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Model for the Coordination of Services to Children and Youth
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Background Information
The Department of Health and Community Services, Education, Human Resources and Employment and Justice have agreed to the implementation of the Model for the Coordination of Services to Children and Youth. To facilitate the implementation process six regional teams have been set up throughout the province. The teams are comprised of consumers as well as representatives from each of the four departments. A standing member on each team is the regional child health/services coordinator. A provincial integrated services management team is in place as well and has been assisting the regions in their efforts in implementing the Model. The Model is mandated to support children and youth from birth to 21 years. The Departments recognize that services cannot be fully effective if provided to a child/youth in isolation. Children/youth must be served within the context of families and communities where they live. The integrated service approach is intended to build on existing services, avoid duplication and at the same time enhance the role of parents/guardians and their children. All of this can be accomplished through the Individual Support Services Plan (ISSP), a child centered approach designed to meet both the individual and service needs of the child/youth. All partners are now able to share information about the child/youth through the development of an Information Sharing Protocol. All Departments and agencies will use a common consent form which will greatly enhance the ISSP process. Another component of the Model is the development of a process whereby children and youth will be profiled if identified to be at risk by a professional or parent/guardian or once an ISSP is completed for a child/youth. The profile is designed to capture information on the needs of children/youth for the purpose of service and resource planning and problem solving. The information from the profiles will enable the Regional Integrated Services Management Teams to; identify the needs of each community in the region, identify barriers to service delivery, and to accurately represent the needs of the regions to the provincial team and the Departments. May 1993 NLTA brought four issues to Government's attention. Issues were:
June 1993 Memorandum of Understanding signed between NLTA and Government agreeing to formally structure a committee to study the issues. October 1994 Classroom Issues Committee formed Chaired by Assistant Deputy Minister from Department of Education Other members
September 1995 Coordinator appointed to oversee implementation of the recommendations Departmental representative appointed from each department 21 working committees formed to action the recommendations June 1996 Committees submitted final reports/documents Examples
Provincial Team held 6 regional consultations September 1996 Pilot began in western region Regional boundaries are very similar to those of the Community Health Board What are the basic principles of which the Model is based?
PRINCIPLES Prevention
The Model is based on a philosophy of prevention and early intervention.
Collaboration is necessary at three levels:
child community region
Planning
Children, unless compelling reasons exists, should be involved in the support services planning process
Vocabulary, utilized by all agencies, should be consistent
The leader of a child specific team is known by all agencies and consumers as an Individual Support Services Manager.
The team is known as an Individual Support Services Planning Team.
The Regional Team which is known as a Regional Integrated Services Management Team oversees the effective implementation of the Model utilizing an integrated services management approach which means an approach that coordinates the actions/supports of all service providers, and one which allows for coordination of various services into a common and cohesive program plan for the child and family.
This integrated services management approach provides the following advantages:
It reflects the regional/provincial circumstances of multiple service providers and the commitment to provide coordinated services to the child/youth at the community level. It allows for effective practice. Coordinated service provision will see the joint development and monitoring of an individual program plan. It is also an opportunity to plan supportive strategies from a preventive rather than from a crises management perspective. It is collaborative. One of the present challenges of working with children and youth who are experiencing difficulties is having to do so in isolation of other professional support or at cross-purposes with other service providers. Stress is also paced on the importance of the full, participative involvement of families. It defines a process which can sustain continuity of service to meet individual needs. Although individual members of a program planning team may come and go, the process will be continuous, and the child/youth and family will always know some of the members. It facilitates and maximizes an efficient use of the existing limited resources. It builds on the support services planning process and other communication mechanisms already in place and formalizes the involvement of personnel in the Department of Education, Health, Human Resources and Employment and Justice. Through the support services process, the team members are expected to reach consensus selecting a single set of priority goals and objectives. The plan integrates input from all involved team members, identifies supportive strategies, time frames and mechanisms for evaluation. An integrated service management approach ensures that input of a specialized nature supports the child's support services plan. It limits the number of service providers with whom the child/youth and/or his/her family interact to a manageable number, and it facilitates the acknowledgment and sharing of skills and information. It includes the child/youth in the decision making process and in ensuring that appropriate services are made accessible, unless compelling
reason(s) exist.
This approach further ensures that the following premises are adhered to by professionals from Education, Health, Justice and Human Resources and Employment:
Parent/guardian or person operating in locus parentis and/or child are considered equal to other members of the team. Information shared is in the best interests of the child/youth/family. Information which would affect the safety or well-being of a child/youth, is communicated to the Individual Support Services Manager and the parent/guardian. All provincial agencies will communicate to the Individual Support Services Manager and/or designated professional and the parent/guardian. Information affecting the best interests of the child/youth/family or individual operating in locus parentis will not be withheld from the Individual Support Services Manager. Confidentiality does not imply secrecy. Where expertise varies, members with similar competencies will be given the authority to represent the specific area of expertise at the team meetings, enabling numbers of team members to be kept to a necessary minimum.
Multiple factors converge to produce any given symptom complex. The development of a symptom is the result of a complex series of interrelated multidirectional forces, with all elements in the system affecting and being affected by each other in linear and nonlinear ways. The child is understood as a whole person in an environmental context. For example, familial and social factors cross over to affect development and are often the most critical factors in tipping a child over the line from functional to dysfunctional. Because of the unity of development in infancy, intimate crossing-over effects among the zones of development promote or prevent optimal progress. The concept of cumulative adversity (McCrae, 1986) implies that a developmental disability is a result of the accumulation of multiple misfortunes set in motion over time, rather than the result of some single unitary event.
The discipline of the individual chosen to be primary provider is typically based on experience training, and the best match with the child's disability. The emotional goodness-of-fit between the professional and family is an important consideration.
April 1997
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