Funding and Sustaining Family-Centered Treatment for Women with Substance Use Disorders

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1 Funding and Sustaining Family-Centered Treatment for Women with Substance Use Disorders Developed for the Center for Substance Abuse Treatment under Contract with Johnson, Basin and Shaw Authored by: Kimberly Dennis, M.P.A., Nancy K. Young, M.S.W., Ph.D. & Sidney L. Gardner Children and Family Futures, Inc.

2 A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Administration on Children, Youth and Families Children s Bureau Office on Child Abuse and Neglect

3 Outline of Presentation Family-Centered Treatment for Women with Substance Use Disorders Funding Family-Centered Treatment for Women with Substance Use Disorders Shields for Families Funding Family Centered Treatment by Kathryn Icenhower, Ph.D., LCSW

5 Principles Family-centered treatment is comprehensive Women define their families Treatment is based on the unique needs and resources of individual families Families are dynamic, and thus treatment must be dynamic Conflict is inevitable, but resolvable Meeting complex family needs requires coordination across systems

6 Principles Substance use disorders are chronic, but treatable Services must be gender responsive and specific and culturally competent Family-centered treatment requires an array of staff professionals as well as an environment of mutual respect and shared training Safety comes first Treatment must support creation of healthy family systems

7 Continuum of Family-Based Services Women s Treatment With Family Involvement Women s Treatment With Children Present Women s and Children s Services Family Services Family-Centered Treatment Services for women with substance use disorders. Treatment plan includes family issues, family involvement Goal: improved outcomes for women Children accompany women to treatment. Children participate in child care but receive no therapeutic services. Only women have treatment plans Goal: improved outcomes for women Children accompany women to treatment. Women and attending children have treatment plans and receive appropriate services. Goals: improved outcomes for women and children, better parenting Children accompany women to treatment; women and children have treatment plans. Some services provided to other family members Goals: improved outcomes for women and children, better parenting Each family member has a treatment plan and receives individual and family services. Goals: improved outcomes for women, children, and other family members; better parenting and family functioning

8 Inter-related Components Community Support Clinical Support Clinical Treatment

9 Clinical Treatment Services Address Medical and Biopsychosocial Issues Continuing care Outreach and engagement Screening Drug monitoring Detoxification Mental health services Crisis intervention Assessment Pharmacotherapy Treatment planning Medical care Case Management Trauma services Counseling and education

10 Clinical Support Services Support Recovery and Maintenance Recovery community support services Continuing care Life skills Outreach and engagement Screening Parenting and child development education Drug monitoring Detoxification Advocacy Crisis intervention Family programs Mental health services Assessment Pharmacother apy Treatment planning Housing support Medical care Case Management Educational remediation and support Trauma services Counseling and education Linkages with legal and child welfare systems Employment readiness services

11 Clinical Support Services Support Recovery and Maintenance Faith-based Organizations Housing Vocational & Education Services Recovery community support services Continuing care Life skills Outreach and engagement Screening Parenting and child development education Familystrengthening Services Advocacy Drug monitoring Mental health services Detoxification Crisis intervention Family programs Child Care Pharmac otherapy Assessment Workplace Prevention Housing support Medical care Trauma services Counseling and education Case Management Treatment planning Educational remediation and support Transportation Linkages with legal and child welfare systems Employment readiness services Recovery Support TANF Linkages

12 Children s Clinical Treatment Services Screening Therapeutic child care and development Intake Mental health and trauma services Assessment Substance abuse education and prevention Medical care and services Case planning Residential care (in residential settings) Case management

13 Children s Clinical Support Services Child Care Recovery community support services Therapeut ic child care and developm ent Screening Intake Mental health and remediation services Mental health and trauma services Assessment Advocacy Substance abuse education and prevention Case planning Case management Residential care (in residential settings) Medical care and services Prevention services Educational services Recreational services

15 Purpose To identify strategies to Increase funding flexibility Maximize revenues Optimize the efficiency of existing resources

16 Funding Family Centered Treatment By Detailing Federal and State funding sources that could support treatment services for women and their families Highlight the experiences and insights of SHIELDS for Families Provide concrete, next-step starting points

17 Prerequisite to Funding Strategies: Taking Stock of Your Program and Community

18 Understand Existing Funding Streams How they flow into their communities How they are currently allocated among different service providers How they might be better allocated to meet needs What is needed to tap into those existing resources

19 Taking Stock of Your Program and Community Who are my clients and what are their needs? Changes over time Financing for what? Understand and correctly prioritize clinical treatment and support services Use case reviews, surveys or focus groups to find out what services were most/least useful, and needed but not received

20 Taking Stock of Your Program and Community What services do we currently provide to meet parents needs, and where do we fall short? What about others in the community that serve our parents? Comparing parents priority needs with existing program services Parents are typically involved with other community service systems

21 Taking Stock of Your Program and Community What funding and other resources in the community are currently used to fund these services? Are those resources sufficient to achieve intended outcomes? How can the agency s resources be combined with others to achieve greater impact?

22 Taking Stock of Your Program and Community What funding and other resources in the community are currently used to fund these services? Create an inventory of what other resources and services already exist in the community and the total level of public and other dollars flowing into the community to support those services Identify who controls these resources

23 Taking Stock of Your Program and Community To what extent can we tap into these existing sources? What partnerships need to be established? Identify potential collaborators Initiate discussions about which service providers have the capability and capacity to offer which services Develop an interconnected service delivery system that reflects family and community needs

24 Taking Stock of Your Program and Community Should we can we offer services ourselves? If the resource mapping identifies significant unmet service needs, providing services inhouse may best meet family needs

25 Taking Stock of Your Program and Community Should we can we offer services ourselves? Internal planning and decision-making considers: Do we have the appropriate facilities, technology, licensing, qualified staff, and prior experience How will we accommodate budget/program growth Do we use our own staff, employ additional staff, or bring in outside contractors? What are the expected savings, benefits, and outcomes

26 Strategies to Create Unified Financing Increasing Funding Flexibility Maximize Revenues Optimize the Efficiency of Existing Resources

27 Increasing Funding Flexibility Decategorization A Federal- or State-level strategy used to reduce or eliminate categorical funding stream constraints Pooled or Blended Funding Formally combine a portion of funds from several agencies or sources into a single funding stream

28 Increasing Funding Flexibility Braided Funding Used to obtain or weave together multiple funding sources to create and support comprehensive services Wraparound A process in which clients receive a full range of services to meet their needs

29 Strategies to Maximize Revenues Leveraging Maximize Federal funding by taking advantage of Federal programs that provide matching funds contingent on State/local/private spending Refinancing Maximizing use of Federal entitlement funds to pay for services financed with State/local funds Administrative Claiming Making use of available child welfare and Medicaid administrative funds

30 Strategies to Optimize Efficiency of Existing Resources Redeployment Move funding from higher cost remedial services to lower cost prevention and early intervention Reinvestment Identify cost savings generated by effective programs and reinvesting those savings Redirection Identify the least effective programs and redirect resources to more effective programs with documented results

31 Primary Federal Funding Types Entitlement Programs Open-ended, uncapped appropriations to all individual who meet eligibility criteria (Medicaid, Title IV-E) Formula or Block Grants Capped appropriations to States or localities based on established formulas (SAPTBG) Discretionary Grants Capped appropriations for specific programs under competitive awards (PPW, Regional Partnership Grants) Direct Payments Capped appropriations to individual beneficiaries (SSI, Section 8)

32 Primary Federal Sources for Adults Substance Abuse Prevention & Treatment Block Grants - SAPTBG Temporary Assistance for Needy Families - TANF Medicaid Workforce Investment Act Community-Based Child Abuse Prevention Program Child Welfare Services IV-B, Subparts I & II Developmental Disabilities Basic Support and Advocacy Grants Community Mental Health Services Block Community Services Block Grant Maternal and Child Health Block Grant- Title V Social Services Block Grant Community Prevention Incentive Grants Title V Family Violence Prevention and Services Housing Opportunities for Persons with AIDS HIV Care formula Grants Project for Assistance in Transition from Homelessness Residential Substance Abuse Treatment for State Prisoners

33 Primary Federal Sources for Children and Youth Substance Abuse Prevention & Treatment Block Grants - SAPTBG Temporary Assistance for Needy Families - TANF Community-Based Child Abuse Prevention Program Child Abuse and Neglect State Grants Child Welfare Services IV-B, Subparts I & II Promoting Safe and Stable Families IV-B, subpart 2 Child Care and Development Fund/child care and Developmental Block Grant Medicaid/Early and Periodic screening, diagnostic, and Treatment Program State children s Health Insurance Program (SCHIP) Individuals with Disabilities Education Improvement Act (IDEA) Developmental Disabilities Basic Support and Advocacy Grants Community Mental Health Services Block Community Services Block Grant Maternal and Child Health Block Grant- Title V Social Services Block Grant Chafee Foster Care independence Program Juvenile Accountability Incentive Block Grants Community Prevention Incentive Grants Title V Family Violence Prevention and Services HIV Care formula Grants

34 Details for Each Funding Source Responsible Federal Agency General Description/Overview Type of Funding How Funds are Managed Eligible Populations Use of Funds How Substance Abuse Treatment Providers can Leverage These Funds Important Restrictions Special Notes

35 Guiding Principles and Specific Steps Ensure family s needs drive the funding search Map and track funding streams Develop collaborative relationships at all levels Ensure funding is diversified Customize the approach and prioritize targets Promote the connections between funding and outcomes Work to change the rules and the priority given to substance abuse treatment funding

36 Requirements for Sustainability Products The program or initiative to be sustained Financial The potential of revenue source Political and Community Support Outcomes to justify investment

37 To Order a Copy or Obtain Website Address for White Papers Contact: Larisa Owen, M.B.A. Director of Technical Assistance Services 4940 Irvine Boulevard, Suite 202 Irvine, CA ncsacw@cffutures.org

38 Administration for Children and Families Regional Partnership Grantee Conference: Advancing Clinical and Collaborative Practice Washington, D.C., January 15-16, 2009 Presented by Kathryn Icenhower, PhD, LCSW SHIELDS For Families, Inc. Los Angeles, CA

39 FUNDING AND SUSTAINING FAMILY CENTERED TREATMENT FOR WOMEN WITH SUBSTANCE USE DISORDERS Successes and Challenges in Sustainability at the Exodus Program

FUNDING AND SUSTAINABILITY Successes and Challenges Shields is a non-profit agency serving the Compton and Watts communities of South Central Los Angeles.

40 FUNDING AND SUSTAINABILITY Successes and Challenges Shields is a non-profit agency serving the Compton and Watts communities of South Central Los Angeles. We have approximately 300 employees with an annual budget of $21 million. SHIELDS provides programs in multiple sites, including: 8 Substance Abuse Programs 10 Mental Health Programs Community Assessment Center 3 Youth Programs 5 Child Development Programs Family Preservation Family Support Partnership for Families Prevention Initiative Vocational Services Center Adoption Support Federal Healthy Start Program Partnership for Families 126 Units of Low-income Housing Transportation

41 SHIELDS for Families Exodus Program

42 Exodus Program The Exodus program is located at Keith Village, an 86 unit apartment complex in Compton, California. Services on-site include: treatment program, child development center, youth program, vocational services center. Facility also houses two play grounds, a community room and a Laundromat. Keith Village was purchased in 1994 and the Exodus program has been in operation for twelve years. A maximum of 45 families are enrolled in the program.

Exodus Program Originally funded through the Federal Center for Substance Abuse Treatment s (CSAT) perinatal initiatives in 1994, the Exodus program provides comprehensive care for women and their

43 Exodus Program Originally funded through the Federal Center for Substance Abuse Treatment s (CSAT) perinatal initiatives in 1994, the Exodus program provides comprehensive care for women and their children including: counseling, child development, vocational services, mental health, medical care, family support and family reunification. Annually, approximately 60 women and 250 children are served with an average length of stay of months.

Exodus Program Currently, 45 moms with approximately 170 children are enrolled in the program. Services are six days a week (Monday thru Saturday) from 8:30 a.m. to 5:00 p.m. Average length of stay is 18 to 24 months.

44 Exodus Program Currently, 45 moms with approximately 170 children are enrolled in the program. Services are six days a week (Monday thru Saturday) from 8:30 a.m. to 5:00 p.m. Average length of stay is 18 to 24 months. Families are allowed to remain in housing one year post completion in order to transition back to the community Completion rates have remained at 70% or higher since the program was implemented. Family reunification rates are 85%.

45 SHIELDS for Families Funding Family Centered Treatment: How We Did It

46 The Dollar Didn t Drive Us: We Drove the Dollars We knew that the program was: Needed in the community, Requested by our consumers Supported by our evaluation results Essential in furthering our mission. We developed the model and started searching for funding.

47 The Dollar Didn t Drive Us: Success #1: Funding for the Initial Program Applied twice to get the money, first to CSAP then to CSAT. We knew it would work, so we didn t change the model, we kept trying. Finally funded by CSAT in The Pregnant and Postpartum Women s grant enabled us to provide a wide range of services to women and their children. Also received a SAMHSA grant to provide specialized services to children in the program. However.we did not want to do traditional residential treatment too costly and restrictive. We wanted a model that allowed the entire family unit to participated in services housing and treatment combined.

48 SHIELDS for Families Challenge #1: Funding for Housing We knew that CSAT funding was not enough, especially for the housing component.

Funding for Housing To address this challenge: SHIELDS began looking at services in a different manner.we began exploring alternatives in order to implement the model we had developed.

49 Funding for Housing To address this challenge: SHIELDS began looking at services in a different manner.we began exploring alternatives in order to implement the model we had developed. We realized that we could provide the housing ourselves. After exploration, we set up a separate non-profit housing corporation. Loans were acquired to purchase the facility through the State of California and the Community Development Division of a Bank.

50 Funding for Housing: Success #2: What we Know Now Alternative sources of funding for Housing include: HUD Continuum of Care, Section 8 State Sponsored Loan Programs Corporation for Supportive Housing Community Development Departments Specialized Non-Profit Lenders Tax Credits New Market Tax Credits

51 SHIELDS for Families Challenge #2: Don t Put All Your Eggs in One Basket

52 Don t Put All Your Eggs in One Basket When we implemented Exodus, we knew two things: 1. We needed more money than our CSAT grant 2. We had five years to find funds to continue services.

Don t Put All Your Eggs in One Basket What we realized Our families needed extensive services that were not available anywhere in the community.

53 Don t Put All Your Eggs in One Basket What we realized Our families needed extensive services that were not available anywhere in the community. Challenge became twofold 1. Eliminating the dependency on the CSAT funding (one funding source) 2. Finding a way to address the special concerns of our families.

54 Don t Put All Your Eggs in One Basket Continuing our philosophy of looking at treatment in a different manner, we starting looking at two things: The services we needed to offer to meet our families needs What funding was available from anywhere that could pay for them

55 Don t Put All Your Eggs in One Basket SERVICES WE NEEDED: Substance Abuse Treatment Services Mental Health Child Development Youth Services Case Management Vocational Services Educational Services Health Promotion Family Support/Reunification Legal Services Food Services Transportation

56 Don t Put All Your Eggs in One Basket Funding Available: Providing Family Centered Treatment required a paradigm shift in how we thought about funding The first step in looking at funding availability was the identification of all the potential systems that are families were a part of..

57 Don t Put All Your Eggs in One Basket Funding Available: This included the following systems: Substance Abuse Treatment Child Welfare Mental Health Vocational Rehabilitation Developmental Disability Public Health/Health Public Social Services Criminal/Juvenile Justice Education

58 Don t Put All Your Eggs in One Basket Funding Available: The second step was looking at the funding available through these systems and what services they might be able to finance.

59 Don t Put All Your Eggs in One Basket Funding Available: Traditional treatment sources of funding: Block grant Medicaid Center for Substance Abuse Treatment Center for Substance Abuse Prevention

60 Don t Put All Your Eggs in One Basket Mental Health Funds: Funding for prevention, case management, treatment for children and adults Center for Mental Health Services Medicaid, EPSDT Child Welfare Funds: funding for prevention, case management, treatment for children and adults Administration for Children and Families Block Grant Title IV-E Safe and Stable Families Health funding: funding for case management, support services, parenting, child care: Maternal and Child Health Block Grant Health Resources Services Administration Medicaid

61 Don t Put All Your Eggs in One Basket Public Assistance Funding: funding for case management, treatment, child care, transportation TANF/Responsibility to Work Funds Criminal Justice Funds: funding for prevention, case management, treatment for children and adults Juvenile Justice Probation Adult System Patriot Act Second Chance Act Vocational Services: funding for supportive services, financial literacy, job readiness and training Department of Labor Department of Rehabilitation Title IV-E

62 Don t Put All Your Eggs in One Basket Education System Funds: funding for educational classes, certificate programs, trade programs ADA Adult School System Charter Schools Community Colleges Trade Schools We also needed to look for other resources to cover needs outside those systems Food and Transportation: FEMA Federal transportation funds

63 SHIELDS for Families Challenge #3: Accessing Funding and Services.Moving Mountains

64 Moving Mountains Five years of funding through CSAT was racing by rapidly.after identifying the systems and funding that might be available.the challenge facing us now was to identify what funds we could access and what resources we could obtain through existing systems. First, we looked at what was available through existing resources in the community. If the service existed, we worked to establish collaborative relationships. win-win situations. If no or limited resources were available, we sought funding through SHIELDS. This included becoming mental health and child welfare providers during our initial five years of funding.

Moving Mountains Additionally, key to obtaining our on-going funding was advocacy for our program as well as others. In California: Nine programs facing the loss of CSAT funds.

65 Moving Mountains Additionally, key to obtaining our on-going funding was advocacy for our program as well as others. In California: Nine programs facing the loss of CSAT funds. We joined together to form the California Perinatal Treatment Network. We worked together to lobby for continued funding from the State of California. We were successful in obtaining this funding in 1999 and continue to receive an annual allocation for our core treatment services.

66 SHIELDS for Families Success #3: Long Term Integrated Funding and Services for Exodus.Where we are now

67 Where We Are Now Exodus has been in operation for 14 years 9 years beyond the end of our original CSAT funding. Our current budget is approximately twice that of our initial grant. Services are funded by the following sources:

68 Where We Are Now Substance Abuse Treatment Services: Federal Block Grant, State General Funds, TANF Mental Health: Medicaid, County General Funds, MHSA, TANF, PSSF Child Development: Proposition 10, EPSDT, Treatment funds, PSSF, County Health Department, HRSA; Services accessed on site through Regional Center Youth Services: EPSDT, United Way, Federal Block Grant, PSSF; Services provided on site from local schools.

69 Where We Are Now Case Management: PSSF, Treatment Funds, HRSA, EPSDT Vocational and Educational Services: PSSF, United Way, Proposition 10; Services accessed on site through three Unified School Districts (ADA), Community Colleges, Department of Rehabilitation Health Promotion: CSAT, HRSA, Los Angeles County Health Department, Proposition 10; Services accessed through local Health Providers for on-site classes and resources. Family Support/Reunification: PSSF, IV-E Waiver

70 Where We Are Now Legal Services: PSSF, Proposition 10; Services accessed through local legal clinics Food Services: FEMA, Treatment funds, United Way Transportation: CalTrans, PSSF, Treatment funds, TANF

71 Where We Are Now Additionally, SHIELDS is certified to complete applications for all public benefits for our families. And now we are trying to replicate the model with the implementation of Tamar Village targeted towards women in the county jail system

72 Where We Are Now QUESTIONS AND ANSWERS

73 The End SHIELDS For Families, Inc South Avalon, Suite 300 Los Angeles, CA ph (323) , fx (323) Kathryn Icenhower, PhD, LCSW Presented by the SHIELDS for Families IT Department

Collaborating to Meet the Needs of Families Presented at the TCE Methamphetamine Grantee Meeting

Collaborating to Meet the Needs of Families Presented at the TCE Methamphetamine Grantee Meeting October 29, 2008 Presented by Sharon Amatetti, MPH SAMHSA/CSAT Topics to be Presented ACYF s Regional Partnership