GARRETT COUNTY'S CONCEPT PAPER VISION TO SCALE

Table of Contents:

• Cover Page
• Introduction
• Garrett County's Readiness to Proceed
• Outcome: Stable and Economically Independent Families
• Outcome: Communities Which Support Family Life (1)
• Outcome: Communities Which Support Family Life (2)
• Outcome: Healthy Children
• Outcome: Healthy Children/Healthy Adults
• Outcome: Children Completing School
• Recommendation: Management Information System
• Attachment A: Guiding Principles
• Attachment B: Family-Based Systems Coordination [under construction]
  
  

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GARRETT COUNTY
VISION TO SCALE

CONCEPT PAPER

PRESENTED TO:

THE GOVERNOR'S OFFICE FOR CHILDREN, YOUTH AND FAMILIES

BY:

THE GARRETT COUNTY COMMISSIONERS

AND

THE GARRETT COUNTY LOCAL MANAGEMENT BOARD

March 6, 1997

OCYF

This concept paper is the result of six years of dreaming, planning, and developing by the Garrett County Local Management Board (LMB). Since its inception in 1991, our LMB has viewed its mission as serving all children and families in the County, and not just those families who have children in the initial target populations of "Intensive Family Preservation and Return/ Diversion". Our Mission, adopted in 1991, states: "The mission of the Garrett County Office for Children, Youth and Families, Inc. (GC OCYF) is to promote a stable, safe, healthy environment for children and families; thereby, increasing self-sufficiency and promoting family preservation." Furthermore, the LMB adopted Guiding Principles (Attachment A) in January 1993, which affirmed its commitment to a coordinated human services system sharing common values.

Remaining true to this mission, the LMB has developed partnerships with local agencies to improve the overall service system in Garrett County. In some cases there has been joint planning; in other areas the LMB has provided a home by serving as the local lead agency for the Infants and Toddlers Program, the Local Interagency Early Childhood Committee, and the Family Support Network. These ventures have allowed the LMB to expand its sphere of influence beyond the initial target population and to begin focusing on primary prevention activities.

The Federal Family Preservation and Support grant offered our LMB the opportunity to complete a thorough assessment; to develop a five year plan; and to begin implementation of that plan for Garrett County. Going "To Scale" is the next step. Through a partnership with the State, the LMB intends to develop a locally driven system that will provide better outcomes through funding flexibility achieved by local collaboration.

Garrett County's Readiness to Proceed:

Garrett County's LMB has been operational for nearly six years. During that time the LMB has worked in collaboration with agencies to ensure that services in Garrett County are efficient and effective. GC OCYF, serving as the operational arm of the LMB, has been able to secure numerous grants that have expanded the services available in the County. As the fiscal agent for the LMB, GC OCYF has had annual budgets of approximately $400,000. We have in place an established accounting system and proven policies and procedures. GC OCYF is eager to work with the Governor's Office for Children, Youth and Families to implement systems that better meet the State's need for accountability while also supporting funding flexibility.

Additionally, Garrett County's size may actually work in its favor when developing and re-engineering the design and delivery of local services for children and families. The County's service system is small enough to manage, and providers are already familiar with each other's agencies, services, and restrictions.

Garrett County has been interested in the "Vision to Scale" concept for some time. As early as December 1995, the LMB held a retreat to begin planning a pilot. Our efforts were put on hold to await the Report of the Governor's Task Force on Children, Youth, and Families Systems Reform. On December 19, 1996, our LMB voted to proceed with planning, investigating and becoming a pilot site. We would do so by (1) having agency, consumer and provider representation at a brainstorming session to decide where we are going and how we are going to get there; and (2) focusing on utilizing our Five Year Plan's three goals with the Task Force's identified nine outcomes intertwined. And on January 16, 1997, we did just that. Ten different committees were formed to examine service areas that could fit into the "Vision to Scale" pilot Each committee used a universal document/ questionnaire to provide continuity and fairness (Attachment B) at their meetings. The committee's findings were then compiled in a notebook and distributed to the 67 individuals who represented agencies, consumers, providers and local government. On February 20, 1997, the LMB heard committee reports and voted on areas they wished to be included in a Concept Paper. The developed Concept Paper was then presented to the Garrett County Commissioners on March 4, 1997, for their approval, and to the LMB for their approval on March 6, 1997.

Garrett County's Vision to Scale is very broad. The components offered for negotiation may stand on their own; however, they are best viewed as a composite.

Outcome: Stable and Economically Independent Families

In 1995 Garrett County was ranked 9th (out of 24 jurisdictions) overall in the State according to the 14 benchmarks in the Maryland Kid's Count Fact Book. Despite our generally good ranking, Garrett County ranked 21st for the number of children living in poverty. Garrett County, historically and currently, has one of the highest unemployment rates in the State.
Garrett County has a fair amount of resources available. The Garrett County Family Services Directory lists twenty (20) different employment programs; twelve (12) income support programs; and four (4) job training programs. It is believed that all of these programs contribute to create a patchwork of support for Garrett County residents who live in poverty. There may be significant areas for collaboration which would enhance the current system to make it better.
The LMB believes that the stability and economic independence of families is critical in attaining all other results. For this reason we have placed this outcome as the key component to our Vision to Scale model, even though it is traditionally outside of the human service delivery system.

I. Goals:

A. Garrett County residents will have the skills and/or the support necessary to obtain and maintain employment.

B. Garrett County residents will have access to wages and benefits which yield stability and economic independence.

C. Garrett County residents who desire to own their homes, will have the means to do so.

D. Barriers (access to safe and affordable child care, health benefits, transportation, training, etc.) which prevent Garrett Countians from becoming stable and economically independent families will be eliminated.

II. Objectives:

A. We will be able to measure the progress towards creating more stability and economic independence for Garrett County families.

Strategies:

1. Identify key indicators of stability and economic independence.
2. Maintain a database that includes the key indicators.

B. Build a relationship between the Local Management Board and the Private Industry Council (PIC) so that job development/ creation goes hand-in-hand with the development of needed family support services. The LMB membership could be expanded to include (1) a member of the PIC and (2) the Economic Development Director.

C. Address the need for benefits(retirement, health insurance, child care, etc.) for the self-employed and for those persons employed by small enterprises that cannot afford benefit packages.

Strategy:

1. Formation of a partnership between the private and the public sector that would examine this issue. Options may include health care cooperatives and "cafeteria" plans.

D. Support for the Micro Enterprise Development Project being considered by Garrett County Community Action and Garrett Community College.

E. Case Management will be available for families who are receiving services in Garrett County (see details in next section).

F. Child care will be available in Garrett County at a cost that is affordable to parents in entry-level positions (at or near minimum wage).

Strategies:

1. Expansion of the Head Start "Wrap Around" child care program.
• Use existing community facilities, including Head Start Centers and schools, to house the programs.
2. Pooled funds
• MD Child Care Block Grant
• Fee for service (sliding fee scale)
• Vouchers
• Flexible grants
  

Outcome: Communities Which Support Family Life

Garrett County, like all counties in Maryland, has numerous services available to children and families. These services are delivered by multiple agencies who provide a range of services or program components at varying levels of intensity. This "continuum of care" in theory meets the program needs for children and families, However, it is disjointed. Some consumers, in particular those most at-risk, receive comprehensive case management. These programs are provided across agencies in order to manage resources and to steer consumers through the maze of services. It is clear that many families, who may not be identified as "at-risk", are still in need of a "key" individual in the system that has some overall understanding of their needs.

It is obvious that Garrett County is in need of a system of care that not only includes the program and service components, but also encompasses mechanisms, arrangements, structures and/or processes to insure that the services are provided in a coordinated, cohesive manner.

I. Goal:

A. A continuum of service management will be available to children and families receiving multiple services in Garrett County.

II. Objectives:

A. Individuals and families can identify a professional/para-professional as their service contact.

Strategies:

1. An assessment for the need for service management will be completed at service intake.
2. Consumers who desire assistance will be assigned a case manager (surface management).
   

B. Individuals and families have the opportunity for service coordination.

Strategies:

1. Consumers may have a designated Service Coordinator who would serve as their primary contact person.
2. Develop a model for a continuum of service management.
3. Use existing personnel in the system to provide service coordination.
• Determine what staff currently in the system could provide service coordination as part of the "service coordination continuum."
• Development of uniform minimum procedures for personnel across agencies who will be providing "service coordination."
• Develop a common language and understanding of the requirements of staff participating in the system.
• Develop common contact forms to be used by interagency staff providing service coordination.
• Development of a Memorandum of Understanding among the LMB agencies, as well as other agencies, wanting to participate in the service coordination continuum.
• Pool resources to provide training for those agencies participating in the service coordination continuum.
4. Development of outcome measurements and a review methodology.

C. Individuals and families have the opportunity to be referred for interagency comprehensive case management.

Strategies:

1. Interagency case management would continue to be a primary treatment strategy for individuals and families who require intensive services. These services are designated and would require a referral.
   

Outcome: Communities Which Support Family Life

Garrett County, like most communities, is facing a child care crisis. Specifically, more parents are working which creates a need for school-age child care. The need for more before and after school programs, as well as summer school programs, is preeminent. Demographics, due to the rural nature of the county, has contributed to the lack of programs offered by the private sector as profit generating enterprises. Those available for-profit endeavors are not affordable for many parents.

In addition to the need for affordable child care, many parents desire access to safe and affordable activities for their children and the family unit. The third greatest need identified in 1995 was for more recreational activities. This need is exacerbated by the fact that Garrett County is the only county in Maryland which does not have a Parks and Recreation Commission.

I.I. Goals:

A. Working families of school age children will have access to before and after school programs (latchkey) and summer programs.

B. Families will have access to safe and affordable activities for their children and the family unit.

II. Objectives:

A. Expansion of the Head Start "Wrap Around" program to sites throughout the County.

Strategies

1. Use existing community facilities (Head Start Centers, Schools, etc.) to house the programs.
2. Funding
• Pooled funds
• MD Child Care Block Grant
• Fee for service (Sliding fee scale)
• Vouchers
• Flexible grants

B. Establish a Garrett County Parks and Recreation Commission

Strategies:

1. Develop a study group to conduct a feasibility study.
2. Work with other entities (Allegany County YMCA, GCC, etc.) to expand programs in Garrett County.
3. Cultivate funding strategy.
4. Use a "pay as you go" strategy. Offer camps using GCC as a site; students and faculty for staff with all day, day care.
5. Use Career Exploration and Volunteer Service Hours as resources.
   
   

Outcome: Healthy Children

The need for home visiting has developed as an effective strategy to support family and community health. An analysis of young children in Garrett County reveals that many children and their families would benefit from home visiting services. A specific concern of our service community is for those children who have developmental delays, but do not qualify for the Infants and Toddlers Program; and for those children who have social/ emotional risk factors. (Also, many of these children do not possess a Medical Assistance Card.) Individualized early intervention for children, coupled with family involvement, assists the child in his development within the physical, cognitive, communication and psychological parameters.

In the report Home Visitation in Maryland for At-Risk Children (0-5) and Pregnant Women published in November 1996, the Department of Health and Mental Hygiene recommends that Maryland: "Implement home visiting as a statewide strategy to improve the health and welfare of pregnant women, children, and communities." While this may be a difficult recommendation for the rest of the State to adopt, Garrett County is small enough that it may be possible to act on this recommendation for children 0-3 by adding or re-deploying as few as one or two staff persons. After age three, many of these children are enrolled in Head Start or Pre-K programs.

I. Goal:

A. All prospective and new parents (with children up to age 3) would be able to receive Nurse and/or Social Worker visits. There are approximately 225 children per year who fall into the current gap. The average births per year in Garrett County is 385.

II. Objectives:

A. Assure continuing regular home visiting and monitoring services to "high risk" (24% or less developmental delay, or other social or health problems) through age 2.

Strategies:

1. Examine program regulations for the Infants and Toddlers Program to determine if there is the ability to assist with this population.
2. Request a waiver from the State in one or more programs to allow funds, currently restricted, to be pooled.

B. Implement home visiting as a strategy to improve the health and social development of pregnant women and children.

Strategies:

1. Find funding for 1 to 2 additional FTE nurses and/or social workers professionals to provide "Healthy Start" type of visits. These visits would be for all prospective parents and children under age 3 who request services, but are not targeted under the current system.
2. Develop a single intake procedure that meets the needs of the Garrett County Health Department, the Garrett County Infants and Toddlers Program, and other participating agencies to help streamline the process.
3. Pursue Early Head Start funding from the Department of Health and Human Services.
   
   

Outcome: Healthy Children/Healthy Adults

Garrett County's system of care for children and families has been a mosaic of services and programs. All programs are inter-related and have to be viewed in context as part of a whole. Changes in one piece have far reaching effects in the service system. The LMB views the need for responsive and effective mental health services for children and adolescents as a critical community need. The LMB is extremely concerned with the changes that are occurring in the Mental Health system. Mental Health services for children and their families is a key component of our local system. The changes in Mental Health (i.e. 1115 waiver) is frightening to the LMB. To compound this problem, Garrett County does not have a Mental Health Core Services Agency (CSA). The County has submitted a proposal to the Mental Hygiene Administration for the funding of a CSA in Garrett County.

If the CSA is funded, the LMB and the CSA will enter into a Memorandum of Understanding or interagency agreement, which will describe collaboration for the following areas: authority/decision-making; voting representation; dispute resolution; roles and responsibilities for planning including resource development; data collection and tracking; evaluations; resource development; proposal development/procurement/ review; fiscal issues; technical responsibilities; service coordination; advocacy; etc.
If a local CSA is not funded, the LMB will be even more aggressive and seek access to all mental health funds for child and adolescent services.

I. Goals:

A. Mental Health Services will be provided to consumers in the least restrictive manner.

B. The continuum of mental health services will be expansive, responsive, and coordinated.

II. Objectives:

A. The Local Management Board will seek to access all mental health dollars specified and projected for child and adolescent services. (This result is presented as a contingency plan if the CSA proposal is not approved, or if the CSA in conjunction with the Administrative Service Organization [ASO] are not responsive to the mental health needs of children and their families.

Strategy:

1. The LMB will, due to the philosophical conflict in delivery strategies, request that the MHA divert funds for child and adolescent services to the LMB.

B. The Local Management Board will maintain a proactive and educative role in the ongoing preservation and development of local mental health services.

Strategy:

1. The LMB will continue its role as the comprehensive decision-making body for the county's children and family service delivery system.

C. Secure a safety net for consumers.

Strategy:

1. The Local Management Board will seek a contingency plan from the CSA as services shift from a grant service model to a fee-for-service model.

D. Intensive community-based mental health treatment will be available to children and adolescents.

Strategy:

1. That the LMB secure the in-state hospital and residential placement funds when diversion is viable. Funds will be used for the diversion of children to community-based placements.
2. Surplus funds can be used to augment services (e.g. assist transitioning youth; youth who cannot secure the support of the adult system).
   

Outcome: Children Completing School

Garrett County's high school dropout rate for 1996 was 4.31%. Although this rate is lower than the baseline year of 1990 (4.4%), it is viewed by the LMB and Board of Education as not acceptable. Obtaining a high school diploma indicates that a teen has acquired some minimal basic knowledge and skills. Teens who do not complete high school narrow their opportunities and diminish their earning power. The risk of sporadic, low-wage employment and poverty increases for these teens. "In Maryland, 57% of high school dropouts ages 16-19 were either unemployed or outside of the labor market in 1990 (MD 1994 Kids Count Factbook)."

There are quite a few contributing factors to Garrett County's relatively high dropout rate (family/student expectations, firm discipline policy, lack of a variety of alternative programs, etc.). The LMB would like to include dropout prevention in the Vision to Scale negotiations. It is hoped that the State will be able to assist the County evaluate this problem and develop creative solutions. At this time, the LMB was unable to identify resources that will require the state's assistance to pool.

I. Goal:

A. A comprehensive approach to drop-out prevention and recovery of drop-outs will be available to at-risk youth.

II. Objectives:

A. A community-wide approach will be used to address Garrett County's high (3.85% in 1995) drop-out rate.

Strategies:

1. Hold a community meeting to: (a) familiarize the community with the problem; and (b) to develop a community strategy to prevent dropouts.
2. Provide in-service training to staff from ancillary agencies to implement drop-out prevention strategies; understand local and state attendance policy, develop ways of assisting youth to avoid attendance problems.
3. The LMB will support the Garrett County Board of Education in addressing the above objectives.


B. The addition of alternative programs available to youth who are at risk of drop-out.

Strategies:

1. Day program for high school students at risk of expulsion.
2. Secure funding for a broader offering of classes in the evening high school program.
3. The LMB and other key agencies (State Attorney's Office, law enforcement) to support the Garrett County Board of Education in addressing the above objectives.
   
   

Recommendation: Management Information System (MIS)

To fully implement Vision to Sale, it is imperative that the LMB insure that agencies and individuals have easy access to reliable information on services, outcomes and processes. During the Federal Family Preservation and Support (FFPS) planning process completed in 1995, the two areas that Garrett County needs to improve as cited most by key informants were: (1) knowledge of how to access services and (2) information on existing services. Garrett County is addressing these needs through its FFPS grant funding by developing a communication strategy that employs an on-line GC Family Service Directory (address: http://www.gcnet.net/garrettinfo); updated hard copies of the Family Service Directory; staff trained in the use of the directory and established access sites. Fiscal Year 1997 goals are: (1) maintenance of the on-line Family Service Directory database and Web page; (2) creation of a Family Activities Directory database; (3) establishment of satellite Garrett Information Centers; and (4) developing funding mechanisms for purchase of equipment and software upgrades for participating LMB agencies.

The communication strategy is essential in addressing all of the Tasks Force's outcomes in our Vision to Scale plan.

I. Goals:

A. A coordinated communication plan for family and children services.

B. Public access to information regarding family development and community development projects.

C. Availability of state-of-the art information services to participating agencies, including a database of local outcome measures.

II. Objectives:

A. The infrastructure and personnel needed for comprehensive communication planning will be developed.

Strategies:

1. GC Net will meet the infrastructure needs and provide technical expertise to support the implementation of the plan.
2. Strategic planning for implementation needs (hardware, software, GC Net accounts, and dedicated telephone lines for LMB agencies; to include public access points).
3. Pooled funding for one staff person dedicated to maintenance of the directory, system development, technical assistance and training.

B. Implementation of the LMB Communication Plan will build on existing initiatives to support families in Garrett County.

C. Increased access to information.

Strategies:

1. Development of an interagency web page that builds on the Family Services Directory database.
2. Identification of Internet bookmarks pertinent to LMB member needs.
3. Broad-based service capabilities; questionnaires; forums; on-line newsletters; posting of committee minutes; e-mail, etc.

D. System-wide instruction and training.

Strategy:

1. Provide ongoing updates on database, web page and events calendar functions for satellite "Garrett Information Centers."
   

This is an unofficial electronic transcript of the Garrett County Local Management Board's Vision to Scale Concept paper which was submitted to the Governor's Office for Children, Youth and Families on March 6, 1997. The LMB sanctioned the posting of the concept paper in good faith with the understanding that the board is not to be held liable for any unintended inaccuracies.

Attachment A: Guiding Principles