EMQ Children & Family Services

This document was peer reviewed through the NWI. Supporting Wraparound Implementation: Chapter 5d.6 EMQ Children & Family Services: Transformation from Residential Services to Wraparound F. Jerome Doyle Eleanor Castillo Laura Champion Darrell Evora EMQ Children & Family Services Introduction MQ Children & Family Services (aka Eastfield Ming Quong) Eis a private, not-for-profit community-based organization that provides a wide range of services, from addiction pre- vention to wraparound and Rate Classification Level (RCL) 14 group home care (aka residential treatment services), in four major counties throughout California: (a) Santa Clara, (b) Sacramento, (c) San Bernardino, and (d) Los Angeles. It also provides foster care services in 20 other counties. The agency is over a century old, founded in 1867 with roots as an orphanage (Home of Benevolence, later known as East- field’s Children Center) and a rescue mission for Chinese girls (the Presbyterian Mission Home later known as Ming Quong) founded in 1874. In 1970, Jerry Doyle became Executive Director of East- field Children’s Center. At that time, the agency had an annual budget of approximately $300,000 to provide residential treatment. In 1987, Eastfield and Ming Quong merged to become Eastfield Ming Quong. Prior to becoming the first wraparound provider in California in 1994, EMQ operated 130 RCL 14 residential treatment beds, at a cost of $95,000 per year per child. The most common primary diagnosis was related to disruptive behaviors (47%), with some type of de- pressive disorder as the second most common. The outcomes for these youth, after an average of 18 months of service, reflected the general “treatment as usual” outcomes. Today, residential treatment revenue represents 5% of a $55 million annual revenue stream, as compared to 72% of a $12 million annual revenue stream prior to the implementation of wraparound. The purpose of this article is twofold: The Resource Guide to Wraparound Section 5: Supporting Wraparound Implementation 1) to present a case study of how a child-serving events, EMQ underwent a fundamental reinven- organization transformed itself from residential tion, or what is referred to by Nadler and Tushman to innovative, community-based services; and 2) (1995), as a reorientation, “a fundamental redefi- to share issues revealed in the process of imple- nition of the enterprise—its identity, vision, strat- menting wraparound. The article contains three egy and even its values” (p. 26). In a reorienta- major sections including Introduction, Current tion, the organization must change the definition Operations, and Tips to Implement Wraparound, of its work, the attitudes of its people, its formal as well as a final section that includes Lesson structures and processes, and its culture. Learned. Throughout this article, we will reflect Embarking on a New Path. Under the leader- on the significant systems change required to im- ship of Jerry Doyle and Rick Williams (Chief Operat- plement wraparound. ing Officer during the most tumultuous pe- Part 1: From Residential to riod of the process), Community Based Care the agency consulted with Michael Doyle, Attempt to Grow a nationally promi- In a reorientation, Residential Treatment nent expert in the the organization Initial County Partnership. In the course of change management the 1987 merger, EMQ collaborated with the Santa and consensus build- must change the Clara County Executive and local Social Service, ing process, to lead definition of its Juvenile Probation and Mental Health Agencies to a visioning process work, the attitudes assess their need for residential treatment beds which would result and arrived at an agreement that would make in the fundamental of its people, its EMQ’s 130-bed residential treatment program reinvention of the formal structures available exclusively to referrals from Santa Clara then-123-year-old and processes, and County. EMQ accepted any child the County re- organization. Existing ferred to the residential program. In return, the assumptions about its culture. County provided additional funding to meet the the business were set mental health needs of all the children in the aside so as to start program, as the basic residential or group home a visioning process rate structure covered only the care and supervi- from a blank slate sion of the children. Initially, the agreement met (see Doyle, 1986). the respective parties’ needs. However, review The change and renewal process began with a of the program’s outcomes revealed that while self-assessment of strengths and weaknesses. some children seemed to benefit from the resi- The second step was an environmental scan- dential program, for many others, the gains were ning process which included dialoguing with all short-lived once they returned home. Often, this customers, conducting market research, review- was due to the complex family needs that were ing trends in the children’s mental health and left unaddressed by the residential stay, including child welfare fields, and benchmarking services siblings with significant emotional and behavioral in an effort to find more effective approaches to challenges. serving children with serious behavioral and emotional disturbances and their families. Through Private Insurance. For a brief period in the this benchmarking process EMQ learned about early 1990’s EMQ explored the possibility of serv- wraparound from some of the early pioneers of ing children whose treatment could be covered the wraparound movement including Karl Dennis by private insurance. As the trends suggested that (Kaleidoscope Program, Chicago), John Vanden- the managed care environment was likely to im- berg, Ph.D. who led the Alaska Initiative wrap- pact both the public and private sectors in Cali- around program (see Burchard, Burchard, Sewell, fornia, the organization realized that it was on & VanDenBerg, 1993), and John Burchard, Ph.D., an unsustainable course. With the confluence of Chapter 5d.6: Doyle, et al. who had developed a wraparound program in Ver- Persistence in Creating Systemic Change. Im- mont (see VanDenBerg, Bruns, & Burchard, 2003), plementation of wraparound is more than simply and with whom Richard Clarke, EMQ’s Research starting a new program. Successful implementa- Director at the time, had worked. Simultaneously, tion requires a major systems change effort that EMQ also codified its values and beliefs with an affects and is affected by all levels of the services end product of an organizational Values Constitu- system. In any social system, 2.5% of the individu- tion, which would guide the work and behavior of als are innovators and 13.5% of the individuals are the organization and its employees. This process early adapters to change (Rogers, 1995). More- involved staff at all levels of the organization. over, if a heterogeneous 5% of a social system fun- The next step in the change process was to damentally shifts its culture, fundamental change create a vision of the desired future which was will occur in other areas of the system (Rogers, congruent with the result of the self assess- 1995). ment, environmental scan, and Values Constitu- With EMQ’s experience, it took four years to tion. It was proposed that a visioning approach create significant systems change. Initial efforts be utilized, emphasizing a future ideal state, and then creating a plan to reach that state. A growth and renewal strategy was then developed and a change architecture was designed to move the organization to be more wraparound focused and less dependent on residential services. Transformation from Residential Services to Wraparound Creating a wraparound Funding Source. In 1991, there was no funding structure for wraparound in California. The County agreed to con- tinue to pay EMQ the same 60% share of the group home rate that it would otherwise fund to have the same children in the residential program. In addition, EMQ worked in partnership with the county in an ultimately successful four-year effort to secure passage of legislation (AB2297) concentrated on identifying and working with in- providing that the state’s 40% share of the group novators and early adapters that would support home rate was made available to help fund wrap- the change. This included the presiding judge of around, and to leverage potentially available fed- the dependency court at the time, the Honorable eral funding streams including Title XIX (Medicaid Len Edwards, who became an early champion of federal mental health funding; known as Medi-Cal the wraparound process. in California) and Title IV-E dollars (federal reim- As change is dynamic, it is important to ad- bursement to states for the board, care, and su- dress local, state, and national levels concurrent- pervision costs of children placed in foster homes ly. This includes extensive wraparound training for or other types of out-of-home care under a court all employees within the organization, manage- order or voluntary placement agreement). To en- ment and line staff of the Social Services Agency, sure cost neutrality to the County, EMQ was paid and the Mental Health Department, the District the appropriate share of the group home rate less Attorneys, Public Defenders, and County Counsel. any concurrent out-of-home placement costs to Through this process, additional champions for the County for children in wraparound. Although the change process will emerge. Partnerships with each county varies in application of the 60-40% national wraparound experts may help

Load more