Advancing Integration

In January 1997, in response to a ComPac 21 recommendation that called for a restructuring of county government, Marc Cherna was appointed to head the newly created Department of Human Services (DHS). DHS embraced a community-developed vision for meeting the human service needs of county residents – one that challenged the department to create an integrated human service system. Since then, integration has occurred structurally – by consolidating the functions of administration, communications, data analysis, evaluation and research while programmatically, the department has advanced through the creation of a number of nationally-recognized collaborative strategies designed to creatively and effectively meet the needs of Allegheny County residents.

How DHS is Advancing Integration

In 2011, as the next step in the DHS vision of full integration, Patricia L. Valentine was appointed to oversee all service offerings and to further program integration. After a year of assessment and preliminary planning, and with the involvement and endorsement of 50 senior managers, a universal DHS Practice Model was defined in late 2012. Implicit in this model are long-term goals in the following five areas:

  • Common practices
  • Community relations and participant engagement
  • Financial and operational efficiency
  • Quality assurance
  • Structural integration

Meetings with senior management will continue quarterly and will serve to inform the implementation of these goals and translate them into actionable objectives.

An initial focus is the adoption of common practices and models of service across all program areas. While some adaptations may need to occur to meet regulatory requirements in specific service areas, the fundamental strategy, structure and use of DHS practices is designed to be uniform and standard.

These practices, guided by the principles, values and overarching purpose of the DHS Practice Model, initially include

This next phase of integration, supported by new opportunities emerging at the state and federal level (e.g., Human Services Block Grant and Child Welfare Demonstration Project), will require more comprehensive and consistent planning, policies/procedures development, contract monitoring and personnel training.

Additional Resources

A Discussion on the Evolution of DHS(PDF, 322KB)
Read the answers given by Marc Cherna, Patricia L. Valentine and Walter H. Smith Jr., Ph. D from the December 2012 Q&A session concerning the continuing evolution of DHS.

Common Assessments

What are the common assessments?

The common assessments (CANS, ANSA and FAST) are communication and planning tools used to direct initial and subsequent conversations between the people receiving DHS services and the staff member responsible for capturing the strengths and needs of that individual/family member.

Why use common assessment tools?

  • Common assessment tools are instrumental in fulfilling the DHS vision to create an accessible, culturally competent, integrated and comprehensive human services system.
  • Common assessment tools open up a conversation with an individual, therefore, the information gathered is based on the person’s voice, vision, culture and experiences.
  • Common assessment tools establish a common language and therefore improve communication and understanding among users.
  • Common assessment tools provide a wide range of individual/family-guided information used in treatment planning and quality improvement.
  • Common assessment tools are applicable broadly, yet identify specific needs and strengths to help ensure that each person receives the most appropriate and beneficial services possible.
  • Common assessment tools are flexible over time in response to the changing needs and strengths of the individual.

Who conducts the conversations?

Child and Adolescent Needs and Strengths (CANS)

  • Children in shelter placement – The DHS Screening Unit
  • Children in foster care/kinship care or group homes – The out-of-home placement provider
  • Children receiving OBH blended service coordination, or involved with RTF units, the Joint Planning Team or the Life Project – Service Coordination Units
  • Youth involved in independent living programs – Independent Living Program providers

Adults Needs and Strengths Assessment (ANSA)

  • Adults seeking behavioral health recovery services – OBH blended service coordination unit

Family Support and Advocacy Tool (FAST)

  • Families involved with the Office of Children, Youth and Families (CYF) – Child and family advocates at each CYF regional office

What are the “domains” reviewed in the conversations?

The following domains, when used together, are designed to capture a comprehensive view of the individual.

CANS and ANSA

Strengths
Individual strengths – The positive resources and assets in the individual’s life that can be used to promote healthy development, recovery (in adults) and positive outcomes.

Needs

  • Life functioning – The activities and relationships that are a part of the individual’s everyday life including family, school, employment and health.
  • Culture – The individual’s adjustment to the primary culture in which s/he lives, including factors such as language barriers or barriers that prevent the practice of their beliefs. Culture is broadly defined to include, but not limited to race, ethnicity, sexual orientation, religion, age, gender and socio-economic status.
  • Behavioral/Emotional needs – The symptoms and/or behaviors that an individual may display. This is intended to capture “what” is occurring and not the reasons “why” it is occurring.
  • Risk behaviors/factors – Whether or not the individual currently behaves in ways that could prove to be dangerous to him/herself or others.

Trauma (CANS/ANSA/FAST)
Trauma experiences – An individual’s exposure to potentially traumatic/adverse experiences over their lifetime.

CANS Only

Caregiver Strengths and Needs – Areas in which the caregiver may need assistance or support in their caregiving role/responsibilities while simultaneously highlighting the areas in which the caregivers can be a resource for the child.

FAST Only

The Family Together – How the family is functioning as a system. The family system is the set of inter-relationships among the family members within the context of their roles and responsibilities in that family

Caregiver functioning – The individual strengths and needs of each of the parents and/or caregivers in the family. These are the adults in the family who have been identified as having some responsibility for helping raise the children in the family

Child functioning – The individual strengths and needs of each of the children in the family

What is the common assessment rating system?

CANS and ANSA

Strengths Ratings
Rating Level of Strength
0 Significant/Strong strength (Centerpiece Strength)
1 Good. Can be strong with some help
2 Potential. Strength identified, needs to be developed
3 No identified strength (doesn't mean there aren't any strengths, need to help identify strengths)
Needs Ratings
Rating Level of Need Action Level
0 No evidence needed. No action needed
1 History of need or potential need. Watchful waiting, prevention, additional assessment
2 Moderate need. Need interferes with functioning. Action/Intervention
3 Need is dangerous or disabling. Help needed now. Immediate/Intensive Action
Trauma Ratings (CANS/ANSA/FAST)
Rating Level of Trauma Experience (Rated Over a Lifetime)
0 No evidence of any trauma of this type
1 A single incident of this type of trauma occurred or suspicion exists that this type of trauma occurred.
2 Person experienced multiple incidents or a moderate degree of this type of trauma.
3 Person experienced repeated and serve incidents of this type of trauma with medical/physical consequences.
FAST
Rating Level of Need or Strength* Appropriate Action
0 No evidence of need, can also indicate a clear strength* No action needed or can be used as a centerpiece strength; strength-based planning*
1 History of need or potential need, potential strength identified. Watchful waiting; Prevention; Additional Assessment OR opportunities for strength building*
2 Moderate Need. Need interferes with functioning. Action/Intervention
3 Need is dangerous or disabling. Help needed now. Immediate/Intensive Action

When do the conversations happen?

CANS conversations happen within the first 30 days of either a child’s out-of-home placement or involvement with OBH blended service coordination. Follow-ups occur at six-month intervals thereafter, or concurrent with treatment planning.

ANSA conversations occur at an individual’s intake involvement with OBH Blended Service Coordination. Follow-ups occur at six-month intervals thereafter, or concurrent with treatment planning.

FAST conversations happen within the first 60 days of a family being accepted for child welfare services, as long as children are living in the family home. Follow-ups occur at six-month intervals thereafter, or concurrent with planning.

How is use of the common assessment evaluated?

DHS has adopted the SPANS (Service Process Adherence to Needs and Strengths) as the tool to measure the connection (fidelity of the relationship) between the needs and strengths identified using the common assessment tool, and the resultant service plan, service implementation and outcomes a child and family, or individual experience.

The SPANS

  • Determines whether the needs and strengths identified in the CANS/ANSA/FAST are being addressed or utilized
  • Evaluates the progress of the service participant, service coordinator, program or agency
  • Creates a guide to identify areas for quality improvement and for developing plans for improvement at the individual, team, agency and system level
  • Informs on agency needs and targets training opportunities

Who uses the SPANS?

The Office of Behavioral Health adult and children’s monitoring teams.

The SPANS will be utilized by agency supervisors for supervision and team monitoring purposes.

Conferencing and Teaming at DHS

DHS is adopting DHS Conferencing and Teaming as its common, universal case management practice. Implementation of Conferencing and Teaming is a key strategy in the system-wide adoption of a DHS Practice Model, integrating DHS services according to a shared vision and values, in order to promote the health, well-being and self-reliance of those served. This common case practice of assessing, planning and integrating services fosters and supports the weaving of services around the particular needs of participants.

In 2012, DHS adopted Family Team Conferencing (FTC) as the model of common practice. As implementation of FTC progressed, it became evident that DHS would benefit from its own unique family engagement model, rather than trying to fit all of needs into an existing model. DHS Conferencing and Teaming emerged from blending the best of FTC, Family Group Decision Making and High Fidelity Wraparound, three participant and family engagement models.

Conferencing and Teaming relies heavily on FTC for many of its main practices, but incorporates strengths from the other conferencing models. It combines initial engagement, assessment and planning through a family conference, with continuous service integration through teaming to help a participant meet his or her goals. It also includes the opportunity for private family time in every conference or meeting, should the family want it.

The conferencing portion of the model engages the participant and his or her natural support system in a planning process that manages risks and improves long-term functioning. Using existing records and assessments, the participant, family and all natural supports formulate a plan based on the perceived needs and goals of all involved. The main principle behind this conferencing portion of the model is that the participant benefits from decreased dependency and increased personal responsibility.

The teaming portion of the model recognizes that as a person's situation changes, his or her plan may need alteration. The individual meets periodically with his or her natural supports and attending professionals to address events or circumstances that may call for a reassessment of current plans and strategies. The goal of this process is to build a strong support system that can continue to assist the individual after services end.

DHS envisions that all DHS direct services staff and human service providers will eventually utilize this integrated conferencing and teaming approach with people as their core case management practice. Any person who needs coordinated planning regardless of system involvement should have the option to participate.

DHS Conferencing and Teaming

  • Is how direct workers will do business; it is not a referral service
  • Focuses on identifying and utilizing the strengths, needs and goals of people and families
  • Emphasizes natural supports and informal resources
  • Focuses on individualized needs of people rather than traditional services to be offered
  • Promotes the coordination of multiple plans into a single plan by serving as the primary planning meeting for people.
  • Is appropriate for all people in Allegheny County.

DHS Conferencing and Teaming will be slowly phased in across DHS. Families currently being served through FGDM or High Fidelity Wraparound will continue under those models. But once Conferencing and Teaming is fully implemented, all new individuals needing services will be using this newly developed approach.

In 2013, DHS launched the DHS Conferencing and Teaming Institute -- a community-wide resource available to provide training, consultation and orientation regarding DHS Conferencing and Teaming in Allegheny County. Full implementation of the model is expected to take three to four years.

Additional Resources

Conferencing and Teaming Overview Video

Conferencing and Teaming in CYF

Conferencing and Teaming at DHS(PDF, 1MB)
This brochure describes the concept of Conferencing and Teaming.

Conferencing and Teaming in the Office of Children, Youth and Families(PDF, 590KB)
This brochure describes the process that is offered to families as a way to involve people in their life, along with professionals, to come up with and follow through on a plan to help them reach the outcomes they decide are important.

A Conferencing and Teaming update
DHS News, February 2014

An Orientation to Conferencing and Teaming(PDF, 324KB)
April 2013

Conferencing and Teaming: Inside the Process
DHS News, April 2013

DHS Conferencing and Teaming
DHS News, March 2013

Family Team Conferencing(PDF, 109KB)
The Child Welfare Policy and Practice Group

Family Teaming: Comparing Approaches(PDF, 137KB)
Annie E. Casey Foundation/Casey Family Services

Evidence-based Practices at DHS

Across a variety of fields, including most areas of practice that fall under DHS, there exists today a growing universe of proven interventions-be they clinical practices or therapeutic programs-that are grounded in evidence, peer-reviewed and readily available.

DHS, in our efforts to ensure that we continuously improve and strengthen our service system by depending upon the latest data and research, is increasingly looking to these "evidence-based practices" as a standard by which we, and our contracted agency partners, serve the residents of Allegheny County.

These high quality interventions, implemented with fidelity across the system, will improve outcomes for individuals, families and communities. DHS will continue to use data and quality improvement strategies to monitor and measure the impact of all of our programming, with a particular focus on the use of evidence-based practices where possible.

DHS will be undertaking periodic reviews of our services, grouped thematically. These service reviews represent a first step toward a system-wide effort to better align the network of DHS services with the needs of people receiving services, address any variations in quality of services, and advance the adoption of evidence-based and evidence-informed programming where possible throughout the human services system.

Additional Resources

An Introduction to Evidence-based Programming
U.S. Department of Health and Human Services, Administration for Children and Families

Evidence-based Practice
Child Welfare Information Gateway

National Registry of Evidence-based Programs and Practices
SAMHSA (Substance Abuse and Mental Health Services Administration)

Evidence-Based Practices Examined to Improve Child Welfare Outcomes
DHSNews, September 2013

Accomplishments & Innovations

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