• A unified strategic plan encompassing all applicable child-serving agencies and funding sources has been developed and implemented. Attainment of objective milestones and performance targets in the strategic plan is routinely monitored and reported.

• All participants and constituents of the system, including children and their families, will have a clear understanding of how the disparate child-serving elements are integrated into a unified system of care, and how well the current system measures up to the vision of an integrated system.
• Parents, teachers, and service providers will spend much less time attempting to access and coordinate disparate services.

• All parties to the unified plan cede control and share resources in meaningful ways.

• Interactions among all parties in the child behavioral health system will focus solely on how to best meet the needs and choices of children and their families, not on turf or funding issues.

• Locally-based single-site management of all resources has been established, and has the authority to access all applicable service modalities and to commit funds for these services.

• Each defined geographic region of the state will have a single entity with unified and singular clinical, administrative, and financial authority to manage and deliver integrated services to children and their families.
• As a proportion of total system costs, administrative costs of child and family behavioral health services will be substantially reduced.

Methods and supports for empowering children and their families and front- line staff have been effectively implemented.

Children and their families do best when they participate fully in treatment planning and service choice. In many best practice models, families choose service models, select providers, and train and supervise them to work in their own homes and schools. In a similar fashion, front-line staff must feel free to be flexible, creative, and individualized in assisting children and their families to access services. They must also feel supported and free to take risks without fear of retribution;

• Families and their children participate in all levels of service planning, implementation, management, quality improvement and evaluation as well as in treatment planning and provider choice.

• The local integrated child behavioral health system will become accountable to the primary users of services, and will be less beholden to oversight and funding agencies.
• As children and families become more engaged, knowledgeable, and empowered, their capacity for coping and problem resolution within the family will also be strengthened.

• Families are supported in securing their own chosen methods of in-home, school and community-based services and supports.

• Child and family satisfaction with services of their own choice will lead to improved treatment outcomes.

• Family peer supports are available to educate families and their children about service options and treatment planning, and to assist families and children to advocate for their needs and choices in the system.

• Effective peer support and advocacy will result in increased use of natural as opposed to formal services and supports, will improve outcomes for children and their families, and will reduce the system-wide costs of serving high need children and their families.

• Front-line staff receive sufficient training and support to feel competent and skillful in accomplishing their missions. Front-line staff also feels supported and protected by system management to be creative and to take risks.

• Staff will become more effective and efficient in meeting child/family needs and choices, staff turnover will be reduced, use of high cost residential services is reduced, and children and families will be more satisfied with their interactions with the system.

Systematic and coordinated approaches to access, comprehensive assessment, service planning, and outcome measurement for services.

Children and their families should have one and only one integrated assessment and treatment plan, and should be able to access all needed and chosen services from wherever they present in the system. This unified access and treatment planning approach should also assure continuity of treatment and supports as well as facilitate access to a variety of services across agency lines.

• Children and their families receive one unified comprehensive, strengths-based assessment and treatment plan governing all aspects of service access and delivery wherever they present in the child-serving system.

• Elapsed times for entering the service system and for moving among service components in the system will be reduced.
• The single uniform strengths-based assessment and treatment plan will accurately reflect the total range of child and family strengths, needs, and choices.
• Children and their families will become significantly more satisfied with the unified intake, assessment, and treatment planning process.

• Children and their families have one single point of contact in the service system which (who) has full responsibility and accountability for maintaining contact with the assigned child and family and for coordinating and assuring continuity of care and service access.

• Continuity of system contact will result in reduced over-all lengths of stay in high intensity and/or out of home services, improved treatment outcomes, and reduced life-cycle costs of child behavioral health services.

• Service access and treatment planning criteria facilitate movement among all components of the child/family service system without delays or the need for additional paperwork.

• Elapsed times for moving among service components will be reduced, and over-all system administrative costs will be reduced.

• The child-serving system makes a promise not to let children and their families go: the system will be there for them whenever and wherever they want, with whatever they need and choose.

• Admission and length of stay rates to child inpatient and residential facilities will be reduced; child/adolescent arrests and incarcerations will be reduced; and out of home placements will be reduced.

• All service modalities and locations within the child/family service system will be responsible for attaining the same outcome, performance, and satisfaction measures, and will use the same outcome and performance data recording and reporting mechanisms. These include: timely access to urgent, emergent, and routine services; reduced admissions and days spent in hospitals and other congregate settings; increased time at home and in school settings; and increased self-report of choice, participation, and satisfaction.

• The overall performance of the child/family behavioral health system will be measured and evaluated in a consistent manner, and the contribution of each component of the system to overall performance will be objectively documented.
• Outcome, satisfaction, and performance measures will address issues of greatest importance to children and their families.
• Quality management plans and annual evaluations will document how child/family outcome, satisfaction, and performance data will be used to increase the quality and effectiveness of the system.