TCOM Conversations

The Need for TCOM-365, Not Just 3 Days

Written By: Ken McGill, EdS, LMFT

By now, you may have heard the news about this year’s conference moving completely to a virtual platform. Serving as chair, I was so hopeful for an in-person experience, and the planning was taking place right up to the very last minute for this to happen. However, with the continued impact of COVID and the delta-variant on states, counties, and individual communities, there was no other choice but to keep health and safety paramount. In fact, each week since January 7th the Conference Planning Committee has met to prepare for the 17th Annual TCOM Conference.

As chairperson, I witnessed firsthand the many facets connected to preparations for a worldwide 3-day conference. On Thursday mornings at 9:00 am, a dedicated group of individuals came together to outline each step needed to move us towards the completion and kick-off of an amazing conference. This conference was an event that I looked forward to from the moment last year’s conference ended. In many ways the 2020 Conference really did not end for me, rather it expanded into a weekly and monthly experience where TCOM was alive and part of my daily life.

Last year’s conference had to be setup in a way that paralleled the shift we all made back in March of 2020. The worldwide pandemic abruptly created an overnight switch to a new virtual world, where we worked from home, children/youth attended school virtually, and tried to remain connected to our community. Our once in-person world morphed to totally online with a ‘flick of a switch’ and technology became our ‘life-line’ to the outside world. We all managed as we moved forward throughout 2020 and most of 2021. All of us began to laugh and look back at the mishaps we experienced working from home; everything from testing our internet bandwidth, to our children and pets entering the room letting us know that they were hungry or just wanted to play.

The 2020 TCOM Conference was a success because of the work of so many who were able to shift to a completely virtual platform for three full days of amazing sharing. The conference continued the journey of the past 16 years of Transformational Collaborative Outcomes Management. The takeaway for me was not about the event being held online, but that conversations were continuing in support of the work being done throughout the world. The work will always be the ‘take-away’ for everyone who is part of the TCOM Collaborative. I remember Dr. Lyons discussing the importance of ‘remoralization’ of the shared vision, whereby clearly defining our work as transformational in serving those in need of assistance, support, and care.

TCOM-365 will actively support the work of those who have attended conferences in the past, who will attend this year, and those who may have never have the opportunity to attend the actual event. We will be bringing TCOM worldwide through our transformative collaborations.

So, I would like to re-moralize this blog message for a clear ‘take-away’ as we move closer to the October 6th start of the 2021 TCOM Conference. Since our world continues to be greatly impacted by less than positive events, let’s all make a commitment to enhance the purpose of TCOM by expanding it from a 3-day event to 365-days of collaborative activities. We must recognize that each of us not only play an important role as change agents in our work, but also in our homes and throughout our communities. TCOM-365 will actively support the work of those who have attended conferences in the past, who will attend this year, and those who may have never have the opportunity to attend the actual event. We will be bringing TCOM worldwide through our transformative collaborations.

Here are just some of the ways to start TCOM-365 today:

1. You may sign up for the TCOM YouTube Channel to listen, learn and share.

2. You can also go to TCOMConversations.org and read up on the blogs and write up a blog about your work and share your ideas for the world to read.

3. If you haven’t already done so, review the Conference draft agenda. If you like what see you can make sure to attend the session.

If you are a little more adventurous, you may want to email the presenter(s) with some questions to learn more about their work. For example, I will be co-facilitating a session with Lizzie Minton-Kentucky Child Welfare Clinical Consultant, “Using the CANS to Engage and Support Children & Families-Beyond Certification & Compliance” if you were to email me at kmcgill@opeeka.com we would be sure to include those answers during our presentation.

TCOM-365 is needed more than ever to strengthen our world-wide collaboration; especially in the efforts to support our workforce and their well-being as they continue to navigate challenges. When I was putting together a webinar back in August, I reached out to several key individuals who embody the essence of TCOM. There were four amazing panelists who shared their time and knowledge around ‘A Collaborative Discussion: Workforce Well-Being, Post-COVID Challenges & Opportunities’

In this spirit of TCOM-365, let us hear from each of you on the ways we all can actively support this shift from 3-days to the entire year of transformational collaboration outcomes management! Remember to sign up for the TCOM YouTube Channel just click here, read and contribute to TCOM Conversations to the blog just click here and if you want to make a difference in our world just click here and continue to do what you do to make this world a better place (the last click here is for you to fill in and share with all of us!).

Looking forward to all the tomorrows leading up to TCOM Conference 2021 and beyond!

Moving Virtually – 2021 TCOM Conference

Message from the TCOM Team:

After careful discussion and consideration, the TCOM Team has decided to move the 17th Annual TCOM Conference, scheduled for October 6 – 8, 2021, to a solely virtual format. This decision was not made without significant deliberation.

In light of the COVID-19 Delta Variant and the rising number in cases, and the additional ways that the pandemic has affected travel budgets, travel restrictions, and in-person events, we will instead be convening the 2021 TCOM Conference entirely virtually on Socio and Zoom. This decision was made overall to ensure the safety of our collaborative.

All presenters, team members, and attendees will participate remotely. We will be transferring all current registrants automatically to our virtual Cloud Attendee ticket. This means that all presentations will now be available for virtual attendees.

Please stay tuned. We will continue to keep you updated through email (Subscribe to our email list) as we roll out new information about this year’s now virtual TCOM Conference.

Please contact us with any additional questions or concerns you may have at communications@praedfoundation.org.

Be Well & Stay Safe,

The TCOM Team

Virtual Conference Updates

Time Change:

Since we have transitioned the 2021 TCOM Conference to a fully virtual platform, we have moved the start time of the conference to be 11:00 AM EST (8:00 AM PST) to better accommodate all of our attendees and presenters who are planning to join us from the safety of their homes and offices. 

New Schedule:
New Cost:

We have adjusted the price for the 2021 TCOM Conference to be $180.00 for the 3-Day event. This will include virtual access to all sessions and our virtual event platform. Please note that all sessions will be recorded. You can purchase tickets through Socio: https://registration.socio.events/e/tcom2021

Session Access:

All sessions will be accessed through our virtual event platform, Socio app. All sessions will be hosted through Zoom.

Other Questions?

You can subscribe to the TCOM Conferences mailing list, and also follow our blog, TCOMConversations.org, for updates on the 2021 TCOM Conference. Please reach out to communications@praedfoundation.org for any other additional questions.

Research Project: Teaming and Connectedness

Group of 4 people silhouette on top of a hill with hands raised celebratory

Teaming & Connectedness Survey: https://redcap.uky.edu/redcap/surveys/?s=LDTWAA3EE4MLW8P3

The Center for Innovation in Population Health at the University of Kentucky is undertaking a program of research on teaming across helping organizations. Since a large focus of our work is on collaboration, we hope to try to deepen our understanding of the workplace conditions that both facilitate and frustrate effective teaming.

If you are interested and willing, we would appreciate you taking 15 to 20 minutes of your time to complete a survey that will initiate this program of research. We will post results on the blog as soon as they are available.

We appreciate all that you do for others. If you have any questions, please do not hesitate to contact Dr. John Lyons at either john.lyons@uky.edu or 859-562-2734. Thank you for considering our request.

TCOM Conference’s COVID-19 Health Policy 

The TCOM Team’s updated COVID-19 Health Policy for the 2021 TCOM Conference.

*Important Announcement related to COVID-19 and the 2021 TCOM Conference.*

We are excited to welcome the TCOM Collaborative to the bluegrass state in Lexington, Kentucky for the 2021 TCOM Conference at the Hyatt Regency Lexington on October 6-8th, 2021.

To assure the optimal safety of all attendees, this year’s TCOM Conference in Lexington will require either evidence of full vaccination1 OR a negative PCR test for COVID-19 within 72 hours (3 days) prior to in-person conference check-in at the hotel. We will follow CDC and University of Kentucky guidelines regarding masks and social distancing during the conference.

We are confident that vaccines are safe, effective, and crucial to end the pandemic. We are also confident that public health precautions like hand-washing and mask-wearing are compassionate, safe, and simple practices. However, we accept everyone’s right to make choices that feel best to them. If you do not wish to follow these requirements, we can either switch your registration to the virtual conference track or provide you with a full refund. 

We are looking forward to seeing you all in Lexington in October. We are committed to making the conference engaging, informative, fun, and safe for everyone. 

Additional COVID-19 Information:
Entry Requirements
  • At in-person check-in at the hotel for the 2021 TCOM Conference, bring a copy of your COVID-19 Vaccination Card or Negative COVID-19 PCR test result (showing test date).
  • Regardless of vaccination status, you will be required to wear a mask throughout the 2021 TCOM Conference.
We ask that you not attend if any of the following is true for you or anyone in your party:
  • Within 14 days before attending the conference you have tested positive, or been exposed to someone who has tested positive for COVID-19;
  • Within 72 hours prior to attending the conference, you have experienced symptoms of COVID-19 (e.g., a fever of 100.4F or higher, cough, shortness of breath or difficulty breathing, chills, repeated shaking muscle pain/achiness, headache, sore throat, loss of taste or smell, nasal congestion, runny nose, vomiting, diarrhea, fatigue or any other symptoms associated with COVID-19 identified by the Centers for Disease Control and Prevention);
  • Within 14 days prior to attending the conference, you have travelled to any international territory identified by federal or applicable state or local governments as being subject to travel or quarantine advisories due to COVID-19.

These policies are subject to change, in accordance with state and local guidelines and changing circumstances. We will be updating procedures as necessary as we get closer to October 6, 2021.

If you have questions about the COVID-19 vaccines or need resources to find a vaccination location near you, please check out www.vaccinefinder.org.​

1 2 weeks after the second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson.

If you have any questions related to the 2021 TCOM Conference and our Health Policy, please contact Diamond at communications@praedfoundation.org.

Safety Culture and Child Welfare with Vermont

Just like in aviation and the nuclear industry, child welfare is a safety critical industry and high stakes high consequence decisions are made every day by child welfare workers and caregivers.

Dr. Michael Cull, Associate Director for the Center for Innovation in Population Health (IPH Center), was recently interviewed in Welcome to the Field, a podcast for child welfare professionals, caregivers, and community partners. This podcast is hosted by Cassie Gillespie and Pete Cudney at the University of Vermont’s Child Welfare Training Partnership.

Dr. Cull discusses his work applying safety science in child welfare, and the work he is doing in Vermont as part of the IPH Center’s support for the National Partnership for Child Safety.

Listen Below:

*Information from this post was found on Vermont’s Child Welfare Training Partnership, which you may find here: Safety Culture with Dr. Michael Cull – Vermont Child Welfare Training Partnership (vermontcwtp.org)

Early Bird Gets The Discount

*please note that the 2021 TCOM Conference has now been moved to a fully virtual format*

Early-bird discounts for in-person 2021 TCOM Conference tickets will be ending July 31st, 2021.

Register by 11:59PM EST Saturday, July 31st, to receive 25% off your ticket!

For those that have yet to attend an in-person 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. 

If you are interested in Sponsoring the 17th Annual TCOM Conference, take a look at our Sponsor Brochure or connect with the Diamond, our Conference Lead, at communications@praedfoundation.org.

Poster Submissions for the 2021 TCOM Conference are accepted until August 20, 2021. Please check out our Call for Posters for more information.

3-Day Early-Bird Rate: $338

Now – July 31, 2021

Discounted ticket for in-person admission to the TCOM Conference, Oct 6-8, 2021.

*All food during the conference is covered in this ticket*

3-Day Regular Rate: $450

Starts August 1st

TCOM Conference 3-day in-person admission, Oct 6-8, 2021.

*All food during the conference is covered in this ticket*

Virtual: $180

Starts August 1st

Limited streamed and virtual presentations available.

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

Book your stay at the Hyatt Regency Lexington.

For group rates, please contact our team at info@praedfoundation.org. For questions other than group rates, we ask that you contact us at communications@praedfoundation.org.

For refunds and frequently asked questions, please visit our 17th Annual TCOM Conference page.

10 Seconds to Make a Difference – National Be Someone Day

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

Every July 21st, National Be Someone Day, challenges each of us to take ten seconds to make a difference in a child’s life.

The mission of the TCOM community has always been to elevate the shared vision of the people and the communities that serve them. We believe that every day we can play a part in helping improve the lives of the children, families and adults we serve.  That being said, today is “National Be Someone Day”. Project Be Someone encourages the broader community to commit to making a difference in a child’s life. 

You are part of the solution. #BeSomeone from ProjectBeSomeone.org

We’d like to echo their call and add that this is a good day to highlight the work that all of you do on behalf of children.  More than ever we are aware of the lasting impact that child trauma experiences can have on across the lifespan. As a community we are aware of the benefits of being better prepared to recognize, discuss and work to prevent the trauma experiences for children in our communities.  

There are a few ideas on the Project Harmony on how to be supportive, but we’d like to add a few of our own:

  • Reach out to a colleagues working directly with children and their families and let them know how much you appreciate what they do.
  • Highlight information within your agency that supports the continued work around prevention.
  • Highlight and support resources for family and children in your community.

So let’s celebrate “National Be Someone Day” together and thanks for all you do to continue making the work about the people we serve.

Pre-Conference Vignette-A-Thon

Black typewriter

By: Lynn Steiner, MSW, Center for Innovation in Population Health

Calling all writers! Would you like to receive a discount to the TCOM Conference in 2022 in New Orleans? Would you like to win recognition and prizes? Then read on!

People and society constantly learn and grow, and sometimes our ideas and strategies become outdated or incomplete and we need to update them. As a result, we need to also update our training materials. Training vignettes are a piece of this. We are constantly adding (and sometimes removing, sometimes revising) vignettes but we are always in need of fresh vignettes and there are also gaps in certain areas that we want to reduce.

To that end, we are announcing a vignette-a-thon, an event to allow us to expand our pool of potential vignettes in areas where they are most needed. Submit a vignette that meets the following criteria (per our review), and you’ll receive a discount on next year’s conference registration. Virtually attend the Conference this year and you’ll receive prizes for submissions during our social hour.

[Note: By submitting your vignette to us, you give Praed permission to revise and/or use this vignette in training and it becomes the property of Praed.]

Here’s what you need to do:
  1. Review the criteria below.
Criterion: pick (at least) one per row
Age0 thru 518 thru 21Dependent adult with caregiver65+Family: at least one caregiver and one child
NeedsDevelopmental, medical and/or cognitiveComplex needs: developmental or cognitive + mental healthComplex needs: medical + mental healthComplex needs: trauma + medical + mental healthSubstantial actionable needs but also usable strengths.
CharacteristicsNon-traditional family structure: multigenerational; same-sex parents; single fatherMulti-racial/ethnic familyRural locationIncludes response post natural disaster, war/terrorism trauma, and/or current event but generalized (e.g., immigration-focused like a child separated from parent at border, or COVID-like virus).Integration of culture (including Native American), gender identity (including transgender) or sexual identity throughout the vignette.
Criteria for the 2021 Vignette-a-thon

2. Pick at least one criterion from each row and create your vignette. Good vignettes include both NEEDS and USABLE STRENGTHS (0, 1) to be scored, and are 1 to 1.5 pages long.

3. Score your vignette for the version of the assessment tool that you are using (make it clear what version that is) and include rationales for all of your ratings.

4. Submit your vignette, ratings and rationales to communications@praedfoundation.org with an email titled “Vignette-A-Thon Submission” by September 13, 2021. If you meet the criteria, you will receive a 50% discount* for the 2022 New Orleans TCOM Conference and be entered into a giveaway*!

5. Attend the 2021 Virtual TCOM Conference.

For questions about vignettes generally, or how to craft a good one, please contact Lynn Steiner at lynn.steiner@uky.edu.

Prizes for the 2021 Pre-Conference Vignette-A-Thon:
  • All people who submit a Vignette will receive a 50% discount* for registration for the 2022 New Orleans TCOM Conference if their submission meets the criteria.
  • The Top 3 Submissions will receive 1 free pass* to the 2022 New Orleans TCOM Conference.
  • There will be a giveaway* that will allow 3 Winners to receive a prize, which will be presented during the 2021 Virtual TCOM Conference.

* The discount and free pass do not include travel, lodging, or food. 3 winners will also be selected for the giveaway during the 2021 Virtual TCOM Conference, and must attend the 2021 Virtual TCOM Conference to receive a prize.

Download Now:

LIVE NOW: Registration for 2021 TCOM Conference

The 2021 TCOM Conference will take place in-person in Lexington, Kentucky virtually, October 6 – 8, 2021. Registration is now available: https://registration.socio.events/e/tcom2021.

Grounded in a philosophy of generating a shared vision to help people and their communities achieve wellness goals, Transformational Collaborative Outcomes Management (TCOM) is an approach shared among thousands of professionals and advocates worldwide. For nearly two decades, the national TCOM Conference has provided a platform for the field to meet up, develop their skills, and share their knowledge. This year, experts and professionals throughout the field will gather to focus upon a theme of “Getting A Leg-Up on TCOM,” in Lexington, Kentucky-October 6-8, 2021 virtually.

Registration for the 17th TCOM Conference is available now.

Draft Schedule with updated times:

TCOM: Building Momentum for Shared Vision

This is a prime opportunity to engage with us and our work. In the last year, the COVID-19 pandemic expanded racial and socioeconomic disparities in our communities and institutions. Our relationships are more strained and remote, our communities increasingly divided. At this alienating moment, the TCOM Conference brings a field of disparate professionals together to develop a shared vision. Using that vision, the momentum of the TCOM field carries forward lessons learned, links findings, and transforms healthcare, child welfare, behavioral health, and other complex systems for the better.

TCOM: Pulling Around the Bend Together

What is more, the TCOM approach has a long-standing reputation and body of work – for years, past TCOM Conferences and the larger world-wide TCOM Collaborative have provided a platform for innovative thinking & sharing across all systems. Over decades of building the field, the Collaborative has shared a wealth of information and knowledge about systems of care. That said, the far reach of TCOM approach does also create a diaspora of experts and data and findings throughout the world. TCOM Conferences lead the charge in breaking down siloes and bringing thought leaders together in order to create transformation and implement systems improvement.

Through the TCOM Conference, we build momentum to serve youth & families in equitable and transformative ways. We hope that you will join us.

To book your hotel stay for the 17th TCOM Conference, visit the Hyatt Regency Lexington. This conference has been moved to a fully virtual format.

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.

TCOM Certified Trainer Training

We are hosting a virtual workshop June 16 – 17, 2021 for those that are interested in being a certified Trainer in either the ANSA or CANS.

If you are already certified in either the ANSA (Adult Needs and Strengths Assessment) or CANS (Child and Adolescent Needs and Strengths), and have interest in supporting its use in your organization, you might consider becoming a coach or trainer.  To become a certified trainer in the TCOM Tools, you are required to attend a Certified Trainer Training that takes a deeper dive into the key concepts of TCOM.

The TCOM Certified Trainer Training virtual workshop is designed for ANSA or CANS certified individuals who have completed the ANSA or CANS Orientation and TCOM Overview course and are interested in coaching and/or training their staff on the ANSA or CANS. Key concepts and skills will be practiced through small group discussions, exercises and activities.

More information below:
Pre-requisite: CANS & ANSA Overview Training
Date: June 16 – 17, 2021
Time: 11am – 5pm, EST
Where: Virtual (Zoom)
Cost: $150/person
Deadline to register: June 9, 2021

Please contact Laura Rogers at l.rogers@uky.edu for more information and/or to register.

*please note that space is limited to 25 people for this training

Italy’s 5th TCOM Conference

As a part of our quarterly blog series, International Implementation, we would like to highlight Italy’s 5th TCOM Conference.

Since 2017, our partners in Italy have hosted a conference dedicated to the CANS and TCOM. This year’s conference, titled, “CANS tools to learn about users’ clinical histories and their transformations over time: collaboration and outcome assessment“, will be May 27 – 28, 2021.

The experience of the pandemic has once again highlighted the crucial importance of promoting the neuropsychic health of children and adolescents and the articulated problems it presents. In a context accompanied by the dizzying growth of complex neuropsychic needs, the increase in demand and user access, and a dispersed, uneven and resource-based system that was already largely insufficient before the impact of the pandemic, the promotion of collaborative practices oriented towards user transformations and outcome assessment becomes a crucial and innovative perspective to face future challenges.

During the conference, the implementation of CANS tools in Italy and in the United States will be presented, for the promotion of collaborative practices oriented to outcome evaluation. In the US, about 80% of children and adolescents in care of mental health services receive an assessment through CANS. In Italy, there are about 1000 trained operators, 80 agencies involved, 7 interinstitutional research projects, and others still in the planning phase. During the training days, reflections will be presented starting from clinical research conducted with the use of the instruments of the CANS family, and the operators will be confronted with the usefulness, strengths and limits and possible future developments of this innovative approach. The course is free and will take place online. ECM accreditation is expected.

If you’re interested in learning more about the tools of the CANS family in the Italian experience, check out this book written by Stefano Benzoni, Maria Antonella Costantino, and John S. Lyons: Participation and outcome assessment in developmental mental health

Participation and outcome assessment in developmental mental health John S. Lyons - Erickson

Registration for the 5th Italy TCOM Conference has closed.

This information was provided by the TCOM Italia Conference website: https://www.tcomitalia.com/formazione/convegni

Have a Moment?

The TCOM Team has created an audience survey, and would appreciate your participation: Audience Survey

As TCOM has grown, so have the members of the community we serve. We understand that continued communication with the TCOM Collaborative and understanding who you are is an important part in our goal to continue to connect and collaborate with you.

As members of the TCOM Collaborative, we are interested in understanding your perception of the three brands we serve, as well as learning a bit about yourself, your job, and how familiar you are with us.

Our intention with our survey is purely to understand our audience in order to service the TCOM Collaborative to the best of our ability. Your responses will provide valuable feedback which will shape our communication in the coming year. We would appreciate your participation in our audience survey, and ask that you please click on the link below.

Audience Survey (google.com)

We would be incredibly grateful for your help, and we thank you for your time.

*The data collected is processed for our own purposes and is not shared with any third parties outside the Praed Foundation. Further, this data is under no circumstances used for other purposes or sold.

ACRC: 65th Annual Conference

The ACRC is currently requesting Call for Papers for their 65th Annual Conference. The deadline to submit is April 30, 2021.

The Association of Children’s Residential Centers provides a network of learning and support, and advocates for quality residential interventions for children. They are dedicated to being a powerful international voice for best practices and innovation in the field.

The Association of Children’s Residential Centers is seeking presentations for its 65th Annual Conference, to be held August 3-6, 2021, in Fort Lauderdale, Florida. The ACRC is seeking abstract submissions from presenters willing to present live: in-person, virtually, or in either format. They also offer a robust poster presentation session both in person and virtually. Presenters with the voice of lived experience and/or who reflect the diversity of the populations we serve are especially encouraged to submit.

It is inarguable that the children and families we serve deserve both access and excellence when they experience mental and behavioral health interventions. This conference is intended to acknowledge those intrinsic rights and to support providers in that goal. Building on 64 years of laser focus on best practices, the ACRC’s 2021 annual conference will take on an overarching theme of Quality.

The deadline to submit a proposal for the ACRC 2021 conference is Friday, April 30, 2021. You can submit a proposal and find more information at their website: Call for Papers | ACRC (togetherthevoice.org)

Visit the ACRC’s conference page to learn more about keynotes, schedule of events, and how you can participate.

ACRC Banner

Information in this blog post was provided by the ACRC’s website at Annual Conference | ACRC (togetherthevoice.org)

Saw Han Quah, Ph.D.

Saw Han Quah is a Clinical Psychologist in private practice in Singapore. For the past 20 years, Saw Han has worked with children, young persons and their parents in relation to child protection, juvenile crime and family issues. Prior to private practice, Saw Han worked as a Principal Clinical Psychologist and Assistant Director at a government department dealing with rehabilitation and protection cases. She has a wide range of interests: parenting, disabilities, child development and protection, mental health (especially trauma, resilience and children of mentally ill parents), family therapy, programme implementation and evaluation, research, learning and behaviour, and issues related to burnout. Saw Han has been a trainer and involved with the implementation of TCOM tools like CANS (Child and Adolescent Needs and Strengths) and FAST (Family Advocacy and Support Tool – called the Family and Adult Support Tool in Singapore) for the past 10 years.

POSTS WRITTEN BY Saw Han quah

 

Lea Wong, MA


Lea Wong, Assistant Director, Children Services, oversees the Children Services Case Management in Mother’s Choice and she is passionate in child welfare and committed to be the voice for children in their best interests to pursue their permanency plan. Lea takes lead of developing the first self-financed fostering program in Hong Kong called Project Bridge and with the vision to enhance the current foster care system in Hong Kong. She works directly with social workers and the leadership team to bring the CANS, an evidence-based tool, to Hong Kong with the vision to transform practice and measure outcomes for children and families. Lea is a certified user and trainer for CANS in Hong Kong.

Lea holds a Degree in Social Work and Master Degree in Counselling from the University of Hong Kong. She is a highly motivated professional with comprehensive employment background in which she developed an extensive experience of supporting, developing and motivating teams to do better and to drive continuous improvements across a range of work activities. She describes herself as compassionate with logical, problem-solving skills and ability to work positively with people from diverse background while her wide-ranging background offers much versatility and a commitment to excellence. Lea and her family are an approved Bridge Family, and they have fostered 5 children since 2017. In the future, Lea wants her passion and commitment to be continuously focused on working with those vulnerable children and to learn and grow professionally in order to provide the best services possible to the community.

POSTS WRITTEN BY Lea Wong

How is Implementation of the CANS Outside of the U.S? – featuring Mother’s Choice in Hong Kong

Child Care Home at Bowen Road Hong Kong

by: Lea Wong and Saw Han Quah

Recognizing the valuable TCOM work that is being engaged in around the world, we are excited to announce a quarterly blog series that will focus on implementation in different countries. These posts will provide information on implementation considerations, challenges and learning opportunities, and will give a peek into how places outside of the United States are using the TCOM tools.

We begin this series with an implementation of the Child and Adolescent Needs and Strengths (CANS) in its early stages in Hong Kong by Mother’s Choice, a local charity serving children without families and pregnant teenagers. The following is an interview with Dr. Saw Han Quah, Clinical Psychologist in private practice in Singapore, and Lea Wong, MA, Assistant Director, Children Services at Mother’s Choice, in which they discuss their efforts to implement the CANS.

Question: Praed (P): What TCOM tool(s) are you using?

Answer: Lea Wong (LW): Since 2018, Mother’s Choice has implemented the CANS adapting it to the Hong Kong context. Our vision is to see every child in a loving family, and our mission is to join hands with our community to give hope and change the life stories of vulnerable girls and babies.  We support three main target clients:

  • Children in care: At Mother’s Choice, we run a Child Care Home for children aged 0-6 years and foster care services for children aged 0-18.
  • Youth: Girls facing crisis pregnancy, and those who may be at risk of facing crisis pregnancy (primary & secondary school students).
  • Families: Foster families, adoptive families, and struggling birth families.

To date, we have integrated the CANS reporting tool in our service delivery and case management for children and youth.

P: Why did you decide to use this tool?

LW: Every day, as social workers, we have the privilege to hear and witness the life stories of our vulnerable clients. As they share their experiences and seek help, we, along with multiple professionals, retell parts of their stories, based on our specific skills and focus. Case Management at Mother’s Choice is a collaborative process of assessment, planning, care coordination, intervention, and advocacy to meet a child and their family’s needs, all working towards placing that child in a safe, permanent, loving family as soon as possible. We take a holistic and shared approach to each case: social workers, medical professionals, supervisors all work in partnership towards a shared vision for the child.  Our case management framework needed this tool to reliably and succinctly communicate a client’s status, the focus of care and the level of intervention needed, enabling us to monitor our client’s needs and the impact of our interventions.

At the agency level we also needed to monitor our programs, their impact, and their outcomes in a systematic and consistent way, using evidenced based data and best practices to review our program design and performance, in order to drive continuous improvement in our services.

Our Deputy COO Helene Rao stumbled upon the CANS tool whilst researching IT solutions for a case management system. We were fortunate enough to hear more about the IT transformation and the use of CANS from the Casey Foundation, which then led us to speaking with Dr John Lyons. We had explored many different assessment tools to measure the all-rounded needs of our clients aged from 0 to 25 years. CANS and its standardized scale to collate information reliably on needs and strengths of a client gave us a clear framework to streamline our processes and flow of information.

The change management that followed was no small feat! Most of our team was a little sceptical and overwhelmed at first, but we were very fortunate to partner with Dr Saw Han Quah who had the rich experience of going through a similar process in Singapore. As Saw Han made regular trips to Hong Kong to see her family, she very kindly and patiently sat with us to map out the next steps!

P: How are you implementing the CANS?

LW: We spent around a year researching on CANS, dialoguing and evaluating our readiness so as to ensure that this was the right tool for our agency. We then mapped out an implementation plan, starting with the contextualization process for its use in Hong Kong.

Dr Saw Han Quah was invaluable in this process. Introduced to us by Dr Lyons, we leaned on  Saw Han’s rich experience as a clinical psychologist in the Ministry of Social and Family Development from 2010 to 2015 tasked with implementing the CANS and FAST.  Singapore was the first Asian country to have adapted and implemented the CANS. Together, we discussed and refined the definitions of our CANS items taking into consideration the similarities in culture between Hong Kong and Singapore. Mother’s Choice contextualized a 0-6 years old version and a 7-25 years old version of the CANS manual based on our client profile and services nature, including modules for pregnant and parenting teens.

We first embedded the use of CANS into our case management processes for children aged 0 to 6 years placed in our child care home and foster care. Their individual baseline CANS is completed within 90 days after admission and every 3 to 6 months thereafter or whenever there is a significant change.  Using the CANS data collected, we developed an algorithm to measure the complexity and intensity of cases which helps to inform our casework decisions, the level of care needed to provide targeted services. This first rollout required initial training and coaching to our team of social workers as well as ongoing workshops and reviews to ensure a consistent and reliable use of the tool to drive treatment planning and program design.

The next step was to repeat this process for older children, partnering with our Youth and Pregnant Girls team to address the specific needs of a parenting or pregnant teen. Leveraging our learnings and past experience, the process was a lot quicker! The 7-25 years old CANS has just been endorsed by the Praed Foundation in December 2020.

P: What stage of implementation are you in? How long since you began implementation?

Saw Han Quah (SHQ) and LW: We began in December 2018,  certifying all of Mother’s Choice social workers to use the children aged 0-6 years CANS and have since then rolled out the CANS for all clients aged 7-25 years. Our implementation of the CANS was accompanied by a parallel rollout of the technology tools to manage cases and collect CANS data electronically, so as to facilitate the process. With the systems in place, we are now just beginning on our journey of data analysis and reporting.

P: What barriers have you faced? What would you tell others to prepare for?

SHQ and LW: Colleagues at Mother’s Choice have most often been trained in the use of psychometric tools, and the CANS, being a communimetric tool, required time, training and regular reviews of case studies to fully understand its application in our services beyond the theory.

Our work relies heavily on communicating our vision for clients with a large stakeholder group, including clients and their family members, professionals from the government and other community agencies. Being one of the first agencies in Hong Kong to integrate the CANS into our case management processes, it will take time and effort for us to illustrate to others how the tool can be used by the clients themselves to voice and work towards their aspirations, as well as how it can assist all professionals, not just Mother’s Choice, to reach and measure outcomes.

At Mother’s Choice, we look forward to using the CANS with our families and youth directly. Engaging our youth and families with CANS as the key tool to guide the conversations will be great asset to delivering the best services.

The CANS is the tool that allowed us to implement TCOM as a case management framework. When onboarding such a tool, the organization must be ready to review not only their assessment reporting, but also how they will align these to  case management tactics and models including decision making, service planning, supervision, etc.

P: Have you developed any resources (outside of the reference guide/manual) that might be shareable?

LW: We have developed program logic to measure and monitor the complexity and intensity of cases. This algorithm puts a rating on each case that helps us make decisions on the resources that are needed to manage the cases.

A Chinese translation of the CANS is in progress and we are currently working on setting up a Hong Kong CANS E-learning Certification.

P: What advice would you have for others planning a new implementation?

SHQ and LW: We suggest setting a working group at the beginning of the project that consists of representatives from the frontline, data professionals, IT professionals and management so as to have all stakeholders involved in the design and planning.

Both for the design and the implementation of CANS in your region, we suggest to take an “agile” approach, starting with a shorter list of CANS items first (our suggestion is to start with the Standard CANS Comprehensive). Use Standard items to map out retrospective local cases and analyse how the items fit and sit with front line users, editing and specifying more clearly your item definitions. Work in iterations. From our experience, once the implementation kicks off, new insight and conversations on clinical practices, service delivery gaps, and organization improvement will surface which can then inform the next steps of the implementation plans.

P: Who are your “TCOM Champions” within the system (i.e., those who understand and are eager to use the TCOM framework and the CANS)?

LW: Saw Han is our TCOM champion extraordinaire! She has walked alongside Mother’s Choice all this time with insight, patience and encouragements. She has enabled us to develop our very own TCOM champions amongst our Mother’s Choice colleagues always speaking out the heart and voice of the TCOM principles. We are so grateful for her expertise and consult on this critical project as we advance and refine our clinical use of the tools. We are inspired by her professionalism, enthusiasm and passion in bringing the TCOM tools to Singapore and Hong Kong.

At Mother’s Choice, we strive to implement best practices by modeling small, building up internal capacity, and using that to influence big.

P: What are your future goals with the CANS?

SHQ and LW: In the short-term, we plan to continue to work with the Praed Foundation to build the training tools online in English and Chinese for our Hong Kong CANS to enable efficient recertification for all our users.

At Mother’s Choice, we strive to implement best practices by modeling small, building up internal capacity, and using that to influence big. We want to inspire and equip others to be able to do what we have done. Part of that vision includes integrating the TCOM tools at all levels of our practice so that we can then share these tools with our peer agencies and the Social Welfare Department. This will allow all involved in the care of our clients to all speak a common language, to translate our findings, and turn evidence into actionable and measurable steps with the goal of reaching better outcomes for clients and influencing practice in the long term.

images of hong kong:

What if adopting an entrepreneurial mindset can help academics succeed in their professional development?

What IPH… – A Seminar Series hosted by the Center for Innovation in Population Health

New Faculty are given an office, a computer and teaching assignments and are expected to develop a successful program of research. In many ways, each faculty position is its own ‘start-up’. Like start-ups, some succeed and some do not. Perhaps we can learn from the field of entrepreneur development how to better support the process of faculty development. 

Warren O. Nash III is the Executive Director of The Von Allmen Center for Entrepreneurship (VACE) at the University of Kentucky. Previously he was Director of the Lexington Office of the Kentucky Innovation Network and has served as the deputy commissioner of the Department of Commercialization and Innovation

Warren Nash

Executive Director of The Von Allmen Center for Entrepreneurship (VACE) at the University of Kentucky

We invite you to attend the What IPH Seminar on Wednesday, April 21, 2021.

What IPH Seminar Series

Title: What IPH.. adopting an entrepreneurial mindset can help academics succeed in their professional development?

Webinar date: April 21, 2021

Time: 2pm – 2:45pm EST

Speaker: Warren O. Nash III

Location: Zoom

Registration: What IPH Seminar Series

Cost: Free

Contact Email: diamond.darling@uky.edu

For more information on the event, click the link below:

https://iph.uky.edu/calendar/2021-04-21-180000-2021-04-21-184500

This free webinar is hosted by the Center for Innovation in Population Health. Our goal with our What IPH series is to present innovative ideas that can apply to the public health space. We invite all University of Kentucky faculty, staff, students, and the TCOM Collaborative to join us for our first seminar series. 

Call For Proposals – Extension Announced

New Proposal Submission deadline is March 31, 2021 23:59 CST

Deadline extension announcement!

We have extended the deadline for proposal submissions until March 31, 2021 (23:59 CST)!

If you are interested in presenting at the 17th Annual TCOM Conference, you now have over two weeks to work on and submit your presentation proposal. We would be delighted and encourage all those of the TCOM Collaborative to think about sharing at this year’s conference.

Call for Proposals: download here

To submit your proposal, please email Diamond Darling at communications@praedfoundation.org.

Below you will find some answers to frequently asked questions, but please be assured that our team will be more than happy to assist you with any questions that you may have. If you find yourself with a question, requesting clarification, or assistance in the proposal process, please contact us at communications@praedfoundation.org

Interview with Lizzie Minton – Kentucky’s Clinical Consultant

Written By: Ken McGill, EdS, LMFT

Lizzie Minton headshot

Lizzie Minton is a Child Welfare Clinical Consultant in Louisville, Kentucky. Since 2016, she has worked with Kentucky’s Department for Community Based Services (DCBS) to implement a standardized screening and assessment process for children in out-of-home care placements. Lizzie is a CANS Trainer and provides support and technical assistance to providers across the state as they work to implement and integrate the TCOM philosophies into their work. Lizzie previously worked as a therapist for children in residential treatment and foster care. She is a member of the 2021 TCOM Conference Program Committee.

Recently, Ken McGill, this year’s TCOM Conference Program Chair, sat down (virtually, of course) with Lizzie to talk about the upcoming conference!

Q: Tell us a little bit about the work that is happening in Kentucky.

A: This is a very exciting time for the TCOM work in Kentucky. We began the process of statewide implementation in 2016 and added our last two service regions in June 2018. Since June of 2018, we require that every child that enters out-of-home care undergo a screening process with their child welfare worker. This screener determines whether the child should be referred for behavioral health treatment. Once a child is referred for treatment, the behavioral health provider has 30 days to complete a CANS Assessment.

Q: How many children are in out-of-home care in Kentucky?

A: There are currently more than 9.000 children in out-of-home care in Kentucky. Of these children, about 6,100 children have “screened in” and been referred for a CANS.

Q: How many agencies are able to complete the CANS?

A: We have over 75 agencies who are able to complete the CANS at this time, including private child caring/placing agencies, community mental health centers, and independent providers. In 2020, we trained over 1,000 clinicians!

Q: What does the future of screening and assessment look like in Kentucky?

A: Another exciting piece of this process has been the ability to expand to other populations. Kentucky’s Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), through a System of Care grant, is expanding the screening and assessment process to include children and families involved in the child welfare system, but children are not removed from the home. It is a great time to be a part of this work!


Q: What can we expect during this year’s TCOM Conference in Lexington, Kentucky?

A: If all you know about Kentucky is horse racing, you have a lot to learn! I hope you will be wowed by our southern hospitality and charm. If you are a fan of bourbon, you may want to add an extra day or two on to your trip this year. Kentucky is home to nearly 70 distilleries and you could spend a few days enjoying the Kentucky Bourbon Trail. Lexington is also home to many great restaurants and breweries, many within walking distance to the Hyatt Regency where the conference will be held.

Q: If anyone is interested in learning more about presenting & attending the TCOM Conference what should they do?

A: My hope is that everyone reading this attends this year’s conference. If anyone is interested in presenting they can either go to the Praed Foundation or TCOM Conversations websites. The process of submission is easy…I already submitted my proposal and really looking forward to sharing more about what we are doing here in Kentucky!

Getting A Leg Up On TCOM

Written By: Ken McGill, EdS, LMFT

What are the steps needed to begin the process of getting a leg up? First we must name-it to obtain-it, the work assists to gain-it & sustain-it and the goal is to for it to remain long after we are gone.

So let’s take that first step to define TCOM or Transformational Collaborative Outcomes Management.

Those who are familiar with communimetrics in human services know that information that is presented in an accessible way serves as a conduit for transparency and aides with the ease of interpretation while maintaining both validity and reliability (Praed Foundation, 2021). The CANS tools are used to facilitate Transformational processes of the human services field. These tools assist with the collaboration and developing a shared vision with those which are connected with the children/youth, adults, & families we serve. The focus must remain on monitoring outcomes ensuring that the work remains effective. Management of the data is essential in the work at all levels-direct care, agency and county/state levels.

Drs. John Lyons & April Fernando created a snap-shot visual of TCOM:

TCOM Framework visualization. TCOM is being symbolized by Roots of a tree.
TCOM Framework – Managing the ‘Business of Helping’

Communimetrics values “a deep appreciation for the unique position of service delivery systems at the intersection between science and management” (Praed Foundation, 2021). Using communimetric tools such as the Child Adolescent Needs & Strengths (CANS) aid in the creation of a measure which can be used immediately translated and used for individualized care planning with those being served-children/youth, adults, and their families.

So getting a leg up on TCOM focuses on the goal of CANS to ‘name-it’ or – what is going on in the lives of those we serve. How can someone obtain-it if they do not first name-it or what is being identified as needs and/or strengths. The plans of care than are constructed to outline the transformation goals or the ‘gain-it.’ These become the skills, functional strengths being developed as part of care planning process. It will be the child/youth & family team that will ‘sustain-it’ developing/utilizing family & community supports. It is only with a shared vision that a child/youth, adult & their family will remain focused on reaching their own aspirational goals throughout life.

Getting A Leg Up On TCOM - Name-It, Obtain-It, Gain-It, Sustain-It are the steps, and if those steps remain, then we get TCOM. We are now moving from Systems of Care to Systems that Care.
Getting A Leg Up on TCOM – Moving from Systems of Care, to Systems That Care

My hope for 2021 and beyond is for everyone to name what they need to obtain & gain to sustain a fulfilling life and remain empowered to transformation their home, community, and the world in which we all inhabit. You now have a start to getting a leg up on the 2021 TCOM Conference

It is so exciting to be serving as the 2021 TCOM Conference Chairperson as I will have the distinct honor to serve alongside an amazing group of leaders who embody the philosophical tenets of TCOM!

NOTE: Call for Papers has been sent out, for more info you can go to TCOMConversations Deadline for submission is March 15th has been extended until Wednesday, March 31, 2021. If you are interested in presenting but you have questions please feel free to email me at KenMcGillLMFT@gmail.com 

Deadline Approaching – Call for Proposals

17th Annual TCOM Conference – Call for Proposals

Getting a Leg Up On TCOM

Call for Proposals: download here

Deadline For Submission: Monday, March 15, 2021 has been extended until Wednesday, March 31, 2021

We are excited to have our 2021 TCOM Conference at the headquarters for the TCOM team – Lexington, Kentucky! We have been shown gracious southern hospitality since we moved to the Bluegrass state in 2019, and have felt welcomed by colleagues at the University of Kentucky.

The continued global pandemic has highlighted–and in many ways, expanded–the racial and socioeconomic disparities in our communities and institutions. The world feels divided on many issues, yet the TCOM desire to create a shared vision remains the same. That shared vision cannot happen unless we are committed to providing opportunities for learning and collaborating across healthcare, child welfare, behavioral health and other complex systems.

TCOM Conferences and the larger world-wide TCOM Collaborative has provided a platform for innovative thinking & sharing across all systems. Over the decades there has amassed huge amounts of information on systems of care. The challenge has always been that data often gets siloed, where it is not shared for the betterment of service-delivery. TCOM Conferences have led the charge in breaking down siloes in order for ‘thought-leaders’ to successfully & creatively achieve implementations, as well as continuous quality improvement measures. It is through this collective gatherings which has affirmed that we need each other in order to serve youth & families in equitable and transformative ways. We hope you’ll join us.

All members of the international TCOM collaborative are invited to submit proposals to share your work.

“This year’s theme is ‘Getting a Leg Up On TCOM’ which directly connects to the locale of the conference, Lexington Kentucky. Kentucky’s rich history of hosting the Kentucky Derby dates back to 1875. The theme also directly connects with TCOM’s goal of assisting others with support, assistance and a helping hand. The phrase ‘Getting a Leg Up’ can aptly be applied to each attendee and our role as ‘professional helpers.’ Whether you are a direct care worker, an agency/organization administrator, a county/state director or a family member attending the conference will expand your knowledge of TCOM and how to apply TCOM in these roles.” – Ken McGill, 2021 Conference Chairperson

17th Annual TCOM Conference

Theme: Getting a Leg Up On TCOM

Conference date: October 6-8, 2021

Location: Lexington, Kentucky

Due date for Proposals: March 15, 2021 has been extended until Wednesday, March 31, 2021

Contact email: communications@praedfoundation.org

Call for Proposals Form: Call for Proposals – TCOM 2021 Download

For topic suggestions, please click here: TCOM Conference 2021 – Content Areas and Topics

For more information and inquiries, please contact:
Diamond Darling @ Communications@praedfoundation.org

What if learning how Shakespeare wrote Hamlet could help you in writing papers, grants, or even to develop a treatment plan?

Flyer for IPH Center's Seminar, titled, "What IPH Learning how Shakespeare wrote Hamlet would help you in writing papers or grants or even developing a treatment plan?'. The event will be online using Zoom webinar February 18. 2021, from 2 pm to 3 pm EST.

In 2019, the TCOM group established the Center for Innovation in Population Health (IPH) at the University of Kentucky. We are proud to announce that through the IPH Center, we will be hosting a free seminar series, and encourage our TCOM Collaborative to attend.

Stephen Wrentmore, a lecturer in the Department of Theatre and Dance at the University of Kentucky, has experience as a theatre director, writer, curator, academic, and change consultant. In the IPH Center’s very first seminar, he will be providing a unique perspective for clinicians: What if Learning How Shakespeare Wrote Hamlet Could Help You in Writing Papers, Grants, or Even to Develop a Treatment Plan?

Mr. Wrentmore will introduce us to Dramaturgy, or, the science of storytelling. He will walk us through ways of exploring health outcomes, and how the structure of storytelling can be a framework to help others.

Stephen Wrentmore has been invited to speak on this by Dr. John Lyons, the founder of TCOM.

We would be grateful if members of the TCOM Community attended this free event. For information about registration, please see the information below:

Title: What IPH… the science of storytelling can help researchers tell the stories of their publications and grants?

Webinar date: Febraury 18, 2021

Time: 2pm – 3pm EST

SpeakerStephen Wrentmore

Location: Zoom

Registration: What IPH Seminar Series

Cost: Free

Contact Email: diamond.darling@uky.edu

This free webinar is hosted by the Center for Innovation in Population Health. Our goal with our What IPH series is to present innovative ideas that can apply to the public health space. We invite all University of Kentucky faculty, staff, students, and the TCOM Collaborative to join us for our first seminar series. 

Keeping it Fresh: Updating Your Reference Guide

Image is of 3 pages from the updated TCOM Reference guides as an example with dark olive green background

By: Lynn Steiner, MSW

Happy New Year! As we settle into another year, it’s amazing how quickly we fall back into the same routine, the familiar tasks and obligations, the repetitions. If you have been using the CANS, the FAST, the ANSA or the CAT Reference Guides for a while, you’ve come to know it well, both how it can be useful in assessment, service planning and evaluation, and how it can be frustrating (misspellings, anyone?).

Did you know that we sometimes re-visit our standard versions of the TCOM tools in order to replace outdated language, fix errors, update content and more? In recent months, we have updated our Standard Comprehensive versions of the CANS, ANSA and FAST (with the Early Childhood and CAT versions not far behind). Keep reading to learn about general and tool-specific updates and how you can access these new versions.

Why we do this

The use of the TCOM tools began with a small number of agencies and jurisdictions. Customization, one of the selling points of the tools, was present from the beginning and promoted meaningful use and local application of these tools. To maintain the integrity of the TCOM tools, we identified a core item set for the CANS, ANSA and now the FAST that captures the minimum information needed to understand an individual’s needs and strengths. We incorporated these core item sets into the standard comprehensive versions of each tool. Occasional reviews of these tools become necessary as our understanding of individuals and the world grows with experience.

Another incentive for the core item sets relates to the recent development of the TCOM Data Reservoir that provides us a place to receive and have available data from the TCOM tools that are used in  jurisdictions all over the world. See elsewhere on the blog for information about the Data Visualization Garden (a resource for report-sharing) and how to submit your jurisdiction’s TCOM data for inclusion in the TCOM Data Reservoir and how you and your system can benefit from participating in this collaborative effort.

What has changed

Our review and refresh of the TCOM tools try to balance standardization and customization. For all versions, you may notice the following updates:

  • Clear Praed branding and standard formatting
  • Gender-neutral language
  • Updated Action Level wording that is also incorporated into the items
  • Modules that follow their trigger item rather than appearing at the end of the document to better support learning
  • Minimizing the use of mild/moderate/severe for items along with updated descriptions for some items to help reinforce the use and intent of the Action Levels
  • Changing the Trauma exposure (aka Potentially Traumatic/Adverse Childhood Experiences) items from a 4-point rating scale to a 2-point rating scale (No/Yes) to better capture the exposure to trauma rather than its severity

While the newer versions of the Standard Comprehensive CANS and the ANSA may not seem so different content-wise, if you currently use a version of the FAST – Family Advocacy and Support Tool, – it will look VERY different. You might say it has been completely overhauled! In addition to the above changes, highlights to the new Standard Comprehensive FAST include:

  • The return of the Advocacy and Capacity sub-domain, with a new skills rating system (5-point rather than 4-point)
  • Separation of Needs and Strengths Family items that are grouped into their own sections and use the corresponding Action Levels that are aligned with the CANS and ANSA
  • Alignment of Caregiver and Child items to the ANSA and CANS respectively
  • Separation of child items by age group (rated if relevant): 0-5 and 6+
  • Modules that are triggered by a rating of ‘1,’ ‘2,’ or ‘3’ on specific Child or Caregiver items
  • A new Family item: Family Social Identity, and updates of other items
  • The addition of Supplemental Information for many items to provide helpful information for assessment

How this can benefit you

If you are currently using a version of the ANSA, CANS or FAST that’s at least a year old (or substantially older), you may want to take a look at the updated standard versions. We would be happy to work with you on updating your current version.

If you are thinking about adding another tool to your toolkit, take a look at the updated versions to see if any of them might fit the bill.

For questions, or if you want to talk to us about updating your older version to the newer one, please contact April Fernando at April.fernando@uky.edu or Lynn Steiner at Lynn.Steiner@uky.edu.

_______________________________________________________________________________________________________

Introducing Our 2021 TCOM Conference Chairperson – Ken McGill

Written By: Ken McGill, EdS, LMFT

Background Information:

To be chosen to serve in this role is an absolute honor! I think it is important to further introduce myself to those whom I have not yet had the privilege of meeting. I have been the lead CANS/TCOM Trainer for the New Jersey Children’s System of Care for the past 12 years. My very first introduction to the CANS and Communimetrics was back in 2004, when I attended a training that John Lyons was facilitating here in New Jersey. It was in my role as a Regional Care Coordinator for the Contracted Systems Administrator to support the rollout of the statewide system of care for the northern region of the state.

It was exciting for me to learn from the person who literally ‘wrote the book’ on the Child Adolescent Needs & Strengths or CANS. In fact, I was given a copy of Communimetrics, which I later got signed by Dr. Lyons, and it was an amazing read. I would strongly recommend that you read it if you have not yet already done so.

It was at this point that I knew I made the right choice to shift to the public sector. My total number of years serving the New Jersey Children’s System of Care (NJCSOC) is 17, spending 4 years as a Clinical Director of a Care Manager Organization before transferring to Rutgers University-University Behavioral Health Care-Behavioral Research Training Institute. It should be noted that NJCSOC is celebrating a milestone this year-20 years!

My professional life prior to moving over to the public section consisted of working as part of a private practice as a Marriage & Family Therapist working in one of the richest counties in New Jersey-Bergen County. The practice was owned by a psychiatrist and the other group partners included a psychologist, social worker, nurse-practitioner, an educational specialist and me…a family therapist. The ‘clients’ were executives of business & industry, celebrities and their families who paid for these services ‘out of pocket’ because of their socio-economic status. Many of my fellow students from Seton Hall University told me how ‘successful’ I was because of my employment at this ‘prestigious’ agency.

However, I had another life-changing event happen to me which shifted my thinking and my life journey. It was when I listened to Dr. Nancy Boyd-Franklin speak at a statewide conference for systems therapy. Dr. Boyd-Franklin is a professor, author, and clinician who has become a dear friend of mine over the years.  It was during this presentation that she asked the audience the question, “How many families are not able to access your services?” and went on to highlight some alarming facts: many individuals, couples and families do not have access to medical/mental health resources, and people of color were impacted by systemic poverty, racism and other societal factors having generational impacts on their lives. It was then I made the shift over to ‘serve’ in the rollout of New Jersey’s Statewide Children’s System of Care.

The reason for outlining my journey is two-fold; first it gives you a background of what I bring to discussions; secondly it will further expand upon how I fit into the larger TCOM Collaborative. It is the latter which I believe is the most meaningful to everyone. You may be asking, “What do I get out of attending/participating in the conference?” The answer to this question is, “So much more than just attending a single event!” As I look back over the 14 years of conference attendance & presentations it has been a meaningful journey of ‘shared knowledge.’ Over these years I have learned from very intelligent people about training, certification, implementation, data analyses and managing complex systems. Additionally, I have developed friendships for which I am truly grateful and value not only their expertise but assistance in providing me with such unconditional support. As a result my understanding of TCOM (i.e. CANS, FAST, ANSA, etc.) is so much richer. I know that these tools can gather a depth potential information, but the ultimate goal of TCOM is to always adapt to meet the needs of individuals, families, and communities all over the world. 

The ‘Call for Papers’ was just sent out for those who are interested in sharing and becoming a part of this Worldwide Collaborative Learning Community or the TCOM Collaborative.

This Year’s Theme:

I hope you are even more excited to both attend and present at the 2021 TCOM Conference! This year’s theme is ‘Getting a Leg Up On TCOM’ which directly connects to the locale of the conference, Lexington Kentucky. Kentucky’s rich history of hosting the Kentucky Derby dates back to 1875. The theme also directly connects with TCOM’s goal of assisting others with support, assistance and a helping hand. The phrase ‘Getting a Leg Up’ can aptly be applied to each attendee and our role as ‘professional helpers.’ Whether you are a direct care worker, an agency/organization administrator, a county/state director or a family member attending the conference will expand your knowledge of TCOM and how to apply TCOM in these roles.

TCOM Blog-since you are reading my write-up it will only take a move of the mouse and a click to access the Blog where there are insightful articles on various topics connected with systems, society and self. Please consider writing up a blog on a topic of your interest & expertise and submitting it communications@praedfoundation.org

Contact Information:

My hope is that I was able to connect with you and spark your interest in not only attending this year’s TCOM Conference but to presenting your knowledge and joining the TCOM Collaborative. If you have any questions please feel free to contact me directly at KenMcGillLMFT@gmail.com or communications@praedfoundation.org

IPH Center’s First Seminar – You’re Invited!

What IPH… The Science of Storytelling Can Help Researchers Tell the Stories of Their Publications and Grants?

We are thrilled to invite you to the IPH Center’s very first seminar series!

In 2019, the TCOM group established the Center for Innovation in Population Health (IPH) at the University of Kentucky. We are proud to announce that through the IPH Center, we will be hosting a free seminar series, and encourage our TCOM Collaborative to attend.

In our very first seminar series, Stephen Wrentmore, a lecturer with the Department of Theatre and Dance, UK College of Fine Arts, will be discussing dramaturgy, the science of storytelling. Stephen will offer ideas on how dramaturgy can help researchers tell the stories of their publications and grants. This will give our audience an alternative way that health scientists can tell their stories and their work.

Stephen Wrentmore

Lecturer, Dept. of Theatre and Dance, UK College of Fine Arts

About the Speaker:

 Mr. Stephen Wrentmore is the University of Kentucky’s resident expert in Dramaturgy- the science of storytelling. Over his career, he has written, directed, and staged productions all over the world, from Omsk to San Jose. Originally from London, he teaches and is a lecturer in the Dept. of Theatre and Dance, UK College of Fine Arts. He will be discussing how storytelling can be beneficial to people in the healthcare field.

We look forward to your attendance for the very first What IPH Seminar Series!

What IPH Seminar Series

Title: What IPH… the science of storytelling can help researchers tell the stories of their publications and grants?

Webinar date: Febraury 18, 2021

Time: 2pm – 3pm EST

Speaker: Stephen Wrentmore

Location: Zoom

Registration: What IPH Seminar Series

Cost: Free

Contact Email: diamond.darling@uky.edu

For more information on the event, click the link below:

https://cph.uky.edu/calendar/webinar-researchers-science-storytelling

This free webinar is hosted by the Center for Innovation in Population Health. Our goal with our What IPH series is to present innovative ideas that can apply to the public health space. We invite all University of Kentucky faculty, staff, students, and the TCOM Collaborative to join us for our first seminar series. 

17th Annual TCOM Conference – Call for Proposals!

The 2021 TCOM Conference will be in the horse capital of the world – Lexington, Kentucky! Our theme for this year’s TCOM conference is “Getting a Leg Up On TCOM” – hosted by the Praed Foundation

All members of the international TCOM collaborative are invited to submit proposals to share your work. Download the Call For Proposals document below.

Back in September of 2019, the TCOM group established the Center for Innovation in Population Health (IPH) in Lexington at the University of Kentucky. Since moving to Kentucky, we have gotten to experience the southern charm and hospitality that Lexington has to offer.

Whether you submit a proposal to present or not, we look forward to seeing all of you in Lexington, Kentucky.

For those that have yet to attend an in-person 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. 

Call for Proposals: download here

Deadline For Submission: Monday, March 15, 2021 has been extended until Wednesday, March 31, 2021

17th Annual TCOM Conference

Theme: Getting a Leg Up On TCOM

Conference date: October 6-8, 2021

Location: Lexington, Kentucky

Due date for Proposals: 15 March 2021 has been extended until March 31, 2021

Contact email: communications@praedfoundation.org


FAQs for the Call for Proposals process

Q: How long is the Call for Proposals open for the 17th Annual TCOM Conference (2021)?
A: The Call for Proposals for the 2021 TCOM Conference is open through January 19, 2021 and will now be closed on March 31st, 2021.

Q: What is the deadline to complete a submission?
A: 
All submissions must be completed by Wednesday, March 31, 2021 23:59 CST in order to be considered for the 17th Annual TCOM Conference.

Q: What is the theme for the 17th Annual TCOM Conference?
A: “This year’s theme is ‘Getting a Leg Up On TCOM which directly connects to the locale of the conference, Lexington Kentucky. Kentucky’s rich history of hosting the Kentucky Derby dates back to 1875. The theme also directly connects with TCOM’s goal of assisting others with support, assistance and a helping hand. The phrase ‘Getting a Leg Up’ can aptly be applied to each attendee and our role as ‘professional helpers.’ Whether you are a direct care worker, an agency/organization administrator, a county/state director or a family member attending the conference will expand your knowledge of TCOM and how to apply TCOM in these roles.” – Ken McGill, 2021 TCOM Conference Program Chair

Q: What topic should I submit for consideration for the 17th Annual TCOM Conference?
A: For the annual TCOM Conference, we are always looking for a wide array of topics that are innovative, engaging, inspiring, and informative in relation to TCOM. We also have suggested topic categories if you would like your presentation to be CE Eligible for the 17th Annual TCOM Conference.

Example topic themes: Communimetrics, TCOM, Direct Care, CANS, ANSA, FAST, SSIT, Safe Systems, CAT/CSPI, Juvenile Justice, Behavior Health, Outcomes Management, Education, Leadership, Child Welfare, Person-Centered Care

Q: What information is required within a proposal?
A: Your proposal(s) will not be accepted without the following information from all presenters:

  • Faculty Information Sheet – completed by each presenter
  • Learning Objectives – completed by each presenter
  • Disclosure of Financial Interest – completed by each presenter
  • Current Curriculum Vitae (CV) – completed by each presenter
  • Current Headshot – completed by each presenter
  • Draft presentation (outline)

Q: What should I provide for Learning Objectives?
A: A clear learning objective states what the learner will be able to do upon completion of a continuing education activity, in terms of behavioral change. A clear objective identifies the terminal behavior or desired outcome of the educational offering. If you’re interested in more information, you can view the Learning Objectives Guidelines.

Q: Who is the audience for the TCOM Conference?
A: 
We invite all that are interested in TCOM to attend the annual TCOM Conference. Many of our attendees are direct care workers, social workers, researchers, agency/organization administrators, county/state directors, or even family members that are wanting to expand their knowledge of TCOM.

Q: How do I submit my proposal?
A: You will need to submit your proposal(s) by email to Diamond Darling at communications@praedfoundation.org

Q: How will I know if my proposal was submitted successfully?
A: Once you email your Call for Proposal submission to communications@praedfoundation.org, you will receive an email confirmation from Diamond Darling that we have received your presentation proposal.

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8 Tips to Keep the Holidays Happy

’Tis the season that families and friends would typically be gathering to exchange gifts and celebrate traditions. With the COVID-19 pandemic, this year will be different. 

We encourage our TCOM Collaborate to celebrate this year’s festivities in ways that we hope will help keep us all safe and healthy. We understand that this may present some difficult emotional and logistical challenges. Celebrating holidays alone or only with our immediate household members can be a new hurdle that many of us haven’t experienced before.

But the holidays aren’t canceled. We can still share our love, show gratitude, and plan creative activities to make this holiday a season to remember.

Here are a couple of ideas that you may want to consider to celebrate this holiday season in new and different ways:

  1. Share a Meal Remotely
    Most of our end-of-the-year holidays involve our family and friends gathered around a table with our favorite traditional meals. To include people outside of your household, use one of the many videoconferencing platforms that are available to share your meal and good conversation remotely. Have people share their recipes, compare culinary creations, and show how their dishes were prepared. (For recipe ideas, the College of Public Health at the University of Kentucky recently created a virtual cookbook that you can find here)

  2. Organize a Game Night
    This would be a good time to bring out any old board games or teach your kids new games that they haven’t gotten the chance to play yet. Many games can also be played online, or you can play traditional games (e.g. trivia, scavenger hunts, charades) on a video call.

  3. Holiday Movie Watch Party
    Hosting a virtual movie night might be the way to go to be able to entertain as well as connect with your friends or your family. Netflix, Hulu, and many other streaming platforms can allow you to watch the movie all at once. You can send a poll to your virtual “guests” for the movie night to see what movie you will be screening, then set aside a block of time to all watch the film together.

  4. Caroling Karaoke
    Traditional caroling this year is a high-risk activity with COVID-19. Using a video call platform and some karaoke apps, you can convert your caroling to an online event. Record your video, then post your family or your friends’ magical voices onto any of your social media platforms to spread holiday cheer.

  5. Holiday Lights Tour
    To bring back the magic of the holidays, plan a road trip around town with your household members to see the light displays around your neighborhood, local downtown area, or businesses.

  6. Visit with Santa Claus on Your Computer
    Santa is still coming to town, sort of. His visits are much trickier this year, as there have been restrictions on his in-person visits due to the pandemic. However, many sites allow you to connect with Saint Nicholas virtually. Even though his appointments are booked (since tonight is his busiest night), you can see a pre-recorded video on Santa Calling for free.

  7. Attend a Virtual Storytelling, Mass or Concert
    Not many in-person events are being hosted this holiday season. Luckily, many of those events are still taking place online. Many holiday theaters and musical performances are still taking place virtually, such as San Francisco Ballet’s Nutcracker until December 31st.
    These online events have made it possible to experience different celebrations all over the country. Checking with your favorite local organizations to see what they have planned is also recommended.

  8. Bake and Decorate Some Sweet Treats
    Gingerbread houses + sugar cookie decorating have always been a fun tradition. Whether this involves your household or done virtually, this allows others to be creative and to have a snack at the end! For recipes, there’s an abundance of recipes on the internet, and Food Network provides a step-by-step guide. I personally pair my sweet treat with a sweet drink, like eggnog or hot cocoa.

COVID-19 is still surging in most of the United States, and in different areas around the world. Many of us are breaking tradition this year by having to physically social distance, which can add a new stress on this holiday season. This year, everyone will need to rethink what truly matters about holiday gatherings — or rather, what exactly it is we love about them.

The University of Kentucky (where our Center is based) will be closed from December 19, 2020– January 3, 2021. As a courtesy, our Support Services will still be available on a limited basis during this time. This includes the General TCOM Training Support, Coaching Support, and eCANS Support. Support Services will respond to your requests within 2 business days, holidays notwithstanding. Due to these limitations, we urge you to use the guides provided on the Praed Foundation Website.

Mine-CANS Winner – TCOM Conference 2020

During the TCOM 2020 Virtual Cloud Gathering Conference, Community Data Roundtable (CDR) hosted a conference-wide virtual scavenger hunt for all of our attendees.

This scavenger hunt highlighted all the “nuggets” one “mines” at the TCOM conference. These “nuggets” were featured within every presentation as little Minecraft style blocks.

The attendees were able to win points by finding these nuggets, as well as receive extra points for engagement in the Virtual Café. At the end of the conference, the attendee with the most points won a gift basket with gift cards, a fancy-coffee kit, and even a copy of John Lyons’  Communimetrics.

We would like to congratulate our scavenger hunt winner from this year’s conference, Lydia Shaw!

Community Data Roundtable put together a video highlighting Lydia receiving her prize, and features CDR, members of the TCOM Team, and Dr. John Lyons awarding this year’s winner via Zoom.

To see the video that Community Data Roundtable put together, please click the link below:

Thank you to all who played and participated in this year’s TCOM Cloud conference. 

New Website Announcement

Today we are excited to announce the launch of our new website!

Back in September of 2019, the TCOM group established the Center for Innovation in Population Health (IPH) at the University of Kentucky.

Our site for the Center for Innovation in Population Health has officially gone live. We hope that with our brand new website, we can further improve our engagement with the University of Kentucky, Commonwealth of Kentucky, and beyond. On our site, you will be able to gather an understanding of what the IPH Center hopes to accomplish, the work that we do, and learn more about our team.

The IPH Center is based in the College of Public Health, and we have found with its high-energy leadership and vibrant faculty, a home in a field that is the most congruent with the mission and approaches of our work

Our goal at the IPH Center is to create a culture of health. To do this, we emphasize four strategic goals: making health a shared value, fostering cross-sector collaboration to improve well-being, creating healthier and more equitable communities and strengthening integration of health services and systems.

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.

We invite you to visit our site at iph.uky.edu

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.

Invitation: Presenting at the Annual TCOM Conference

We invite you to submit a proposal for the 17th Annual TCOM Conference in Lexington, KY from October 6-8, 2021.

As you may already know, TCOM (Transformational Collaborative Outcomes Management) is a theory based approach to managing human services. 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.

We would like to hear from all the voices of the TCOM Collaborative for our annual TCOM Conference.

Our Conference Committee accepts a wide range of topics, and we are always thrilled to see what the Collaborative is working on in the world of TCOM. Our goal at each TCOM Conference is to provide a stimulating and engaging experience where you can learn from and network with colleagues from around the world.

Call for Proposals: download here

If you are not able to make a submission to the Call for Proposals, we hope you can attend this year’s conference. The 17th Annual TCOM Conference is scheduled to be in-person from October 6–8, 2021, in Downtown Lexington, Kentucky.

If you have any questions regarding your proposal submission, please contact our TCOM Conference Lead, Diamond Darling, at communications@praedfoundation.org, or the 2021 Conference Program Chair, Ken McGill, at kenmcgilllmft@gmail.com. We’d be more than happy to assist you in your submission process.

Ken McGill, EdS, LMFT

Headshot of Ken McGill, who is the 2021 TCOM Conference Chair


Meet Ken McGill, the Conference Chairman for the 17th Annual TCOM Conference!


Ken McGill, EdS, LMFT has been the CANS/TCOM Trainer for the New Jersey Children’s System of Care for the past 12 years. His first introduction to the CANS and Communimetrics was back in 2004, when he attended a training that John Lyons was facilitating in his home state New Jersey. It was in his role as a Regional Care Coordinator for the Contracted Systems Administrator to support the rollout of the statewide system of care for the northern region of the state.

Ken’s is currently serving as President of the New Jersey Association for Marriage and Family Therapy (NJAMFT). His total number of years serving the New Jersey Children’s System of Care (NJCSOC) is 17, spending 4 years as a Clinical Director of a Care Manager Organization before transferring to Rutgers University-University Behavioral Health Care-Behavioral Research Training Institute.

He was the 2013 recipient of the Praed Foundation’s Outcomes Champion (CANS) Award for his work in children’s systems of care and outcomes management. He has more than 20 years of experience in marriage and family therapy, education and research. Ken received his Education Specialist degree in marriage and family therapy from and his Master’s in Education from Seton Hall University.

Ken has attended and presented at the annual TCOM Conference for the past 14 years. Over these years, says he has “learned from very intelligent people about training, certification, implementation, data analyses and managing complex systems”. We are honored to have Ken join us as the Conference Program Chair for this upcoming 2021 annual TCOM Conference.

We encourage you to read more about Ken’s story and background in his blog post here.

If you would like to get in touch with Ken McGill, you can contact with him at kenmcgilllmft@gmail.com.

Posts Written by Ken

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