has their voice in our democracy.

A TCOM Virtual Town Hall with John Lyons

By Kenneth McGill, Senior Training and Consultation Specialist from Rutgers University

On June 30th New Jersey Children’s System of Care held a 2-hour Town Hall style webinar with Dr. John Lyons, developer of TCOM, who provided answers to questions from system partners on the CANS Tools (i.e., SNA, CAT, & FANS). In addition, Dr. Lyons shared the work being done at the University of Kentucky as Director of The Center for Innovation in Population Health.

Click here for webinar (password: yJTJfTX7)

Post-COVID 19 Planning Strategy-As we SIFT through the impact of this worldwide traumatic event-We must support school-age children/youth towards HOPE.

By: Kenneth McGill, EdS LMFT

Kenneth initially wrote this blog in early June. We find his words ring just as true today, as America continues to respond to the pandemic and the racial inequities laid bare and necessitating both a shared vision and transformation.

Like many it only took me a few weeks to recognize the immense impact spreading across my local community, the state, country and throughout the world. Now, as a mental health professional, I began viewing things through a trauma lens as it became clearer that individuals, families, schools, organizations …basically every system having been traumatically impacted. The most vulnerable of the groups were those children/youth who were already affected by abuse, neglect, substance use and/or poverty. School for many of these children/youth was the only ‘safe haven’ as highlighted so well in the article ‘COVID-19: Athlete Impact, The Real Miami’ written by Udonis Haslem of the Miami Heat basketball team. 

Schools closing here in New Jersey has impacted 1.3 million school-aged children/youth in ways similarly described by Haslem. The more than 580 school districts throughout the state shifted instruction to online platforms, which was an amazing feat in and of itself, attempting to ensure that students had access to a computer and the internet. Internet providers along with others began to offer reduced or free access to Wi-Fi so as to bring as many students to their new virtual learning world. Many school districts continued to offer breakfast and lunches to students. We as a community began to do the best we could in spite of the extraordinary circumstances.  

Even though four months have passed and some states have begun to move from sheltering-in to the ‘restart’ there is still a real need to fully comprehend the immense scope of the trauma. As Rebekka Schaffer (Workforce Development and Conference Coordinator, Center for Innovation in Population Health) wrote so eloquently in her recent blog ‘Unprecedented Transformation’ we have an opportunity to move away from the status quo to make meaningful systemic and transformational changes as we move forward. Expanding upon the powerful sentiments written by Rebekka we must first deeply understand the Systemic Interfunctional Trauma (SIFT) of COVID-19 the worldwide pandemic.   

If we accurately want to discovery the ‘what’ connected to COVID-19 using a communimetric perspective it will only make sense if it takes place within a Systemic Interfunctional Trauma (SIFT) context. There needs to be an understanding from the context of the inter-dynamic nature of systems directly impacting children/youth, families, communities, states, countries and the world. It is with this deeper understanding that the needs of that child/youth will become clearer after such unprecedented events connected to COVID-19. Then as a ‘team’ we can more effectively assist in transformational planning. However, we must additionally recognized that all team members including their family, school, and community have also been significantly impacted. It will be with this deeper understanding that systems partners-schools, communities and government officials-meaningfully develop a ‘shared vision’ so that all children/youth and families can be best served moving forward in our post-pandemic world.  

So how can we help children & youth now? There are four concrete strategies which we all can use to help support and reassure our young people-listen, observe, assess and engage

As learned from the Adverse Childhood Experiences or ACEs research studyearly traumatic life events can have a tremendous impact on someone’s future physical, emotional and psychological health. The simple act of listening to a child/youth so that they can be both heard and understood can be paramount in managing the impact of ‘social distancing.’ According to the Center on the Developing Child at Harvard University2 building connections or connecting children with other people, schools and communities not only helps to build their support system but will support their development of resilience.  

Many children/youth after being home and ‘sheltered-in’ have disconnected socially with not only their peers but also with non-related adults. Active observations of verbal and non-verbal interactions can give us a window on how they are doing expressing themselves. A possible outcome of social isolation may be the struggle to reconnect with others, including lack of eye contact, tone of voice and an overall change in body language/posture. When we see this change adults can support them with reassurance and patience. Modeling positive interactions and communication for our children/youth provides examples that can speak louder than most words we may use. 

If they and their families have experienced drastic changes in their lives we must assess specific needs-a valid and reliable communication tool used throughout the United States, Canada and the world is the Child Adolescent Needs & Strengths or CANS tools3. The CANS is an open domain and free to use multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. Since the CANS was developed from a communication perspective it is easy to use and understand which makes it well liked by youth, parents, providers and other partners including schools.  

We must engage various stakeholders or systems throughout the restart Post COVID-19. There will be phases or stages outlined by local, state and federal departments-including education, health, legislative and public safety as we move beyond the sheltering in state where all have been for the past three months. The lack of communication will increase fear while strengthening the silos that we as a society have fostered for many decades. Instead we all must take an active role at the ‘table’ in order to prevent a disastrous outcome, not only including the resurgence of the virus but the ability to plan for everyone’s ‘new-normal’ to positively impact every home, school, community and our country. 

This will be our starting point for intersecting mental health in the weeks, months and years ahead of us in the planning for a ‘restart’ in a post-pandemic world. It will also increase everyone’s sense of hope. Somnieng Houren, a former Cambodian monk (Harvard University graduate) shares his personal story of survival, why he believes HOPE is the most powerful force in the world. Gaining optimism allows the human spirit to regain the ability to redefine our future. It is with this social-emotional reconnection that the seed of optimistic planning will take hold in coming to an understanding of the tremendous losses experienced by our young people.  

References:

  1. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8 
  1. Ginsburg, K. R., & Kinsman, S.B. (2014) Reaching Teens: Strength-based Communication Strategies to Build Resilience and Support Healthy Adolescent Development. American Academy of Pediatrics. 
  1. Child Adolescent Needs & Strengths (CANS) John Praed Foundation (2020) https://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/ 

About the Author:

Kenneth McGill, EdS LMFT is a licensed Marriage & Family Therapy- Clinical Fellow with the American Association of Marriage & Family Therapy (AAMFT) for over 20 years and President of New Jersey Association for Marriage and Family Therapy-Independent Affiliate (NJAMFT-IA). He is also a Senior Training Consultation Specialist in the Behavioral Research Training Institute with the University of Behavioral Health Care at the Rutgers University-serving the New Jersey Division of Children’s System of Care in New Jersey. As a published author and researcher, Ken is the recipient of the Praed Foundation’s Outcomes Champion Award for work done to improve the quality of care for youth & families, especially in the area of increasing ways to collaborate with and empower individuals/families dealing with challenges.  

TCOM and the Post-Truth Culture: The Fourth Monkey

By: Dr. John Lyons

Much has been said about our current cultural moment… where it appears truth does not matter to a large segment of our population.  All that matters is ‘winning’ and if winning requires you to provide inaccurate or misleading information, then it is just another strategy to ‘win’.

This cultural belief system, of course, represents an existential crisis for all of science and, of course, TCOM as well.   If truth doesn’t matter in social services then we should all just claim we are doing a ‘perfect’ job and that everything is great, and there is no need for accountability because we can’t get better than our current performance.   I suspect we all know this way of thinking is dangerous nonsense, but it has led me to think about how we can characterize this problem.

We are all familiar with the three monkeys:  ‘See no evil’, ‘Hear no evil’ and “Speak no evil”.    These three monkeys represent strategies to pretend that something bad simply does not exist.   If you don’t see it, you are not responsible for doing anything about it.   If you don’t hear about it, it does not really pose a problem.   If you don’t talk about it, it will go away, and no one will notice.  

Clearly we now experience a fourth monkey: “Reframe evil” … If something bad happens, let’s just spin it into a positive or come up with a way to blame others, so we have no responsibility for it.


Artist credit:
Isabelle Bisnaire

At the Praed Foundation and the Center for Innovation in Population Health, we feel strongly we are better than that.    We can never learn to be more effective if we cannot accept our imperfections.   We learn far more from our failures than from our successes.   If we always pretend we never make mistakes… we are simply cursed to continue to make them.  The only difference between people who succeed and those who fail is that people who succeed fail more.   If we are truly going to improve the helping sector we have to understand both what we do well and where we need to do better.

In that spirit, we self-reflect on the shortcomings that we, as the TCOM team and field, need to improve.

  1. Better instruction and coaching on how to employ TCOM tools in a fully collaborative manner.
  2. Aligning the initial certification process to more closely match the actual work experience of completing the tools.
  3. Supporting people in developing their abilities to learn from data collected by the TCOM tools.
  4. Translating the good work into the academic research literature to help our academic partners understand the power and utility of the approach.

Moving forward we commit to working with all of you to address our shortcomings.

Transformational Relationships in a Pandemic

By: Cinthya Chin Herrera, PsyD

Across the country, most states have joined the the remainder of the world in moving nearly every aspect of our society into digital spheres.  In the Bay Area, many service providers have begun exploring the intricacies of working from home. At times this has meant connecting with kids, teens, families, and adult clients remotely through phone, video, or other telehealth modalities, and often in the context of new evolving demands from families and our communities.

With the call to action for many providers to maintain the continuity of care for essential services, we find the need to re-balance ourselves and move beyond the technology challenges and general uncertainties to fully ground ourselves in values underlying the CANS–collaboration and client care.

Our clients thrive when they feel safe, seen, heard and helped. This calls on us to be there–not to fix, but to provide the containment to hold all the new needs and strengths that are arising with these changing circumstances.  The ability to maintain a transformational relationship in the context of a pandemic is founded on the ability to provide clients a steady, authentic presence in a sea of unknowns, and to commit to their care, understanding that in times like this, your services are needed more than ever.   

Social distancing does not need to mean social isolation. But it does mean that we have to be intentional about connecting. While we may not be able to provide quick fixes or cures to the pandemic, our presence holds healing and transformative power. Remember, there is value in maintaining and tending to those relationships, innoculating against fear with accurate information, and reminding families that we are still committed to their transformational change and intend to still see them face-to-face when this is all over.  

To download a free, recent webinar by Drs. Lyons and Fernando about completing the CANS and ANSA during this time of social distancing, click here.

Collaborative Assessment in the “New Normal”: Completing the CANS and ANSA via phone

Drs. John Lyons and April Fernando recently recorded a webinar on the use of the CANS and ANSA in non-face-to-face modalities (e.g., telephone). Texas was kind enough to let us share it. Download the webinar for free at the link below:

Stay safe and well.

— TCOM Team

Using CANS Items to Define Child Well-Being and Study Child Welfare Outcomes

By: Dr. Amy Zimmerman, Casey Family Programs

Casey Family Programs (Casey) believes that every child deserves a safe, supportive, and permanent family. Casey works urgently and relentlessly with our target service population of older youth to achieve permanency so that no child will age out of Casey foster care. We believe building, or rebuilding, family is central in our practice and embodies our core values of Family-Centered Practice. Casey is also committed to becoming a learning organization and we regularly engage staff at all levels in the organization in the analysis and application of data so that we can improve the quality and consistency of our outcomes. From Data to Practice is a continuous quality improvement series that represents a learning opportunity driven by overarching questions from the field. We believe that:

  • Every youth and family that walks in our doors is a test of our system.
  • Those that exit teach us about the quality, effectiveness and efficiency of our system.
  • Those who are yet to come represent an opportunity for us to improve.

The focus of From Data to Practice is the quality of practice and achieved outcomes across all of Casey’s Child and Family Services. It also seeks to connect front-line staff with their own data. Staff propose the question and then identify the next steps to be taken based on the evaluation’s results.

In volume 2 of our From Data to Practice series, we explored the impact of placement with relatives versus placement with non-relatives on youth safety, permanency, and well-being. The target population was 436 youth who entered Casey out-of-home care between July 1, 2014, and July 1, 2015. Data were analyzed in July 2017, allowing for two years of tracking outcomes.

Findings

Well-being

More time placed with family while in out-of-home care is associated with better youth well-being, including school achievement, health, and optimism (at most recent assessment).

Child welfare does not use a standard, agreed-upon definition of youth well-being. Because there is no agreed upon definition, Casey staff and leadership were interviewed about how they defined youth well-being. Themes from these interviews fell into four categories: Education Physical and Mental Health, Social Development, and Culture. Within these categories, certain indicators were repeatedly mentioned. These indicators were then aligned with individual items on Casey’s CANS assessment.

We calculated the sum of actionable items (areas where help is needed to improve youth functioning) for the most recent assessment. Youth’s most recent CANS assessment corresponded to either their exit CANS, if they had exited Casey out-of-home care, or their most recent CANS as of July 1, 2017 (the end of the study period). Youth who spent more than half their time placed with family while in out-of-home care had fewer documented well-being challenges (an average of 1.25 actionable well-being items), compared to youth who spent less than half their time placed with family while in out-of-home care (an average of 1.94 actionable well-being items). More time placed with family indicated better youth well-being in school, mental and physical health, social development, and cultural identity.

Legal Permanency

The more time youth spend placed with family while in out-of-home care, the more likely they are to obtain legal permanency.

Youth who spent more time placed with family had higher legal permanency achievement rates, and the percent of youth who achieved legal permanency went up in a step-wise fashion as the amount of time placed with family while in care increased. For example, 38 percent of the youth who spent no time placed with family achieved legal permanency compared to 83 percent of the youth who spent all of their time placed with family.

Time to event analyses were completed to assess the time it took youth to exit to legal permanency. Comparisons were made base don the amount of time youth spent in out-of-home care placed with family. Results indicated that  1) Youth who spent 100% of their time placed with family while in Casey out-of-home care exited to legal permanency significantly faster and at a higher rate than those who spent less than 100% of their time placed with family while in care 2) Youth who spent 51-99% of their time with family in Casey out-of-home care exited to legal permanency significantly faster than youth who spent 50% or less of their time in care with family.

What we can do

This research provides important insights into how to approach practice in the future. This research furthers understanding of how our values affect outcomes among the children and families we serve and affirms Casey’s belief that families and cultural relevance play a central role in the decision-making process

We Recommend

  • Persevering in engaging youth and caregivers in conversations about what well-being means to youth and families.
  • Persisting in exploring youth identity and belonging, and their relationship to well-being.
  • Examining licensing requirements for kinship caregivers and exploring ways to simplify and expedite the process.
  • Persevering in engaging families, including advocating for and elevating the voice of birth parents.
  • Persisting in challenging bias against birth families, including those who have previously had their parental rights terminated.
  • Continuing to use and incorporate family group conferences or other family-centered teaming techniques as a practice strategy to elevate relatives’ voices, create a space for the relatives to develop their own plan, and break down power differentials.

Please visit: https://caseyfamilypro-wpengine.netdna-ssl.com/media/1896-CS-From-Data-to-Practice-2018.pdf for the full From Data to Practice vol. 2 report, which includes more detailed analyses and findings.

Note: Time with family is defined as the number of days in Casey out-of-home care spent residing in a trial home visit, relative placement, or placement with fictive kin. These days were divided by the total number of days in care for that youth (creating the percentage of time placed with family).

Caring for Each Other…The CANS Can Help

By Ken McGill, Eds, LMFT, Rutgers University

The impact of the coronavirus, now labeled a pandemic, has been worldwide. If we take a moment, we will see that there has been a change in daily life; this is true for individuals, couples, families, agencies, institutions or any other entity throughout our planet.

I am sure that many of us are feeling overwhelmed, frightened, angry and unsure about what tomorrow has in store for us. As I am writing this blog entry I can honestly tell you that I am feeling all the above! There have been many things written on the internet, appearing on television and even in shared conversations with others about how we can stay safe and prevent the spreading of the virus. Although this is extremely important, I feel that there is something missing in all of this…that is how we can stay connected to others.

We are being told to abide by ‘social distancing’, which is an appropriate strategy to stay physically healthy. However, for many people on this planet social isolation has disconnected them from interacting socially with others. This aloneness can greatly affect someone emotionally, psychologically as well physiologically. Aloneness can lead to hopelessness and helplessness for those who may have already been disconnected from human interactions.

It is so important that we all stay connected and interact with each other daily-either face-to-face (with some social distancing of course), video-feed or even with a phone call…and yes I still have a ‘land-line’ where I have been making calls to friends and family. In fact, I mentioned to them that I am calling from my house phone, which usually starts great conversation. Usually the response goes something like this. ‘You still have one of those? Man you are getting old!’ along with some laughter.  

As I begin the process of shifting over to remote working I was listening to the radio and the song, from back in 1985, “We Are the World” came on. For those who were not even born at that time, it was song written by Michael Jackson and Lionel Richie to raise funds to support the continent of Africa during the famine. The words resonated in my head to the point that I felt I had to share with others. The lyrics include:

There comes a timeWhen we heed a certain call… When the world must come together as one…We are the world…We are the children…We are the ones who make a brighter day, so let’s start giving…There’s a choice we’re making…We’re saving our own lives…It’s true we’ll make a better day, just you and me.1

So what will a better day look like? I cannot recall ever completing a CANS on my family or myself. I did however use the concepts of CANS when I needed support after my both parents passed away within less than a month of each other eight years ago. At that point, I clearly identified many of my needs and outlined the strengths for which I needed to use or build for support.

This was one of those very stressful times. So it only made sense to me to complete the CANS-ANSA…I expected to see some needs, but when I saw how many actionable ratings of ‘2’ and ‘3’ were given in the various categories it truly surprised me: Life Domain (social functioning, recreational, sleep); Behavioral Health (Anxiety, Adjustment to Trauma); Strengths (social connectedness, optimism, community connection). 

Now that I have a better sense of my needs (strengths to build), I can begin action planning in moving closer to fully answering the question…What will a better day look like? This is the start to my step-by-step (or day-by-day) transformational plan that will not only positively affect me but others such as my family, friends and co-workers.

My enduring hope and reason for writing this was to get everyone to take time in reevaluating their lives, setting prioritizes and always remembering that we are all connected through our shared experiences…even when those experiences are not positive ones. What will your better day look like?

Working from Home – Experiences from the TCOM team

As the COVID-19 crisis changes day by day in the United States and around the world, more people are beginning to work from home. Many resources are providing helpful tips for people new to working from home, so we decided to ask some of our staff who generally work from home to highlight their successes and challenges.

Michelle Fernando, Operations Director, Center for Innovation in Population Health

  • My responsibilities: Pre-award planning and proposals, business operations for the Praed Foundation, policies and standard operating procedures for the Center for Innovation in Population Health
  • How long I have been working full-time from home: 2 months
  • What makes my situation unique: dog owner, and currently a full house
  • My workspace: A carved out space for my laptop, screen and printer.

My dedicated home office space is in a closet in our guest room. We re-arranged the existing shelving to mimic a freestanding home office. By doing this, we saved space and money, as we didn’t have to purchase any additional office furniture. An unexpected bonus is that I can close the closet doors at the end of my workday.

With schools and businesses shut down, and a shelter-in-place order in the State of Illinois, my husband, son and I are all working from home for the next few weeks. Each of us have a designated space in our condo where we work and participate in video conference calls. The dog, in the meantime, is patiently waiting for his “calming dog bed” to arrive.

Office in a closet (top); eLearning space (bottom left); office dog (bottom right)

Laura Rogers, Senior Policy Analyst

In my role, I provide training, coaching and consultation. After a 20-year career of working in the field and/or office-like settings, I began working remotely in November of 2018.  I’m originally from Upstate New York and this is where all my family lives.  I live in the North Park neighborhood in the city proper of San Diego, CA where the average temperature is 65 degrees in the winter and 75 degrees in the summer.  While we live in an arid climate, we tend to get our rain during the winter months.  The neighborhood where I live/work is multicultural: middle eastern, Ethiopian and Hispanic people.  I live at home with my 2 pets: Eclipse, a Siberian Husky, and Char, an Alaskan Klee Kai.  Because I live in the city, my condo is small.  Therefore, my workspace is in my second bedroom in which I have a desk and file cabinet. 

Laura with Eclipse and Char

Being an introvert, the transition was rather easy as far as socializing.  I tend to save up my energy for when I travel to other jurisdictions to provide in-person trainings in front of large groups.  The one aspect I noticed when I first transitioned it that I will sit in front of my computer for hours without getting up.  My iWatch has been helpful in reminding me to stand every hour and move around.  I now try to get out of the house in the afternoon, weather permitting, to take my dogs for a brief walk around the block to stretch and get some fresh air.  While working in an office setting, I used to purchase ready-made, prepackaged food.  Now, I will make a sandwich or salad for myself to get me to break away from sitting and working at the computer.  Another aspect is that I have limited space in my home for handouts, etc. that I may receive and will scan and save it electronically (instead of hard copy).  I have found unique places to store documents (paper for my printer, handouts I will provide at upcoming trainings) in a closet or storage cabinets in my garage.  When I first started working remotely, I began doing monthly webinars.  Because I was an administrator for the last 17 years of my career before shifting to my current role, it had been many years since I did presentations.  While presenting, I felt nervous and it was nice to be able to pet my dog who was sitting next to me patiently wondering who I was talking to aloud. Another change I made in working remotely is getting up in the 5 a.m. hour to workout at my local YMCA as opposed to going to a workout after 5 p.m.  While it is hard getting up at 5 a.m., especially on Mondays, I find that I wake up naturally without caffeine to join in conference calls at 7 a.m. due to working with a team in different time zones.  And, lastly and I’m sure not the least, while I proclaim to be an introvert, I do crave meeting with others.  Therefore, I became a co-organizer of Meetup group in which I schedule events with people who have similar interests as me and I will go to a local dog park where the same group of people meet on a regular basis.  As a resource, I recently heard Scott Kelly, an astronaut, give some good advice for those who had to suddenly make the switch to working from home.  Here’s a link to his tips/suggestions.

Tiffany Lindsey, EdD, LPC-MHSP, Safe Systems Practitioner

  • My responsibilities: I’m a TCOM trainer and provide technical support to 18 jurisdictions (domestic and international) on applying strategies from safety science into public child welfare and adult mental health.
  • Length of time working from home: I’ve been working from home full-time since March 2019, but I’ve worked remotely—in varying capacities—for the past six years.
  • What makes my situation unique: I live in the suburbs of Knoxville, Tennessee, with my husband, our 16-month-old daughter, my mother, three dogs, and a cat. The cat “owns” the house, though!
  • My workspace: I have a dedicated office space now, but it wasn’t always that way! For several years, I worked at our dining room table. I tried the living room couch at one point, and it actually worked well for me. If I’m reviewing peer-reviewed articles or other technical documents, I still prefer to read on the couch with paper, highlighters, and a pen.

I functionally grew up as an only child—my brother is 10 years older than I am. As a result, I may be inclined to working effectively and happily in some isolation. It helps me concentrate and organize my projects well. Since working from home these past several years, my family composition has changed dramatically though! In the past few years, I’ve moved homes twice, married, had a daughter, and had my mother move-in with our family. As much as I love all these happy changes, it’s been an adjustment to my “work from home” life!

What works for me has changed over time. These days, I benefit from the consistency of a quiet home office and set Monday-Friday office hours. In the past, I was most productive when turning on some music, sitting in a common area, and conducting a good portion of my work in the evening. I think the most important things to remember is to be flexible, set realistic goals, and have some grace for yourself when a day isn’t as productive as you planned. It’s easy, in those moments, to let a distracting day become a distracting week. Mindset is everything, and community is also important. Taking time to talk with colleagues and share your webcam is so crucial. Audio alone is never as personal or enjoyable as seeing someone’s face, and interpersonal connections are one of our most buffering factors against burnout.

Here’s a fun picture of me and my daughter taking a break from work to call my husband via Facebook Messenger (image at right). I’m definitely most effective when I have childcare—which fortunately is 99% of the time!

Lynn Steiner, Senior Policy Analyst

My main responsibilities are coaching for certification on the TCOM tools, including reviewing and providing feedback on tests; and developing and reviewing training and testing materials.

I have been working from home full-time since late February 2020. Previous to that, I worked in the office and would work from home about once a week with my laptop, sitting on the couch.

I live alone, with a cat, in a small apartment building in Chicago. I don’t have children but I do have elderly parents who live nearby who require my assistance. I live in a one-bedroom apartment without a spare bedroom/office, so I chose to carve out an office space from my dining room. I set up a small desk and chair in the corner of the room and everything work-related is kept there.

Imagine a person whose work mainly takes place on a computer – reviewing tests; providing feedback by email; asking questions of my colleagues and receiving responses by email; reviewing, revising and creating training materials – with perhaps 10% of the job requiring phone calls or face-to-face meetings. Imagine also that this person has a natural tendency to work independently without much interaction with others. Now imagine that this person is told that they will now be leaving their workplace (where they shared an office with two colleagues) and working full-time from home. Yikes! With a job that mainly is self-initiated and mostly doesn’t require real-time contact with people, the office was a way to connect with people and break my self-isolation. Going to the kitchen to refill my water or get a snack, or past the kitchen to the bathroom was a way to see and say hello to others, to talk about what we did over the weekend, to discuss the political climate or complain about the weather. Working from home completely changes that. It’s a physical change, but also a mental one, even for those who generally do well without too much interaction with others.

Lots of people had advice for me along with standard positive clichés. In the end, you have to try some different strategies and see what works for your unique temperament, goals, needs, and limitations.

Some of the strategies that are working for me (and you might commonly hear them):

  • Sticking to a professional routine when preparing for work: No matter what, I always take a shower, get dressed, and fix my hair before “going to work.” I may cut corners a bit (e.g., not put on make-up if I don’t have any planned video meetings, wear comfortable sweats rather than pants), but making the broader effort puts me into a work frame of mind.
  • Creating boundaries between work and home: At 8 a.m., I am at my computer, working. I’ll take breaks, but I whenever I am working, I am in “the office.” At lunch, I leave “the office” and have lunch in the living room; then I return to “the office.” At the end of the workday, I leave “the office,” turn off the dining room light, and I’m out of there until the next day.
  • Allowing myself to take breaks: Boundaries are important, but I can’t spend 8 hours a day in front of the computer or on calls, just like I couldn’t at the office. It’s OK to get up and go pet the cat (she might not be happy about having her nap disturbed, but that’s not my problem!), stare out the window or get up and walk around a bit, and so on. This was time that I was formerly “wasting” with colleagues that served as “break” time. It may reduce my productivity a little, but it’s key for my mental and physical health.
  • Scheduling occasional meetings and calls with colleagues helps me regulate my productivity: If I’m staring at the computer screen all day, I do tend to lose focus and waste some time. I’ve found that breaking tasks up into large chunks helps to keep me focused, so working for a few hours, and then having a meeting or call tends to help me re-set and transition to the next task without losing my efficiency and attention to detail.

Not all recommended strategies are for me. For example, in our group, we have been encouraged to try to connect with our colleagues by video where possible to try to keep the connection. I’m not a big video fan – seeing someone online is not the same for me as experiencing them in person, — and so this is a strategy I’m likely to use less often than others. I like to be efficient, so it’s easier to me to email someone than set up a meeting, generally.

Working from home before COVID-19 was going to be a challenge for me; working at home since has ramped up the social isolation. And yet, there have been some benefits: no commute, so I’m putting gas in my car less frequently and I have extra time to either sleep in in the morning, or exercise, and to do a variety of activities after work; I’m no longer buying lattes from coffee places, so my disposable income has increased (though this is slightly offset by the cost of purchasing coffee and milk and making lattes at home!); I am surprisingly more productive than I thought I might be, though my productivity does ebb and flow. However, if I get too far off-track, my new office colleague will keep me in line:

Readers: You have heard some stories from us, in our specific situations, but most of us will continue to work from home long after this our situation returns to normal. The TCOM community would like you to share your story and the challenges that you are experiencing or the successes that you have had working from home. We encourage you to share with the community the strategies that have worked for you, or respond to someone else’s challenge to help them figure out how to make a positive impact. Let’s connect and share!

Resilience Reconsidered

by Michael Cull, PhD, Associate Director for Safe Systems, University of Kentucky’s Center for Innovation in Population Health

No doubt our resilience as a nation is being tested by current events.  We’re facing significant uncertainty at home and at work. How will we accomplish home visits? How do we ensure child safety? How can we use technology to help those we serve? How will we address our own and our family’s needs? In the face of growing personal and professional stress, there may be no better time to re-visit how we think about workforce resilience in the helping professions.

We generally understand resilience to be one’s ability to bounce back from adversity. We work to help children, families, and adults as they build resilience. We understand that whatever challenges bring us into someone’s life, our goals in being truly person-centered require us to identify and expand on their strengths. This may, in fact, be our primary function as we support those we help as they go from where they are now to where they want to be.

Of course, to continue to be helpful, we must also focus efforts on our own resilience. Helpers are at high risk for burnout, chronic fatigue, the lack of psychological safety at work, and symptoms related to both direct and vicarious trauma exposure. And while exposure to trauma may be unavoidable in some settings, the systems influences that contribute to high-levels of burnout, unaddressed unprofessional behavior, and work design issues that allow for things such as late nights and sleep deprived professionals only compound the effects of trauma. No doubt, all of these factors overload personal resilience.

Workforce resilience is a well-documented challenge to helping systems. Although some good strategies have been developed to support individuals, very little real progress has been made. Documented high rates of burnout, secondary trauma, and turnover persist. It begs the question, have we framed the problem correctly? Should our primary goal be to build a new capacity into helping professionals that allows them bounce back and survive another day? Or should our goal be different?

Engineers use a slightly different definition of resilience. In engineering, resilience is the property of a system that allows it to “stretch” in the face of increased demands and then return to normal operations. Think of a rubber band. It doesn’t bounce. It’s designed to stretch when it works. A resilient system is one that is not brittle in the face of increased demand. Instead, it stretches.

Perhaps the helping professions would benefit from a new frame in the discussion about workforce resilience. Too often what we describe as interventions designed to support resilience in our professionals is actually a response to adversity and exposures. It’s not prevention. It’s reaction. We would benefit from an engineering approach that shifts the responsibility from the professional – to the system. If we view resilience as a property of our systems it requires us to consider different approaches to building resilience.  We must take an approach that predicts adversities and designs effective solutions to manage them. We don’t assume normal work. We assume things can go wrong. Our approach shifts from responding to the needs of professionals and providing them with tools to be more resilient, to designing a system that anticipates their needs and builds in protective solutions.

The critical component in a more resilient, better engineered, helping system is the team. Designing collaborative work in professional teams has the potential to transform our work and support a safer, more effective, and more engaged workforce. Not only are collaborative decisions of teams known to be more effective, the social connectedness that emerges from what the military calls unit cohesion may be our most effective buffer against the effects of burnout and work-related stress (including traumatic stress).  

Steps to engineering a more resilient system through collaborative work:

  1. Spend time identifying what could go wrong.
  2. Talk openly about mistakes and ways to learn from them.
  3. Test change in everyday work activities.
  4. Develop an understanding of “who knows what” and communicate it clearly.
  5. Appreciate colleagues and their unique skills.
  6. Make candor, transparency, and respect a precondition to teamwork.

For more TCOM tools for engineering safe, reliable, and effective teams check out TeamFirst: A Field Guide

You can reach Michael Cull at michael.cull@uky.edu

Introducing the TCOM 2020 Conference Chair

The Praed Foundation is delighted to introduce Barbara Dunn as our new Conference Chair for the 16th annual TCOM Conference! Read her letter below!


Dear TCOM Collaborative,

I am excited about being asked to serve as the Conference Program Chair in 2020! Last year I served on the program committee and thoroughly enjoyed reviewing the presentation and poster proposals. I’ve lost track of how many TCOM conferences I’ve attended – over 10 – but each one has supported my practice using the CANS. Like many of you, I am responsible for supporting programs and people using the CANS, and have few peers at my company. The conference rejuvenates this battered soul!

I’m also excited to be back in Louisiana where I was part of the initial state-wide trainings on the CANS in 2012. Louisiana has come so far in the use of the CANS and developing a coordinated system of care. I’m looking forward to furthering the collaboration with our community partners!

This year’s theme “Collaboration and all that Jazz” brings front and center the passionate and creative work of collaboration in the field.  The pre-conference will continue the tradition of Master Lectures and round-tables for advanced learning and discussion. Plenary speakers will inspire with cutting edge ideas. About 36 workshops and a full poster session are expected. Did I mention great food?? Oh yes–Louisiana cuisine!

The conference recharges me, and I hope you can attend and be rejuvenated in your TCOM collaboration!

Barbra Dunn


Interested in presenting at the 16th annual TCOM Conference? Check out our conference page to download the Call for Proposals!

Mass Customized Patterns and Priorities for Success

By Kate Cordell, PhD, MPH, Managing Director at Mental Health Data Alliance, LLC


What if we could utilize the CANS and ANSA to identify which items, if resolved, were associated with success in our program? What if we could look at that by race/ethnicity, gender and age? If we could, we could get a lot closer to identifying what works for whom.

The CANS and ANSA are ideally suited for determining what works for whom. These assessments help build a comprehensive picture of a person’s story as it relates to well-being. I find it helpful to visualize a story as a tapestry – each unique and beautiful.

Every story is different. Yet stories are woven with some common thread. The CANS and ANSA help us visualize this tapestry and then track transformational changes in these patterns over time. The CANS and ANSA can track progressive stages toward resilience and recovery – personal to each individual – but with common themes.

Looking at changes over time, the CANS and ANSA ascertain needs which were addressed and strengths which were built, all informed through underlying trauma identified. When an individual transforms his story toward well-being, there are often some natural changes, such as increases in optimism and decreases in frustration. An individual might experience increases in functioning such as more time spent on talents and interests and less time spent exhausted due to sleep deprivation. The changes associated with successful outcomes are likely common among groups of individuals who share some common threads in their stories.

The definition of success is as individual as the story. And therefore, we need to be flexible in how we define success. For one individual, it may be starting a romantic relationship and for another individual it may be starting or advancing a career. However, success in these terms is supported by building common underlying strengths, such as interpersonal skills and addressing common underlying needs, such as anxiety. The CANS and ANSA can identify the proportion of identified needs addressed and the number of strengths built as part of a definition of success.

In thinking through these considerations, I decided to build a tool to help identify items, if resolved, which were associated with success among subgroups of individuals. This dashboard allows agencies and jurisdictions to define success in their own terms – on the fly. Perhaps for one adult program success is defined as addressing 33% of needs and building two strengths and meeting the primary personal goal (e.g., starting a career).

Next, we might look at a children’s out of home placement program and reset the definition of success to addressing 50% of child needs, addressing 30% of caregiver needs, building 2 strengths and maintaining a family placement for 1 year. I decided to build a dashboard which would feed the user’s definition of success into an analysis – as a form of mass customization.

Once a definition of success is established, the dashboard identifies all individuals who met the definition of success and those who did not. In the example of a children’s program, 32% met the definition of success.

Next the dashboard further prioritizes which items are more often associated with meeting that definition of success. In the example, family functioning followed by optimism and living situation are highly prioritized for success. The top 10 priorities are displayed.

The dashboard then creates a decision tree to mark any subgroup differences in probability of success by items addressed. In the example, when family functioning is identified and resolved there is a 76% probability of success versus a 27% probability of success when it is unresolved or not indicated. When family functioning is not indicated or is unaddressed, building a strength of optimism improved the probability of success to 70%. The tree identifies further combinations for success.

My goal is to identify what works for whom, and the CANS and ANSA are ideal for this purpose. You can learn more about my work by emailing me at kcordell@opeeka.com or visiting http://www.opeeka.com.

Connecting Through Communication-The Human Experience

By Ken McGill, EdS, LMFT, Rutgers University

What is more basic to our understanding than how we develop and use language? Language is used to communicate who we are as individuals. It can be used to describe how we are ‘feeling inside’ to others. It is through this sharing or using words to connect feelings and emotional states that we can also better understand our own sense of self–the real self. The genuine person or individual each one of us develops into from birth, throughout childhood, adolescence, young adulthood and later, if fortunate, late adulthood. All human beings are expressive creatures and will often use verbal language to convey their messages.

When you really give this some thought and attempt to break it down to its very simple components, what we get are five letters (sometimes six) which create the essential sounds. When put together, with the twenty or twenty-one letters that make up the rest of the English alphabet, they create words. The words unfold and within a grammar syntax, meaningful communication is created for another individual or individuals to hear with the goal of comprehension.

This is where communication through language starts to get complicated. More importantly, complex is a word that would best describe those who use language…US. My writing this blog is not to further confuse or alienate those who want to serve others in the human services field. In fact, my goal is to make it simpler (or at least less confusing). This is exactly what Dr. Lyons and the development of ‘communimetrics’ has accomplished over the decades. It breaks the work down and captures information about those we serve through communication.

I strongly encourage everyone in this field to read Communimetrics: A Communication Theory of Measurement in Human Service Settings by Dr. John S. Lyons. For more information, you can go to the Praed Foundation website.

It is from a communimetric position that I now go back to the early paragraph where vowels were being mentioned. Those five (or six) letters, A, E, I, O, U and sometimes Y, make up the sounds to create the countless number of words with language. This does not seem possible but it is.

When we look at a communimetric measurement like the Child Adolescent Needs & Strengths (CANS), we may also have this kind of skepticism. How can a compilation of separate items—each given a rating of 0, 1, 2, or 3—represent a list of Needs and Strengths? Further, how can these Needs and Strengths comprehensively and accurately reflect what is happening in the life of a child/adolescent? This does not seem possible…but it is possible.

Since CANS is a communication tool and language is at the core of its use, then the vowels are very relevant as they are the essence of language….communication. Now let us use the vowels as an acronym for how we can embed the CANS into the work that we do with those we serve.

It is important to remember that the CANS is not a form to complete or a checklist to follow. Since many of those we serve report that they are assessed many times and have to share their ‘story’ repeatedly, we must Assess with the purpose to gain knowledge. It is through this Engagement we must listen to learn, which can lead to empathy. Therapeutic rapport can be built in the midst of this perspective sharing. Identification of underlying needs and strengths are what will be implemented in the care planning or treatment plan. The successful plans of care, which are those individualized to match that particular unique person, will lead to Outcomes. The results of this meaningful Understanding strengthens the ‘shared vision.’ It is through this comprehension that we, the helpers, gain a richer picture of those we serve. Additionally, and I would say more importantly, those being served gain a more complete sense of self in this process.

Finally, what about the Y? I would say that YOU or all those who serve in the human services field must have a reverence for those we serve. The ‘Y’ can also serve as a reminder of ‘Why?’ we do the work. I too often think professionals fail to respect the power inherent to our roles. However, if we consistently remind ourselves of what a privilege it is to walk with those on their journeys to increased health and wellness it can be an empowerment.

The next time you look at the CANS, specifically the items on the particular communimetric tool you use, think of them as the ‘vowels’ which can be used to formulate a language or meaningful communication…the actual work we do. CANS supports the foundation of the human services field. 

Transformation: Shared Knowledge & Skills Building

By: Ken McGill
Senior Training and Consultation Specialist

Connecting It All Together…

The work within the field of ‘human services’ can often become quite complicated, especially from the perspective of those we serve…the children/youth & families. I have often wondered, “Why do we make things so complicated?” I thought with all of the advances of modern life, such as internet, wireless communication and the interconnectedness of world-wide economies our lives would be less complicated or at least more ‘user-friendly’ to solve problems or overcome challenges.

If we take a moment to think of how communication and information sharing has advanced in such a short period of a time…the personal computer or Apple came on the scene in 1976 when Steve Jobs and Steve Wozniak introduced the Apple-1 a single-board computer for hobbyists. With an order for 50 assembled systems from Mountain View, California computer store The Byte Shop in hand, the pair started a new company, naming it Apple Computer, Inc. In all, about 200 of the boards were sold before Apple announced the follow-on Apple II a year later (1977) as a ready-to-use computer for consumers, a model that sold in the millions for nearly two decades.

Bringing technology to the masses…Apple II sold complete with a main logic board, switching power supply, keyboard, case, manual, game paddles, and cassette tape containing the game Breakout, the Apple-II finds popularity far beyond the hobbyist community, which made up Apple’s user community until then. When connected to a color television set, the Apple II produced brilliant color graphics for the time. Millions of Apple IIs were sold between 1977 and 1993, making it one of the longest-lived lines of personal computers. Apple gave away thousands of Apple IIs to school, giving a new generation their first access to personal computers.1

You may be asking, “How Does This Connect to Human Services?”

I would encourage everyone who plays a role in the Human Service field to read ‘Communimetrics: A Communication Theory of Measurement in Human Service Settings2 written by Dr. Lyons back in 2009. It is one of those texts that changes the way you conceptualize and structure service delivery for the 21st Century. Dr. Lyons writes that communimetrics has been designed to make thinking processes transparent and provide a conceptual organization or framework for the thinkers to be attuned to the relevant factors that must be thought through in any particular circumstance.2

It is communimetrics we use the Child Adolescents Needs & Strengths or CANS Tools and the over-arching framework of Transformational Collaborative Outcomes Management (TCOM) to better serve those children/youth & families. How I see it, there are two primary components to Communimetrics-Communication and Information.

Since we cannot separate communication and information with technology, it only makes sense to connect them with the primary language of computers…binary codes…0s and 1s. 

Did you know? A 22-year-old graduate student at Massachusetts Institute of Technology (MIT) created the binary code back in 1937. Claude E. Shannon while completing his master’s thesis in electrical engineering proposed a method for applying a mathematical form of logic called Boolean algebra to the design of relay switching circuits. This innovation, credited as the advance that transformed circuit design “from an art to a science,” remains the basis for circuit and chip design to this day. It was in his paper that he used the word “bit,” short for binary digit. Shannon’s thesis became a starting point for the use of the binary code in practical computer applications.… this is why Claude E. Shannon is often called the Founder of Classical Information Theory.3

A binary code can be easily applied to the CANS on two different levels. On one level, the binary is the strength and need. Whereas, on another level the 0,1 are the non-action ratings and the 2, 3 are the action ratings…binary codes.

We can agree that transformation is a goal of treatment…outcomes which significantly affect the lives of others. Communimetrics and TCOM can be the conduits for systemic changes…I say that we must all take ownership of our roles (or binary family level and systems level).  Let us all push beyond ‘system of care’ mindsets and move toward ‘systems that care’ for those we serve!


  1. The Computer History Museum-Timeline of Computer History. (2020) Retrieved on January 23, 2020 from https://www.computerhistory.org/timeline/computers/
  2. The John Praed Foundation. Communimetrics. (2020) Retrieved on January 23, 2020 from https://praedfoundation.org/tools/eating-disorder-symptom-severity-scale-eds3/
  3. The Institute of Electrical and Electronics Engineers. Information Theory Society (2020) Retrieved on January 23, 2020 from https://www.itsoc.org/about/shannon

A Legacy of Relationships

By John Lyons, PhD

In 2019, I became an orphan.  Unlike many of the young people with whom we work, I was privileged to have at least one of my parents in my life for 63 years.  But regardless of our age, losing both parents is a profound experience.   My father passed on December 2nd of 2019.   He was 92 years old.  He truly lived the American dream.   He was the son of a migrant worker who moved from town to town to find day work during the depression.   As a teenager, he settled in Indianapolis but then his father left the family, and he was raised by a single mother in the late 30s and early 40s.   She was quite ahead of her time, creating and building her own business to support her two sons.   After serving in the Navy at the end of WWII, my father received a civil engineering degree and took a job at the Indianapolis Water Company where he stayed for 42 years until he retired as the Executive Vice President.   Although my father accomplished much in his work what strikes me as most profound about his life is that he played golf with the same foursome for 54 years.   He played poker monthly with the same group of friends for 62 years. 

Sixty-eight years ago, my father married my mother.  She hadn’t gone to college and quickly shifted from working as a secretary to becoming a mother and homemaker, a role she cherished until she was 60 and lost her own mother.   To help her with this loss, my father built her a ‘dream house’ in a different town in the middle of a wooded ravine.    My mother had many friends in the town they had lived while we, their children, grew up (Speedway) and on moving my father challenged my mother that she might not like their new town (Zionsville) so much because she wouldn’t know anyone.   Not one to ever back down from a challenge, my mother went out and got a job writing a column for a local newspaper that required her to interview longtime residents.   Before she retired at 84 she had published 1100 newspaper articles about the people of Zionsville and published five books and had been named the Zionsville Town Crier.  Everyone in town knew her. And she knew everyone in town.

So, what do I take from these two stories?   Relationships are treasures.  No matter what our accomplishments nor our accumulation of things, what is truly important in our lives are all the other people that share our lives with us.    Cherish your relationships.   Invest in your relationships.  Be generous in your relationships.    That is our true measure of worth.   

Relationships are one of the key ingredients to a successful implementation of the principles of TCOM.  The ability to make and maintain relationship is fundamental to successful and sustained collaboration.  Perhaps we have not yet talked enough about this aspect of our work.

Story Board

For a printable full size version of this visualization click: Story Board.

Question/Description

The Story Board visualization show change over time for a single individual. It can answer the following questions.

  1. What are the current background needs, actionable needs, and strengths for an individual?
  2. What needs have changed over time?
  3. What strengths have changed over time?
  4. Have the strategies/interventions in place worked?
  5. What strategies/interventions should be put in place to address current needs and incorporate and/or develop current strengths?

Context of Use

Audience
This visualization generally appeals to an individual clinician. It is very youth/family friendly and can be used to celebrate success and plan for future action. There may be times where this can be a useful conversation starter for team meetings, clinical staffing, and/or supervision/coaching.

Decision Points
This visualization can be used after the initial assessment, but it is most effective once two or more assessments have been completed. It is best suited for reviewing change over time and planning for the future. It can be used to determine Intervention Appropriateness and assess Intervention Effectiveness. In addition, it could be used as a tool to determine when it is time for Linkages/Transition to different levels of care.

Utility and Unit
This visualization is Evaluative because it compares assessments to determine change over time. This visualization is applicable at the Individual level.

Measurement Type
This is Product measure since it is measuring the output of the treatment process.

Preparation of Data

This report requires at least an Initial CANS. Ideally, it would be used once at least one reassessment has been completed. It is intended to incorporate multiple assessments. This requires that Initial and Re-assessments are clearly identified in the data. If not, you can estimate the order by using Assessment Dates. In most reporting programs (Tableau, Power BI, etc.) it will be useful to structure the data in “long” format. The minimum requirements for data structure are as follows:

Example Data Table

Column Definitions

Sorting
This report requires sorting for two of the three main sections. The Background Needs section does not require sorting. The Actionable Needs to Target section should be sorted by the Most Recent assessment ratings in descending order. This brings the most recent 3’s and 2’s to the top of the list. The Useful Strengths and Strength to Target should be sorted by the Most Recent assessment ratings in ascending order. This will bring the youth’s centerpiece and useful strengths to the top. The sorting order in this report was examined by a focus group of clinicians who felt that ordering the sections (Background Needs, Actionable Needs to Target, Useful Strengths and Strengths to Target) and sorting as described above was consistent with how they orient to a case from a practice perspective.

Formatting Considerations

This report using color conditional formatting (see appendix for mock up). Items rated as a 3 or 2 are colored in shades of yellow (3 dark yellow and 2 a lighter yellow). Items rated a 0 or 1 are colored in shades of green (0 dark green and 1 lighter green). The initial design used red and orange for 3’s and 2’s but the focus group of clinicians felt it too “negative.” If color printing is not available, it may be required to color the columns using shades of gray.

Take Action

This visualization is very youth/family friendly and can be used to celebrate success and solicit ideas for future planning. It can is useful for reviewing previous strategies and evaluating their effectiveness. In addition, it is useful for future planning. Finally, as progress is made this visualization can also help determine when it is time for stepping down into a lower level of care or it can be useful in illustrating destabilization that may require a higher, more intense, level of care.

Average Impact

Question/Description

The Average Impact visualization provides an overall picture of need reduction over time. It can answer the following questions:

  1. What is the difference between the average number of actionable items at Initial compared to Ever and Last?
  2. What is the total need reduction form the maximum about of need (Ever) and Last?

Context of Use

Audience
This visualization generally appeals to those seeking a blunt high level measure of system performance. It can be used to communicate system level performance to leadership/administration or community constituents.

Phase
Since this visualization is a retrospective look at youth over time it is looking at youth who have been reassessed at least once and/or youth who exited (linkages/transitions). The results of this visualization can be thought of as an aggregated assessment of how a person moves through each of the key decision points in a program. It’s use in decision making is best suited at a programmatic level and may influence one or all of the key decision points.

Utility and Unit
This visualization is Evaluative in that in compares need level at different time points. This visualization can be used at the sub or whole group level.

Measurement Type
This is a product measure, in that it is summarizing the change that occurred over time (in essence it is the result of the program’s process).

Preparation of Data

The Average Impact Visualization has several important data considerations:

Inclusion Criteria
It is helpful to use an entry cohort for this visualization. In this example it includes all youth that had an initial assessment within a given year. In addition, only youth with 2 or more assessments (an initial and at least 1 reassessment), and with at least 30 or more days between assessments were included. Those not meeting this criteria were excluded (this is important to know).

Domains and Item Included
Only “changeable” needs and strengths were used (Behavior, Life Functioning, Risk, Culture, Caregiver and Strengths Domains).

Calculations
Initial = add up all actionable items in the domains listed above on the initial assessments and divide by the number of youth in the cohort (based on inclusion criteria).
Ever = Take the max score for each item across all assessments for each youth (including initial and last) and add up all the actionable items and divide by the number of youth in the cohort.
Last = Add up all actionable items on the last assessment and divide by the number of youth in the cohort.

Example Data Table

Formatting Considerations

This visualization works well as a bar chart with different color bars to distinguish between Initial, Ever and Last. It is also helpful to display the number of average of actionable items above each bar.

Take Action

This report can be used to start conversations about differences seen between Initial, Ever and Last. Here are some questions for consideration:

  • Does the pattern match your lived experience of the people you serve?
  • Does the pattern match your expectation?
  • When filtered by various groups are you surprised by what you see?
  • Can you target efforts to increase the need reduction for certain groups?
  • Can you learn from groups that are seeing significant need reduction?

Stephanie East, MS, MSW/CSWA

Meet Stephanie East!

Stephanie East is a trainer and consultant specializing in CANS and Wraparound training. Stephanie has over fifteen years working in various roles in community-based settings with youth and families but it wasn’t until she was given the role as a care coordinator for a Wraparound program in Central California that she found her true passion. Stephanie is a California native, getting both her Bachelor’s and Master’s degrees in Criminology from Fresno State University. Stephanie moved to Oregon five years ago to support the statewide rollout of CANS into Wraparound. Stephanie then completed her MSW from University of Southern California and began to work as a therapist who also sat on Wraparound teams.

Stephanie is currently training for the WISe Workforce Collaborative in the state of Washington, providing training and technical assistance for the CANS, WISe (Wraparound with Intensive Services) Therapists, and Coaches. Stephanie also supported a statewide initiative to provide Trauma Informed Care in the state of Washington. Stephanie also continues to work part time as a Crisis Response Therapist for Project Respond in Multnomah County. Outside of work, Stephanie has three adopted rescue dogs (Dexter, Arya, and Zero), a horse named Doc, and various foster dogs that she takes care of for a local non-profit. Stephanie loves exploring the hiking and outdoors of the Pacific Northwest, watching scary movies, gardening, and traveling.

To contact Stephanie, please reach out to seast@enroutecoaching.com or check out En Route, LLC.

Wraparound and CANS Strengths: How to Rate CANS Strengths Effectively and Authentically with Youth and Families

By: Stephanie East, MS, MSW/CSWA, En Route, LLC

One of the unique aspects of the CANS assessment is the ability to focus on the whole picture: one that highlights both current strengths and needs as a decision support tool within the Wraparound planning process. A strengths perspective highlights the skills and abilities, attributes and features, attitudes and values, culture, and preferences of youth and families and encourages us to utilize those strengths in planning. How those strengths are categorized and rated is important; if we do not as practitioners fully understand that process, we cannot truly rate CANS strengths effectively, nor can we accurately translate those strengths into planning.

Within Wraparound, there are three types of ways that we can communicate strengths but functional strengths are the most useful within the Wraparound Planning Process. Teams tend to inherently start the strengths identification process with descriptive strengths. Descriptive strengths are typically adjectives and describe attributes and features (i.e. he likes dogs). Contextual strengths are present in specific situations (i.e. I had a dog named Spot that made our lives better). What makes the Wraparound process sustainable and acts as a pathway to solutions are functional strengths. These are strengths that are useful in different settings and meaningful to the youth’s development (i.e. he hugs or walks his dog to help him feel safe).

One of the guiding principles of Wraparound is to be strengths based. The CANS gives us the framework to apply this principle into practice. Strengths are the key to lasting success in the treatment planning process and practitioners have to believe that strengths ultimately resolve concerns. The true application of strengths lies in the practitioners; how strengths are discovered and utilized across teams is largely based on the value that teams place upon them.

When rating the CANS, it is critical that the CANS is not an “event” but a process of discovery through conversation. Within the practice of Wraparound, peers and facilitators are trained to look for strengths in a comprehensive way and explore strengths within the Strengths, Needs, and Cultural discovery. Because of this mindset and the practice of being strengths based, at times the CANS reflects high ratings for strengths despite evidence that they are not yet functional. For teams to truly serve youth and families effectively, teams have to be honest and authentic in the way the Strengths domain is rated. By rating strengths too highly in the beginning, teams are missing an opportunity to truly show and reflect progress in growing strengths during their work with youth and families.

In order to determine which strengths are functional, and how they should be rated, there are several questions to consider. Is the strength useful and something to work with but the youth (or the caregiver) isn’t using it yet? Is the strength currently being used in planning? Is there opportunity to further develop this strength? Applying those questions and truly considering whether a not a strength is being used in a way that furthers development provides a solid framework for rating. Centerpiece strengths are the “headliner” of strengths and if they are not featured in a plan, the strengths are likely not centerpiece strengths.            

Wraparound and CANS both ground themselves in the needs and strengths perspective and through the process, the more intentional and authentic we can be in our ratings, the more we can truly see growth and progression. It’s ok if a youth and family begin Wraparound without many strengths identified; the process of Wraparound is to guide those strengths into functionality as the pathways to solutions.


Editor’s Note: The Praed Foundation and the Center for Innovation in Population Health are focused on taking solution focused action to support systems change during this important period in American history. Ms. East’s focus here on authentic and effective use of the Strengths items of the CANS is a great opportunity to consider and be truly thoughtful about how participation in efforts to impact systems by children and families can be a sign of internal strength.

Participation in rallies and other Black Lives Matter events show us signs of optimism, community life, cultural identity and so much more. A family’s engagement with political movements could reveal much about their own internal strengths and resilience. As we work to build a more equitable world it’s important to observe how those we serve are doing the same, and recognize and engage with the strengths they are showing the world.

Cassandra Cooper, MA LCPC

Meet Cassandra Cooper!

Cassandra Cooper is a Senior Policy Analyst at the University of Kentucky Center for Innovation in Population Health. Cassandra works with jurisdictions in Illinois and other states providing training and technical assistance to systems implementing the Child and Adolescent Needs and Strengths (CANS) tool and Transformational Collaborative Outcomes Management (TCOM).

Prior to coming to University of Kentucky, Cassandra was a Senior Policy Analyst at Chapin Hall in Chicago, Illinois. In her role as a Field Implementation Support Specialist, Trauma Informed Practice Specialist and Learning Collaborative Facilitator at the Illinois Department of Children and Family Services, Cassandra served as a primary facilitator on the implementation of a family- centered, trauma- informed, strength-based model of practice. Cassandra trained, consulted and coached on such subjects as complex trauma, the impact of trauma on children and families, vicarious trauma, the principles of evidence- based trauma intervention models and the use of the CANS in treatment and service planning. She served 6 years as an adjunct professor at Chicago State University in the Psychology Department and taught trauma- informed courses on child abuse and neglect.

Cassandra holds a Master of Arts in Community Counseling Psychology from Loyola University of Chicago. She received a Bachelor of Arts in Psychology from Fisk University in Nashville, TN. She is a Licensed Clinical Professional Counselor in the state of Illinois and a certified CANS assessor.

Cynthia Schelmety

Meet Cynthia Schelmety!

Cynthia is currently the Regional Downstate Lead for the CANS-NY Technical Assistance Institute and the Training Manager at the Collaborative for Children & Families. She graduated with her Bachelor’s degree in Psychology with a minor in Children Studies from CUNY Brooklyn College. She has an extensive background in direct care as a former trainer of trainers with the Administration for Children Services for evidence-based models. Her role as a Regional Lead focuses on providing technical assistance, coaching, training, and support for implementation of TCOM and the CANS-NY in Health Home Care Management for children across New York State. She has over 5 years of experience with the CANS-NY tool and practices the TCOM approach to transform practice and measure outcomes for children and families.

Curiosity: What Does Culture Have to Do with It?

By: Cynthia Schelmety, Training Manager, CCF, CANS-NY Technical Assistance Institute & Cassandra Cooper, MA, LCPC, Senior Policy Analyst, University of Kentucky

“Knowing yourself is the beginning of all wisdom.”-Aristotle

Culture comes from the Latin word cultura, which basically means to build on, to cultivate, and to foster.

Sometimes the term Culture is solely meant to refer to one’s race and ethnicity, but it is important to remember that there are many other elements that contribute to an individual’s culture. 

Elements of culture can sometimes be visible in food preferences, clothing style, language, and other differences.  However, many elements of culture are not immediately visible, such as family values, sexual orientation, or beliefs.  Each one of us has a cultural background that influences our own views, experiences, and behaviors; however, we must also be willing to open ourselves up to learn about other cultures. 

You might be thinking, “Where do I start to learn the subtleties of others’ cultures?”  You begin by being Curious! Being curious, as we know, is having a desire to know and learn something new.  

If we apply this concept of culture through the lens of curiosity, we begin to explore and adapt to a variety of cultures. Without cultural curiosity, we close the doors to learning about others who are different from ourselves. 

So how do you know if you are applying a lens for cultural curiosity? Ask yourself some of these questions: Am I excited about working with other people who are different from me? Am I willing and able to develop a sense of self-awareness?

Self-awareness, in this case, is an awareness of any biases we have that stem from our own experiences and behaviors. We are all familiar with the term “DON’T ASSUME”, right? Think of self-awareness as strengthening communication and relationships with other people by asking questions, observing, and listening. That foundation of using curiosity about others to replace assumptions about others will allow you to understand how Culture is a strong part of someone’s life.

In a culturally inclusive environment, people of all cultural orientations can:

  1. Freely express who they are
  2. Share their own opinions and points of view and
  3. Genuinely feel safe

There is a great deal of value to be had by learning about other cultures, but we must remember that we can never become an expert in someone else’s lived experiences.

Many situations of discomfort come from a misunderstanding of what is acceptable in another person’s culture. This is where cultural humility comes in. Cultural humility is people-centered and encourages ongoing collaborative and transformative changes. To use cultural humility, we cannot dismiss another person’s experiences as being invalid or assume that we are experts by association.  Cultural humility requires us to do more than simply acknowledge the fact that there are differences between us and others. It is our responsibility to learn about how another person’s cultural identity affects their life experiences.

Also, know that culture is not static or fixed; instead, it evolves over time.  Consider Culture as always “LOADING.”

A Statement from the University of Kentucky College of Public Health

The TCOM team is honored to be working alongside the University of Kentucky’s College of Public Health. Below is a message from Dean Donna K. Arnett regarding our country’s most recent incidents of racial injustice. We wholeheartedly affirm this message and share a commitment to seeking equity and justice for the Black community and all other marginalized people.

This weekend saw multiple demonstrations and protests across the U.S. and around the world as people reacted to a series of tragic events. The pain experienced by the loved ones of George Floyd, Breonna Taylor, Ahmaud Arbery, and countless others is unfathomable. The UK College of Public Health stands in solidarity with these families, as well as those protesting these gross injustices. These are not the first incidents of people of color dying at the hands of law enforcement, and undoubtedly will not be the last.

Let us be clear—violence against people of color is a public health issue. Racism and the ideology of white supremacy grow in the shadows when “nice” people feel it is “impolite” to discuss or even acknowledge race. But as public health professionals we cannot afford to be “colorblind.” Rather, we must take the lead in investigating, understanding, and ending race-based and racist violence. We know that people of color are more likely to suffer from health disparities caused by systemic lack of access to health care, poverty, unsafe water and air, stress, and trauma. Most recently, the Black community has been disproportionately devastated by the COVID-19 pandemic. And yet as horrific as the toll of COVID-19 has been, the epidemic of violence against Black people in our country poses an even greater threat. In particular, violence committed by law enforcement results in trauma that ripples through Black communities causing long-term, multi-generational devastation. As public health scholars we have a responsibility to document and study the health impact of law enforcement contact, violence, and injuries on minority communities in order to produce evidence-based interventions to eliminate race-based violence and trauma.

While we use our tools of research, education, and advocacy, we must also call out those who choose to look the other way when they see injustice at work—whether they be friends, colleagues, classmates, superiors, or the justice system. It is not enough to be “not racist.” Each of us must practice anti-racism in our campus community and beyond.

Today we had the opportunity to speak with some of our community members who are people of color, and our takeaway is summed up by the words of one of our faculty members who said “it is exhausting to be a person of color in America. People of color are a key part of our community at the University of Kentucky and yet we feel as though we are outsiders.” A staff colleague adds, “we are not only experiencing an invisible enemy (coronavirus) but racism has reared its ugly head….Everyone, including people of color, must be able to trust and look to those who should have their best interest at heart, whether it is in the medical profession or law enforcement. Our hope for righting the past (and current) injustices is to work with and within the system to root out those that blatantly use their badges as a license to kill.”

To our Black community members: We hear you. You are weary, and rightfully so. It’s time for the rest of us to prove our ally-ship. We urge all members of our community, especially white people who have not lived the experience of our friends and colleagues of color, to take the time to educate yourself on the issues at hand, to understand the history of Black, Latino, and other minority communities being targeted by state-sanctioned violence, and to use whatever platform you may have to actively speak up when you see people of color being targeted, threatened, or even assaulted.

Today we promise that our College will always walk alongside those have been marginalized, targeted, and victimized by violence, as we work together in pursuit of a healthier, more just world.

Signed on behalf of the UK College of Public Health by:

Dean Donna K. Arnett

and the following members of the College Diversity Committee

Dr. Joseph Benitez, Assistant Professor of Health Management and Policy

Ms. Jillian Faith, Senior Alumni Coordinator

Dr. Rafael E. Pérez-Figuero, Assistant Professor of Health, Behavior & Society

Ms. Marla Spires, Chief of Staff


A few resources for further reading:

But I’m not Racist! by Kathy Obear (Dr. Obear was scheduled to be part of UK’s “Facing Change” week this Spring. She has made this book and other resources available for free on her website.)

So You Want to Talk About Race? by Ijeoma Oluo

The New Jim Crow – Mass Incarceration in the Age of Colorblindness by Michelle Alexander

Why Are All the Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race, 20th Anniversary Edition by Beverly Daniel Tatum (Summer 2020 selection for UK’s Inclusive Excellence Book Club)

How to be an Antiracist by Ibram X Kendi (Spring 2020 selection for UK’s Inclusive Excellence Book Club)

Supervision Strategies for the “New Normal:” Remote Work with an Improvement Mindset

Free Recorded Webinar (Listening Time: 42 Minutes)

Last week, TCOM colleagues Mark Lardner and Tiffany Lindsey led a webinar for CANS and ANSA clinical supervisors, coaches and trainers. In the webinar, we present several team-based strategies from our Team First: Field Guide, which is a free download at The Praed Foundation’s homepage.

Texas was gracious enough to let us share it with the TCOM Community. Download the webinar for free at the link below:

Webinar Link

As always, we’d love your feedback and ideas for future webinars.

Unprecedented Transformation

By: Rebekka Schaffer, Workforce Development and Conference Coordinator, Center for Innovation in Population Health

I don’t know about you, but every time I turn on my television, or check my email, or try to order something online, I’m reminded that we’re living in “unprecedented and uncertain times”. It’s a little ironic that the phrase itself has become one of the only predictable things about this season of life. As the communications lead for the TCOM team, I’ve been tempted to use that phrase myself (I actually might have already done it…please don’t go looking for emails I’ve sent in the last two months).

While the phrase may already sound like a cliche, I do think the general sentiment behind it is both well-meaning and necessary. We need to be reminded that this is, in fact, new territory–we’ve never been here before. It’s unprecedented, therefore it’s okay to be uncertain. It’s okay if you don’t know how to feel or react or cope in the midst of a global pandemic. I think we need to hear that.

More importantly, this phrase has pushed us to ask some really critical questions. If we are currently living in unprecedented and uncertain times, then what were we living in before COVID-19? And what will we be living in after? When will things go back to normal? Do we want things to go back to normal? What does a “new normal” look like?

Before going further, I want to be clear: I am not interested in romanticizing this moment in history as merely an opportunity to reset and grow and change. Because while I think all of that is true, it is equally true that this pandemic is highlighting ( and in many ways, expanding) the racial, educational, and socio-economic inequities in our communities, and I don’t take that lightly.

I live in Chicago and have spent the last six years volunteering at an after-school program in Englewood–one of Chicago’s most under-resourced (but rich in history and culture) neighborhoods. In my time there, I’ve begun to accept certain things as “normal” when they really shouldn’t be. It’s normal that there aren’t enough working computers for the students to do their homework. It’s normal for those same students to speedily try to get their work done at the program, because they don’t have wifi at home and won’t be able to complete their research paper. It’s normal to tape books back together because they were worn out by other students at the school that got the copies first.

In the midst of transitioning to online schooling due to COVID-19, however, it has become apparent that what is normal is also detrimental. At the end of April, nearly 115,000 Chicago students were still in need of computers, simply to keep up with their work and learn. Computer and internet access is just one small factor leading to inequity for my students and for other vulnerable populations. Communities of color are continuing to struggle with food insecurity, access to safe transportation, and access to medical care at disproportionately higher rates. We’ve become accustomed to facts like this. So it seems normal that a pandemic would be hitting low-income communities and communities of color harder than others.

And that is why we can’t go back to normal. Not all of it was bad, of course. But if going back to the things I miss about life before COVID-19 means returning to systems that create and perpetuate disparity, then I don’t want it. I can’t long to go back to “normal” when my own sense of normalcy was intrinsically tied to someone else’s inequity. I think we’re doing ourselves, the families we serve, and our greater communities a disservice if our goal is to simply go back to normal.

That is why, in the midst of all of this, I’m grateful to be a part of the TCOM team. TCOM has been challenging the norm since its inception. The very nature of TCOM, as outlined in the Core Principles below, is to transform and redefine the ways we work with youth and families.

  1. All assessments and interventions should be culturally responsive and respectful.
  2. People should have voice and choice with regard to participating in any assessments and interventions.
  3. All interventions should be personalized, respectful and have demonstrable value to the people they serve.
  4. Collaborative processes, inclusive of children and families, should be used for all decisions at all levels of the system.
  5. Consensus on action is the primary outcome of collaborative processes.
  6. Information about the people served and their personal change should always inform decision making at all levels of the system.

The TCOM approach helps to show us what should be normal in the work we do. It should be normal for families to be met with dignity and cultural responsiveness. It should be normal for us to create interventions and action plans based on collaboration and consensus from all parties involved. To implement TCOM is to implement a “new normal”–one that is rooted in equity and the desire to see lives transformed for the better.

I hope that’s the type of “new normal” we establish, collectively, as we emerge from this season. I hope we truly take the time to assess what was normal in our lives, in our work, and in our communities. I hope that we refuse to go back to the patterns and systems that didn’t lead to the best possible outcomes for the most vulnerable among us. Challenging the norm creates an opportunity for transformation–I hope we take that opportunity.

What are some new norms you’ve begun to establish in your work or in you family during this time that you hope to keep moving forward? We’d love to hear about it!

Beyond Compliance

By: Mark Lardner, LCSW, Center for Innovation in Population Health

When a system is looking for an assessment process to help improve their work with individuals, they often explore the TCOM approach. A simplified description of an initial implementation of TCOM tools would include the following activities. First, local versions of the tools are designed with input from a variety of stakeholders. Next, policies are developed that define the population (the youth, families or individuals) to be assessed, and the timeframes for the completion of the assessment. Finally, training is rolled out for the workforce and the system is off and running. 

As an implementation gets off the ground, every system has an interest in measuring the success of the initiative. Tracking the timely completion of assessments seems like a natural next step for a handful of reasons:

  1. It is often the first data that a system has access to.  You can’t analyze data you don’t have, and typically the first complete data set that a system has access to is assessment completion information.
  2. They are easy to design.  The parameters for the design of compliance reports are set within policy, and there are very few data fields needed to create a compliance report (Date completed, Date Expected, etc.).
  3. They are easy to consume.  Most systems have trained their supervisors to manage front line workers through a process of policy enforcement.  They are used to seeing compliance reports.
  4. The reports are scalable.  Systems can create complimentary reports at the system, county/agency, program/site, supervisory and caseload level using the same basic data set.

It is clear that these offer some value to the system, but they also come with some significant downsides. The most potentially damaging downside is that they unintentionally communicate that the priority is the completion of the form, not the utilization of the tool. The measurement of compliance is not inherently flawed, but attention does need to be paid to how it is measured and, more importantly, communicated.

In order to move beyond compliance, the system needs to broaden its focus using “quality of assessment” measures. Determining the quality of any single assessment is a subjective exercise, so when thinking about all assessments across a system we can define quality assessment in the following way: it is accurate, collaborative and timely:

Our challenge is to create and utilize reports that communicate all three aspects of quality while being easy to consume and scalable for each level of the system. The shift beyond compliance enables a system to:

  • have a more nuanced discussion about assessment quality,
  • develop a road map for designing and delivering technical assistance, and
  • create a process for measuring their progress towards building best practitioners.

Below is an example of scalable reports that look at timeliness and accuracy at the state, county/program, supervisor and frontline staff levels. A narrative is provided that illustrates the potential utility of each report.


Let’s take a look at a series of reports used by a Child Welfare system (this data is not real, this is a public blog after all) to get a quick snapshot of the accuracy and timeliness of assessments at the state and county level.

This first bar graph communicates:

  • the % of Completed Assessments that had No Needs identified (all ratings on need items were less than “2”) during the past quarter
  • the % of Completed Assessments that had All Zeroes on Need Items (all ratings on need items were “0”) during the past quarter
  • the % of Completed Assessments that had No Identified or Useful Strengths (all ratings on strength items were “3”) during the past quarter
  • the % of youth without a completed assessment within the policy time frame during the past quarter

The State has concerns in all three areas. 

  • Given what they know about their population, they are concerned that 33% of the assessments completed in the last quarter have no needs and that 8% of assessments were completed with every need item defaulting to “0.”
  • Additionally, the system has for a long time prided itself as being strength-based, but their assessments show that 42% of assessments do not have any identified or useful strengths. 
  • Finally, given that they are in their second year of implementation, they have set a goal of having 80% of children receive an assessment each quarter (the goal for their first year was 70%).  They have not reached their goal this quarter; 28% of youth did not receive a timely assessment.

The second bar graph keeps the same color scheme and presents a visual for:

  • county level accuracy issues related to Need items, and
  • timeliness of assessment. 

The blue bars that approach or cross the red state average line for assessment with no needs are the first counties to receive offers of technical assistance.  (A similar county level report for the green “% No Strengths” bar is generated and utilized.)

In this case, the State would start their outreach with “County H,” “County C” and “County B” who are all having difficulties with accuracy.  (County C and H are also having challenges around the timeliness of their assessments.)  Those counties would be asked to review their county-specific reports that are organized by supervisory unit and caseload.  

The Supervisor Caseload Intensity report provides the supervisor a snapshot of the timeliness (“# of Youth Assessed” and “# of Youth Missing CANS”) and accuracy (“# of Actionable Needs” and “# of Strengths”) for all the frontline workers that they supervise.

With a quick glance the supervisor realizes that more than half of their supervisees are struggling to identify actionable needs and useful strengths.  Determined to provide support to the staff, the supervisor reviews the worker level report before their next supervisory session with R Dahl.

Realizing that there is not enough time to review each individual story in detail, the supervisor selects two individuals, M Wormwood and A Prewt, to review during the upcoming supervisory session.  Instead of going through the completed assessments and asking for changes to be made, the supervisor asks R Dahl to describe his understanding of the youth and to describe any needs that could be resolved, and strengths that could be useful.  The supervisor then helps R Dahl organize their conversation using the common language of the CANS.  The supervisor’s goal is to build agreement and understanding, and to model how conversations with the youth and their team can be organized around action.  These skills are critical to staff trying to complete the CANS with accuracy and efficiency.


The reports above still lack a scalable and easy to consume approach for measuring the collaborative aspect of quality assessments.  The following ideas require testing and further development):

  1. Using twice a year surveys of the experiences of youth, families and adults to create a collaborative score for each case unit.
  2. Sum the number of signatures on each assessment (youth, family, individual and team members).  Use this total # as another bar on the Supervisor Caseload Intensity Report.
  3. Use measures of skill development in the area of collaborative assessment (e.g. items from the CHQIN – the Collaborative Helping Quality Inventory).
  4. For youth with multiple team members completing assessments (e.g., caseworker and MH clinician), measure consistency across assessments completed within the same timeframe.  Create a collaborative assessment score based upon level of agreement between the two assessments. 

The level of collaboration in assessment is the most difficult for systems to measure; it is also potentially the most important metric. Truly collaborative approaches to assessment tend to increase the accuracy of the assessment as every voice is represented.  Collaborative approaches to assessment and planning also tend to increase the timeliness of assessments.  The work of completing the assessment is no longer the responsibility of one solitary worker, but instead the global responsibility of the person-centered team. 

So how does your system measure the quality of assessments?  Share your thoughts and ideas by leaving a reply below.

Cinthya Chin Herrera, PsyD

Meet Cinthya Chin Herrera!

Cinthya Chin Herrera received her doctoral degree in clinical psychology from John F. Kennedy University. In Alameda County, she is a member of the Alameda County CANS Provider Collaborative and provides training and coaching to several community-based organizations in her region on the use of the CANS. She is the Director of Clinical & Community Training at WestCoast Children’s Clinic (WCC), a child and family community mental health clinic in Oakland, California where she assists in the oversight of a comprehensive training program. Cinthya promotes cross-cultural transformational practice to develop mental health professionals who serve youth and families in the areas of resilience, collaboration, advocacy, and empowerment.  She provides trainings on client-centered, trauma-informed care and collaborative engagement with vulnerable children and families in community mental health settings and draws upon her Nicaraguan, Mexican, and Chinese roots and her experiences as an immigrant to the United States to inform her practice, training, and writings.  

Posts by Dr. Herrera:

Amy Zimmermann, PhD

Meet Amy Zimmermann!

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Amy Sharp Zimmermann, M.S.W., Ph.D., is the Director of Systems, Data, and Reporting for Child and Family Services (CFS) at Casey Family Programs. Dr. Zimmermann works directly with social workers and direct service leadership to lead Continuous Quality Improvement and Change Management efforts. These efforts focus on developing innovative practices, based on data-informed decisions, that result in equitable outcomes for the youth and families that Casey Family Programs serves.

Dr. Zimmermann has over 10 years of applied research, program evaluation, and data-application experience in health, human services and educational settings. Prior to joining Casey Family Programs in 2019, Dr. Zimmermann was a Research Scientist at the University of Washington’s Medical School where she was part of the evaluation team for UW’s Physician Assistant Program. She has also been an evaluator with the Seattle Public Schools, was a co-lead for evaluating an applied and project-based educational learning program through the UW, and a behavioral-health research analyst in several different settings. Her professional interests center on the appropriate use of quantitative methods in social science research. In particular, Bayesian and frequentist approaches to multilevel and structural equation (latent variable) models.

Posts by Dr. Zimmermann:

Michael Cull, PhD

Meet Dr. Michael Cull!


Dr. Michael Cull is an Associate Professor in the Department of Health Management and Policy at the University of Kentucky. His work focuses on quality improvement and system reform efforts in child welfare jurisdictions. Cull has specific expertise in applying safety science to improve safety, reliability, and effectiveness in organizations. His approach leverages tools like organizational assessment and systems analysis of critical incidents, including deaths and near deaths, to build team culture and help systems learn and get better. Cull also has 10+ years’ experience working with the Child and Adolescent Needs and Strengths (CANS) and works across the country with leaders of the TCOM framework.

Before joining the TCOM team, Cull served as deputy commissioner overseeing the Office of Child Health for Tennessee’s Department of Children’s Services. Prior to this appointment, he was an assistant professor in Health System Management at Vanderbilt University’s School of Nursing and the director of education and dissemination in the Office of Quality and Patient Safety for Vanderbilt University Medical Center. In addition to clinical practice as a faculty member in Child Psychiatry, he also previously served as executive director of the Community Mental Health Center, administrative director of the Department of Psychiatry Patient Care Center, and director of the Center of Excellence for Children in State Custody. He has a strong clinical background working with vulnerable populations and extensive experience with organizational evaluation and improvement in healthcare and the human services.

Cull is a licensed nurse practitioner with a specialty in child and adolescent psychiatry. He holds a Master of Science in Nursing degree from Vanderbilt University and received his PhD from the Institute of Government at Tennessee State University.

If you’d like to get in touch with Dr. Cull, you can contact him at michael.cull@uky.edu!

Posts By Dr. Cull

Barbara Dunn, LCSW, ACSW

Meet Barbara Dunn!


Barbara Ann Dunn, LCSW, ACSW, is Director of Program Innovation and Outcomes for Magellan Healthcare and is responsible for proposing, implementing and evaluating innovative programs across the public sector. Barbara’s work includes creating data collection systems using evidence-based and emerging assessment tools. Before joining Magellan, Barbara worked in early childhood and alternative education, child welfare, faith-based organizations and community mental health. She holds a master’s degree in social service administration from the University of Chicago and a bachelor’s degree in psychology from Binghamton University.

Barbara is also the Conference Program Chair for the upcoming 16th annual TCOM Conference! If you would like to get in touch with her, you can contact her at BADunn@magellanhealth.com.

Kate Cordell, PhD

Meet Dr. Kate Cordell!

Dr. Kate Cordell is a Behavioral Health Services Data Scientist and Researcher. Dr. Cordell integrates data systems to support a whole-person approach to care and builds solutions to put the person at the center. She implements insightful visualizations to track progress for a person and their care team. She builds models to convert data into decisions and decisions into positive outcomes. 

Dr. Cordell works to identify whether individuals and families are improving during care. She is especially interested in what works for whom. Every person and family have a story, often complex but also sewn with common thread. Dr. Cordell uses longitudinal analysis methods to model the changing patterns in these complex tapestries, hoping to identify the common elements of design. Dr. Cordell holds a bachelor’s degree from Rutgers University, an M.P.H. in Biometry from the Graduate School of Public Health at San Diego State University and a Ph.D. from the School of Social Welfare at the University of California, Berkeley. 

You can reach Dr. Cordell by contacting her at kcordell@opeeka.com!

Ken McGill, EdS LMFT

Meet Kenneth McGill!


Ken McGill, EdS LMFT is the statewide trainer on Wraparound as well as all of the Child and Adolescent Needs and Strengths (CANS) tool trainings offered for the New Jersey Division of Children’s System of Care (DCSOC). Wraparound & CANS are the fundamental trainings offered to all system partners; Care Management Organizations (CMO), Family Support Organizations (FSO), Children’s Mobile Response & Stabilization Services (CMRSS), In-Home Counselors (IIC), Behavioral Assistants and others. Ken was the 2013 recipient of the Praed Foundation’s Outcomes Champion (CANS) Award recognizing his work. He has also been licensed as a Marriage and Family Therapist and a Clinical Fellow with the American Association for Marriage & Family Therapy for 20 years. Ken has served two terms as President of New Jersey Association for Marriage and Family Therapy (NJAMFT). He is also a published author and researcher with expertise in both systems of care and outcomes management. He holds a Bachelor of Arts Degree in Psychology, a Masters of Arts in Education in Psychological Studies and an Educational Specialist Degree in Marriage & Family Therapy.

You can reach Ken by contacting him at kenneth.mcgill@rutgers.edu

Posts Written by Ken

16th Annual TCOM Conference-Call for Papers!

We are happy to announce the 16th Annual TCOM Conference this year in beautiful and vibrant New Orleans. To highlight our host city, the theme of this year’s conference is “Collaboration and All that Jazz”. 

We invite all members of the international TCOM collaborative to submit proposals to present your work. The content of presentations can be varied or broad, but each presentation must include a component related to the concept or practice of collaboration. Whether collaboration is in the design of the work, its implementation or even the presentation of your experiences, we seek to build on the collaborative spirit of our group to learn from each other how to best work together on behalf of the people we all strive to serve. Presentations that involve partnerships of two or more presenters from different community-based or state-based organizations or educational institutions or parents or individuals with lived experience, OR that highlight successful collaborations between different organizations, systems and/or populations are highly encouraged. 

Whether you submit a proposal to present or not, we look forward to seeing all of you in New Orleans to collaborate on helping (and perhaps collaborate on having some fun!) while we experience the unique culture of New Orleans. The conference will be held on September 30th-October 2nd at the JW Marriott Hotel in the French Quarter. For those of you who have never attended a TCOM Conference, we think you will find it a unique conference experience of a large group of committed and humble people seeking to share and learn from each other. We hope you join us in growing this culture of collaboration. 

Download the Call for Papers here!

For more details, visit our 16th annual TCOM Conference page!

Changing Student Outcomes with Restorative Practices, Part 2

By: Amber Joiner-Hill, MSSW
Associate Policy Analyst, Chapin Hall at the University of Chicago

In Part One of this piece, I outlined some of the impacts that the criminalization of students has on youth outcomes—lower high school graduation rates, higher chances of getting arrested, and increased likelihood of entering the adult criminal justice system. Here I’d like to offer restorative justice as a different approach for improving student behavior in school.  

Considerations  

Research does not indicate that students who experience traditional disciplinary actions such as suspensions or expulsions are less likely to violate school policies in the future, or that the punitive actions create safety for the schools or communities. Instead, data implies that the use of punishment and criminalization makes students more likely to suffer academically and get involved in the juvenile and adult criminal justice systems further down the roadi,ii. It is time for education administrators to reconsider the way that schools respond to negative behavior in the classroom.   

One alternative method is called restorative justice. According to the Office of Juvenile Justice and Delinquency Prevention (OJJDP), restorative justice is a theory that emphasizes repairing the harm caused by criminal behavioriii. The goal is to bring together those most affected by the criminal act in a non-adversarial process to encourage offender accountability, to meet the needs of the victims, and repair the harm that resulted from the crime. Restorative justice can be implemented in different ways—the most common of which include family group conferences, victim-impact panels, victim-offender mediation, circle sentencing, and community reparative boards. The amount of research completed on each of the implementations varies, but collectively it suggests that restorative justice reduces recidivism rates among youth as well as men in jail or prison, it reduces the victim’s post-traumatic stress symptoms, and it offers a stronger sense of justice for the victim and the offender than the traditional criminal justice system caniv

The description of restorative justice provided by OJJDP is typically meant to apply to criminal actions that occur in a community. When the same theory of repairing harm caused by criminal behavior is implemented in a school, it is sometimes referred to as restorative practice, and the terms can be used interchangeably. The focus remains on repairing harm done to relationships instead of assigning blame or seeking retribution. Both students and school staff can participate in the activity. The practices in school typically include the following elements:  

  • Peace Room: a physical space inside the school where students and staff can resolve conflicts  
  • Peer Juries: youth discuss the conflict and determine consequences with their peers  
  • Group Conferencing: the victim, offender, and supporters of both describe the incident and the impact that it had on them  
  • Peacemaking Circles: the victim, offender, supporters of both, and community members use a talking piece and discuss the conflict in conversations that are facilitated by a trained Circle “keeper”v,vi  

In the city of Chicago, for example, the Umoja Corporation partners with at least 15 Chicago schools to facilitate restorative practices. The schools that implemented the practices have decreased their suspension rates by an average of 42%, which means that students spend more time in the classroom, giving them less time to engage in criminal behavior outside of the school, and therefore making them more likely to stay in school and graduate with a diplomavii. In addition to quantitative school outcomes such as graduation rates and violations of school policies, the use of restorative practices can positively affect a student’s problem-solving and conflict resolution skills and overall experience in school as it relates to bullying and relationship-buildingviii,ix

Recommendations 

The data from Chicago is promising, but further research should be conducted on the use of restorative practices in schools in order to develop a more robust pool of data. Only then can we access it’s efficacy, modify the approach as necessary, and then determine if and how restorative justice should be widely implemented across school districts. When more outcome data is available, then it can be compared against the outcomes of students who experienced suspensions and expulsions. Potential measurements include high school graduation rates, recidivism rates as they relate to school policy violations, suspension and expulsion rates among students of color, and emotional well-being of the students involved in the offense.  


Additional Resources 

Restorative Practices in Schools 

Basic Restorative Justice Trainings and Events: https://www.iirp.edu/professional-development/basic-restorative-practices 

Minnesota Department of Education. (n.d.). Books and Manuals on Restorative Measures in Schools. Retrieved from https://education.mn.gov/mdeprod/groups/educ/documents/basic/mdaw/mdiz/~edisp/023485.pdf 

Riley, E. (2017 March 17). Implementing Restorative Practices in the Classroom. Getting Smart. Retrieved from https://www.gettingsmart.com/2017/03/implementing-restorative-practices-in-the-classroom/ 

Schott Foundation. (2014, March). Restorative Practices: Fostering Healthy Relationships & Promoting Positive Discipline in Schools. A Guide for Educators. Retrieved from http://schottfoundation.org/sites/default/files/restorative-practices-guide.pdf 

Disproportionality in School Punishment 

Parker, D. (2014, May 17). Segregation 2.0: American’s school-to-prison pipeline. Retrieved from http://www.msnbc.com/msnbc/brown-v-board-students-criminalized 

Skiba, R. J., Chung, C-G, Trachok, M., Baker, T. L., Sheya, A., & Hughes, R. L. (2014). Parsing disciplinary disproportionality: Contributions of infraction, student, and school characteristics to out-of-school suspension and expulsion. American Educational Research Journal, 51, 640-670. doi: 10.3102/0002831214541670 

Skiba, R. J., Michael, R. S., Nardo, A. C., & Peterson, R. L. (2002). The color of discipline: Sources of racial and gender disproportionality in school punishment. The Urban Review, 35, 317-342. 

Amber Joiner-Hill, MSSW

Meet Amber Joiner-Hill!


Amber Joiner-Hill, MSSW is an Associate Policy Analyst working with Chapin Hall’s TCOM team. Her responsibilities include managing the portfolio of data analytic activities, co-developing online training curriculum focused on culture, and analyzing policies relevant to the TCOM philosophy. She is also tasked with developing and maintaining productive relationships with administrators and frontline staff in human services provision.

Previously, Joiner-Hill was a Continuum of Care Coordinator in rural Virginia. She wrote grants, managed application processes for more than $750,000 in federal grants, facilitated a regional strategic planning process, and built capacity within a six-county collaboration focused on preventing and ending homelessness. Joiner-Hill also evaluated grant applications for federal and foundation funds. Prior to that, she worked as a planner in Austin, Texas. In this position, she conducted program evaluations, designed cultural competency curriculum for staff, and published reports on older adults and community planning.

She holds a Master of Science in Social Work, with a concentration in Community and Administrative Leadership, from the University of Texas and a Bachelor of Arts in Psychology from the University of Michigan.

You can reach Amber by contacting her at ajoinerhill@chapinhall.org!

Posts Written by Amber

Changing Student Outcomes with Restorative Practices, Part 1

By: Amber Joiner-Hill, MSSW
Associate Policy Analyst, Chapin Hall at the University of Chicago

I started developing a vocabulary around the criminalization of students—particularly those in elementary and middle school—about four years ago when I participated in my city’s “Citizen’s Academy”. The program exposed residents to various government services, functions, and challenges. The intent was to show what it took to keep the city going and hopefully generate a sense of ownership and connectedness to our community. One of our sessions was with a school resource officer from the local police department. I had not heard that term before and learned that this particular officer was assigned to patrol the hallways of a nearby middle school and high school and participate in disciplinary actions as requested or deemed necessary. The concept of having a police officer regularly present in a school and not just responding to an emergency was bizarre to me. When I was in school, the most threatening figure was Sister Stephanie—the Catholic principal who never smiled. She did not walk amongst us with a taser, baton, bullet-proof vest, or loaded gun like this school resource officer did.  

Years before meeting this officer, I researched and wrote papers about the mass incarceration of Black and Latino men. Listening to the school resource officer talk about her job gave me a clear picture of what likely happened to those incarcerated men before they entered the adult criminal justice system. They could have been victims of the school to prison pipeline.  

The Issue 

The school to prison pipeline is a journey from the education system to the juvenile justice system and perhaps then the adult criminal justice system. There are some specific “stops” along the pipeline that people experience before entering a justice systemi. Two stops often highlighted are the introduction of police officers into schools, and the zero tolerance approach implemented by school administrations. 

School resource officers are local police officers who work on the school grounds and have the ability to ticket, arrest, and detain students in response to a violation of a school policy. When teachers have a student who they would like to discipline but feel they cannot do it themselves, they can give that responsibility to a school resource officer and the consequences (legal and emotional) might place the student in the school to prison pipeline. This criminalization of students was highlighted in recent years with the release of several videos showing physical altercations between officers and the students they were trying to arrest, and encouraged conversations about racism within schools and the need for law enforcement on school campuses.  

The zero tolerance approach is similar to the criminological theory of broken windows—if you punish individuals for minor offenses, then they are less likely to commit more serious offenses or violations in the futureii. For example, if we handcuff a student and take him to the principal’s office for talking back to his teacher, then maybe he will not do it again. There is no data to support the effectiveness of such policies but there is evidence to suggest that they both enforce racial stereotypes against Black and Latin boys and meniii,iv.  

Why It’s Important 

The most commonly used forms of disciplinary action taken in schools are expulsions and in-school and out-of-school suspensions. The use of disciplinary actions that remove students from school, for any length of time, has the greatest impact on Black and Latino students, who are up to three times more likely to be suspended than their White peersv,vi. According to Rumberger and Losen (2016) students who receive a school suspension are 15-27% less likely to graduate high school. Nationally, students who do not graduate from high school are three and a half times more likely to get arrested in their lifetime and eight times more likely to spend time in jail or prisonvii,viii. One cannot draw causal conclusions here but the data supports the existence of a school to prison pipeline and also touches on the disproportionality of Black and Latino men in the adult criminal justice system. 

Communities as a whole suffer when residents are incarcerated because those individuals do not have the ability to work, and therefore are unable to support local businesses, pay taxes, volunteer in their community, or mentor younger generations.  

This is just a snapshot of the impact of the criminalization of students. In part two of this post, I will describe an alternative that school administrators should consider: restorative justice. Do you have a student, client, or family who has been affected by the school to prison pipeline? 

Look out for Part 2 on Friday!


Additional Resources

1 American Civil Liberties Union. (n.d.). Locating the School-to-Prison Pipeline. Retrieved from https://www.aclu.org/sites/default/files/field_document/asset_upload_file966_35553.pdf

2 Skiba, R. (2004). Zero Tolerance: The Assumptions and the Facts. Indiana University: Center for Evaluation & Education Policy.

3 Vedantam, S., Benderev, C., Boyle, T., Klahr, R., Penman, M., & Schmidt, J. (2016, November 1). How A Theory of Crime and Policing Was Born, And Went Terribly Wrong [Audio podcast]. Retrieved from https://www.npr.org/2016/11/01/500104506/broken-windows-policing-and-the-origins-of-stop-and-frisk-and-how-it-went-wrong

4 Advancement Project (2005, March). Education on Lockdown: The Schoolhouse to Jailhouse Track. Washington D.C.: Advancement Project.

5 Losen, D., Hodson, C., Keith II, M. A., Morrison, K., & Belway, S. (2015). Are We Closing the School Discipline Gap?. UCLA: The Center for Civil Rights Remedies.

6 U.S. Department of Education Office for Civil Rights. (2014, March). Civil Rights Data Collection Data Snapshot: School Discipline. (Issue Brief No 1). Washington D.C.: U.S. Department of Education Office for Civil Rights.

7 Rumberger, R. W. & Losen, D. J. (2016). The High Cost of Harsh Discipline and Its Disparate Impact. UCLA & UCSB: The Center for Civil Rights Remedies

8 Christeson, B., Lee, B., Schaefer, S., Kass, D., & Messner-Zidell, S. (2008). School or the Streets: Crime and America’s Dropout Crisis. Washington D.C.: Fight Crime Invest in Kids.

Ritchie Rubio, PhD

Meet Dr. Ritchie Rubio!


Dr. Ritchie Rubio is currently the Director of Practice Improvement and Analytics at the Children, Youth, and Families System of Care (CYFSOC) Behavioral Health Services (BHS) at the San Francisco Department of Public Health (SFDPH). In that role, he plans and coordinates a clinical practice improvement and research/evaluation program focused on identifying best evidence-based and culturally-relevant practices for the CYFSOC. He is also an adjunct Associate Professor at the Counseling Psychology program of the Wright Institute in Berkeley. He teaches courses in child and adolescent counseling; psychological assessment; research and statistics; crisis intervention; and trauma therapy.  

For the past 20 years, he has worked as a clinical child psychologist, play and expressive art therapist, researcher, program evaluator, statistical consultant, and assistant professor/lecturer in a variety of clinical and academic settings including universities, pediatric hospitals, community mental health settings, schools, and research institutes in three countries: Philippines, U.S.A., and New Zealand. He completed his PhD in Clinical Psychology with a Child and Family emphasis from the California School of Professional Psychology (CSPP) in San Francisco. He was born and raised in the Philippines and immigrated to the U.S. more than a decade ago to pursue his doctorate through a Ford Foundation International Fellowship. His clinical work was primarily with immigrant and multicultural children and their families. As for research interests, he explores global gender roles, therapy strategies that blend Eastern and Western paradigms, culture-specific worldviews, and diversity initiatives.

Dr. Rubio prepares to teach an assessment course where he integrates the use of play and sandtray therapy.

You can reach Dr. Rubio by contacting him at ritchie.rubio@sfdph.org!

Posts written by Dr. Rubio

Sandtrays, Fables, and Expressive Arts: Story-telling Adventures with the CANS

By: Ritchie Rubio, PhD

We were fortunate enough to have Dr. Rubio present at the 15th Annual TCOM Conference earlier this month. In his post below he shares more on using the CANS and story-telling to promote client wellness.

Listening to, reading, or sharing a good story is something most if not all of us enjoy. One of the check-in activities I love to use when facilitating CANS training workshops is to ask participants to share the kinds of stories they are drawn to. What I notice is an immediate spark of energy in the room, as participants share about their interests in folktales; myths; children’s stories and fairytales; news stories; stories of resilience; autobiographies; psychological thrillers; celebrity gossip; science fiction; and many more.

Stories and story-telling is not new to TCOM. In fact, John Lyons (see One Person, One Story, One CANS/ANSA, 2019) has always talked about how the goal of the CANS is to “represent a commonly understood story that integrates the perspectives of all story tellers.”  With story-telling as the overarching theme in the most recently concluded TCOM Conference, Dr. Farahnaz Farahmand (interim director of our Children, Youth, and Families system of care) and I took this as an opportunity to share the story of our work at the San Francisco Department of Public Health, and highlight our Data Reflection to Innovate and Revitalize Effectiveness (DRIVE) Initiative. Our data reflection processes have strengthened the story-telling aspects of the CANS while promoting practices that are trauma-informed and culturally-appropriate.

I routinely bring CANS data to clinicians and mental health providers. Our mantra has been, “to be data effective, we need to be data reflective.” My hope is that they will enthusiastically reflect on the data and use their reflections to improve their clinical practices. Easier said than done. Many times, when I open discussions on CANS data with clinicians, I am met with a seemingly ‘deer in headlights’ standstill. We gradually changed this by shoring up story-telling approaches to encourage clinicians to reflect on data with the same engagement and pleasurable feelings like being in a ‘story time’ circle. These approaches have been informed by: (1) narrative data visualization (e.g. Segel & Heer, 2010); (2) neuroscience findings that many areas of the brain are activated more by stories than data (e.g. Zak, 2014); and (3) mathematical mindset development as a means to visually approach numerical data and help heal math trauma (see Boaler, 2019).      

CANS Story-telling with our Community Mental Health programs

We have used story-telling approaches to motivate an effective and meaningful use of CANS data among our clinical and data personnel. One approach is to ask reflection participants to look at data as a storyboard. When we look at data, we tend to approach it by asking questions such as, ‘What do the numbers mean?’ or ‘Where are the statistically significant improvements?’ Using a Storyboard Approach, one can instead ask questions that we customarily use around stories: ‘What’s the story here?’, ‘Who are the protagonists in this story?’, ‘Are there antagonists?’, ‘What are the conflicts in this story?’, ‘What are the resolutions to the conflicts?’ or ‘How does the story end?’ Another approach is to integrate the use of sandtray therapy, in itself an expressive arts story-telling intervention used by many clinicians who work with children and youth. Using a Sandtray Approach, one can look at the data as if it were a sandtray story, and ask sandtray processing questions such as: ‘What is the title of this story?’, ‘What is happening in here?’, ‘Are you, your client, or your program in this scene? Can you show me where?’, ‘Where is the energy here?’ or ‘What has the most power in here?’ I have noticed that using these approaches have augmented the engagement of many of our clinicians around CANS data.

CANS Story-telling with our Clients

Stories of our clients often include a number of actionable needs in their CANS. When this happens, it is important to engage in case formulation to be able to organize our understanding of a client’s needs and strengths, to inform what we prioritize for treatment (see John Lyons’ Treatment Planning with a Communimetric Tool). Using this approach, we generated our CANS Case Formulation and Treatment Planning Worksheet. This worksheet helps clinicians arrange the story of a client in such a way that it reflects a story mountain or narrative arc: reason for referral and background needs (introduction and rising action); priorities for treatment needs and strengths (rising action and climax); and interventions/activities and anticipated outcomes (falling action and resolution).

In the past decade, there was a paradigm shift to make our assessment processes more collaborative and therapeutic for our clients (Finn et al., 2012). Creative platforms have also been recommended as a means to engage children and youth in collaborative assessment feedback that is both meaningful and developmentally appropriate. One of those methods is the use of fables (Tharinger et al., 2008), which uses the realm of fantasy and metaphor to assist children and youth in processing their story or re-authoring their story, without overburdening their emotional capacities or raising their defenses. You can see in Figure 1 some pages of a fable co-authored with Lian (not her real name), a 4-year old Chinese girl who presents with traumatic grief and severe anxiety following the death of her maternal grandmother, who became a primary attachment figure. Many of the CANS items that were prioritized for her treatment (both needs and strengths) were integrated into the fable. Through this story, Lian was able to understand her story and collaborate in re-authoring it for constructive change.

Figure 1: Therapeutic fable with CANS items prioritized for treatment

Many stories are shared and processed verbally, such as the use of the worksheet and fable above. However, many children and youth have difficulty verbalizing their most painful experiences. Especially when children/youth have experienced trauma, self-protection involves difficulty in talking about them. Such experiences are often not readily available to be communicated through language but may be available through the use of expressive arts and other experiential activities (Malchiodi, 2015). As such, trauma-informed approaches like the use of sandtray therapy, art therapy, and play therapy can be used to translate the CANS assessment into a therapeutic intervention that maximizes the engagement of children and youth. For example, in Figure 2, you can see an example of how Lian represented her CANS story in the sand. Story-telling art therapy approaches can also be used such as journey sticks, mandalas, dioramas, comic strips, and others.         

Figure 2: Sandtray story with CANS items represented as miniatures

Stories and story-telling are innate and central to our human experience. It is my hope that we continue to explore and share creative and adventurous ways of strengthening our CANS storytelling. In our work with diverse clients, story-telling is truly a powerful culturally- and trauma-informed approach to promoting our clients’ wellness and recovery.


Some useful references:

Boaler, J. (2019). Developing mathematical mindsets: The need to interact with numbers flexibly and conceptually. American Educator, 28-40.

Finn, S. E., Fischer, C. T., & Handler, L. (Eds.). (2012). Collaborative/therapeutic assessment: A casebook and guide. Hoboken, NJ: Wiley.

Segel, E., & Heer, J. (2010). Narrative visualization: telling stories with data. IEEE Transactions On Visualization And Computer Graphics, 16(6), 1139–1148.

Tharinger, D. J., Finn, S. E., Wilkinson, A., DeHay, T., Parton, V. T., Bailey, K. E., & Tran, A. (2008). Providing psychological assessment feedback to children through individualized fables. Professional Psychology: Research and Practice, 39(6), 610–618.

Zak, P. J. (2014). Why Your Brain Loves Good Storytelling. Harvard Business Review Digital Articles, 2–4.

Melinda J. Ickes, PhD

Meet Melinda J. Ickes!


Melinda Ickes received her Ph.D. from the University of Cincinnati in 2010. Dr. Ickes is a faculty associate for the Kentucky Center for Smoke-free Policy, and the Director of both Tobacco-free Take Action! and Go Tobacco-free, two initiatives to promote tobacco-free college campuses. Her research interests are in the areas of tobacco control, college health promotion, and childhood obesity. Dr. Ickes teaches undergraduate and graduate courses in health promotion including Program Planning, Health Promotion and Behavior Change, College Health Promotion, and is coordinator of the health promotion practicum/internship program.

You can reach Melinda by contacting her at melinda.ickes@uky.edu!

Other posts written by Dr. Ickes

What Will it Take to Reverse the Youth E-Cigarette Epidemic?

By: Melinda J. Ickes, PhD
Associate Professor, Health Promotion; Faculty Associate, Center for Innovation and Population Health, University of Kentucky

When we send young people to school, we think about what they are learning, how they are being prepared for a future career path, if they are building friendships, and hope they engage in positive social emotional learning. However, we are now worried about youth using and becoming dependent on e-cigarettes, which just might derail all of those other efforts.

You might be curious to find that many of the products that look like school supplies in a student’s backpack could in fact be e-cigarettes or other innovatively designed tobacco products targeting our youth. According to the 2018 National Youth Tobacco Survey data, one in five high school students and one in 20 middle school students (over 3.6 million youth) are currently using e-cigarettes or ‘vaping’ – a resounding 80% increase from 2017.

Pod-based e-cigarettes like Juul, currently the most common brand used by young people, have garnered the fascination of youth. The e-liquid used in the ‘pods’ or cartridges of these devices has comparable concentration of nicotine as a pack (or more) of combustible cigarettes, which puts our youth at risk for dependence and subsequent combustible cigarette use. E-cigarette companies make appealing and fun flavors (e.g., strawberry, mango, zombie dust), use targeted and tailored marketing, and aim to create a norm where it seems acceptable for youth to use these products.

Beyond the risk for dependence, e-cigarettes contain numerous chemicals previously linked to increased risk for cavities, seizures, heart disease, cancer, and more recently, an outbreak of lung disease across all states. Sounds eerily similar to warnings included in the Surgeon General’s Report over 50 years ago when talking about combustible cigarettes, right? Along those lines, we also know it is not just water vapor, as the companies might want our young people to believe. The secondhand aerosol given off by e-cigarettes includes tiny particles that are easily breathed into the lungs, as well as nicotine and low levels of toxins, putting even us bystanders at risk. These products are setting up future generations for a lifetime of health risks if we do not intervene now.

Recent research indicates that e-cigarette use is more common among students with lower school connectedness. This reinforces the importance of schools and the need to help strengthen school connectedness for students through adult support, providing opportunities for youth to belong to a positive peer group, and promote an overall positive school environment. The good news is this affords all of us an opportunity to help prevent youth from initiating use and support youth who are already using e-cigarettes to quit. This might seem like a daunting task, but regardless of your role in a young person’s life, we can integrate strategies we already know help promote connectedness. Ask yourself how you might support the development of relationships between youth and positive adults in their lives (e.g., teachers, coaches). Could you be that positive connection they are looking for? Consider how you can encourage student engagement that strengthens social networks and connections. Are there school and/or local club/organizations you might share? Another successful strategy is to create or help support peer-delivered prevention programs and support groups. Youth resonate with other youth and are often more open to having an open and honest dialogue with each other – how can you help support efforts like this in your community?

Given all of this, we also know that prevention is critical – we cannot wait until high school to talk with youth about e-cigarettes and we cannot assume that a one-day presentation is going to reverse this epidemic or promote connectedness. Prevention needs to be supported by:

· Integrating evidence-based, developmentally appropriate, skills-based substance use (including tobacco and e-cigarettes) prevention throughout all grades

· Creating open lines of communication and support systems for youth in and outside of our schools

· Engaging (and educating) parents, advisory councils, administrators, school staff/personnel, healthcare providers, and all others who interact with youth in the conversation

· Empowering students with opportunities to learn more about the issue, problem solve, and develop action projects in their schools and communities to make a difference

If youth are using e-cigarettes, support is essential to understand how their dependence may affect their life now and in the future. Put them in touch with relatable quitting resources and be a shoulder to lean on when needed. This is not the place for judgement or blame, but the time to practice empathy and open dialogue. What makes it difficult for them to quit? What can you do to support them? How can schools create an environment conducive to quitting? For more info on support tailored for young people: https://truthinitiative.org/thisisquitting

While we may not have all of the answers, we know that building connectedness with all youth, particularly those at-risk for e-cigarette and other substance use is imperative to supporting an empowered generation and ending this e-cigarette epidemic.


To discuss partnerships to bring #iCANendthetrend, a peer-led e-cigarette prevention and empowerment program, to your community, email: icanendthetrend@uky.edu

TCOM Conference Recap: Stories Worth Telling

By: Rebekka Schaffer, TCOM Communications and Conference Lead

We had an amazing week at the 15th Annual TCOM Conference! The weather was great, the presentations were powerful, and the sense of community won’t soon be forgotten.


The collaborative work of TCOM lasts all year round, but there’s something meaningful and special about being able to come together in person–even if it’s just once a year. That’s what happened two weeks ago for the 15th Annual TCOM Conference. More than 350 people from across the country (and some from across the ocean!) joined us in Palm Springs, California for a time of sharing, learning, and growing. What started out as a groundbreaking idea from Dr. Lyons has turned into a large and diverse community of people committed to improving the well-being of all through effective and equitable interventions.

This year’s conference theme was “Culture and Community: Sharing Stories from the Collaborative”. In the helping field, we can’t serve others well if we don’t acknowledge their whole story. The story of a person’s life includes their culture and the community that they come from. All of us are shaped by this. The people who raised us, the lessons we were taught, and the things we value can all be traced back to our respective cultures and communities. The problem, however, is that–even when we have the best intentions–some stories are still disregarded. If we don’t take the time to listen and seek to understand different backgrounds, we can fall into the habit of suggesting interventions that might be right for us, but wrong for the person we’re serving. This tends to negatively impact those who are already most vulnerable. This theme helped ground the conference in the importance of acknowledging, honoring, and elevating the stories of the people we serve.

The TCOM tools and principles are built around this idea of storytelling–and so is the conference. Tools like the CANS and ANSA are meant to help tell the story of one person. Our job is not to create a person’s story for them. No one knows a story better than the person living it. Our job is to work with that person or family to create a service plan that matches their story. Our presenters at the conference did an amazing job of using their research, data, and personal experiences to embrace this theme and inspire attendees to do the same. We were fortunate to have a combination of master lectures, round table discussions, and breakout presentations during the three days we got to spend together. If you weren’t able to make it to the conference (or if you were there and want a refresher!) you can go HERE to find all of the presentations.

The work we do in serving youth, adults, and families is meaningful and transformative, but so is the act of sharing those experiences with others. The TCOM Conference invites us all to be storytellers–whether you’re a presenter or attendee. Each person who has ever done the work of putting TCOM tools and principles into practice has stories of frustration and success. Both types of stories are important and necessary to share. It’s how we learn, it’s how we stay motivated, and it’s how we stay inspired. I hope that is how everyone felt as they left Palm Springs: inspired. The goal this year, and every year, is that you take what you learned (and hopefully your new connections!) back to your communities. That’s how the work keeps moving forward.

On behalf of Dr. Lyons and the rest of the TCOM Team, I’d like to say a huge thank you to everyone who made it to the conference this year. If you weren’t able to come, we hope to meet you next year at the 16th Annual TCOM Conference in New Orleans, Louisiana! We already have high expectations for what the next year has in store. This is a super special community to be a part of–thank you all for being a part of it.


Interested in writing for the blog? We’d love to feature your work! Reach out to communications@praedfoundation.org to connect with us!

A Message from Dr. John Lyons

The TCOM group is establishing the Innovations in Population Health (IPH) Center at the University of Kentucky and embedding TCOM into the core of the Center’s work. We are moving our operations to Lexington, Kentucky! We are excited about the opportunities and challenges that lie ahead. 

So why the University of Kentucky? First, the University of Kentucky is one of the original Land-grant universities. Established by Abraham Lincoln through the Morill Act in 1862, the idea was to expand the accessibility and practicality of higher education. Prior to this initiative, higher education was an opportunity reserved only for the rich and powerful. The notion of education for all the people is very congruent with the core values of TCOM and our group.

Second, the College of Public Health with its high-energy leadership and vision of Dean Donna Arnett and vibrant faculty offer a home in a field that is the most congruent with the mission and approaches of our work. The IPH Center will be charged with integrating across all 16 colleges at the University to bring together the best minds and a synergy of approaches to address pressing population health concerns. For example, there is a growing awareness among national child welfare leadership that the field of child welfare should be understood through the lens of public health.   Further, public health has become increasingly aware that the simple delivery of health inventions, without consideration of the social and psychological determinants of health and well-being is inherently limiting. This is a good time to position the work of TCOM and the team squarely as a public health initiative.

Third, a premise of TCOM is that we should go where the need is. Few states have greater need than Kentucky. Challenges confront the state in terms of population mental health, substance use, and child welfare. The opportunity to make a difference where the need is great is compelling to our team.

As the TCOM team embarks on the transition to the University of Kentucky, I’d like to thank Bryan Samuels and Chapin Hall at the University of Chicago for the past five years.  We have enjoyed working with the Chapin Hall staff and getting to know them and their work.  We are grateful for the opportunity to be part of Chapin Hall’s success.  We look forward to continuing collaboration with Chapin Hall in all of our efforts to improve the lives of children, youth, individuals and families with the greatest needs.


Dr. Arnett, Dean of the College of Public Health at UK, will be speaking at the 15th Annual TCOM Conference! Have you registered yet? We’d love for you to join us!

TCOM Conference: Presentation Spotlight

With the 15th Annual TCOM Conference around the corner, we wanted to give you a sneak peek look at some of this year’s presentations!

Casey Family Programs took time to answer some questions about their upcoming presentation, Engaging Staff in Improving and Advancing the CANS in Practice: Integrating TCOM Principles into Casey’s
Continuous Quality Improvement.

Q: What should individuals look forward to gaining from your presentation?

Our workshop is really two workshops packed into one session! At Casey, we are committed to becoming a trauma-and healing informed learning organization. Data-driven decision-making and continuous quality improvement are central to how we operate. In Child and Family Services, we are in our 6th year of CANS & FAST implementation. Our practices, processes, performance and outcome monitoring and feedback are partly driven by the CANS & FAST and are influenced by the TCOM philosophy.

We will be sharing two updates in our ongoing implementation of these efforts; (1) Our frontline staff & supervisor driven process that is critically reviewing our CANS & FAST, and related practices and data collection and assessment and action plan visualizations, that are shared with families and stakeholders. This has been part of an upgrade to our electronic case management (ECM) system that is planned to release in early 2020. We will be sharing our processes and anticipated changes from this work, including changes to our CANS reference guide, the pain-points Social Workers have experienced using our ECM and our plans to address them.

(2) An update in our ongoing efforts using our ECM data, including our CANS data, for predicting which youth are at greatest risks for aging out of our foster care program. Our hopes is that by identifying these youth and families earlier, we can change their services trajectory to more positive outcomes. We are early in our use of predictive, or as we say, precision, analytics, and we are trying to engage our staff in analyzing and applying these data through a collaborative story-telling process. This presentation will highlight how these efforts are part of our approach to CQI, provide an overview of their status, and we’ll share lessons learned along the way.

Q: What drew you to present on your specific topic?

At Casey, we believe that the collaborative approaches we are taking for improving our CANS & FAST, related practices, and analyzing and applying our data are consistent with the philosophies of TCOM. This has been an ongoing effort for us (that has been highlighted as past TCOM conferences, shared largely by our former Director of Data, Systems and Reporting, Stephen Shimshock, who is now part of the Praed team!), and we wanted to continue to share our story so that we can learn alongside others. We believe that by sharing, we can start conversations with others doing similar work. We invite this dialogue as it can be helpful for us, and others, to find ways to make possible improvements.

Q: What about the theme “Culture and Community: Sharing Stories from the Collaborative” resonates with you?

Addressing disproportionality and disparate outcomes, and anti-racism, are foundational values to Casey Family Programs. Being family-centered, relationship-based and culturally-responsive are core to our work. We view our practice with youth and families through a lens of cultural humility and try to engage, empower and elevate youth and family voice through teamwork. We also have a saying in Child and Family Services, “data speaks and stories teach, and it takes both to make a difference.” Joining in the collaborative give us a chance to hear the stories of others implementing CANS and TCOM. Our hope is to collaboratively learn!

Q: From your perspective, what role does storytelling play in the work you/we do?

Simply put, storytelling is central to our work. Youth and family’s individual stories beget an individualized and multidisciplinary team-driven approach to the work. We’ve also learned along the way that there is much we can learn as an organization from our frontline staff, youth, and families, in how to approach our challenges and opportunities. Lastly, our Social Workers are more likely to engage in our organizational improvement efforts when we find ways to successfully connect with them through stories about our practice.  


You can see the Casey group and our many other presenters at the 15th Annual TCOM Conference! Click HERE to register today!

TCOM Conference: Presentation Sneak Peek!

With the 15th Annual TCOM Conference around the corner, we wanted to give you a sneak peek look at some of this year’s presentations!

Conference presenters Celeste Seibel and Danielle Phillips took some time to answer some questions about their upcoming presentation, Utilizing CANS Within the Wraparound Process.

Q: What should individuals look forward to gaining from your presentation?

A: In our presentation we will be talking about how  to integrate the CANS tool into the fidelity-based process of Wraparound. When it comes to fidelity, we must stick to the defined process, however, within Wraparound  there are many places that the communication-based approach of the CANS, with its focus on strengths and needs, folds nicely into the collaborative Wraparound process. Our presentation will highlight how the CANS tool supports and complements Wraparound without taking over the process or interfering with the components necessary to do Wraparound to fidelity.  

Q: What drew you to present on your specific topic?

A: We work with Oregon and Idaho on their Wraparound and CANS implementation and have found that providing clarity on this topic has been helpful to the folks we work with. By understanding  how CANS can be utilized within the Wraparound planning process rather than taking over the process, better outcomes can be achieved for youth and families and Care Coordinators can feel less of a burden.

Q: What about the theme “Culture and Community: Sharing Stories from the Collaborative” resonates with you?

A: We love the idea of learning from everyone using the TCOM tools out in the world! Since we all have some similar experiences, and some different experiences, there’s a real richness in coming together and learning from each other.

Q: From your perspective, what role does storytelling play in the work you/we do?

A: In Wraparound, honoring the youth’s and family’s voice and their own story is key to the process. Wraparound should feel different than other experiences that youth and families have had in their previous involvement with youth-serving systems. Allowing the youth and family to share their vision for the future, actively participate in identifying strengths, meeting needs, and reaching agreed upon outcomes show that we value their lived story.

While training folks on the CANS, we have found it especially helpful to use mini-vignettes to explain the key components. Sometimes these concepts have been tricky for people to grasp at first. By adding in stories of actual youth and families to illustrate the concepts, we have found that folks can understand the components better, and apply them to real-life examples.


You can see Celeste, Danielle, and our many other presenters at the 15th Annual TCOM Conference. Click HERE to register today!

15th Annual TCOM Conference Roundtables

The 15th Annual TCOM Conference is around the corner, and we have some exciting news! For the first time ever, our Pre-Conference Day will feature a series of round tables and master lectures covering a wide range of topics. Attendees will be given the chance to have more in-depth discussions with presenters and each other on topics such as data sharing, Families First legislation, and learning collaboratives–just to name a few! In the upcoming weeks we will be highlighting some of these sessions here on the blog. Check out a few of our featured round tables below!

Family First and TCOM Workshop

Facilitators: Mark Lardner and Miranda Lynch

In this workshop, attendees will hear a structured presentation that outlines the provisions of the Family First Prevention Services Act (FFPSA) and provides an overview of program and jurisdiction specific opportunities for alignment within a TCOM framework.  The interactive workshop will create conversation around the key opportunities for system transformation at the program and jurisdictional level. 

Using small group activities, participants will be invited to share examples of strategies, barriers and lessons learned from their program or jurisdictions. Additionally, each participant can strategize on how they can contribute to Family First planning or implementation from a provider, field staff, management or leadership perspective. Pre-registration is ideal so that workshop activities can be tailored to best meet the participant’s needs and interests in improving their ability to leverage Family First in support of furthering a transformational approach to their work with children and families.

New Immigrant TCOM Tool Development

Facilitators: Stephanie Gilchrist and John Lyons

In Canada and the United States there is an increasing number of immigrants and newcomers. Social service agencies support these individuals with the settlement and integration into their new communities. In order to effectively do this, a plan is developed to outline their strengths and needs. The CANS assessment is used among many agencies to identify client strengths and needs. There is a necessity to develop a version of the CANS that is sensitive to the unique needs of newcomers.

We will provide a brief presentation outlining the requirement for the development of this CANS. Following the presentation, we will facilitate a workshop of experts and professionals in this area to identify appropriate CANS items and begin building a CANS that can be used with newcomer clients.


We hope to see you in Palm Springs! If you have any questions, please reach out to communications@praedfoundation.org

Check out our conference page for registration info, sponsorship opportunities, and the draft agenda!

TCOM Conference: Data Sharing Workshop

The 15th Annual TCOM Conference is around the corner, and we have some exciting news! For the first time ever, our Pre-Conference Day will feature a series of round tables and master lectures covering a wide range of topics. Attendees will be given the chance to have more in-depth discussions with presenters and each other on topics such as data sharing, Families First legislation, and learning collaboratives–just to name a few! In the upcoming weeks we will be highlighting some of these sessions here on the blog. Check out our first featured round table below!

Data Sharing Workshop

By this time there are many successful TCOM implementations collecting CANS/FAST/ANSA data!  This workshop (which is hopefully the first of many!) brings us together to share and compare program norms through the utilization of fundamental, shared reports.

To participate in this workshop you just need to have some ANSA, CANS or FAST data put into selected standard visualizations from the Praed Reports Suite (for more details, please click here). Hopefully, if you are collecting TCOM data, you already have these reports ready.  If not, however, and you would still like to participate, please reach out to dwarner@communitydataroundtable.org, and we will see if we can get your data into shape in time for this workshop!

The workshop will be co-lead by three experts in TCOM data: Dan Warner, Ph.D., Kate Cordell, Ph.D. and Stephen Shimshock, Ph.D.. The workshop format will include a structured training on making meaning out of the reports, including how to assess your program’s functioning in light of the information, and making a plan for program improvement. There are also many interactive components, where participants will actively interpret the data of others and their own programs, and generate increased understanding. 

Participants should leave with a fuller understanding of their own program’s nature and performance, and how it compares to other programs (both similar and dissimilar). Further, participants will have a better understanding of the Praed Reports Suite 2.0, and their ability to summarize system and program performance. 

Because participants need to bring their own data, we ask that everyone pre-register.  The pre-registration form will also explains the specifications for the presentation.  So please click here for details. 

Hope to see you there!


Check out our conference page for registration info, sponsorship opportunities, and the draft agenda!

One Person, One Story, One CANS/ANSA

By: Dr. John Lyons

Chapin Hall at the University of Chicago

A few years ago, I was in Hawai’i over Memorial Day. At the recommendation of a local colleague we attended the candle floating ceremony on Oahu. In the ceremony, people create candles commemorating lost loved ones and float them out to sea together. The experience was very moving as a powerful visual representation of love.

The theme of the ceremony that year was “Many rivers. One ocean”. That theme could very well describe the design of a communimetric tool. Although there are many story tellers in people’s lives there is still just one person, and it is their story. The goal of the CANS is to represent a commonly understood story that integrates the perspectives of all story tellers. Just as there are many rivers (story tellers) there is ultimately one ocean (the person’s story).

I really haven’t met too many people who would argue it shouldn’t be that way. The most common argument against a common story approach comes from people who view themselves as experts. They worry that somehow, if their expertise-driven story of the person is integrated with other story tellers, that their story will be lost. Some worry they will become accountable for a story they only had a part in telling. It is not a sustainable argument.

The assessor does not own the story. The assessor is not the story teller. Each individual owns their own story, and any effective helper knows this. The assessor gives information to be woven into that story, helps identify potential patterns and themes in the story and assists in organizing other perspectives. The process of integrating many rivers into one ocean–or many perspectives into one story owned by the person who is living it–is person-centered, consensus based assessment. This integration of stories is, simply, good care.

Consensus-based assessment arises in situations where multiple sectors or multiple providers are mandated to complete unique assessments. This creates operational challenges to the integration of perspectives into an integrated story. Here is our suggestion for managing this type of complexity:

  1. If one assessment was completed prior, the next assessor should do due diligence to secure a copy and build their assessment process as a check-in to see whether anything has changed or if new information is available to be shared.
  2. If the multiple assessments are to be completed during the same time period then we recommend they be done collaboratively. That does not require everyone to be in the room at the same time, although that would be ideal. All that is required would be that the various mandated assessors talk to each other to ensure that everyone is on the same page.

Some have argued if they are paid to do the assessment, then they cannot look at any versions of the assessment–they have to do it entirely themselves. That is untrue. What assessors get paid to do is complete the assessment. Any competent assessor knows the best assessments are based on as much information as is available. Building off other completed versions of the tool keeps the focus on the person and their story, not on the sole views of the assessor.

It certainly takes more time to complete a strong, consensus-based assessment process. But the evidence suggests slowing down to speed up is essential to ensure client engagement and the provision of good care. The effectiveness-related benefits outweigh the costs of putting more time into the process.

Each of us has to decide who we are professionally: Are we a profession of people who do required tasks as efficiently as possible? Or, are we professionals who take our time to help individuals create, document, communicates, and maintain a comprehensive understanding of their stories? Creating one, powerful ‘ocean’ allows us to effectively communicate with, and on behalf of, individuals to guide practice. In this way we can together achieve personal, program, and system transformation.

Josh Morgan

Meet Josh Morgan!


As SAS’ National Director of Behavioral Health and Whole Person Care, Dr. Josh Morgan helps public sector health agencies use data and analytics to support a person-centered approach to improving health outcomes. A licensed psychologist, Dr. Morgan was previously San Bernardino County Department of Behavioral Health’s Chief of Behavioral Health Informatics. His clinical work includes adolescent self-injury, partial hospitalization, and intensive outpatient programs, psychiatric inpatient units and university counseling centers.

Dr. Morgan earned his Bachelor of Arts in Religious Studies from the University of California, Berkeley, and a PsyD (Doctor of Psychology) in Clinical Psychology with an emphasis in Family Psychology from Azusa Pacific University, and is trained in Dialectical Behavior Therapy.

Posts Written by Josh

Can We Evaluate Whole Person Suffering?

By: Josh Morgan, PsyD

SAS Analytics

In our field of work, there are many calls to reduce suffering. Seems reasonable, right? It’s even in California’s Mental Health Services Act (MHSA), where public systems are called to “reduce subjective suffering.” And as we broadly focus more on outcomes in health, measuring suffering (and hopefully its reduction) is crucial.

In order to measure something, we have to define it.

While some definitions of suffering simply refer to the presence of symptoms, does the presence of illness alone necessarily mean suffering? Have you ever seen someone with an illness who is suffering? It’s painful, and we want to help stop it. In contrast, have you ever seen someone with an illness who is not suffering?

Ever since my Dialectical Behavior Therapy (DBT) training, I’ve preferred a more whole person approach to suffering. Dr. Marsha Linehan, the founder of DBT, defines suffering as non-acceptance of our situation. Think back to people you have known with illnesses. Does their acceptance or non-acceptance of their situation impact their ability to cope with it and therefore their suffering? How does this affect quality of life?

Does this really matter, though? Isn’t it easier to just focus on symptoms?

To measure a reduction in suffering, sure, it’s easier to just look at symptoms. Are there negative consequences of this? As I talked about last year, we can unintentionally contribute to stigma and discrimination by only measuring and talking about negatives.

At a broader level, what happens when we assume that people with behavioral health conditions suffer? Does that help give any hope of living in recovery and resilience, even while symptoms are present?

But a more whole person approach to evaluating suffering can pose challenges. Here are two suggestions on how to tackle this subject.

Natural Language Processing

The words we use matter and express a lot about our cognitive and emotional states. When we talk about things like subjective suffering, as framed in the MHSA, a qualitative approach is virtually required. It can be burdensome to conduct a robust qualitative analysis (Believe me–my dissertation was qualitative), but advances in technology, like Natural Language Processing (NLP) can speed up the process while also helping ensure all voices are heard.

As an example, many organizations already get consumer (and family member) feedback via written responses, grievances, compliments and focus groups. Well-established NLP includes sentiment analysis, which provides a quick quantitative sense of how people feel about something. A common tool in retail, sentiment analysis can be useful for stakeholder feedback, public comment periods and experiences of care. Diving deeper, NLP can pull out themes and trends that do not depend upon a person catching the right phrases and interpreting the feedback. Frankly, it can be easy to accidentally skip over a part of a response, misinterpret it, or not catch a subtlety that advanced analytics can assist in identifying. Pair those results with human wisdom in interpreting the meaning of the themes and trends, and more voices have been heard in their own words for greater impact!

In today’s quantitative world, we often shy away from the qualitative for many reasons. NLP can help bridge the gap and give rich life to our understanding of people’s lives. It’s one of the best ways, in my view, of seeing the whole person.

Whole Person Analytics

As the Chief of Behavioral Health Informatics at the San Bernardino County Department of Behavioral Health, I led systemwide strategy to evaluate outcomes. We spent many hours talking about how to tackle subjective suffering. Our solution was to not focus on just a single metric, but at least two data points. Symptom reduction could be one, but there had to be another metric along with it, such as improvements in hope. If someone had improvements in hope AND improved symptoms, for instance, the chances of reducing suffering is likely.

Oftentimes, we focus on a single data point as our metric. There’s good reasons for this. But it can be limiting and inaccurate, especially when we try to get at concepts like suffering. Combining data points together to get a more whole person perspective will give us a better sense of what’s really going on in our communities and with the people we serve.

A major question with these suggestions is how to get the data I suggest. Head over to my LinkedIn article, “Data sources to assess whole person suffering” for initial thoughts on potential data sources. Stigma and discrimination reduction are major themes in the work we do. Let’s use data for good to tell a more complete, accurate story of people’s lives, suffering, recovery, resilience, and wellness!

Transformative Culture: The Call for Psychological Safety

By: Tiffany Lindsey, EdD, LPC-MHSP

Chapin Hall at the University of Chicago

Have you ever made a mistake at work—maybe even one that could have affected you, your teammate, or a client’s safety?

If you’re a human who helps other humans for a living, the answer is a prevailing yes. None of us do the work perfectly. Mistakes aren’t intentional, but it’s hard to get it right every time. Clinicians and human service professionals, in general, are tasked with making high-consequence choices at alarmingly fast rates. So I have another question:

Did you tell anyone about your mistake?

If you didn’t, you’re not alone. A healthcare study found, when confronted with a patient’s adverse outcome, most physicians are unwilling to admit an error (Gallagher, Garbutt, & Waterman, 2006). It’s hard to imagine disclosing mistakes to teammates would be much higher, even though processing a mistake and receiving feedback and support is crucial to professional development and gives teammates an opportunity to learn too.

There are lots of reasons why we aren’t prone to vulnerable disclosures—liability concerns, fear of seeming “less than” or incapable; in modern Western society, we tend to view colleagues as competitors. We’re hard-wired as children to think this way (remember those Spelling Bees?) not to mention Super Bowls wouldn’t be nearly as fun if we weren’t rooting for one team to win over the other. In Western society, we celebrate achievement over others and sweep our failures under a rug.  

While our competitive spirit isn’t all bad, spending time “saving face” is both dangerous and unhealthy. Talking about concerns, being honest about personal experiences, and processing undesired outcomes is central to innovation. Safe, engaged, reliable teams have to innovate to succeed in an increasingly complex and dynamic environment. Not only that, but consensus-based decision-making is a foundational element of TCOM. Such consensus involves reflection, engagement, and even some productive debate as the care team (which includes the client) reaches an understanding of the family’s story and shared vision for transformation. True, informed, consensus—without psychological safety—would be quite a challenging achievement, arguably an impossible one.

Psychological Safety: A Shared Experience

Psychological safety is a shared belief that people are accepted, supported, respected, and free to take interpersonal risks (Edmondson, 2019). While trust is about whether or not we believe others will behave supportively when we take an interpersonal risk, psychological safety is about a shared practice that others actually do behave supportively when those risks are taken.

Psychological safety seems simple, but the nuances are relevant. Consider the following attributes of psychological safety (Frankel, Haraden, Federica, & Lenoci-Edwards, 2017):

  • Anyone can ask questions without feeling stupid.
  • Anyone can solicit feedback without seeming incompetent.
  • Anyone can be respectfully candid about concerns without being viewed as “negative.”
  • Anyone can suggest ideas without sounding disruptive.

Google’s well-publicized study, Project Aristotle, was about identifying team factors central to successful innovation. For years, the research team investigated an array of variables (e.g., educational credentials, personality, gender, supervisor’s management style, professional experience) without an emerging theme. Then they stumbled onto psychological safety—it ended up being the single factor most predictive of a team’s success. Despite wide variations in the groups’ demographics, psychologically safe teams would brainstorm, test things (often failing but always while learning and progressing) and, therefore, arrive at successful ideas sooner. Such teams demonstrated situational humility and conversational turn-taking—meaning every member spoke (albeit unintentionally) about the same amount throughout the week (Duhigg, 2016).

Psychological safety is the cornerstone of a Safety Culture—the attitudes, values, behaviors supporting a safe and engaged workforce. Though sometimes coined by other related names, like High Reliability Organizing, Human Factors, or Resilience Engineering, the pursuit of Safety Culture has a tremendous amount of evidence in high-risk industries. In healthcare, the presence of behaviors indicative of Safety Culture (see my last blog post for a list of those behaviors) correlates to fewer patient readmissions, patient falls, and medication errors (Vogus & Sutcliffe, 2011).

In child welfare, growing evidence suggests team-based Safety Culture behaviors correlate to the entries, exits, and re-entries of children in state care. In short, teams may experience more entries into state care but also might experience a higher percentage of exits, and fewer of those children re-enter (Lindsey, 2017).  Not surprisingly, psychological safety has an evidenced connection to burnout; in an analysis of child welfare professionals, higher psychological safety correlated to less emotional exhaustion (Cull, 2018).

In considering whether or not the culture of your workplace supports psychological safety, think through these statements (Edmondson, 2019):

  • If someone makes a mistake, is it often held against them?
  • Can people bring up problems and tough issues?
  • Is it difficult to ask others for help?
  • Is it safe to take an interpersonal risk?
  • Are peoples’ unique skills and talents used?

You might find the answers are different as you consider different teams or hierarchies within your organization. Some people feel psychological safety among their small cohort (i.e., a team of counselors reporting to one supervisor, a single unit within a psychiatric hospital) but unsafe among another unit or perhaps a group of leaders.

Cultivating Psychological Safety

Psychological safety is a shared experience. We can all support it, but none of us can singlehandedly accomplish psychological safety alone. It’s not an intrapsychic experience; it’s an interpersonal one. Leaders are capable of the most widespread change, but all people are responsible for culture. And like most cultural phenomenon, it’s a journey of improvement and not a single stroke destination.

If you’re looking for some ways to improve psychological safety to advance a safety culture in your workplace, consider these possibilities:

  • Be present. Psychologically safe cultures value active listening, situational humility, and empowering people to exercise voice when they have a concern.
  • Language drives culture, so be intentional about it. Rather than refer to a direct care workforce as “workers,” consider the term “professionals.”
  • Cultivate avenues for “speaking up.” This may look like confidential reporting systems, where people can privately (but not anonymously) report safety issues. It may also look like “Resilience Rounds,” where leaders step out of the executive suite and meet informally with frontline professionals to model values, express appreciation, and check-in about frontline’s needs.
  • Be wary of bias. While it’s impossible to entirely avoid, self-awareness is key. Hindsight, outcome, and fundamental attribution error are among the worst.
  • Gossip is the pollution of good culture and yes—you can be held guilty by association. Candidly and respectfully ask those who gossip to stop.
  • When looking into an undesirable client outcome, lead for learning and offer support to professionals assigned to the client. Conduct “studies” instead of “investigations.”
  • Consider Psychological Safety and Accountability concurrent experiences; they are best practiced together. It’s not a balance so much as an integration. If you have 11 minutes, watch this video to learn what I mean.

References

Cull, M. (2018). Casey Family Programs: Child safety convening. Keynote Speaker.

Duhigg, C. (2016). What Google learned from its quest to build the perfect team. Retrieved from: https://www.nytimes.com/2016/02/28/magazine/what-google-learned-from-its-quest-to-build-the-perfect-team.html.

Galler, T., Garbutt, J., & Waterman, A. (2006). Choosing your words carefully: How physicians would disclosure harmful medical errors to patients. Arch Intern Med, 166: 1585-1593.

Edmondson, A. (2019). The fearless organization. Wiley: New York, NY.

Frankel, A., Haraden, C., Federica, F., & Lenoci-Edwards, J. (2017). A framework for safe, reliable, and effective care. White Paper. Healthcare Improvement and Safe & Reliable Healthcare: Cambridge, MA

Lindsey, T. (2018). The effects of safety culture on the outcomes for children in state care. Available from ProQuest Dissertations & Theses Global (10750794).

Vogus, T., & Sutcliffe, K. (2011). The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Journal of Nursing Administration, 41 (7/8), S25.

Registration is Open! #TCOM2019

We are so excited to announce registration for our 15th Annual TCOM Conference in Palm Springs is now open!

Culture and Community: Sharing Stories from the Collaborative

Every year the TCOM Conference provides an opportunity to collaborate with and learn from leaders and innovators in behavioral health, child welfare, education, juvenile justice, and more. While we all have a shared passion for serving youth and families, we each bring a unique perspective to the table. This year’s theme, “Culture and Community: Sharing Stories from the Collaborative” reminds us that it is incumbent upon us to understand, to the best of our abilities, the impact of cultural and community factors on the applications of our common language and shared approaches.

This year, for the first time, we will be offering a unique and exciting Pre-Conference Day consisting of master lectures and a series of round table discussions! You won’t want to miss it! More session and presentation details will be published over the coming weeks.

Register NOW to take advantage of Early Bird Rates–offer ends June 30th!

  • Pre-Conference (Oct. 2) $180
  • Pre-Conference + Day 1 (Oct. 2 & 3) $340
  • Day 1 + Day 2 (Oct. 3 & 4) $240
  • Full Conference (Oct 2-4) $336

The Praed Foundation has applied for continuing education credits through NBCC. Confirmation of credit hours available will be posted in August.

Book your stay at the Hyatt Regency Indian Wells Resort & Spa!

Sponsorships

The annual TCOM Conference isn’t possible without the generous support we’ve received over the years. If you are interested in becoming a sponsor, please reach out to communications@praedfoundation.org or check out our Sponsorship Guide.

Defining Serious Mental Illness

By: Beth Anne Nichols, NH Mental Health Block Grant Plan Administrator

New Hampshire Department of Health and Human Services

In the rugged landscape that is New Hampshire’s mental health system, serious mental illness (SMI) is a powerful thing. On an individual level, an adult experiencing SMI becomes eligible for community-based psychiatric rehabilitation. Psychiatric rehabilitation consists of an array of services reimbursable by NH Medicaid alone. The privately insured may access these services via a sliding fee scale – if they are assessed and determined to be SMI.

The capstone of NH’s Community Mental Health provider programs is the case management and treatment for our SMI population.

If the ten Community Mental Health Centers (CMHC) are the spokes in the sturdy wheel of the SMI treatment services system, the hub of the wheel is the NH Department of Health and Human services (NH-DHHS).

The NH-DHHS has established the Adult Needs and Strengths Assessment (NH-ANSA) as the instrument that informs and directs the treatment, and records the treatment outcomes, of the thousands of SMI adults in the care of the CMHCs.

In the world of psychiatry, the classification of mental illnesses changes as the body of knowledge, experience, and science evolve. But the federal government’s – and the state of NH’s – definition of “Serious Mental Illness” has remained unchanged for decades. Labeling someone as “Seriously Mentally Ill” can create nearly as many social and vocational barriers as it does opportunities for psychiatric rehabilitation.

Into this world of mixed blessings comes the NH-ANSA.  The original vision for the NH-ANSA was to serve as a standard for determining the presence of SMI, serving as the “ticket” to psych-rehab services like the valuable case management and “functional supports” provided in the community, at home, or in the workplace. Increasingly– as the treatment focus for a large portion of the SMI population under our care follows a progression of symptom management to functional improvements, especially employment stability– tracking impairment needs and improved functioning has assumed a high priority.

For NH community mental health programs, the ANSA, as a periodic measuring stick of symptom and functioning, has replaced a narrative annual assessment of functioning (though not without resistance!).  Gradually, the CMHCs and growing numbers of their partners, are using the NH-ANSA to chart a path toward clear reporting of treatment and recovery trajectories. The NH-ANSA provides a sound objective basis for program screening based not only on diagnosis, but on levels of need and clusters of impairments that clearly inform treatment planning, and outcomes goals across the service system.

The NH ANSA to the Rescue

The federal definition of serious mental illness was created to assist in the determination of eligibility for Social Security disability benefits.  Specifically, assessment of impairments interfering with the ability to maintain employment or other “major life activities” were a key component for Social Security disability determinations. New Hampshire embraced these criteria because of the strong link between Social Security and Medicaid.

Psychiatric diagnosis and symptoms form a slice of SMI criteria; the degree of “functional impairment” contributing to disability caused by mental illness is a much larger slice.  The ANSA, with the elemental nature of its Life Functioning domain, provides an objective yardstick.

For those who are interested, NH’s SMI criteria are laid out in He-M 401 of our “Administrative Rules”.  These criteria were the basis for the work of New Hampshire and Dr. John Lyons to crosswalk SMI requirements into the NH-ANSA.

Collaboration between an individual, their natural supports, and their treatment team to craft a treatment and recovery trajectory based on the ANSA removes the directive and top down nature of the narrative assessment previously employed by our providers.

Today the State of NH continues to collaborate with our providers and the Praed Foundation to polish the assessment instruments that can order the landscape of our mental health service system. The NH-ANSA, with its efficiency and objectivity, strengthens the foundations recovery for our SMI adults. 

Appendix

Tiffany Lindsey

Meet Tiffany Lindsey!


Tiffany Lindsey is licensed professional counselor working as a Safe Systems Practitioner at the University of Kentucky. She collaborates with child serving agencies to implement the strategies of safety science to create a Safety Culture in child welfare work. Prior to this, Tiffany was a quality improvement director for the Tennessee Department of Children Services. She was foundational to the creation and successful implementation of a critical incident review model acknowledged as a “gold standard” in child death reviews. Tiffany was a primary contributor to the development of the Safe Systems Improvement Tool—the Praed Foundation’s first-of-its-kind, multipurpose, information integration tool for use in quality improvement activities.

Tiffany serves as adjunct faculty in the School for Graduate and Continuing Studies at Trevecca Nazarene University and owns a small mental health counseling practice in Lebanon, Tennessee. She enjoys equestrian events in her spare time and partners with her husband, Jesse, in competitive ballroom dancing. Jesse and Tiffany have a daughter, Cadence, and live in Mount Juliet, Tennessee.

Tiffany holds a Doctor of Education in Leadership and Professional Practice from Trevecca Nazarene University, a Master of Arts in Marriage and Family Therapy/Professional Counseling from Johnson University and a Bachelor of Art in Counseling from Johnson University.

You can reach Tiffany by contacting her at tiffany.lindsey@uky.edu!

Other posts written by Tiffany Lindsey

TCOM and Systems Safety: My Journey

By: Tiffany Lindsey, Policy Analyst

Chapin Hall at the University of Chicago

My journey towards Safety Culture began in a group home.

I was 24-years-old and had just started a new job as program manager—my first supervisory role. I was the only clinician on-site. All but one of my staff were older than I was, and the group home appeared on the verge of closure. Per state auditors, no new admissions were allowed in the facility until we had things “cleaned up.” From what I could tell, it was going to be a very long Performance Improvement Plan.

I worked there constantly, sometimes just sleeping a few hours on the couch in my office rather than drive home. The group home housed 8 adolescent females. Every night it seemed one or more of the girls were self-harming, fighting, sneaking in contraband, or running away. It wasn’t uncommon to find staff crying in the office. I honestly wanted to cry several times myself but was too overwhelmed for the tears to come out.

My boss, Kim, was new to supervising both me and the group home. She was compassionate, assertive, calm, and smart. She was in charge of several programs and did not work at my location, but I remember calling her several times in the middle of the night:

Kim: Hey Tiffany.

Me: It’s crazy here, Kim. I don’t know what to do… [insert rambling, hurried, nearly nonsensical story]

Kim would always help me solve the crisis quickly, even if it meant she traveled out to help me in the middle of the night. She was never mad at me or my staff, even if we had made mistakes (which we often did). She always wanted to talk through it and help us plan ahead for the next time. After all the residents were in bed, Kim and I would finish up documentation at 3-4am. During one of those times, she said:

“I want you to learn to think beyond these crises, Tiffany. Get upstream. Take a problem and ask yourself why it occurs. Then, whatever that is, ask yourself why it occurs. Keep doing that until you think you’ve found a systems issue we can reasonably tackle.”

Kim was an amazing mentor to me and my teammates. At the time, neither she nor I knew anything about the Safety Sciences or Safety Culture. Without knowing it, she was instilling in us the habits consistent with a Safety Culture. Those team-based habits are:

  1. Candor and respect are preconditions to teamwork.
  2. Spend time identifying what could go wrong.
  3. Talk about mistakes and ways to learn from them.
  4. Discuss alternatives to everyday work activities (i.e., finding efficiencies, testing out small iterative changes).
  5. Develop an understanding of “who knows what” by communicating clearly.
  6. Appreciate colleagues and their unique skills.

Those habits became the basis for all our improvements at the group home. Rather than blame the residents or fire a bunch of staff, we solved all the underlying systemic issues we could. We changed our staffing pattern, hired more PRN staff and targeted our employee recruitment at MSSW programs, created a new treatment process and positive reinforcement-based behavioral program for residents, and reallocated some resources to foster more safety in community outings. We did far more than that, but those changes alone made a huge difference. Our group home held a sense of community and pride.

I intend for this blog to be the start of a new featured series on System Safety and Safety Culture. There are several core values (e.g., psychological safety), quality improvement tools (e.g., driver diagrams, TCOM’s Safe Systems Improvement Tool), and team-based strategies (e.g., huddles, debriefs) useful in the interdependent, high-risk work of human services. In every way, the TCOM values of shared language, honest and respectful communication, and collaboration are parallel to the values of Safety Culture.

I’m going to make a bold claim: Safety Cultures are the best cultures to support TCOM. Where there is one, there needs to be the other. With that in mind, I trust I’ll find some kindred spirits among TCOM’s thriving community. I’m the “new girl on the block” with the TCOM Team, but you already feel like home. 

Thanks for welcoming me into the TCOM community!

Tiffany

TA Network Webinar: Effectively Integrating the CANS into the Wraparound Process

Date/Time: April 30, 2019, 11am – 12:30pm PT / 2pm – 3:30pm ET

The Wraparound process is the most common care coordination model for youth with complex needs and their families. Meanwhile, the Child and Adolescent Needs and Strengths (CANS) is now the most widely used assessment tool in public child-serving systems. While some states, systems, and organizations have determined how the Wraparound and CANS philosophies can co-exist and enhance each other, others have struggled, undermining the potential for positive impact of both efforts.

This webinar is based on shared work of the National Wraparound Implementation Center (NWIC) and Chapin Hall at the University of Chicago (organizational home of the CANS) to develop a guidance document around how to best integrate the CANS into the Wraparound process. The webinar will follow the “joint statement” from NWIC and Chapin Hall, and begin with a brief summary of how differences in the Wraparound and TCOM philosophies may raise “operational frictions” and problems in practice. Presenters will describe potential ways to effectively coordinate the CANS assessment with Wraparound practice – including “Do’s” and “Don’ts” – across the four phases of Wraparound.

Click here to register!

The Joy of Saying Goodbye

This is a farewell blog post about our teammate and friend who is leaving Chapin Hall at the University of Chicago for an exciting new opportunity. Katherine “Katie” Sun joined the TCOM Team in the summer of 2016. Since then, she launched communications platforms, including this blog, to expand the work and voices of the entire TCOM Collaborative.

Katie Sun

Katie has been a key member of the TCOM team for almost three years. With her big heart and good humor she has been the social glue of both the team at Chapin Hall and the larger international TCOM community. In addition to successfully launching this platform, she has organized and supported the annual TCOM Conference since 2017. It has become a stronger and more effective event with her steady, guiding hand. But her most important contribution to our work may be less about the big, visible things and much more about the way she carries herself in all of her interactions with others. She is kind and respectful to everyone no matter their role. She is always willing to go beyond her duties to extend a hand to someone in need. We often say that the helping field is the work of angels. Katie is truly one of those.

We recognize her many contributions to our work and will miss her presence in our daily lives. But in the TCOM frame saying goodbye is as important as saying hello—and often saying goodbye is a much more joyous occasion than any welcoming. We are very happy to see Katie’s life and career evolving in the direction of her aspirations. From a TCOM perspective, it is all of our responsibilities to support each other in becoming our best selves. Aspirational management is core to our approach. We are happy that she is following her dreams and wish her nothing but the best in her future endeavors. We celebrate that we have had Katie Sun as a part of our lives and know that she will continue to have a positive impact on the lives of others as her journey continues.

The TCOM Team

For continued TCOM communications connections, contact communications@praedfoundation.org.

Marrianne McMullen

Meet Marrianne McMullen!


Marrianne McMullen is the Director of Communication and Dissemination for Chapin Hall. McMullen drives Chapin Hall’s communications strategy, including dissemination planning, media relations, branding, and effective use of digital platforms. She advises on the effective use of communication to manage change in systems to improve the lives of children, youth, and families.

McMullen came to Chapin Hall after serving in the Obama Administration at the Administration for Children and Families (ACF) at U.S. Department of Health and Human Services. There she served as the Deputy Assistant Secretary for External Affairs, overseeing the division’s 10 regional offices, and the news, digital, and FOIA departments in the Office of Communications. Prior to joining ACF, McMullen worked with the District of Columbia Public Schools as Chief of Staff for Public Engagement, and at the Service Employees International Union, where she was the Communication Director for Illinois before becoming a senior aide to the international president. Her journalism career included being the news editor at Sojourners magazine, a reporter at the Palladium-Item in Indiana, and the editor and co-publisher of The Dayton Voice, an alternative newsweekly in Dayton, Ohio.

McMullen holds a Master of Arts in Communications from the University of Dayton and a Bachelor of Science in Journalism from West Virginia University.

You can reach Marrianne by contacting her at mmcmullen@chapinhall.org!

Other posts written by Marrianne McMullen

 

A community gathers to learn how to prevent the trauma of high homicide rates

By: Marrianne McMullen, Director of Communication and Dissemination

Chapin Hall at the University of Chicago

Audrey Wright, a senior at North Lawndale College Prep High School in Chicago, described the unthinkable to an auditorium packed with 1,500 people. She lost her mother and brother to gun violence within three days. The following year, she lost her father.

“I was introduced to Peace Warriors at my school, and I now serve as its president,” she told those gathered to learn more about combating gun violence. The Peace Warriors support other students affected by gun violence, they run a summer jobs program and they “interrupt nonsense,” she said.

Core to their mission is to do condolence runs to students who lost a loved one, delivering sympathy and an opportunity to process their grief. Last year, in 183 school days, they did 178 condolence runs.

Members of the TCOM Collaborative know the devastating impact that violence has on families and their communities. The desire to prevent that traumatic violence is palpable in Chicago, which has had a level of homicide that exceeds other large U.S. cities. So when community members were invited to a session where Wright spoke, the large venue was quickly booked.

The gathering was called Cities Striving for Peace: What Chicago Can Learn from Five Big-City Mayors who Successfully Lowered Gun Violence. It was organized by Chicago CRED (Create Real Economic Destiny), an organization funded by the Emerson Collective, led by former U.S. Education Secretary Arne Duncan. Participants heard from mayors of five other cities who saw dramatic drops in gun violence during their tenures. The cities were Los Angeles, Minneapolis, New Orleans, Philadelphia, and Washington, DC.

The mayors–each of whom saw double digit reductions in homicide on their watch–presented a menu of programs and approaches that have potential for implementation in Chicago. But nothing was more striking in contrast to the other cities than Chicago’s homicide resolution rate—or the rate at which homicide cases were closed or resolved. Los Angeles had the highest resolution rate at 74%; DC was at 71%; Minneapolis came in at 67%; Philadelphia at 44%. Chicago’s homicide resolution rate was 17%.

“If the community doesn’t trust your police department, you are not a safe city,” said Betsy Hodges, the former mayor of Minneapolis. The right leadership for, and community trust of, the police department is critical, the mayors said. Adrian Fenty, former mayor of Washington, DC, credited much of DC’s homicide reduction to hiring the right chief: Cathy Lanier—a woman from the community who came up through the ranks.

Law enforcement, all mayors stressed, is only one piece of the puzzle. “Law enforcement is going to get you as far as it’s gotten you,” said Hodges of Minneapolis. “Every part of the city has to be engaged and you have to be focused on the causes.”

Residents of the most violent neighborhoods in Minneapolis were asked to develop their own community-based strategy to address crime. And then the city invested in those strategies. “It was public budgeting meets public safety,” said Hodges. And it worked. Minneapolis saw a 23% decrease in homicides under Hodges.

Former Los Angeles Mayor Antonio Villaraigosa pointed to a critical program called Summer Night Lights. “We opened eight, 16, then 32 parks in the places of highest gun violence in the city,” Villaraigosa said. “We were open from 7 pm to midnight, Wednesday through Sunday. It was midnight basketball on steroids. We did soccer, Zumba for moms, we had movies, we fed people. And we invited gang members. We said, ‘come to the park – you are welcome.’”

They saw a 75% reduction in gun violence in those neighborhoods. “There were problems from time to time,” Villaraigosa said. “We had a couple shootings near the park on nights when we were open.” The response to the problems was predictable: some people wanted to shut down the parks. “But we stuck with it because we knew it was working.”

Concentrating resources was also key, he added. Public safety dollars were not distributed evenly across Los Angeles. They were spent where they were most needed. L.A. also started an academy for former gang members. The police department objected to the academy, but the city did it anyway. As a result, retaliation shootings went down dramatically. Overall, homicides dropped by 48% while Villaraigosa was mayor.

Mitch Landrieu, former mayor of New Orleans, emphasized the need for early education not just on math and science, but on conflict resolution. “You have to create places where these young men have sustenance,” he said, whether that’s through music, recreation centers, libraries or other programs.

“If you give a kid love, opportunity, security, resources – they are going to act like everybody else in America who has all that,” said Landrieu. Homicides decreased by 25% under Landrieu’s watch.

Michael Nutter, the former mayor of Philadelphia, stressed the need to set an ambitious homicide reduction goal and to “hold yourself publicly accountable to reaching that goal.” Philadelphia took early public policy steps to ensure the positive re-integration of people who had served time in prison. The efforts ranged from “banning the box” on job applications that asked about criminal records, to providing tax credits to employers who hired returning citizens. Philadelphia saw a 24% decline in homicide rates under Nutter.

All of the mayors talked about the critical role of schools: from quality early education, to strong high school programs to keep kids engaged and in school. Fenty emphasized that the core of his anti-violence approach was to fix the public schools.

Nationally, we’re having a conversation about what constitutes an emergency, said Landrieu. “In the U.S. since 1980, 630,000 American citizens died as a result of guns. Many were murder. That’s more Americans than were killed in all of the wars of the 20th and 21st century. So, what’s the emergency?”

“This is what I believe,” said Arne Duncan. “I believe our actions don’t justify us saying ‘black lives matter.’ I believe that in so many situations we’re not giving these young men a second chance. We are giving them their first one. These young men have been failed.” And finally, Duncan captured a fundamental TCOM strengths-based approach when he concluded: “And I believe our young men are the solution, not the problem.”

15th annual TCOM Conference

Culture and Community: Sharing Stories from the Collaborative

TCOM is an approach based on storytelling. People seeking help share their experiences (i.e., tell their stories). Sometimes, parts of their stories are retold by multiple professionals based on their skills and focus. In order to effectively help, these stories must be combined into a single story, and then, common themes from these stories are identified to decide how exactly to help. We do not help based on how people are different but on common themes they share.  

The storytelling aspects of helping do not stop at the client level.   Supervisees tell their stories to their supervisor who should help the supervisees integrate their own story with the stories of the people they serve. Program administrators combine the changing stories of clients across their experience in care to help tell the story of the program. And systems can tell their story by combining all the measured stories across programs, agencies, and communities. Within the international TCOM collaborative, we also share our stories so that others might learn from our experiences.

Culture and community are two almost inseparable factors that have a significant impact on both how our stories unfold and how others can understand us. As the only comprehensive management approach that fully integrates culture into its fabric, the TCOM approach calls on us to be increasingly aware of the role of culture and community in how we decide how to help. The TCOM community is in a unique position to help bring people together while still respecting our differences. This is the theme of the 15th annual TCOM Conference-Culture and Community: Sharing Stories from the Collaborative. This conference will take place in Palm Springs, California on October 2-4, 2019.

Strategies associated with TCOM are now used across the world to create a common language in such diverse places as Italy, Kenya, Hong Kong, and Singapore. This year approximately 80% of all children and youth served by the public sector in the United States will participate in a CANS assessment process. Given this widespread use, it is incumbent upon us to understand, to the best of our abilities the impact of cultural and community factors on the applications of our common language and shared approaches.

Click HERE for full conference details and how to submit your proposal for a presentation!!!

Shelly Paule

Meet Shelly Paule!


Shelly Paule, MSW, LCSW is currently a Policy Analyst with the County of San Diego Health and Human Services Agency, Child Welfare Services. Shelly graduated with her BS in Psychology and her MSW at San Diego State University, completing her final degree in 1998. Shelly has twenty years of experience with Child Welfare Services, including positions as a front line worker, supervisor, manager and now as a Policy Analyst focusing on Mental Health.

Shelly obtained her LCSW in 2004 and began working as a clinician part time. Shelly greatly enjoys using her clinical skills and knowledge as a Field Instructor for multiple undergraduate and graduate programs. She had the pleasure of running an intern unit for two years, completing individual and group supervision. In total, she has provided supervision for 27 interns. In addition, Shelly has provided group and individual supervision for more than 50 LCSW/MFT Candidates. She also trains for the Academy for Professional Excellence, currently focusing on CANS.

Shelly considers the social worker’s role critical to the outcomes that our families experience. Her goal is to support others as they approach and engage families and children in a way that allows us to best meet their needs and build on their strengths in a collaborative and respectful manner. Shelly is proud to be heading up the CANS roll out in San Diego. We are already seeing the positive impact that completing the CANS in the Child and Family Team Meeting is having on the children and families we serve.

You can reach Shelly by emailing her at Shelly.Paule@sdcounty.ca.gov!

Posts written by Shelly Paule

Viva La CANS

By: Shelly Paule, Policy Analyst

County of San Diego Child Welfare Services (CWS)

Hi, my name is Shelly Paule. As a policy analyst with the County of San Diego Child Welfare Services (CWS), I was the lead for managing the Child and Adolescent Needs and Strengths (CANS) implementation. My role included drafting the policy, training roll out and completion, and coordinating with our Behavioral Health Services partners. As a trainer and an advocate for the positive impact CANS will have on the children and families we serve, I also have the privilege of being the face of CANS via road shows.

We started our CANS journey in June 2018 by organizing a committee to discuss potential implementation plans. Who would complete the CANS? How would we know which children and families needed the program? How would we successfully integrate this new assessment into the Child and Family Team (CFT) meeting? How would we help families understand its purpose and how this conversation will come alive in the case plan?

Our committee completed an analysis of these questions and provided some answers to County leadership. Simultaneously, we were invited to participate in the Behavioral Health Services CANS Training for Trainers (T4T), with three of us fortunate enough to be able to attend.

Each of us successfully certified at the .70 level, but hitting the .80 required to become a certified trainer was a bit more challenging! This was a great time for us to pull together, review vignettes and practice using the CANS together. This collaborative effort reflects not only the vision of the CANS completion, but also the heart of CWS and the entire Health And Human Services Agency. We know that together we make better assessments and decisions than we do alone.

At CWS, we have also been working collaboratively with the San Diego County Behavioral Health Services (BHS) CANS team led by Eileen Quinn-O’Malley. Eileen has been a great support since BHS completed the CANS roll out in July to its providers. She has shared successful strategies with us and we are scheduled to co-present at Community Presentations to demonstrate our collaboration as large systems.

The CWS training and implementation roll out is scheduled to occur through spring 2019 with additional trainings to follow. More than 700 staff will be trained and certified by April 2019. The first cohort of training was our Pathways to Well Being Social Workers, who started in October and will complete the intake CANS within the CFT meeting on all new cases. They also will assist with coaching and support as more social workers become trained and certified in the CANS. As we complete the phased training roll out, all staff who are trained and certified will start utilizing the CANS within the CFT meeting prior to every case plan update.

We are also reminding staff that the Voice of the Family is a critical factor in the choice to utilize the CANS in the CFT meeting. Children, youth and families have shared concerns that their voices have not always been heard in the assessment of their families, as well as in the decisions around the case plan services and expectations. As we message to staff about the CANS, we are sharing with them the benefits of collaborative completion of the assessment in the CFT meeting to guide the creation of the case plan. We will increase our collaboration and transparency with families to ensure their voice is heard and becomes part of the case plan. As families assist with the creation of case plans they will be more engaged, which may increase the speed of reunification or permanency to ensure children safely remain home.

When speaking with staff, we remind them there is no item on the CANS we have not historically discussed and addressed in CFT meetings. We are helping staff realize this is not a practice shift, but rather a guide to discussing potential areas of needs for a child or family along with the discussion about how to address those needs, whether services should be referred, or another intervention put into place. We are also sharing that the Strengths section focuses on evidence-based areas of resiliency. The CANS helps to inform the CFT to look at ways to build a strength, which in turns increases resiliency for the child / youth we are serving.

Are we excited about CANS and the positive impact this will have our Families? Yes we are! In fact, we have two mottoes at CWS in San Diego – Viva La CANS and Yes we CANS! That being said, we are also aware this is a big shift in our practice. We are supporting our staff through training, coaching and ongoing implementation discussions. Though they are not always easy, these discussions are essential to the successful engagement of our teams.


For more information regarding CANS implantation in County of San Diego Child Welfare Services, please contact Shelly Paule, Policy Analyst at 858-616-5942.

Deborah Daro

Meet Deborah Daro!


Dr. Deborah Daro, Senior Research Fellow at Chapin Hall, is considered one of the nation’s leading experts in the area of child abuse prevention policy and early home visiting research. Her current work focuses on the unique and pivotal role early intervention programs, such as home visiting programs, can play in strengthening parental capacity across diverse populations, enhancing child development and keeping children safe. Most recently, Dr. Daro’s research and writing have focused on developing reform strategies that embed individualized, targeted prevention efforts within more universal efforts to alter normative standards and community context. Dr. Daro developed and currently chairs the Doris Duke Fellowships for the Promotion of Child Well-Being, funded by the Doris Duke Charitable Trust. In this capacity, she oversees a network of over 100 young scholars from across the country that represents a diverse array of disciplines and research interests. A primary focus of the fellowship is assisting these young scholars in translating their academic research into relevant policy and practice reforms.

Dr. Daro has completed dozens of multi-site evaluations over the past 40 years that have incorporated a range of research designs including both randomized clinical trials and various quasi-experimental designs. More recently, her work has been guided by the growing realization among program evaluators, implementation scientists and policy makers that a new balance is needed between effectiveness and efficacy studies when investing in program research to guide broad scale replication of evidence based program models. She has served on multiple national advisory boards and has received numerous awards for her contribution to the field of child abuse prevention.

Dr. Daro holds a BA in communications from the University of Illinois at Urbana and a Masters in City and Regional Planning and Ph.D. in social welfare from the University of California at Berkeley.

You can reach Dr. Daro by checking out Chapin Hall or by emailing her at ddaro@chapinhall.org!

Posts written by Dr. Deborah Daro

Home Visiting and the FFPSA: Expanding Child Protection Opportunities

By: Deborah Daro, Senior Research Fellow

Chapin Hall at the University of Chicago

The Family First Prevention and Services Act (FFPSA) (Family First) represents an opportunity to bridge the historic gap between interventions to resolve unhealthy parenting practices and behaviors and programs designed to prevent these behaviors from developing. Creating a shared understanding that treatment and prevention are mutually reinforcing would move us closer to an equitable and just balance among the goals of child safety, child development, and parental autonomy. The trick in accomplishing this integrated effort, however, is determining how best to shift Title IV-E funds from foster care reimbursements to supporting direct services to improve parent and child outcomes.

Two factors are central to making this strategy work – selecting the right target populations and investing in those prevention options most likely to successfully reach and serve these target populations.  In discerning which families are the most appropriate recipients for Family First investments, there is an unsolved tension in the legislation between targeting these investments to children who are identified by the child welfare system as “candidates for foster care” versus broadening the access portal to include parents at who have not formally entered the system but are at high risk of mistreating their children. Other populations likely to qualify for these service investments include children in unstable adoption situations and pregnant or parenting foster youth.

The potential role early home visiting services might play within this new Family First system will depend upon how states resolve the target population issue. Not all home visiting programs working with young children are equally beneficial for all families.  The current three evidence-based home visiting models being considered by the Family First Clearinghouse (Healthy Families America, Parents as Teachers and Nurse Family Partnership) are great fits for working with adoptive families in crisis (assuming the child is an infant or toddler) and for pregnant and parenting foster youth. All three of these models are widely available in many states and have established strong track records with young families.  They strengthen parental capacity and enhance child outcomes. Although many of the families served by these models face significant personal and situational challenges, it is less clear these models have as strong a track record engaging and successfully supporting families currently involved in the child welfare system.

There are other evidence-based home visiting models, however, that have deeper experience with child welfare populations including those who have been identified as likely foster care candidates. Three programs – Attachment and Biobehavioral Catch-Up (ABC), Child First, and SafeCare — all have robust evidence of effectiveness in engaging these populations and achieving outcomes.  And all are “evidence based” as defined by the federal Maternal Infant and Child Early Home Visiting (MIECHV) initiative, suggesting a high likelihood of approval under the Family First Clearinghouse selection criteria.  Specific features of these models include:

  • ABC: a 10-session home visiting model designed to enhance parental sensitivity and enhance child attachment security and regulatory capabilities.  It has been successfully offered to foster parents and birth parents for children 0-5. ( www.abcintervention.org)
  • Child First:  a 6-12 month intervention, targeting prenatal women and those with children under the age of five that blends parent guidance and dyadic, psychotherapeutic treatment.  The program targets children with emotional/behavioral or developmental/learning problems and families with multiple challenges. (www.childfirst.org)
  • SafeCare: a parent-skills training program that addresses three key risk factors associated with child maltreatment – parent-child relationships, home safety, and insuring a child’s health. Each topic is addressed in a 6 session module, with all three modules being delivered in 4 to 6 months. The program has been developed for and successfully served families with substantiated cases of maltreatment and other issues placing them at high risk of out-of-home placement. (www.safecare.org)

All three models meet the qualification criteria established by the Children’s Bureau for using Title IV-E dollars: they have been the subject of randomized controlled trials, with the findings well documented in multiple peer review journals; they have demonstrated a history of working with child welfare agencies and child welfare-involved populations; they can be successfully delivered within the recommended 12 month widow; and they offer a strong replication package including manualized operational guidelines, training protocols and supervisory systems. 

Many families reported to the child welfare agencies are rearing their children in conditions fraught with parenting challenges and safety concerns far beyond what any specific parenting program can hope to resolve, regardless of rigor and quality. Removing children from these environments will remain an unavoidable choice in certain instances. That said, the frequency of this outcome can be reduce by the thoughtful adoption of home visiting programs that fit the challenges these families face. The three models described in this post, coupled with the three models currently under review by the clearinghouse, offer child welfare agencies a strong set of options to advance the Family First mission.


For additional information on ABC, Child First and SafeCare see:

Chaffin, M., Hecht, D., Bard, D., Silovsky, J.F., & Beasley, W.H. (2012). A statewide trial of SafeCare home-based services model with parents in child protective services. Pediatrics, 129(3), 509-515.

Crusto, C.A. Lowell, D.I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S. R., & Kaufman, J. S. (2008). Evaluation of a Wraparound process for children exposed to family violence. Best Practices in Mental Health: An International Journal, 4(1), 1-18.

Dozier, M., & Bernard, K. (2017). Attachment and Biobehavioral Catch-up:  Addressing the needs of infants and toddlers exposed to inadequate or problematic caregiving.  Current Opinion in Psychology, 15, 111-117.

Gershater-Molko, R.M., Lutzker, J.R., & Wesch, D. (2002).  Using recidivism data to evaluate Project SafeCare:  Teaching bonding, safety and healthcare skills to parents. Child Maltreatment, 7(3), 277-285.

Lind, T., Raby, L., & Dozier, M. (2017). Attachment and Biobehavioral Catch-up effects on foster toddler executive functioning: Results of a randomized clinical trial.  Development and Psychopathology, 29, 575-586.

Lowell, D.I., Carter, A.S., Godoy, L., Paulicin, B., & Briggs-Gowan, M.J. (2011). A randomized controlled trial of Child First: A comprehensive, home-based intervention translating research into early childhood practice. Child Development, 82(1), 193-208.

Dan Warner

Meet Dan Warner!


Dr. Warner is a licensed clinical psychologist with extensive background in human services and mental health.  As the executive director of the nonprofit organization Community Data Roundtable, Dr. Warner has helped implement TCOM systems at all levels, from small providers, to managed care entities, and large state-wide projects.  For Dr. Warner, the heart of human service work is human connections.  His trainings focus on the use of TCOM tools and visualizations to increase human connection, empowering whole systems to become engaged, collaborative, and person-centered for the benefit of a flourishing and just society.

Dan has also been a presenter at the TCOM annual conferences since 2012. He also received the Founders award from The Praed Foundation in 2018 for his innovative and collaborative leadership in supporting the use of data to inform decision making in practice and policy.

You can reach Dan by checking out Community Data Roundtable or emailing him at dwarner@communitydataroundtable.org.

Other posts written by Dan Warner

 

Avoid this Fundamental Mistake in TCOM Tool Scoring: confusing anchor definitions, for concrete details

By Dan Warner, Executive Director-Community Data Roundtable

I have seen many hard-working, diligent people fail TCOM certification because they over-focus on anchor definitions, and do not properly understand the item they are rating.  They think that by focusing on the anchor definitions they are being “detail oriented,” but instead they are “missing the forest for the trees.”  The anchor definitions are not the “concrete” part of a TCOM tool.  It is the items themselves that are concrete.  After all, this is the first rule of a communimetric tool: It is an item level tool, and items are chosen because they lead to different action trajectories in the client’s treatment.  Attending to anchor definitions without fully understanding the items in which they are trying to anchor you, all but guarantees you will score the item incorrectly.

This is one of the key ways that TCOM tools are different from similar biopsychosocial assessments, which spend much of their certification processes making sure that the concrete differences between the levels of a “domain” (typically their “items” are actually whole domains) are well understood by people pursuing certification on their tool.  The details of a “domain” are the most concrete part of the tool in those situations (see for instance CAFAS, DLA-20).  In such a situation, being very attentive to the exact nuances of the language of the anchors for each level of a domain-item makes sense, and attending like this helps you pass those certification exams well.  However … it doesn’t really help with treatment planning.  Further, it is not very flexible in accounting for all the diverse ways that needs and strengths can show up on any given item-domain in the world. 

Anyone who has tried to use such tools in practice realizes quickly that many people simply do not fit in well to the anchor definitions of the various levels.  While passing the testing vignettes is easy, because the vignettes for those certification exams are written to exactly fit into the concrete anchors specified in the tool, in the “real world” no one quite looks like what the assessment captures.  Thus, workers find themselves finagling a person into the tool’s limited concrete definitions, cutting off what doesn’t fit, oblonging other things to make them fit better.  It’s a procrustean process done for the service of the tool, instead of designing optimal treatment.

In contrast, TCOM tools focus on items that we all have to do in our work.  These are the concrete parts of the tool.  If it is not relevant for this person: score a 0!  If it is relevant, now the issue is what are we going to do about it?  Here the action levels are essential: are we going to watch this problem (1), put it on the treatment plan (2), or jump on it intensely (3)?  The anchors affiliated in each item for each of these levels are helpful to see what the item is describing, and to help you pick the appropriate action level.  However, those anchors are concrete only in the context of the item and the actions that need to be taken. And frankly, once you understand the item, scoring these levels is usually a pretty straight ahead process.

In conclusion, if you find that you are failing TCOM certifications over and again, have someone quiz you on what the items on the tool you are testing on mean.  You might be misunderstanding several of these items fundamentally.  It is not because you think something is a crisis, while the vignette designers felt the problems were mediocre.  Instead, you are not understanding a sufficient amount of items, that your scoring is simply looking random.  Reign yourself in, slow down – look at what the item is about, and then scoring it well enough will always get you passed certification, and quite frankly – will get you working actively in the field making top quality plans, that also produce helpful, analyzable data.

Extra note: I wrote this blog post a few weeks ago, but was teaching this morning and again saw a hard working person, furiously scrutinizing her CANS manual during her testing vignette.  She was working on an item and saw that the word “willful” appeared as a part of the anchor definition of the level 2 rating, and then was trying to figure out if the child in the vignette had acted willfully or not.  This was an absolute distraction from the question of if this item was actionable or not for the client.  Willful is just a word that helps describe what an actionable need on this item is, but she was getting all distracted by whether or not in this particular vignette, we were seeing a willful problem.  My response? I took the manual from her, and asked her what the item she was looking at is about.  She couldn’t tell me.  So this helped get us back on course.  I didn’t give her back the manual for the rest of the exam, but asked her to ask her friends what items meant if she didn’t know.  She passed the exam with a high reliability!  This is exactly what I am talking about — the anchor defintions were distracting her from actually understanding what needs to get done.  She was too preoccupied with fitting things into the test, and it wasn’t until I refused to allow her to do this, that she could successfully pass the exam.  Hopefully, this little interchange is also going to help her be a better clinician — focusing on the work she needs to do, not the scoring she needs to do.


For additional support and references on training and certification, visit the TCOM Training FAQ page on the blog for tip sheets and blog posts about TCOM and its tools.

Strategic Sustainability Learning Collaborative

The following blog post is written by our friends at Open Minds. Open Minds is a Behavioral Health Market Research and Management Consulting firm based out of Gettysburg, Pennsylvania. They specialize in the health and human service sector to serve individuals with the mission of providing providers and payer organizations the resources and knowledge to best inform their practice. They believe that by helping organizations in the field make better, more informed, decisions, they will have the means necessary to improve services to those individuals with the most chronic complex needs.

Greetings from OPEN MINDS! I want to take a moment to introduce a new executive education opportunity. The Strategic Sustainability Learning Collaborative has been specifically designed for executives of small to medium size provider organizations. This 12-month, web based program provides an affordable method to gain the tools and insights needed for sustainability in today’s changing health and human services environment. Working together with OPEN MINDS Senior Associates, up to 30 executives from across the country will address the following learning objectives:

  • Understand the drivers of current health and behavioral health market change
  • Assess the ever changing needs of consumers and requirements of funders in order to build effective strategy
  • Develop an organizational competency portfolio for your organization and create a plan to address any deficiencies
  • Prepare your organization to effectively respond to environmental changes through scenario-based planning
  • Understand the framework for organizational strategic planning required to achieve continued sustainability

OPEN MINDS recognizes that in the current human services landscape, managed care and alternative payment models are redefining the “optimal” provider organization size, driving M&A and other affiliations, and disrupting the market.

With over 25 years of human services executive leadership experience, I am excited to coordinate this new Learning Collaborative.

Whether you are a current CEO, member of the Executive Team, or a candidate for a future C-Suite role, the OPEN MINDS Strategic Sustainability Learning Collaborative will provide you the skill sets necessary to develop and implement an organizational strategic sustainability plan to re-position your organization in an ever changing external environment. There are only a few slots left! More information and enrollment forms may be found at:
https://www.openminds.com/store/strategic-sustainability-learning-collaborative/
You may also contact me directly at pneitman@openminds.com if you would like to discuss enrollment further. I look forward to working with you and/or members of your executive team in this unique and affordable professional development opportunity.

openmindfoot

How to do a Quality Assessment, TCOM Style

Presented and written by Lynda Killoran (Centerstone), Lynn Steiner (Chapin Hall at the University of Chicago), and Deborah Thomas (Centerstone)

In our work as trainer, supervisor or clinician, we often hear a variation on THIS theme from assessors who were recently trained on a version of the CANS: “It’s SOOOO long and there are too many questions for me to ask. I have no idea how to use this during the assessment process (or, I already know how to do an assessment, so I don’t need anyone to tell me how to do it).” The implementation of a new tool or resource is often perceived by those who are expected to use it as, alternately, overwhelming, stressful, confusing, frustrating, demoralizing, and so on. This is why in October 2018, at the TCOM conference, we took it upon ourselves to see if we could provide an example of how to use the CANS effectively and seamlessly in practice.

The idea was to show how to bring the CANS to life as a process—not a document—and to demonstrate how the key principles are intertwined with the assessment process. We did not introduce a new way to do an assessment, but rather a new way to name and organize the information that is already collected during an assessment.

The way we did this was to use a short video of a mock assessment, breaking it into three sections and actively engaging our audience in identifying which needs and strengths had been identified during each section, and which principles were being used during the assessment. We pointed out that you can learn a great deal of information in 10 minutes without asking much, or with some prompting – no need to go through every item and ask about it. The discussion focused on what actionable needs and what useful strengths were observed, what key components were evident, how this was similar or different from how they currently did an assessment, and how they might use this information to improve their current method of assessing using the CANS. The feedback we received overall was that attendees found this to be a useful resource for them. They identified how it could be used or adapted both in assessment and in training staff on assessment. We hope you will find it helpful too!

To access the materials that we provided attendees – training video, training guide and activity worksheet—please click here:

S44 vid

This post was collaboratively written by

Lynda K. Killoran, MA, LCPC
Clinical Manager, Centerstone of Illinois

Lynn Steiner, MSW
Senior Policy Analyst, Chapin Hall at the University of Chicago

Deborah Thomas, LCSW
Clinical Manager, Centerstone of Illinois

Family Matters

Family Matters: Why finding and engaging extended family and fictive kin is critical to positive outcomes for children in foster care

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Readiness Inventory for Successful Employment

RISEmploy

Each TCOM tool is a combination of items inside of a domain meant to reflect the emerging needs and strengths of its population of use. It is adaptable. One of these adaptations is the “Readiness Inventory for Successful Employment (RISEmploy), also known as the Strengths at Work (SAW), can be implemented as its own tool or included as a module in the Adult Needs and Strengths Assessment (ANSA). This tool focuses on skills and strengths that can ensure success in obtaining and maintaining a job.

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Continuous Quality Improvement-Moving beyond the data dashboard

“Getting beyond the data dashboard means continuously using rigorous data and evidence to answer the questions that will lead to the solutions that will positively impact the children, youth, and families served by our organizations.” -Yolanda Rogers, Chapin Hall at the University of Chicago

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Reflections from the conference-TCOM2018

2018 was a big year for the TCOM Collaborative. Based on your conference feedback from years before, we work tirelessly to make sure YOU get the most out of the event. From planning, to producing, to posting materials after the conference ends, we depend on your voice.

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Wrapping up the 14th Annual TCOM Conference-Evidence and Transformation: Taking Person-Centered Care to Scale

Here’s What Happened

About 300 people gathered at the Drake Hotel in Chicago last week to attend the 14th annual Transformational Collaborative Outcomes Management conference. Person-centered care was the theme of this our conference this year, and we were excited to collaborate with domestic and international participants.

Workshops focused on how to make best use of TCOM tools in practice, implementations, and supervision. Participants learned how to make meaningful use of CANS data, including using it for effective planning and for measuring well-being. This year also featured a learning track on safety culture. Despite the wide range of topics covered, every presentation was connected through the belief that making that people we serve full partners in the process of care is how transformation happens.

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Conference organizers, Katherine Sun and Michelle Fernando, and additional team members produced an agenda that featured presentations from multiple levels of the system. These included a collaborative workshop by Parent Consultant, Jennifer Griffis, and Chapin Hall at the University of Chicago’s Director of Communication, Marrianne McMullen. They collaborated for months leading up to the conference to share their personal stories and work to produce an interactive session for all attendees. We also had the pleasure of inviting Antonella Di Troia and Anna Didoni from Fondazione IRCCS “Ca’Granda” Ospedale Maggiore Policlinico to deliver a key note address and an additional presentation on how the CANS has been adapted to meet the needs of the children they serve.

Scholarships and Learning Opportunities

The Praed Foundation is proud to announce that more than $7,000 was awarded to individuals and parent partners at the conference for travel support, accommodations coverage, and registration discounts.

CONGRATULATIONS!

Congratulations to the following 2018 TCOM Champion Award Recipients!

  • Carroll Schroeder, Executive Director, California Alliance of Children and Family Services: Founders award for his visionary leadership in encouraging providers and systems in California to bring a transformational perspective to their work.
  • Dan Warner, Executive Director, Community Data Roundtable: Agency level award for his innovative and collaborative leadership in supporting the use of data to inform decision making in practice and policy.
  • Tanya Albornoz, Foster Care Program Administrator, and Kyla Clark, In-Home Program Administrator, Dept. of Human Services in Utah: Systems level award for their innovative adoption of communimetric and TCOM principles in the development and implementation of the UFACET in Utah.
  • Janet Hoeke and Jennifer Griffis, Parent Consultants, Youth Empowerment Services Project (ID): Family partner award for their thoughtful and persistent inclusion of parents’ perspectives in the planning and implementation of TCOM in Idaho.
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Special thanks to our Sponsors:

The TCOM Conferences are made possible by the individuals who organize and manage the conference and all of our sponsors. This year 12 separate organizations made the 3-day conference with over 60 different sessions possible. Among these sponsors were Seneca Family of Agencies, Centene Corporation, Okay to Say, Fidelity EHR, Magellan HealthCareCalifornia Alliance of Children and Families, Objective Arts, TenEleven Group, and Community Data Roundtable, all supported critical events at the conference including the poster session, AV needs, and breaks. A special thank you to Chapin Hall at the University of Chicago, eInsight, and Casey Family Programs, as our Partner Level Sponsors at this year’s conference.

Couldn’t make this year’s conference? Click the link below to download materials. Presentations will continue to be uploaded as they are sent our way.

Conference Program and Presentations


Join us next year for our 15th annual TCOM Conference in Palm Springs, CA!

October 2-4, 2019

Copy of SAVE the Date (4)


TCOM 2018 Speaker Spotlight-David Channer

Meet one of your #TCOM2018 Presenters!

Featured in this post: David Channer

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TCOM 2018 Speaker Spotlight-Betty Walton, Gina Doyle & Wendy Harrold

Meet some of your #TCOM2018 Presenters!

Featured in this post: Betty Walton, Gina Doyle, and Wendy Harrold

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TCOM 2018 Speaker Spotlight-Antonella Di Troia

Meet some of your #TCOM2018 Presenters!

Featured in this post: Antonella Di Troia

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TCOM 2018 Speaker Spotlight-Rachel Andrew

Meet one of your #TCOM2018 Presenters!

Featured in this post: Rachel Andrew

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TCOM 2018 Speaker Spotlight-Nate Lubold

Meet one of your #TCOM2018 Presenters!

Featured in this post: Nate Lubold

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Mapping it out with CANS-Y-LAND

Of the TCOM suite of tools, the most widely used tool is the Child and Adolescent Needs and Strengths Assessment (CANS). The CANS is a communimetric measurement tool that utilizes direct feedback from the youth, family & other team members to identify the actionable needs & strengths of the youth & family in developing and informing the treatment plan. While the tool is proven to be successful and helpful to many people, we always want to make sure that clinicians, case workers, and children find the CANS to be engaging and accessible. This desire is what led Lisa, Caitlin, Dan, Vince and Grace to create CANS-Y-LAND.

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TCOM 2018 Speaker Spotlight-Kyla Clark & Tanya Albornoz

Meet some of your #TCOM2018 Presenters!

Featured in this post: Kyla Clark & Tanya Albornoz

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TCOM 2018 Speaker Spotlight- Vida K. Khavar

Meet one of your #TCOM2018 Presenters!

Featured in this post: Vida Khavar

khavar pic

Vida Khavar is a Licensed Marriage and Family Therapist who has 25 years’ experience in child welfare. Vida began her career as a clinician in various agencies throughout Los Angeles. She developed expertise in all areas of child welfare while striving to bring Permanency to center stage. Vida became a consultant in 2012 and since then, has assisted a multitude of organizations in developing new or enhancing existing child welfare programs. One of Vida’s priority is to transform the platform on which public and private organizations operate by creating a community that embraces collaborations.

Vida served as a master coach and fidelity reviewer for RISE, a $15 million federal initiative which aimed at improving the lives of LGBTQ youth in foster care. She is currently the getREAL CA project director through Family Builders. She has been collaborating with the California Department of Social Services to develop and implement new policies for LGBTQ+ children in child welfare.                                                e: vkhavar@familybuilders.org

Q: What does Person-Centered Care mean to you?
VK: Many of us have entered the field of social work and social justice in order to improve the lives of children and families. It is crucial to remember that each person is their own expert, therefore, as healthcare practitioners, we must focus on developing treatment plans that match our clients’ needs and the way they see themselves. We must remember that each person is at the center of the many identities they represent through their culture, race, religion, socioeconomic background, SOGIE (Sexual orientation, Gender Identity & Expression), mental health etc., therefore we must listen in order to serve them appropriately.

Q. Why should individuals attend this year’s conference/your presentation?
VK: 22.8% of children in out of home care in the United States identify as LGBTQ, and 57% of these youth are youth of color. These numbers are startling. As health care practitioners, it is essential to develop appropriate programs that meet the needs of these children and their families. LGBTQ+ youth are at a higher risk to find themselves involved with child welfare, criminal justice and homelessness because of their sexual orientation, gender identity and expression.

This presentation will address how to implement practices that address the needs, well-being and permanency of LGBTQ and gender expansive children.  The necessity to address every aspect of each child through the intersection of race, culture, ethnicity and SOGIE will be discussed. Finally, the SOGIE portion of the CANS as well as new policies, lessons learned and practical concepts will be presented to initiate and implement child welfare practices that are LGBTQ affirming.

Q: What drew you to attend this year?
VK: The SOGIE portion of the CANS is not yet well known, even though several counties throughout the US are already using it. It is a wonderful assessment that should be used more systematically and I hope to shed some light on it.

Q: What drew you to present on your specific topic? 
VK: I have had the privilege to collaborate with John Lyons and April Fernando from Chapin Hall at the University of Chicago in redesigning the LGBTQ portion of the CANS. It is an important piece of assessment for organizations who seek to get a better understanding of the children and youth entering their programs. The SOGIE piece allows agencies to provide better tailored services toward the needs of the children they serve. It is my goal to highlight the importance of using this tool when assessing all children.


Connect with Vida!

Attend Vida’s presentation at the 14th Annual TCOM Conference on Thursday, 10/4/2018 at 4:00 pm.

Child Welfare Practices for the Well-Being of LGBTQ and Gender Expansive Children and Youth

22.8% of children in out of home care in the United States identify as LGBTQ. Child welfare reforms throughout the country are mandating that all children be affirmed, and respected and their families supported. This presentation will address how to transform your organization in becoming affirming and develop programs that will address the needs, well-being and permanency of LGBTQ and gender non-conforming children and their families. This plenary will also discuss the intersection between race, culture, ethnicity and SOGIE, and the necessity to address every aspect of each child.

A special thanks to our sponsors this year and other individual donors!
The Praed Foundation, Chapin Hall at the University of Chicago, Casey Family Programs, eINSIGHT (eCenter Research), Seneca Family of Agencies, Centene Corporation, Okay to Say (Meadows MHPI), Fidelity EHRMagellan HealthcareCommunity Data Roundtable, California Alliance of Children and Family Services TenEleven Group

TCOM 2018 Speaker Spotlight- Emily Shapiro & Melissa Villegas

Meet some of your #TCOM2018 Presenters!

Featured in this post: Emily B. Shapiro & Melissa Villegas

emily

Emily B. Shapiro is a Quality Improvement Associate at Jewish Child and Family Services (JCFS) located in Chicago, IL. She has experience in qualitative research, project management, and evaluation consulting for nonprofit and philanthropic organizations. She provides direct quality improvement and evaluation support to a K-12+ Therapeutic Day School and programs serving adults and children with disabilities. Emily earned her Masters of Education from the University of Illinois Chicago’s Measurement, Evaluation, Statistics, and Assessment (MESA) program in 2016 and completed her Bachelor’s Degree in Sociology from Loyola University Chicago in 2012. e: EmilyShapiro@jcfs.org

melissa

Melissa Villegas is currently a Quality Improvement Associate at Jewish Child and Family Services (JCFS) located in Chicago, IL. She has over 13 years of social service experience working in direct service and administrative capacities. She has experience in community organizing, program evaluation, educational workshop facilitation, and has provided trainings on assessment tools and research methods. She is a certified trainer in the CANS, ANSA, and FAST assessments. Melissa earned a Master of Social Work degree from the University of Michigan at Ann Arbor with a focus in Social Policy and Evaluation and a specialization in child welfare. e: MelissaVillegas@jcfs.org

Q: What does Person-Centered Care mean to you?
ES: Person-centered care means seeing the individual and family as equal partners and experts in their own care. It is an actively engaging and flexible process that fosters the individual’s ownership over their own care and allows the provider to improve the quality of support.
MV: When I think of person-centered care, I think of an approach where clients are empowered to directly inform and partner in determining their services and the trajectory of their treatment. It is a philosophy where services should not be a ‘one size fits all’ approach, but really honor that each person is different, and care should be individualized to what each client needs.

Q. Why should individuals attend this year’s conference/your presentation?
ES: The conference provides a space to connect with others working within the TCOM framework, to share challenges with others, and celebrate successes in the field. Our presentations will offer an opportunity to share our recent experiences with implementing an education version of the CANS in a Therapeutic Day School setting this past year as well as our longer-term efforts to keep the ANSA “fresh” for both providers and individuals over the past 9 years of implementation.
MV: Attending the TCOM conference provides an opportunity to network, learn from each other, and continue building upon the knowledge of what is considered best practice. Coming from a quality improvement perspective, it provides an opportunity to see what other organizations are doing related to evaluation. It also provides a forum to learn how to continue making the CANS, ANSA, and FAST assessment tools meaningful across all levels of care.

Q: What drew you to attend this year?
ES: This will be my first year attending the TCOM Conference. I’m excited to learn from others and contribute to the larger discussion of taking person-centered care to scale.
MV:  I have attended the CANS conference once before, and I walked away with so many resources and ideas on how to strengthen our systems. I am excited to hear about new innovations in the TCOM field.

Q: Why did you choose to present on this specific topic?
ES: As one of the few organizations to implement an educational version of the CANS in a Therapeutic Day School setting, we want to share our motivations behind implementation and the lessons we’ve learned along the way. We hope that this topic will resonate with other educational programs and multi-service organizations committed to person-centered care for young people and their families.
MV: At JCFS, we utilize the ANSA, CANS, and FAST assessment tools. We have been using the ANSA assessment in our counseling program for 9 years and the CANS is new to our Therapeutic Day School. When reflecting upon our implementation of these assessments, we thought it would be interesting to share lessons learned in implementing these tools in different settings.


Connect with Emily and Melissa!

Attend their presentations at the 14th Annual TCOM Conference on Wednesday, 10/3/2018 from 2:50-3:50 pm and Friday, 10/5/2018 from 10:10-11:10 am.

Creating a Shared Vision in a Therapeutic Day School Setting

During this session we will share a version of the CANS that combines both social-emotional and academic domains implemented in a therapeutic day school setting. CANS was implemented based on staff recommendation to address the limitations of other data sources (e.g., Individualized Educational Program plans, CAFAS, incident reports). The session will also describe how the CANS supports implementation of Collaborative Problem Solving, an approach to resolve behavioral problems in a collaborative, mutually satisfactory manner. This presentation will provide insights for how to use the CANS in conjunction with other school related data sources. Lessons learned and preliminary data analysis from year 1 of CANS implementation in a therapeutic day school setting will be shared.

Keeping It Fresh: 9 Years of ANSA Implementation

JCFS has been implementing the ANSA in its Counseling program since 2009. This session will focus on the ANSA and 9 years of data analysis and implementation. Participants will see an example of how one organization has adapted the ANSA over time to reflect the needs and strengths of the clients served and how the ANSA is used to communicate, assess, organize, and evaluate individual client progress over time. For example, given that our Counseling program often works with the family and not just an individual, it became evident that the family component was missing from the shared vision of our assessment, and the FAST was incorporated into both the CANS and the ANSA. This session will share reflections on implementation and multi-year data analysis. Several key findings will be shared as well as how this information was integrated into our CQI process.

My Introduction to TCOM

Rebekka Schaffer, Project Assistant at Chapin Hall

I joined the TCOM Team here at Chapin Hall at the University of Chicago at the start of July 2018. When I was first introduced to the team, I was worried I wouldn’t even remember what TCOM stood for, let alone understand what they really do. My fears were eased, however, as soon as I began my online training on the Child and Adolescent Needs and Strengths Comprehensive tool (CANS-Comprehensive). I am by no means an expert in this, but I was able to quickly grasp the progression of the online training and its larger implications in practice (even for someone who has no prior training in this area). While there are many important characteristics to TCOM implementations, and the CANS, its accessibility is the most critical. I think that its accessibility allows everyone to participate in and engage with the process of achieving positive life outcomes.

Unlike other measurement tools, the CANS items are customized for each jurisdiction that utilizes it. The ratings for each of these items aren’t arbitrarily assigned scores—they are ratings that translate into actions. These actions rely on the patient’s identified strengths, which can be used to support their needs.

Too often, the only people who understand the jargon behind these tools and measurements, that are meant to serve others, are the very people who created the tools in the first place. What we need, however, is for people involved at every level of care to understand how measurements work in order to achieve the best possible outcome. TCOM isn’t just geared towards researchers in its own community. It aims to create a common language between researchers, clinicians and case workers, and the families we serve. People should not be left out of their own transformation. TCOM presents a collaborative approach that needs everyone involved to participate in it—and makes that participation possible.

I know that I will continue to learn so much more about TCOM and its tools during my time at Chapin Hall, but I’m already encouraged by how much I’ve learned in just this past month. This is due to the structure of TCOM and its goal of making sure that the people we serve remains as a central tenant of why we all do what we do.

This post is written by Rebekka Schaffer, Project Assistant at Chapin Hall at the University of Chicago. Rebekka joins the TCOM team after graduating June 2018 from The University of Chicago with a major in Comparative Human Development and a minor in Human Rights. Her undergraduate research largely focused on trauma-informed approaches in urban schools and communities.

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You can meet Rebekka, along with many other people using the CANS in their work, at this year’s TCOM Conference!

TCOM 2018 Speaker Spotlight- Jen Cardenas

Meet one of your #TCOM2018 Presenters!

Featured in this post: Jen Cardenas

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Jen Cardenas is a Licensed Clinical Social Worker and the founder of the Cardenas Consulting Group. She uses her expertise in clinical and operational management to be a critical thought partner, designer, and coach to leaders of behavioral health and child welfare organizations. She brings her no-nonsense, get-things-done approach to help clients through training, quality management, quality assurance, organizational analysis, implementation, and technical assistance on EHR systems. Previously, Jen was the Director for Quality Improvement at Seneca Family of Agencies–one of the largest children’s mental health providers in California. She has 18 years of experience in behavioral healthcare and 13 years of experience implementing and using TCOM tools. e: jen@cardenasgroup.org

Q: What does Person-Centered Care mean to you?
JC: Person centered care is all about honoring the client and family you’re working with. Trust them – they are the expert in their own lives.  By centering the voices of kids and families, we have the ability to achieve a shared vision and facilitate a corrective therapeutic experience.

Q. Why should individuals attend this year’s conference/your presentation?
JC: The TCOM conference is a great opportunity to meet like-minded folks engaging in transformative work across the world. I’ve picked up tips and tricks for clinical practice, systems work and implementation efforts from the conference.  Attending has made me a better clinician, manager and collaborator!

Q: What drew you to attend this year?
JC: It’s always helpful and grounding to reconnect with the broader TCOM Collaborative. Transformative and collaborative practice is hard and implementations are challenging undertakings.  Connecting with those who are doing similar work rejuvenates me and encourages me to keep moving forward.

Q: What drew you to present on your specific topic? 
JC: We’ve been working on the implementation within Alameda County for more than 5 years. So many ups and downs have been experienced in this effort and we hope that folks can learn from our successes and mistakes.


Connect with Jen!

Attend her presentations at the 14th Annual TCOM Conference on Wednesday, 10/3/2018 at 1:00 pm and Thursday, 10/4/2018 at 12:30 pm.

TCOM Provider Collaborative: Coaching for Success

TCOM Provider Collaboratives have been developed in three jurisdictions (Alameda CA, Washington and New York) and are a new model for TCOM implementation support.  These collaboratives use TCOM practices at a system level to inform implementation activities, sustain progress, coach stakeholders and create a targeted portfolio of tools to create transition from CANS/ANSA as a form to TCOM as a practice model. The collaboratives will present attendees with information on the function and purpose of Provider Collaboratives, integration with TCOM principles and the stages of development of a learning collaborative. From the fragile beginning stages of change management and generating buy-in to creating short term wins, coaching for true family and youth engagement and problem solving to developing and sustaining best practices, the collaboratives will guide a discussion highlighting strategies to engage stakeholders, build competency, improve organizational structures and motivate leadership.

Fostering Radical Collaboration: Regional Reflections on CANS implementation

California’s new CANS mandate is widely accepted as an opportunity for a unified strategy to communicate, address and monitor the individual needs of children, youth and families. This presentation will discuss these opportunities through discussion of a regional convening of providers that explored the challenges and promise of implementing the CANS with the proper supports and regional vision.  A summary of the challenges and strategies shared during that day, as well as highlights of local best practices will be shared. Example Tip Sheets and resource links will be provided to attendees for use in their own organizations.

A special thanks to our sponsors this year and other individual donors!
The Praed Foundation, Chapin Hall at the University of Chicago, Casey Family Programs, eINSIGHT (eCenter Research), Seneca Family of Agencies, Centene Corporation, Okay to Say (Meadows MHPI), Fidelity EHRMagellan HealthcareCommunity Data Roundtable, California Alliance of Children and Family Services TenEleven Group

TCOM 2018 Speaker Spotlight- Jen Griffis & Marrianne McMullen

Meet some of your #TCOM2018 Presenters!

Featured in this post: Jen Griffis and Marrianne McMullen

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