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Community Caring Collaborative

WHY IT STARTED

In March of 2006, 17 service providers and community members met with two mental health professionals at the Department of Health and Human Services office in rural Washington County to consider a Roberts Woods Johnson Request for Proposals for at-risk children in rural states. The two professionals knew Washington County well from years of work at both state and national levels in children’s mental health: Marjorie Withers was an experienced national consultant in systems of care, tribal issues, and emergency services; Jane Weil had founded The Washington County Children’s Program and was active in developing infant mental health resources and expertise in Maine. This gathering asked themselves the question, “What is our most pressing need regarding young children?”

As the group discussed the issues facing Washington County, they realized they didn’t want to apply for a grant. Too many grants and programs had come and gone in the County’s history; many had stressed collaboration, but rarely created the environment necessary to foster true collaboration. The group’s discussions centered on their common concern about risk for very young children, citing disturbing statistics for Washington County:

• One out of three infants born at risk due to substance exposure, low birth weight, or exposure to trauma or as the result of poverty
• The highest percentage in Maine of infants in child protective custody, as well as the highest percentage of terminated parental rights
• The highest percentage in Maine of children in special education
• The highest percentage in Maine of children under the age of four dismissed from child care due to behavioral issues

The environment that these statistics described had given rise to a sense of hopelessness in the social services community, as well as in the community members seeking services; people felt lonely & despondent about their work. These partners in The Community Caring Collaborative were convinced that if they didn’t do something differently, an entire generation would be lost. Even though Washington County is large geographically, it has a sparse population of 32,000. So everyone at this meeting knew someone who was raising grandchildren or someone battling drug abuse or addiction. The unanimous first response was to address the compelling problem of a large number of babies being born with Neonatal Abstinence Syndrome (NAS) due to maternal substance abuse and methadone replacement therapy.

Early on the Collaborative thought of itself as a workgroup. For the first six months the workgroup met monthly and held focus groups with parents, schoolteachers, health providers, social service workers, special education teachers, and child care center workers to become clear about the gaps in the service system. They then looked for gaps in the knowledge base and developed training workshops for the service agencies and community members. With a focus on “de-siloing” agency interaction, the Collaborative decided to ensure that every worker had a solid knowledge and skills base in trauma, substance abuse, cultural competency, and early intervention/infant mental health  issues.

WHO IS INVOLVED

The Community Care Collaborative has 35 partners altogether, with an active core group that includes Downeast Health Services; Community Health & Counseling; Washington County Children’s Program; Department of Health and Human Services; Passamaquoddy Tribe @ Indian Township; Downeast Community Hospital; Maine Families (Home visiting program); Washington County Children’s Program; the University of Maine at Machias; and Washington County Community College. Programming designed by the CCC is implemented with staff from existing partner agencies. It is important to note that the involvement of the tribal communities of Washington County in this Collaborative represents a major step forward for Washington County.

HOW THEY WORK TOGETHER

Forming a true collaborative structure was of primary importance from the beginning, so the Community Care Collaborative is not a non-profit entity. Sunrise Opportunities, an agency that provides services for the developmentally disabled, is its fiscal sponsor. Early in its formation, the CCC was able to secure resources from the Adams Family Foundation so that Marjorie was able to become the full time executive director of the CCC, devoting her time to bringing partners together and developing and delivering training for partner agencies, as well as creating a financial base for the CCC through a number of funders. Jane Weil, the former Community and State Liaison, developed state wide relationships that are the foundation for the State Agency Partnership. Since Jane’s retirement Marjorie is assisted by a marketing professional, a part-time administrative manager, and a quarter-time mental health consultation coordinator.

The Collaborative has organized itself around three different entities:

• A Workgroup that is made up of front-line workers, supervisors, and tribal and community members.
• An Executive Council that is comprised of agency directors, family members, and tribal/community members.
• A State Agency Advisory group that includes representatives of all branches of DHHS, the Department of Education, and the Director of the Early Childhood Comprehensive Systems, and other early intervention specialists.

The three groups have different functions. The Workgroup forms the grass roots foundation of the CCC, meets once a month for two hours, and handles all program planning; the Executive Council is responsible for policy and interagency sharing; and the State Agency Advisory Board makes up those essential and often missing state partners that are best positioned to change state policy and respond to local need and best practice development.

From the start, the CCC envisioned a structure with little administrative overhead to allow different agencies to receive funding that could support innovative approaches. Besides the Adams Family Foundation, partners have received funding from the Betterment Fund, the Maine Community Foundation, Jane’s Trust, The Sewall Foundation, and federal funding through Project LAUNCH.

CHALLENGES

Many rural areas across the country face similar challenges to those faced by Washington County: transportation across large geographic areas; finding adequate numbers of professionals who will commit to remote areas; and historically low wages for professionals dealing with generational challenges. Until six months ago, Washington County had only one full-time pediatrician. Since the closest Neonatal Intensive Unit care is in Bangor, at least 90 miles away, it is difficult for rural families to have their infant with multiple medical issues treated so far away. Considering the issues of high risk babies and their families, the CCC has discovered that it pays off in the long run to front load intensive services, so that through early supports families can develop both the skills and attachment their infants need to have healthier outcomes. Unfortunately, it is sometimes difficult to get this message across to state policy makers. Finally, the financial structure of MaineCare does not focus on dealing with root issues to intractable problems. The CCC and its partners and champions are working to bring about a new understanding of effective service delivery that results in long-lasting improved outcomes.

PROGRESS TOWARDS GOAL

The CCC has always had lofty goals: to change statistics for at-risk infants and children; to guarantee a system of care that will bring services closer to home and reduce the number of children returning to Neonatal Intensive Care Units (NICU); to create a mechanism by which agencies can be collaborative instead of competitive; and to improve the level of hope for families and the service provider community.

Through a Bridging Program that matches high-risk parents with a bridging provider or nurse bridging provider, the CCC has sponsored the training of 25 workers across four agencies in their Infant Family Support Specialist (IFSS) Curriculum, as well as provided training to hundreds of service providers and policy makers across the state. This has resulted in families staying on average of two days less in NICU, and has reduced the number of infant re-admissions. An integrated services training program has focused on laying a common foundation of expertise across service providers. Staff from four partner agencies are offering integrated early intervention services in six primary care centers one day a week; this model combines social service supports with medical service to change outcomes for families. Through the Mental Health Consultation program, the CCC offers early intervention specialists and mental health consultants to provide consultation to schools and child care centers so that children with behavioral problems are able to stay in mainstream classrooms, and child care centers can more effectively accommodate and meet children’s needs and regulatory issues through new skill development. Through its many training activities, the CCC has created a learning environment for professionals so that knowledge and expertise have improved among service providers.

Challenges remain. Finding ways to sustain the CCC is on everyone’s mind, since the current Project LAUNCH grant runs out in two years. Overriding this concern, however, is the remarkable change that the efforts of the Community Caring Collaborative have brought about among the service provider community. Service professionals now speak of feeling less isolated and lonely, with a sense of having a community of people who care. Without using the word “hope”, the CCC considers this one of its greatest achievements, believing that if they can reduce a community’s hopelessness, they can increase its overall health.