Engaging Family Report_YR13-14 Final

Engaging Family & Youth:2013-2014 Year in Review Tell Us about Partnership Each year, the County of San Diego Health and Human Services Agency’s Behavioral Health Services Division for Children, Youth and Families (HHSA BHS CYF) entrusts Family & Youth Roundtable (FYRT) with preparing a report on strategies to effectively identify and engage families and youth. As best practices and standards dictate, authentic engagement of family and youth includes participation in program evaluations, policy formation, and service-level program development and enhancement with public, private, and educational partners. To determine the current level of family and youth engagement as well as areas of need, FYRT partners with contracted providers by placing Tell Us about Partnership surveys in their lobbies and supporting the development of agencies’ Program Advisory Groups (PAGs). These evaluative methods, coupled with FYRT’s twelve years of expertise as the HHSA BHS CYF Liaison, inform the recommendations found within this report. Authored by Family & Youth Roundtable on June 30, 2014 Address: 5005 Texas Street, Suite 104, San Diego, CA 92108 Telephone: (619) 546-5852Funded by: County of San Diego, HHSA, Behavioral Health Services, Children, Youth and Families

Table of Contents Engaging Family & Youth: 2013-2014 Year in ReviewLetter from Donna Ewing-Marto, CEO, Family & Youth Roundtable ............................................ 2Tell Us About Partnership Foundation ........................................................................................... 3 Meaningful Family, Youth, and Systems Partnership .................................................................. 5 Recommended Strategies ..................................................................................................... 6 The Ladder of Authentic Family & Youth Engagement ......................................................... 7Resources to Enhance Family, Youth, and Systems Partnership ................................................... 9 Family & Youth Roundtable Services ........................................................................................... 9Tell Us About Partnership Survey Findings................................................................................... 10 Demographics ............................................................................................................................ 10 Engagement ............................................................................................................................... 13 Outcome Achievement........................................................................................................ 17 Positive Experiences ............................................................................................................ 19 Suggested Improvements.................................................................................................... 19

Engaging Family & Youth: 2013-2014 Year in Review Engaging Family & Youth: 2013-2014 Year in Review A Letter from Donna Ewing-Marto, CEO, Family & Youth Roundtable As we near completion of the Annual Engaging Family & Youth Report, I find myself reflecting on all of the accomplishments our Children’s System of Care has achieved since its inception, and the positive impact it’s had on children, youth, and families receiving services. At the forefront of these improvements are the Family & Youth Support Partner Professionals, who work tirelessly to navigate the system hand-in- hand with others like themselves whose families have been touched by mental and behavioral health challenges. When my family was first introduced to the system, I was fortunate to be assigned a team comprised of both a Family and Youth Partner, who were two of the first in the County of San Diego in what was then a new profession. Today, we have over 91 Family and Youth Support Partner Professionals within our system, and their impact on the health and well-being of our community is profound. Having a Family & Youth Support Partner empowered my family and me to stand on our own, and opened the doors for us to partner with systems to create meaningful change for not only ourselves, but for others. While there is no doubt Family & Youth Support Partner Professionals have enhanced our system, they need our additional support now more than ever. Through the ongoing coaching and training of our partners, it has become apparent they lack clear national, state, and local support, and are not being utilized in the manner in which they were meant to be. Over the 2014-2015 fiscal year, Family & Youth Roundtable will be assessing the experiences of our Family and Youth Support Partner Professionals as well as the children, youth, and families whose lives they have touched to further validate their profession. We ask that you partner with us in our effort to collect this valuable feedback and ensure the continued utilization of support partners’ lived experience that is so vital to our community. We hope that you are equally excited to further empower our Family & Youth Support Partner Professionals in much the same way as they have done for us. Sincerely,2 Donna Ewing-Marto, CEO and Founder of Family & Youth Roundtable Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

Engaging Family & Youth: Family Youth Systems Partnership (FYSP):2013-2014 Year in Review FYSP is family, youth, and systems partners working together by sharing information, resources, and responsibilities. Partners are responsive to the needs, cultures, and success ofTell Us about Partnership each other. A successful FYSP utilizes a multi-stakeholder approach where there is genuine intent to achieve their common purpose.Foundation Engaging Family & Youth: 2013-2014 Year in ReviewOver fifteen years ago, the County of San Diego,under Children’s Mental Health leadership, beganbuilding a foundation to improve outcomes forSeverely Emotionally Disturbed (SED) children,youth and their families. This effort became knownas the Children’s System of Care (CSOC). Rooted ina Children’s System of Care is a rich array ofcollaboration between publicly-funded agencies,community-based organizations, service providers,educational systems, and the family1 youth2 sector.The family youth sector, as it is referred to withinSan Diego County, plays a critical role in improvingservices for children, youth and their families. Onemight say this sector is the ultimate stakeholder.The growth of a successful Children’s System ofCare requires behavioral changes for systems,programs, practices and the people that make up asystem of care. These systematic behavioralchanges necessitate inclusion of full partnershipsthat are trauma informed, have a gainedunderstanding of environmental burdens, and thatfully support the overall health and well-being ofthose they serve. A fundamental component ofachieving the vision of a Children’s Systems of Careis the robust participation of families and youthwho possess lived experience with or as achild/youth that has experienced behavioral, social,emotional, trauma and/or health issues. Thesuccess of Systems of Care is reliant on family andyouth partnering with practitioners in their own1 Family: Parent/Caregiver of a child/youth that is or has received servicesfrom a public child-family serving system.2 Youth: Individual that has or is currently receiving services from a publicchild-family serving system.

Engaging Family & Youth: 2013-2014 Year in Reviewcare, and in using their experiences to inform evaluations, programs, policies, service-level developments and enhancement activities. Nourishing family and youth participation requires a culture shift at the systems, agency and direct-service levels and often within the families. This behavior change nurtures partnership and involvement. It is noteworthy that partnership among family, youth and practitioners is a core component of the most effective (evidence-based) family therapies and treatment models. The evolution of our local practice of Family Youth Systems Partnerships can be linked to implementation of significant initiatives and behavioral shifts, including:  County of San Diego’s Board of Supervisors adoption of an innovative and comprehensive ten-year plan aimed at improving the health and overall well- being of County residents called the “Health Strategy Agenda: Building Better Health.” The County’s Health and Human Services Agency (HHSA), along with other County departments, has embarked on an ambitious mission to engage the County workforce and the community, encouraging, children, and youth and families participation in the county’s efforts to “Live Well San Diego!”  A few legislative and legal supports can be identified in the Mental Health Services Act legislation which requires the full participation of families and their children/youth at all levels of development, implementation, evaluation and practice.  Pathways to Well-Being (formerly Katie A.) Core Practice Model legitimized public systems support for the implementation of authentic family/youth teams at all levels.  Systemic changes are displayed by way of policies and the institutionalized approach to coordinating authentic family and youth involvement in Children Youth and Families Behavioral Health Administration, as well as trainings and coaching services offered by this administration for contracted providers to enhance their practice of Family Youth Systems Partnership.  Program behavioral changes are measured by the number of authentic Family /Youth Support Partners employed within an agency, as well as the level of influence these partners and the families and youth sector have on programs, policies and practices within a providing agency.  Behavioral changes at the practice level are measured by the amount of evidence-based practices that require family/youth involvement, which can be incorporated into the array of services offered by an agency.  The level of involvement families and youth feel they have contributed to their and/or their child’s treatment can also be measured. Furthermore, an indicator of successful Family Youth Systems Partnership is the level to which families and youth feel entry into services and the services received have been welcoming and responsive to their needs, customs and norms.4 Family and youth involvement is integral to the vision and mission of Behavioral Health Services, Children, Youth and Families in San Diego County. The County’s Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

vision statement notes that “... We work with a broad constituency of stakeholders Engaging Family & Youth: 2013-2014 Year in Reviewto build a community of families, neighbors, schools and child serving agencies,which fosters physically and mentally healthy children and adolescents, maximizestheir potential in school and in the home, and prepares them to be productive andresponsible adults.”Children, Youth and Families Behavioral Health Services promotes this vision byadvancing “...a rich array of services delivered through an integrated, community-based, mental health System of Care that enables children and adolescents toachieve positive outcomes.”Positioning for Meaningful Family Youth Systems PartnershipFamily and youth are first and foremost involved with the service delivery system inorder to resolve issues in their own or their family’s lives. This means that theextent to which family/youth will be interested and able to participate in agencydevelopment and enhancement activities will naturally vary.Family and youth have a variety of treatment experiences, favorable andunfavorable, which they may or may not be comfortable sharing. Additionally, theirinterest in sharing their lived experiences will vary, based on a number of conditions,including:  The degree to which they perceive stigma associated with their status  The degree to which they perceive that their input is valued  Their ability to provide input without undue burdenAt the service level, administrators must create varied and meaningful opportunitiesfor family and youth to share their perspectives in ways that are respectful,supportive, and produce clear and observable impacts. It is important to note thatinauthentic or token efforts to engage families and youth are not only weak in theirimpact, but may stifle future family and youth interest. A service system’s culturethat truly values and supports authentic family/youth participation is critical forengaging and sustaining robust family/youth interest. The goal of this report andsubsequent recommendations is to promote the advancement of agency and servicesystem culture that supports participation of families and youth in their owntreatment services. Families and youth who are valued and know they are part ofsolution to their and/or their child’s health, safety and well-being are more apt toembrace treatment and partner to achieve shared goals.At the individual client level, it is incumbent upon provider organizations to makeuse of intervention models and approaches that value and deliberately build uponindividual and family culture, norms and strengths, while taking into considerationthe environmental circumstance of the family and their surrounding community. Inaddition, provider organizations need to ensure that all of their practitioners arewell trained in and routinely utilizing family/youth engagement and partnership-

Engaging Family & Youth: 2013-2014 Year in Reviewbuilding skills. Finally, outreach and education efforts to inform family and youth of the importance of their participation in directing their own and/or their child’s care are vital in establishing positive participation, thereby advancing authentic Family Youth Systems Partnership within an agency. Recommended Strategies: 1. Oversee that staff are upholding the clear and concrete Family Youth Systems Partnership policies and procedures. 2. Conduct an agency assessment to determine current level of Authentic Family & Youth Engagement. 3. Provide an orientation to new family & youth service recipients that includes information on how they can utilize their experiences to influence your agency’s policies, programs, and practices. 4. Ensure that all practitioners are fully trained in and are routinely utilizing strategies to partner with family and youth, in the context of the family’s culture, values and beliefs, to develop and provide treatment services. These strategies should be evident throughout all stages of the treatment process from triage and assessment, to service plan development, therapeutic intervention, discharge planning and termination of services. Furthermore staff and program evaluations should incorporate adherence to agency’s policy (s). 5. Utilize the Children’s System of Care Principles to identify and resolve discrepancies between the experiences of the families and youth surveyed in Tell Us about Partnership and the outcomes and statistics reported by agencies. 6. Develop a mechanism to receive input from employed Family & Youth Support Partner Professionals as it relates to your agency’s policies, programs, and practices to improve family & youth involvement. 7. Maintain an array of diverse opportunities for family & youth participation that ranges from service-level to policy and governance. 8. Introduce service recipients and Family & Youth Support Partner Professionals to the BHS Children, Youth, and Families Liaison to utilize their lived experience to influence system-wide policies, programs, and practices.6 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

The Ladder of Authentic Family & Youth Engagement Engaging Family & Youth: 2013-2014 Year in Review Rung 8: Family, Youth, and Systems Equity Rung 7: Completely Family & Youth Driven Rung 6: Family, Youth, and Systems Equality Rung 5: Family &Youth Consulted Rung 4: Family & Youth Informed Rung 3: Tokenism Rung 2: Decoration Rung 1: Manipulation The Ladder of Authentic Family & Youth Engagement3 was created to assist providers with objectively assessing their agencies’ and organizations’ level of Family Youth Systems Partnership as well as delineating the level of engagement they aspire to achieve. It should be noted that though the top rung, Family, Youth, and Systems Equity, is the highest achievable, it may not be attainable for all agencies and organizations. Instead, the goal should be to transcend the lower rungs of engagement (1-3) and embark on those that include active participation (4-8), as detailed below.3Adapted from Hart, R. (1992). Children’s Participation from Tokenism to Citizenship. Florence, Italy:UNICEF Innocenti Research Centre.

Description Why it’s rewarding Why it’s harmful Rung 1: System-led activities in which Families and youth are Families and youth do not families and youth are manipulated and exposed to new have clear understanding of only do as directed. opportunities and systems the purpose and therefore gain basic understanding cannot fully participate. of family and youth involvement. Rung 2: Systems treat families and youth Families and youth Families and youth have little as decorations to convey the appearance participate in and have full to no input on the activity. of family and youth involvement. understanding of the system-driven activity. Rung 3: Families and youth are tokenized Families and youth are Systems do not include family and youth feedback, instead by systems. consulted within system- they focus on giving off the appearance of family and led activities. youth involvement.Engaging Family & Youth: 2013-2014 Year in Review Rung 4: Families and youth inform Families and youth Systems do not have to heed systems. provide input and or act upon family and youth feedback to inform feedback. systems. Rung 5: Families and youth are consulted Families and youth have Systems control the amount and type of authority family by systems. some authority and and youth are granted. demonstrate leadership. Rung 6: Systems initiate family and youth Systems provide family & Families and youth remain involvement and share decision-making. youth with meaningful unequal to systems activities and share professionals. decision-making. Rung 7: Families and youth initiate Families and youth have The expertise and authority of activities and do not include participation complete control over systems are not utilized. from systems. activities and decision- making. Rung 8: Families, youth, and systems Families, youth, and This level of family and youth have full equity in decision making and systems are equal in engagement can be difficult to share responsibility for the outcome. regard to decision-making, achieve and requires a change authority, and investment in systems culture.8 in the outcome. Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

County of San Diego, HHSA Behavioral Health Services, Engaging Family & Youth: 2013-2014 Year in Review Children, Youth and Families sponsored resources.The Children, Youth and Families Liaison (CYFL) has the primary duty ofcoordinating, training, and advancing Family Youth Systems Partnership for Children,Youth and Families (CYF) within Behavioral Health Services (BHS) of the County ofSan Diego Health and Human Services Agency (HHSA). Advancement shall bedemonstrated by:  Reinforced policies and procedures on Family Youth Systems Partnership through participation in CYF meetings and work teams.  Increased family/youth representation in CYF policies, programs and practices.  Improved partnerships between service recipients and providers resulting in higher adherence to service plans and positive client outcomes, enhanced development and retention of talented family-centered staff, and increased performance aligned with organizational goals.  Increased awareness and reception of the benefits of employing family/youth support partners in HHSA BHS CYF programs.  Enhanced training of HHSA BHS CYF program management and staff on working effectively with family and youth support partners.  Ongoing HHSA BHS CYF system trainings and coaching sessions specific to the role of family/youth partner.  Ongoing HHSA BHS CYF provider support to encourage, assist, and support agencies in their efforts to incorporate family/youth partners into their program design.Family & Youth Roundtable Services to Enhance Engagement  Countywide Supervision for Peer Navigators and Family and Youth Support Partner Professionals working in children’s services.  Online and in-person workshops that provide introductions to the Principles of Family Youth Systems Partnership. o Note: CEU’s are offered for both workshops  Program Advisory Group (PAG) technical assistance for the facilitation of family and youth advisory groups.  Certification training for Peer Navigators that provides a standard foundation for the profession of Peer Navigators in children’s services.  Agency assessments to determine current level of Authentic Family & Youth Engagement as well as recommendations for improvement.

Engaging Family & Youth: 2013-2014 Year in ReviewSurvey Findings The Tell Us about Partnership survey was developed in conjunction with the County of San Diego Behavioral Health Services for Children, Youth and Families Administration and Liaison to engage service recipients in a conversation about their experiences. Family & Youth Roundtable (FYRT) conducted the Tell Us about Partnership survey throughout the 2013-2014 fiscal year, receiving a total of 271 completed responses. The focus of Tell Us about Partnership ranges from engagement to satisfaction with the intent of gaining family and youth perspective on how their voice influences policies, programs, and practices. Respondent Demographics Respondents represented all five regions of San Diego County and resided in a variety of communities, including Chula Vista, El Cajon, Lakeside, La Mesa, Santee, and San Diego. Respondents were primarily from Hispanic, Caucasian, and Multi-ethnic backgrounds.10 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

Services Received The primary systems Engaging Family & Youth: 2013-2014 Year in Review represented were Child Welfare and Behavioral Health, with only a small percentage of youth and families with Juvenile Justice Involvement. 84% of respondents were either youth who have received services or their biological parents. Other respondents include foster and adoptive parents. 60% of respondents had received services within the last 12- months.

Engaging Family & Youth: 2013-2014 Year in Review79% of respondents began services when they or their child was between the age of 0-5 or 14-18 years old.12 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

EngagementOrientation to ServicesAt the beginning of services, it is vital to provide children, youth, and families withan overview of the services being rendered….Q1: When starting services, did the provider give you an orientation about theiragency?90% No Engaging Family & Youth: 2013-2014 Year in Review80%70%60%50%40%30%20%10% 0% YesQ2: If yes, how helpful did you find the information provided in the orientation toservices?Additional Comments:  Pretty vague  What they said and described was not what they delivered  I received trainings like this through agencies

Engaging Family & Youth: 2013-2014 Year in ReviewExpectations In order to produce optimal treatment outcomes, children, youth, and families require…. Q3: When starting services, did the provider give you information on what to expect from the services? Q4: If yes, how helpful did you find the information provided on what to expect from services? Additional Comments:  Did not get the services they said they would give (example: $75 a month for clothes)14 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

Q5: When starting services, what do you wish you would have been told or Engaging Family & Youth: 2013-2014 Year in Reviewinformed about?  I felt very informed even though I did not quite understand how much control I could have in how our services were provided.  The facilitator was very informative. I was pretty much given all the information that I needed.  What services we would get and how the services will fulfill my family's need also it would have been helpful if they told me what they will not do, and guided me get the other services my family needs  I wish I had been formed about service providers' roles, how services were designed to serve me, who I could go to regarding concerns, and explanation of why forms were given to me to be filled out.  The information provided informed me about everything.  the truth not get our hopes up and then that deliver not good for foster child has been let down most of life  What I was getting myself into. No one really told me, I was just put in Foster Care and the rest is history.  What they could or could not do.  I felt very informed even though I did not quite understand how much control I could have in how our services were provided.  That everything was fine  What exactly I was getting.  More information on teens on drugs  Expectations and the process  The process  Resources for counseling and housing  None, I was offered every service available to me  Initially, at the XXX, I would have liked to been included more in my child's plan through her therapist rather than receiving advice through my therapist. Here at XXX, I would have liked to have learned more about the EMRD therapy and how, exactly I could refer to that practice/utilize any aspect of it at home.

Influence At the beginning of services, it is vital to provide children, youth, and families with an overview of the services being rendered…. Q6: On a scale of 1 to 5, how much influence do you feel you had on each of the following? In developing your or your Not at all Very little Somewhat Mostly Very Much child’s treatment or care plan? 1 2 3 4 5 0.04% 30.00% 30.00% 19.00% 15.00% 31.00% 46.00% 23.00% 11.00% In evaluating your or your child’s 0.50% 28.00% 41.00% 21.00% 10.00% plan? 19.00% 65.00% 3.00% 7.00% In making changes to your or 0.00% 38.00% 19.00% 11.00% 7.00% your child’s plan? 38.00% 8.00% 3.00% 0.00%Engaging Family & Youth: 2013-2014 Year in Review Do you feel you had complete 3.00% understanding of the goals and outcomes expected in your or your child’s plan? Do you feel you had a voice in 23.00% the program’s design? Do you feel you had influence in 50.00% the agency’s policies?16 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

Outcome Achievement Engaging Family & Youth: 2013-2014 Year in ReviewBenefitAt the beginning of services, it is vital to provide children, youth, and families withan overview of the services being rendered….Q7: Would you say that services received were beneficial to your child/youth? If youare a child/youth that received services, would you say the services were beneficialto you?Q8: Would you say the services received were beneficial to your family?

Engaging Family & Youth: 2013-2014 Year in ReviewQ9: Please rate the degree to which the outcome you hoped for was achieved. Additional Comments:  The continuity of services can be improved through development of specific, incremental goals (however, I should have had more say in making these goals).  The staff where very nice & open minded.  We were not made aware of any treatment goals or anticipated outcomes, therefore we could not have achieved what we wanted to.  Still ongoing and I am optimistic about the long and short term benefits for my child.18 Family & Youth Roundtable, 5005 Texas Street, Suite 104 San Diego, CA 92108 Tel: (619) 546-5852 Web: www.fyrt.org

Positive Experiences Engaging Family & Youth: 2013-2014 Year in ReviewQ10: Based on your experiences, were there aspects of the services you receivedthat were positive?  Being connected and thinking I was going to get help.  I felt validated and supported and not judged. Service times were flexible  I got exceptional services.  Yes, help when I asked for it.  Thanks to my support system  In home parenting and the services provided by the agency.  Changed our lives completely!  After years of friends, family, and first responders not believing and/or minimizing the violence and subsequent emotional damage we both sustained, just having people who listened, understood, told us we were safe and not crazy, and were going to help then did help made for a very positive experience.  I like the attitude and way that they all get together to help children. I have a lot of respect for this organization and the people who work in it. Thank you  Understand our family is different than the other families they serve. We are not one size fits all. And when we don't fit into their perception don't blame us and make it our fault. It’s theirs if they don't know how to help my family.  Stop taking kids from good parents!  Well, not really because even bad experiences have something to learn from.  Let's tell the kids the truth and stop letting them down let's give them real services that will help them to do that too productive adult kids in foster care of already lost a lot  Listen to the youth they know what is best for them. Do not force them to do anything that they do not want to do. And for crying out loud get more LGBTQIA Trained Staff/Providers, Etc…Suggested ImprovementsQ11: Based on your experiences, are there suggestions that you would like to makethat would have made your services more positive?  Caring and good follow through. More aware of Domestic Violence  My experience was very positive. I think explaining to the parents more clearly that they hold the key to things improving not the children, would be helpful.  That all the workers were on the same page. Lack of communication.  Social worker needed more training in regards to domestic violence and substance abuse  More partnership in relationship between organization & birthparents  The Juvenile System is giving up on my son to make room for someone who wants help. Have other outside programs instead of just locking them up or Drug Court.  I would make services more publicly known in layman's terms and easier to access.  Services often felt forced and my opinion was not included in the treatment planning process. It felt very adult/provider driven and my voice as a youth was ignored.  Not at CFC but at FJC the intake for family that is just hours or days away from an abusive life can be very overwhelming. I volunteered at NFJCA and heard this complaint frequently from others. The initial process immediately after escaping abuse needs to be calmer, slower, gentler, and more guided-assisted by an advocate 1-on-1.  Services should be based on the family/child need not the team's need/wants the team all work together and make decisions before the meeting.