Family Youth Stakeholder annual report

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report Family & Youth Roundtable of San Diego County 2011Family & Youth Roundtable We wish to thank all of the individuals who contributed to this report, 345 15th Street, Suite A especially the family and youth who participated in the How to Engage Family & Youth Survey, and whose participation in policy and program San Diego, CA 92101 activities is today helping to shape San Diego County’s service system. Telephone: 619-546-5852 The following report presents a plan of concrete strategies for how to involve and support family and youth, in a variety of policy, program, and practice-level activities, large and small, that will further enhance the county’s system of care, and in turn improve outcomes for children and families.

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual ReportTable of Contents Foundation: The Importance of Family and Youth Involvement ................................3 Challenges: Developing Robust Family and Youth Participation...............................4 Solutions: Creating a Culture of Participation ...........................................................5 Participation Engagement Plan..................................................................................5 Survey Findings.........................................................................................................8 Appendix A: How to Engage Family & Youth Survey ...............................................13Participation Engagement Plan 2

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report The Family and Youth Roundtable of San Diego County (Roundtable) is chargedwith preparing a plan on how San Diego County Children’s Mental Health Services(CMHS), and their contract providers, can best identify and engage families and youth,including transition age youth (14 to 17 years of age), to participate in CMHS program,evaluation, policy, and practice-level development and enhancement activities. The following Participation Engagement Plan is informed by results from the How toEngage Family & Youth Survey conducted by the Roundtable, over the past year (asdetailed at the end of this report) and the Roundtable’s extensive experience developingand supporting youth and family partnership activities in San Diego County.Foundation: The Importance of Family and Youth Involvement Involvement of family/youth is integral to the vision and mission for children’s mentalhealth services in San Diego County. The County’s vision statement notes that “...CMHSworks with a broad constituency of stakeholders to build a community of families,neighbors, schools and child serving agencies, which fosters physically and mentallyhealthy children and adolescents, maximizes their potential in school and in the home,and prepares them to be productive and responsible adults.” CMHS promotes this vision by advancing “...a rich array of services deliveredthrough an integrated, community-based, mental health System of Care that enableschildren and adolescents to achieve positive outcomes.”1 Central to achieving CMHS’ vision, and to Systems of Care, is robust participation byindividuals who have lived-experience with emotional disorders, including youth whohave experienced mental health disorders, and their family members/caregivers. Thesuccess of Systems of Care is reliant on family/youth partnering with practitioners in theirown care, and in using their experiences to inform program, evaluation, policy, andpractice-level development and enhancement activities.1 CMHS Mission/Vision Statement at www.sdcounty.ca.gov/hhsa/programs/bhs/mental_health_services_children/Participation Engagement Plan 3

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual ReportChallenges: Developing Robust Family and Youth Participation Insuring that mental health services are routinely being developed and delivered inpartnership with youth and their families is critical to successful systems of care, butchallenging to accomplish. Moreover, developing and maintaining hardy and authenticparticipation, by family/youth members with lived-experience, in program, policy,evaluation and practice development and enhancement activities is also critical butchallenging. Key challenges to participation by youth and families, in their own care, are related tothe provider agency’s organizational and treatment culture, evidenced by theintervention models offered, and practitioner attitudes and skills around engagingyouth/family and building upon their strengths. In addition, family/youth expectations,about their role as consumers of services, will also impact the degree to which servicesare developed and delivered in partnership. In a parallel manner, participation by family/youth in systems development andenhancement activities is impacted by the service systems’ culture, notably by thedegree to which family/youth participation is valued and the degree to which barriers toparticipation are proactively addressed. Although Systems of Care are benefited by the participation of family/youth in avariety of development and enhancement activities, family/youth members are first andforemost involved with the service delivery system in order to resolve emotionaldisorders that bring them to treatment. The extent, to which family/youth will, in turn, beinterested and able to participate in systems development and enhancement activitieswill naturally vary. Family and youth have a variety of treatment experiences, favorable andunfavorable, which they may, or may not, be comfortable sharing. Moreover, theirinterest in sharing their lived-experience will vary, based on a number of conditions,including: - The degree to which they perceive stigma associated with their status as a mental health consumer - The degree to which they perceive that their input is valued - Their ability to provide input without undue burden on time or resources Finally, the service delivery system is dynamic, with the experiences of individualfamilies and youth varying over time. As a consequence, participation by family/youthalso needs to be dynamic, with involvement from different and varied family/youth overtime, commenting upon their experiences with the contemporary service system.Participation Engagement Plan 4

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual ReportSolutions: Creating a Culture of Participation Robust family and youth participation stems from a culture, at the systems, agencyand direct service levels, that nurtures partnership and involvement. At the individualclient level, it is incumbent upon provider organizations to make use of interventionmodels and approaches that value and intentionally build upon individual and familystrengths, and familial/community relationships. It is noteworthy, that these features arecore to the most effective (evidence-based) family therapies and treatment models. Inaddition, provider organizations need to insure that all of their practitioners are welltrained in, and routinely using, family/youth engagement and partnership building skills.Finally, outreach and education efforts, to inform family/youth of the importance of theirparticipation in directing their own care, are needed for establishing positive participatoryexpectations. At the service systems level, it is similarly incumbent upon policy makers andprogram administrators to create varied and meaningful opportunities for family/youth toshare their perspectives, in ways that are respectful and supportive, and that lead toclear and observable impacts. And further, to take the initiative to invite families andyouth to participate in these activities, and in turn to share with them how theirparticipation is helping to improve services for others. Finally, it is important to note, that inauthentic or token efforts to engage families andyouth, which may occur from time to time, are not only anemic in their impact, but maystifle interest, on the part of other families and youth, going forward. A service systemsculture, that truly values and supports authentic family/youth participation, is critical forengaging and sustaining robust family/youth participation.Participation Engagement Plan The proposed Participation Engagement Plan is designed to be dynamic, and tosupport formal and informal levels of participation, with family/youth having an array ofopportunities, varying by level of effort, to share their lived-experience. The goals of this plan are to promote robust sharing of lived-experience by familiesand youth to inform system development and enhancement activities, and in turn,promote development of agency and service systems cultures that support participationby and partnership with families and youth in their own treatment services.Participation Engagement Plan 5

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report The plan consists of the following nine recommended strategies to promote familyand youth participation: 1. Family-Centered Practice Policy and Procedures Provider organizations have clear and concrete Family-Centered Practice policies and procedures, as a foundation for guiding all of their treatment activities. 2. Practitioner Partnership Training Provider organizations insure that all practitioners are fully trained in, and routinely using, strategies to partner with family/youth, in the context of the family’s cultural values and beliefs, in developing and providing treatment services. These strategies should be evident during all stages of the treatment process from triage and assessment, to developing service plans and providing therapeutic interventions, through discharge planning and termination of services. 3. Strength-Based Treatment Models Provider organizations adopt treatment models/interventions that build upon individual and family strengths and familial/community relationships. 4. Family/Youth Professional Partners Provider organizations hire, one or more, Family/Youth Partners, to provide a variety of program and direct service activities. The role of Family/Youth Partners is described elsewhere in briefs and curriculum prepared by the Roundtable2; however, in this context, the Family/Youth Partner would serve as the hub for organizing participation engagement activities for the agency. As the hub for supporting engagement activities, the Family/Youth Partner would organize educational and solicitation materials (see below), and participate in monthly Family and Youth Council, and Countywide Family & Youth Partner Peer-to-Peer Supervision meetings. 5. Administrator Champion of Family/Youth Participation A high-level agency administrator who is responsible for overseeing and insuring adherence to family-centered practice policies and procedures, supporting Family/Youth Professional Partners, and actively shepherding agency-sponsored family/youth participation activities.2 http://www.fyrt.org/ 6Participation Engagement Plan

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report6. Agency-Sponsored Family and Youth Engagement Activities Provider organizations develop and implement an array of strategies for soliciting and accepting input from family/youth, for example, online and hardcopy surveys, participation in committees and planning groups, or developing quality improvement goals that focus on family/youth partnership.7. Educational and Engagement Materials An education and engagement campaign, consisting of posters and brochures, inviting family/youth to share their lived-experience. The campaign materials explain to family and youth why sharing their experiences is relevant and valued and how it will be used to support system development and enhancement activities. In addition, the campaign materials will explain a variety of ways in which family/youth can share their experiences including: - Talking with the agency’s Family/Youth Professional Partner - Responding to agency-specific surveys or joining agency-specific committees or workgroups. - Attending a Family and Youth Council meeting (with in-person, web-link and call-in attendance options) - Responding to online surveys conducted by the Roundtable - Completing a brief (online or hardcopy) Post-Treatment Partnership Questionnaire about the level of partnership and involvement they experienced in their treatment services, and recommendations for any improvements (see below).8. Post-Treatment Partnership Questionnaire Develop and implement a Post-Treatment Partnership Questionnaire. The questionnaire would be brief (4-5 items) and available online (on the Roundtable’s website) and in hardcopy form (available through Family/Youth Professional Partners and at service providers’ offices). The questionnaire would inquire about the level of partnership in the delivery of services, and recommendations for improvements. The surveys would be submitted to the Roundtable to be summarized in an annual report (see below). Individual survey responses would be kept confidential.9. Annual Lived-Experience Report Develop an annual Lived-Experience Report summarizing results from the Post-Treatment Partnership Questionnaire, and the impacts of participation enhancing strategies being implemented across provider organizations. This report, among other things, will be used to demonstrate the impact of family/youth participation, and in turn, stimulate future participation.Participation Engagement Plan 7

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual ReportSurvey Findings The Roundtable, during the 2010-11 fiscal year, conducted the How to EngageFamily & Youth survey focusing on strategies for engaging families and youth toparticipate in policy, program and practice-level development and enhancementactivities (See a copy of the survey in Appendix A). Youth and family members were invited to complete the survey during Roundtabletraining events and online. In the latter case, the survey was distributed to family/youthwho are either Roundtable members or have otherwise provided their email address tothe Roundtable. The Roundtable received 182 completed surveys. The majority of surveys werecompleted by parents/caregivers (60%), with the remaining surveys being completed byyouth 18-25 years of age, 14-18 years of age, and under the age of 14, representing26%, 13% and .5% of the respondents respectively (see chart below). How to Engage Family & Youth Survey 2010-11 Respondents 13% 1%26% Parent /Caregiver Youth 18-25 60% Youth 14-18 Youth under 14Participation Engagement Plan 8

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual ReportSurvey respondents were ethnically diverse, with the majority of respondents (28%)identifying themselves as Hispanic, followed by African-American, Caucasian, Asian,Pacific Islander, and Native America with 20%, 17%, 14%, 9%, and 4% respectively.Finally, 8% of the respondents identified themselves as multiethnic (see chart below). How to Engage Family & Youth Survey 8% 28% Hispanic 4% 20% African American 9% Caucasian Asian14% Pacific Islander Native American 17% Multi EthnicParticipation Engagement Plan 9

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report In general, survey results indicated that family/youth believe that there involvement indevelopment and enhancement activities is important, and they are prepared to sharetheir lived-experience, but need to be invited and supported to do so. Responses tospecific survey items are detailed below. Respondents provided a number of recommendations when asked what thesystem/service providers could do to engage them to assist with policy, programs orservice enhancements and changes. Responses largely fell into four approaches asfollows: 1. Reaching out and welcoming participation - “Yes, by being more accessible.” - “Yes. By opening up the channels of communication a little more and being a little more accessible.” - “Include/invite me to these meetings where I can make a difference.” - “Simple invitations.” 2. Providing incentives or honoraria to cover time and expenses - “Honoraria.” - “Incentives.” 3. By demonstrating that participation was resulting in concrete improvements - “Yes, by showing proof of how this benefits people in the system.” - “Ask, support, and act upon recommendations.” 4. Through community forums or initiatives to engage large segments of the community. - “A way may be to get together and plan out fun activities, out on the street, and engage more people to become part of it, this way policies will be made with the help of a lot of people in a fun way.” - “If you are talking about engagement strategies, I've always been a proponent of family outings, barbeques, and forums!!! Forums on violence, poverty, illiteracy, gentrification, etc. Start with the needs of the neighborhood and you will have families willing to share and be more engaged. Start with a policy and you are going to get more confusion and questions. Keep it free too.”Participation Engagement Plan 10

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report Respondents also articulated a number of ways in which they could assistsystems/service providers in being more family centered. Suggestions fell into fourcategories as follows: 1. Involve family/youth in a variety of program, planning and administrative activities - “Engage in dialog. Offer opportunity for collaboration, forums, etc.” - “Review a new service prior to an agency investing in it. Being part of an independent evaluation team on programs. Asking the county to make sure that all contracted CBOs actually include families/consumers in determining focus, policies and new programs.” 2. Demonstrate the benefits of family centered practices - “Showing others the difference it makes by working close with families and youth rather then just telling them what they need.” 3. Training on family centered practice and model programs. - “Tell them my experiences, educate them.” - “Councils and workshops.” 4. Use Team Decision Making or Child and Family meetings - “CPS has Team Decision Meetings. In my experience being in the system and now part of the system working for a nonprofit, I believe this is effective. Everyone must be sitting at the table.” Virtually all respondents (97% of those responding to this item) indicated that theythink it is important for family/youth to attend public systems meetings. Notablecomments included: - “This is the only way one will become aware of how, who, why policies are implemented and be better able to discuss concerns and issues not considered.” - “Decisions will affect us so we should have a say.” The vast majority of respondents (96% of those responding to this item) alsoindicated that they think it is important for family/youth to give public testimony/input atsystem meetings. A notable comment included: - “So the public gains more than just one side.” Most respondents (75% of those responding to this item) think that when afamily/youth attends a weekly or monthly meeting it contributes to or influences policies.Notable comments included: - “Because it gives the public more insight.” - They hear unedited information.” - I think it really depends on the level of involvement of the family/youth. I also think it needs to be consistent, due to the high learning curve that’s needed to understand things like policy and theory.” Finally, virtually all respondents (99% of those responding to this item) indicated thatthey think that it is important for a family/youth meeting representative to have access toother family/youth receiving services. Notable comments included: - “We help each other, provide information and support.” - “To see what works for others and compare strategies.” - “Can only gain valuable knowledge through shared experiences.”Participation Engagement Plan 11

County of San Diego HHSA Children’s Mental Health Services Engaging Family and Youth in Policy, Program and Practice Annual Report The majority of respondents (82% of those responding to this item) indicated thatthey were able to serve/attend a weekly or monthly meeting. However, some helpfulcomments in regards to barriers included: - “Being a high school senior my schedule is quite hectic....otherwise, I would.” - “I have to work.” - “Depends on my schedule.” - “Currently overbooked with commitments.” When asked about the preferred method for receiving invitations to events, themajority of respondents (84% of those responding to this item) indicated that theypreferred email, followed by telephone and hardcopy mail, at 8% each. Although the majority of respondents endorsed the importance of participating inmeetings, only a small number of the respondents (24% of those responding to this item)had been invited to participate in a policy, program or practice-level activity. Notablecomments included: - “Only if I initiate and press.” - “Parent and youth support partners made it feel less like being on a distant planet. May not have affected policy change, but felt less bewildered, biased against, alone.” - “Only at FYRT.” In addition, only a small proportion of the respondents (13% of those responding tothis item) indicated that they knew what each public service system is required toprovide in the way of services. Notable comments included: - “I'm still learning and teachable.” - “To a degree but they are all so separate and no one wants to take responsibility to coordinate.” Importantly, family and youth indicated that they are interested in knowing how theirinput has impacted policies, programs and services, with the vast majority ofrespondents (96% of those responding to this item) endorsing this perspective. Notablecomments included: - “Otherwise why expend my energy to make change.” - “Never did know what my voice accomplished, if anything. Didn't just want to agonize through it. Will always value the opportunity I had to present a parent's view to child social workers.”Participation Engagement Plan 12

County of San Diego HHSA Children’s Mental Health ServicesEngaging Family and Youth in Policy, Program and Practice Annual ReportAppendix A How to Engage Family & Youth SurveyParticipation Engagement Plan 13