Vol. 21, No. 3
June 2016

NC's Five-County Project: Strategies for Successful Collaboration between Child Welfare and Mental Health

Ensuring the safety, permanence, and well-being of children is too big a job for one agency or one service system alone. Success depends on our ability to collaborate across multiple sectors.

Fortunately, there are many groups in North Carolina working to better coordinate services to children and families involved with child welfare. The Five-County Project, which is active in Franklin, Granville, Halifax, Vance, and Warren counties, is one such effort.

The Five-County Project
The Five-County Project seeks to strengthen the system of services and supports for children with behavioral health care needs. The team for this project is made up of representatives from the five county DSS agencies, Cardinal Innovations Healthcare (the area's MCO), schools, juvenile justice, and mental health providers.

After it began in 2013, this multidisciplinary team went through a process of reviewing data, identifying problem areas, and prioritizing strategies to increase placement stability for children in care. In the hope of supporting other cross-organizational efforts, here are some strategies this team has found useful on its journey.

Strategy 1
Identify and focus on a goal with mutual importance
Most parties working with children in child welfare are involved because they care deeply about the well-being of children. It is important to remember that, although we have different roles across organizations, everyone is here for similar reasons.

Example: After reviewing relevant data, DSS agencies from the five counties and their managed care organization (MCO) agreed reducing placement disruptions was an important shared concern. They reached this conclusion because they all understood the harmful impact disruptions can have on children. Additionally, everyone had other "pain points" that placement disruptions contributed to, including:

• Missed state permanency goals
• Long evenings or working on weekends
• Foster parent turnover
• Strained relationships with other parties (DSS, MCO, providers) over finding a new placement
• Financial costs of moving a child
• Delays in payment approval, etc.

Although it is necessary and helpful to acknowledge these very real challenges, the group found that frequent reminders about their primary goal kept them from getting sidetracked by struggles with these "pain points."

Strategy 2
Develop an understanding of each organization's role
DSS, MCOs, and providers all serve the same children, but they each have different legal and policy drivers, and may use different terms to discuss the same issues. Understanding everyone's legal and policy constraints helps collaborative groups brainstorm viable solutions instead of blaming each other for the dysfunction.

Example: One of the first things the Five-County team did was map each organization's process for referring children to receive mental health assessments and services. This "process mapping" revealed differences in language, documentation, and child and family team (CFT) requirements. This, in turn, helped the team zero in on gaps and identify ways to improve processes.

Strategy 3
Play to your strengths using small groups
Everyone involved in a cross-system, collaborative project needs a deep understanding of the problem, the desired outcomes, and the "big" action items needed to achieve those outcomes. For this you need a big group.

Once a solution is identified, however, you need small groups focused on specific tasks. The composition of these small groups matters. So do the parameters of their work: the larger group must always have an opportunity to provide feedback and input on small group efforts. Communication must be two-way.

Example: At the beginning of the project the team collected, analyzed, and discussed data related to placement stability to help it decide about goals, outcomes, and action steps. However, it did not use a small group to assist with this. As a result, the process took an unnecessary amount of time and frustrated group members, who were ready to move forward with action planning. A lesson learned here was that the process of data mining would have been better delegated to a small group while the larger group focused on other tasks.