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Improving Outcomes for Children and Families in Allegheny County (Improving Outcomes) Initiative

The Allegheny County Department of Human Services is committed to safely reducing the number of children in out-of-home placements by integrating children’s services and improving outcomes for children who enter the DHS system through the Improving Outcomes for Children and Families Initiative. This department-wide service-integration plan helps to ensure that all child-serving systems within the county plan together as one system to determine what services are appropriate for a child and his or her family.

The specific goals of the DHS Improving Outcomes Initiative were articulated in apdf.gif proposal to Casey Family Programs, a national foundation focused on improving the child welfare system, in 2008. Casey and local foundations embraced the concept and provided operational funding assistance. Since that time, DHS has been capturing system-wide and individual-level data about child outcomes to continuously measure the initiative’s success.

DHS “Improving Outcomes for Children and Families” Initiative Quarterly Reports 
While service integration at the systems level is paramount to the “Improving Outcomes” Initiative, several specific interventions, like the High Fidelity Wraparound (HFW), are being implemented to integrate services at the child-level. The quarterly reports provide descriptive data on these interventions to monitor their implementation. 

January 2013 

pdf.gif Family Group Decision Making: A Quantitative Analysis of the Impact on Out-of-Home Placement
Fred Wulczyn and Bridgette Lery, Chapin Hall at the University of Chicago
January 2013.
In 1999, Allegheny County became the first county in Pennsylvania to implement Family Group Decision Making (FGDM), an intervention designed to improve safety and permanency for maltreated children. FGDM involves bringing a family’s natural support system to the table with the formal child welfare system when making critical decisions, including placement decisions. In 2011, with the support of Casey Family Programs, the Department of Human Services commissioned Chapin Hall at the University of Chicago to evaluate the effectiveness of FGDM.

This report describes Chapin Hall’s research into the impact of FGDM on the 2,908 children who were enrolled from 2001 through 2010.

January 2011

pdf.gif Transforming Lives Through Systems Integration 
Data gathered January, 2010; Published January, 2011
Bruce Barron

The Department of Human Services contracted with a writer, Bruce Barron, to document the “Improving Outcomes” Initiative. This first report summarizes the history of the principles that led to the development of the initiative and highlights how the impressive systemic changes the Department has brought about can lead to unmistakable transformations in the lives of the children and families they serve.

October 2009

Improving Outcomes for Children and Families Initiative 

Research indicates that as compared to children who live safely with their families, children who are removed from their homes because of threats to their well-being are significantly more at risk for hardship in their futures. Eliminating the circumstances that lead families to require out-of-home placements is the overarching goal of the DHS Improving Outcomes for Children and Families in Allegheny County (Improving Outcomes) Initiative

Improving Outcomes focuses on eliminating or overcoming barriers to a family’s success.  

Barrier:      Too many services systems for a family to manage
Improving Outcomes Solution: Convene a multi-system team to coordinate all services into one plan

Barrier:      Too many forms for a family to complete
Improving Outcomes Solution: Complete one intake e-form that is shared with all service providers

Barrier:      Too little family experience in successfully navigating the ‘system’
Improving Outcomes Solution: Include family and youth support partners to advocate along side family members at team meetings.   

Improving Outcomes has a built-in feedback loop.

  1. RESEARCH “best practices”
    Consult family members about what has helped them reach their goals 
    Consult professionals about what methods have worked best for other similar programs
  2. DEVELOP the program
    Gather input from individuals involved at all levels of the human services system
    Include ways to gather feedback
    Include criteria to gauge success  
  3. IMPLEMENT the program
  4. GATHER outcomes information        
    Whether family goals were met
    Whether program goals were met
  5. EVALUATE the gathered information
    What worked?
    What did not work?
  6. REFINE the program
  7. REPEAT steps 3 – 7.

Improving Outcomes will be evaluated based on the ability of DHS to keep children and youth safe while:

  • Reducing the number of children and youth placed in out-of-home care (placement)
  • Placing children and youth in the most familiar type of residential setting possible
  • Reducing the length of time a child or youth is in placement
  • Reducing the number of children and youth who need to reenter placement

Specific goals for each of these categories of improvement will be determined as a result of careful baseline, trend, and comparative analyses.

Improving Outcomes is based upon the High Fidelity Wraparound model. (see High Fidelity Wraparound, below). Casey Family Programs is providing technical assistance to DHS through the University of Chicago Chapin Hall and VROON VanDenBerg. This effort is also supported by local foundations.

The New Children's Cabinet 

The New Children’s Cabinet was established in 2008 as a community advisory group consisting of key stakeholders who are involved with services for children and youth and their families.

Family members and youth advocates who have been recipients of DHS services are included as valued members of the Cabinet. The Children’s Cabinet was called together primarily to facilitate candid discussion and to elicit a broad spectrum of input from the community regarding the Improving Outcomes for Children and Families Initiative. The group is led by DHS Director Cherna and meets quarterly.

High Fidelity Wraparound 

High Fidelity Wraparound (HFW) is a collaborative, team-based approach to planning for services and supports for children and youth and their families. Through the HFW process, teams create individualized plans to meet the unique needs, and improve the lives, of the child and thereby his or her family. The HFW team members—the identified child/youth, parents/caregivers and other family and community members, DHS professionals, educators, family support partners, youth support partners and others—meet regularly to design, implement, and monitor the family’s plan.

The therapeutic goals of HFW are to meet the needs prioritized by youth and family, improve their ability and confidence to manage their own services and supports, develop or strengthen their social (natural) support system over time, and integrate the work of all child-serving systems and natural supports into one streamlined plan. Allegheny County currently offers HFW to youth with complex needs involved in DHS child-serving systems.  

Unique to the HFW process is the support the youth and family receive from a Facilitator and Youth and/or Family Support Partners. These individuals ensure that the process works effectively, that care is coordinated, and that the youth and family increasingly direct their own care as they build their skills. Over time, the formal system supports withdraw and the youth and family are sustained by their natural community supports. Eventually, the Facilitator becomes the single point of accountability across systems. This process has proven to be effective in engaging youth and families by giving them control over their own services. It enables them to avoid excessively restrictive or intrusive services in favor of community-based alternatives and natural supports that yield better and longer lasting results.

Allegheny County has partnered with VROON VanDenBerg, LLP and the Pennsylvania Youth and Family Training Institute (YFTI) operated by the University of Pittsburgh/ Western Psychiatric Institute and Clinic (WPIC) to implement the nationally recognized HFW model. PA Secretary of Human Services Estelle B. Richman assisted with the creation of YFTI which is designed to strengthen mental health services for children and their families. Support from the Children’s Bureau in the Office of Mental Health and Substance Abuse Services (OMHSAS), will provide free training to early implementer counties in Pennsylvania.

YFTI and VROON VanDenBerg will provide technical assistance, training, certification, coaching, and monitoring for staff members who facilitate and support HFW. This process will be adapted and applied beyond the mental health system to create an integrated process for service planning across all child-serving systems for youth and families with complex needs.  

Family Support Partners /Youth Support Partners 

Family Support Partners and Youth Support Partners are available as part of the High Fidelity Wraparound process to ensure that the individuals that they represent have their voices heard and their choices honored.  

Family Support Partners (FSP) are available to assist parents whose family is involved in High Fidelity Wraparound (HFW). FSPs have experience raising a child with severe emotional and/or behavioral health challenges. As a member of the HFW team, he or she provides an empathetic link to the parents, and supports and extends the work of the Facilitator. The FSP also provides direct services to the parents to ensure an individualized approach. These positions are currently seated with the Allegheny Family Network (AFN), a family-run 501-(c)(3) non-profit organization that serves families in Allegheny County and helps families navigate the system.

Youth Support Partners (YSP) are available to assist youth whose family is involved in High Fidelity Wraparound (HFW). YSPs are young adults who have utilized services from the one or more of the DHS child-serving systems and who bring their personal experience to the HFW process. As a member of the HFW team, he or she provides an empathetic link to the youth and extends the work of the Facilitator. The YSP supports the young person and ensures that his or her voice and choice are incorporated in the planning process. Currently, a pool of Youth Support Partners with various system experiences work out of the DHS Executive Office. DHS plans to engage additional youth who choose to volunteer in this way.

pdf.gif Youth Support Partners: Building Trust and Improving Service Delivery for Youth
Locally Speaking - Policy and Practice, December 2012

July 2009 
Improving Outcomes Glossary
Improving Outcomes is moving forward. New language is being used by the planning team that has the tendency to leave those who are out-of-the-loop feeling, well, out of the loop. Since the ultimate goal of the Initiative is to expand the Initiative across all DHS offices, there is value in learning the meaning of the commonly used new terminology. The following is a sample of the terms that are defined as they pertain to the Improving Outcomes Initiative in the pdf.gif Improving Outcomes Glossary of Terms . 

Behavioral health 
Family Group Decision Making (FGDM)
Family/Youth Support Partner
High Fidelity Wraparound
Improving outcomes
No Wrong Door policy 
Single assessment tool
Single Point of Accountability 

October 2008
Improving Outcomes Progress Report
Since being established in 1997, DHS has worked toward seamless and holistic service delivery to benefit the persons we serve. The Improving Outcomes for Children and Families in Allegheny County (Improving Outcomes) Initiative is a natural outgrowth of this effort. Work began in 2007 to define the desired outcomes and to research best-practices methods to reach them. By October 2008, a report was produced that detailed the progress made.

Improving Outcomes Initiative-related DHS News articles

December 2009 - DHS part of nation-wide effort aimed at safely reducing the need for out-of-home placements
DHS is playing an important role in a national effort to test and endorse policies and practices that will improve outcomes for children and families.

November 2009 – Yes we CANS
Explains the development and implementation of the CANS Comprehensive as the DHS child-serving systems’ common assessment tool.

September 2009 – Lifting the fog on the Improving Outcomes Initiative
Glossary of terms commonly used in relation to the Improving Outcomes Initiative

July 2009 – DHS to co-host Youth Summit for 75 youth
Discusses the Youth Summit (Reducing Violence) and other youth-centered activities and programs

April 2009 – OBH incorporates Single Point of Accountability for adult consumers
Explores the application of the concept of SPA to streamline the provision of services for adults with mental health and/or substance use concerns

pdf.gif March 2009 – Youth voice takes on advisory role
Announces the formation of the DHS Youth Advisory Council, the members of which will contribute to conversations about services for children, youth and young adults

pdf.gif Jan 2009 – Youth Support Partners plan to impact High Fidelity Wraparound system
Introduces the first three Youth Support Partners who will be peer advocates during family planning sessions

pdf.gif November 2008 – Improving Outcomes for Children and Families implements new, powerful approach
Details the process of High Fidelity Wraparound as it applies to the DHS Improving Outcomes Initiative

pdf.gif June 2008 – DHS takes integration of services for children to next level, aims to improve outcomes
Introduces the goals and strategy of the DHS Improving Outcomes (IO) Initiative for Children and Families in Allegheny County Initiative

Related Documents 

Improving Outcomes Initiative-related research 

Securing Child Safety, Well-being and Permanency Through Placement Stability in Foster Care, Fall 2009. 
Reports Year 1 findings from the Children’s Stability and Well-Being Study (CSAW) at
 PolicyLab. CSAW is tracking, in partnership with the City of Philadelphia, 450 children in the Philadelphia child welfare system to identify intervention opportunities that may improve placement stability and thereby improve outcomes for children.