Strategies for Achieving Sustainability

Integrating Professional for Appalachian Children (IPAC)

Jane Hamel-Lambert, MBA, PhD, President, IPAC

Sherry Shamblin , Chair, Board of Directors, IPAC

ORHP All Grantee Meeting, Washington, DC Peer to Peer Sustainability PanelAugust 2, 2010

Overview

Integrating Professionals for Appalachian Children

Seven Strategies for Achieving Sustainability

Exemplar: Tri-County Mental Health & Counseling Services, Inc

Vertical network: participating agencies… child serving systems… mental health, medicine, speech language, audiology, nursing, schools, early intervention … and parents.

Legal Status: 501(c)3

Governance Structure: Independent Board of Directors,15 person; bylaws (corporate regulations)

Vision & Mission

IPAC’s vision is to ensure healthy development for all children.

Mission: By leveraging our expertise and integrating our resources, IPAC will develop innovative, culturally-sensitive programs that address the critical and complex challenges impacting the health and mental health of our region’s children and families.

Rural, Appalachian, Southeast OH

Professional Shortages: HPSAs, MHPSAs, Dental

Medically Underserved Areas (MUAs)

High Poverty High Unemployment Low Educational

Attainment

What was happening …

Visual Tracking Therapy

GI Children’s Hospital

Mom’sFP

Physician

Head StartHome

Services

Local Hospital

ER

OU Therapy

Associates

FamilyNavigator

UMAPediatrics

OU Psych & Social Work

Clinic

Public School

EndocrineChildren’sHospital

Grandma’s FP

Physician

GI Specialist

Local Hosp

OTSensory

Integration

ERZanesville

Redesigned ServicesAuditory

ProcessingEvaluation

IPAC’s Vision for Change

Ensure healthy development for all kids by improving our community’s ability to identify, to refer, and to provide

comprehensive, coordinated care to young children with developmental and behavioral concerns.

Network Development

“….to develop a formal network with the purpose of improving the coordination of health services in rural communities and strengthening the rural healthcare system as a whole.”

Office of Rural Health Policy http://ruralhealth.hrsa.gov

Balancing Strategy & Structure

Strategy: Collaboration & Capacity Building Interagency collaboration Blend wisdom of “doers and

directors” Build balanced community-

university partnership

Structure: Non-Profit Organization Bylaws, 501(c)(3) status, bank

account 15 member board of directors,

organized around 7 constituency groups

Clinical Programs Achieve VisionClinical Programs Achieve Vision

Interagency Collaboration

Developmental Screening in Primary Care and Childcare Settings

Family Navigator Program

Local Interdisciplinary Assessment Team

Co-locating behavioral health providers in primary care

Two Sustainability Challenges

Sustain the Programs Fiscal challenge: clinical services generate revenueCulture of collaboration (3 separately owned)

Sustain the Network: “We are the keepers of our culture” building trust takes time building a network is a long-term commitmentcelebrate the successes share responsibility for challenges transparency regarding budgets, decisionsprudent fiscal management

Grant Funding

Net Planning ($85,000):

Focused on deciding what being a network would mean, designed the infrastructure (board, bylaws, legal structure). What will the network will do?

Network Development ($540,000): Two goals

Network self-sustaining Incorporate, network policies,

leadership, membership, dues structure, communications (internal & external stakeholders), collaboration skills

Build integrated health delivery system through interagency collaboration/programs

Outreach Grant ($375,000): Programmatic agenda: ECMH consultation for preschools, plus workforce development trauma and autism trainings.

SAMHSA Project LAUNCH (3.5 mil): Programmatic agenda: Regional

expansion and diversification of programs (i.e., health and wellness), workforce development

Network Agenda: board development, membership, functions, communication

Sustainability: Facets other than Funding Partnership and Collaborative Capacity Development

Shared identity, logos… mugs, magnets, stationary Shared clinical focus: young kids, interdisciplinary Core values: Integration, Access, Collaboration Stakeholders: doers/directors, univer/community

Incorporating brings substantial structure You are an organization (not just a program) Governed by a board of directors (power assigned) Bylaws set expectations (attendance, who gets on the

board/how you get on the board, etc)

Plan, plan, plan …

“There are good ideas and then there are good ideas with a plan. The former often die on the vine, having nowhere to go. The latter create companies.” (www.hivelocitymedia.com, July 2010)

Grants … work plans sets goals, objectives and activities on timeline…

Create a Sustainability Plan…network committees to examine dues structure, board structure, revenue generating strategies, personnel needs. What are you operational expenses; how are you paying your bills. Identify consultants, go to management trainings, read.

IPAC Operational SnapshotRevenues:

Bank account opened with a donation Dues structure… know why your charging what you do charge. We

started at $500/yr, now $1000/yr…

Annual Expenditures Directors and Officers liability insurance (approx $1300 per year) Server for website (approx $330 per year) Filing taxes .. Donated services local CPA

Slow Growth (board paces growth) Contract for Coordinator, Interdisciplinary Assessment Team ($3180) Personnel (?$15,000): part time employee (a) website,

communications (b) professional develop programs for revenue Employment: HR consultant paid through another grant; legal

consultation costs loom President is volunteer (no cost) but capacity is limited

Seven Strategies for Sustainability

1. Care about the emerging culture of your network (trust, transparency, respect, conflict management)

2. Strengthen organizational identify: shared vision/purpose, jointly agreeing on the problems to solve, then jointly designing solutions, anchors ownership and responsibility

3. Visual Representation of you Network: logos, website, stationary, newsletter.

4. Build capacity of network: leadership, management, strategic planning, fiscal/accounting, communications

5. Find ways to diversify revenue streams (grants, donations, dues, in kind services, revenue generating programs)

6. Fiscally prudent decision making… grow at a pace you can afford

7. Plan, plan, plan… know where you are, know where you want to go, and know how you intend to get there..

……and celebrate the successes along the way!

Tri County Mental Health and Counseling Services, Inc

Sherry Shamblin, PCC-S

Exemplar

Sherry Shamblin

From Network Participant to Network Leader

From Provider to Department Director

Tri-County Mental Health

From Network Skeptic to Network Supporter

From Isolated Competitor to Collaborative Community Partner

Changing Agency Culture

CEO: 2007 CEO: 2009

“Collaboration might be good for services, but its not good for business.”

“Membership in IPAC has led to several direct benefits for our organization...valuable assistance in obtaining new funding to expand our early childhood services. The collaboration fostered within the IPAC network also helped us to establish a successful behavioral health/ primary care integration service delivery model… The Interdisciplinary Assessment Team… helpful resource for children served by our clinical staff, while the trainings sponsored by IPAC have increased the capacity of our staff to deliver standardized assessments to young children.”

Growth contributes to sustainability but growth is interconnected

LEVERAGING THE NETWORK TO ACHIEVE SUSTAINABLE ORGANIZATIONAL CHANGE

Administration has changed attitudes about partnerships, about the potential of grants to support innovation, about services delivery.

From a single early childhood mental health (ECMH) provider to a ECMH Department

Expanded EMCH staff from 1 – 4 with grant funding; 5th funded through state EMCH dollars

ECMH Director is on agency leadership team shaping direction of organization

Expanded services offered: co-located behavioral health providers in primary care; ECMH in new settings, use of evidenced-based models, conducting developmental screenings

LEVERAGING THE NETWORK TO ACHIEVE SUSTAINABLE ORGANIZATIONAL CHANGE

Emerging Community Based Participatory Research Committee

Accessing national expertise through technology

State and regional ECMH training including other mental health agencies

Initiating and leading EMCH workforce development opportunities with Ohio University’s counseling department.

HOW EACH IPAC GRANT CONTRIBUTED

 STAYING ON TRACK: EXPANSION OF CHILDCARE TRAININGS, TEAM BUILDING WITH OTHER FUTURE NETWORK PARTNERS

NET PLAN: TRAINING, EXPOSURE TO NEW IDEAS

NET DEV.: TRAINING, SKILL DEVELOPMENT, LEADERSHIP OPPORTUNITIES, EXPANSION OF CHILDCARE CONSULTATION, CO-LOCATED SERVICES, IAT ACCESS, INCREASED TRUST/COHESION WITH NETWORK PARTNERS

HOW EACH GRANT CONTRIBUTED:

 OUTREACH: GRANT WRITING EXPERIENCE, INTRODUCTION TO CBPR, LEADERSHIP DEVELOPMENT, ECMH SCHOOL PARTNERSHIPS

SAMHSA PROJECT LAUNCH : ECMH DEPARTMENT, EVIDENCED-BASED MODELS, EXPANSION OF PRIMARY CARE VENTURES, OPPORTUNITIES TO TRAIN/ DEVELOP REGIONAL WORKFORCE

 

Why We Needed IPAC & What We’ve Given IPAC

 

OPPORTUNITYSupport

CAPACITY DEVELOPMENT

Contact information:

Jane Hamel-Lambert, MBA, PhDOhio University 740-593-2289Hamel-lj@ohio.edu

Sherry Shamblin, PCC-STri-County Mental Health and Counseling Services, Inc. 740-592-3091, x4631sshamblin@tcmhcs.org

Photo credit: Larry Hamel-Lambert at hamel-la@ohio.edu