“Champions Corner” is a new blog series from the Texas System of Care that highlights the incredible work our sites, various government agencies, and other communities are doing towards implementing system of care values.
This month, we sat down with Kisha Ledlow, the Texas System of Care project director for the Texas Health and Human Services Commission (HHSC), to get a comprehensive picture in simple terms of what a system of care is, and how it functions in Texas.
In simplest terms, what is the Texas System of Care?
Kisha Ledlow: The Texas System of Care is a cross-systems approach that fosters collaboration at state and local levels to ensure children, youth, and families have access to coordinated behavioral health services and supports that are grounded in the foundational values of being family-driven, youth-driven and guided, and culturally and linguistically responsive.
Under this current grant, we contract with Local Mental Health Authorities (LMHAs) to oversee the implementation of systems of care in local communities. Currently, our sites — the places where we as the state are setting up the Texas System of Care — are through Burke in East Texas and LifePath Systems in Collin County. We are also working to expand to two additional communities this year.
So do other states have their own versions of the system of care approach?
K.L.: Right. Just like we in Texas provide unique support to meet communities where they are, systems of care are unique to each state. A system of care is an approach at a state level and at a community level. It’s also a developmental process. Some states have had systems of care efforts for decades, while others are in the early stages of implementation.
The values are the same. The core is always the values and principles that make up the approach. Again, two systems of care won’t look the same because it’s an approach. There’s no instruction manual or how-to for it. There are just guiding values and principles.
The core (of the system of care) is always the values and principles that make up the approach. Again, two systems of care won’t look the same because it’s an approach. There’s no instruction manual or how-to for it. There are just guiding values and principles.Kisha Ludlow, TxSOC Project Director (Texas Health and Human Services)
What is the history of the system of care in Texas?
K.L.: In the early 1990s, the Substance Abuse and Mental Health Services Administration (SAMHSA) started providing federal grants to states and communities for system of care development and implementation. In the early 2000s, Texas passed legislation to establish the Texas Integrated Funding Initiative (TIFI) which brought together many of the child- and youth-serving state agencies, who combined their resources and funding to provide system of care grants to a handful of local communities.
In 2011, the Texas Health and Human Services Commission was awarded its first system of care grant from SAMHSA. That round of grants was for the development of a plan to implement systems of care statewide and locally. In 2013, we received a second grant that was for system of care implementation, and so that was a planning and implementation grant. And in 2017 we received the current grant, which is focused on expansion and sustainability.
What is the connection between the Texas System of Care, the Texas HHSC, and the Texas Institute for Excellence in Mental Health (TIEMH)?
K.L.: HHSC contracts with TIEMH to help support the system of care communities. So TIEMH assists in the development of strategic plans around the identified needs within the communities. TIEMH also provides support like technical assistance and training to other communities that have developed or are wanting to develop systems of care, even those not directly funded through HHSC. We try as a team to meet communities where there are in implementing the systems of care approach and provide whatever resources we can to help.
TIEMH also helps with state-level work, which includes meeting with stakeholders to identify barriers on a systems level to improve policies. In a system of care, there should be a feedback loop between all levels (child and family level, service level, community level, systems and policy level) where families and youth are identifying gaps and barriers and giving feedback on what’s helping and what’s not, and what’s effective and what’s not.
Then there’s the Texas Family Voice Network, which is an organization of family members or caregivers with the lived experience of having a child or youth with behavioral challenges or complex needs who look to amplify the family voice. There is also ACCEPT, an organization of youth and young adults who work together to increase youth voice across the state.
All of these groups work together to provide support for sites looking to implement the system of care framework — whether they are officially contracted as a system of care site through the state, or an independent organization interested in system of care work.
So TIEMH and HHSC work to improve services within the system of care based on that feedback?
K.L.: The goal is to improve services based on feedback driven from the children, families, and youth themselves. So, for example, lots of children and youth with behavioral health challenges are receiving services and supports in multiple systems. We look for ways to help support those conversations between communities, agencies, and systems with the goal being coordinated care and services.
And are those agencies participating in those conversations?
K.L.: Yes, in multiple ways. For example, there are six state agencies that have entered into the Texas System of Care Memorandum of Understanding (MOU) — HHSC, the Department of State Health Services, the Department of Family and Protective Services, the Texas Education Agency, the Juvenile Justice Department, and Texas Correctional Office on Offenders with Medical or Mental Impairments at the Texas Department of Criminal Justice. Essentially, the MOU outlines strategies that each of the agencies can employ to integrate the system of care values and principles into their work to make them more family-driven, youth-guided, and culturally and linguistically responsive.
Another big part of that collaboration is the Children and Youth Behavioral Health Subcommittee, which is a subcommittee of the Behavioral Health Advisory Committee. Its purpose is to support the implementation or development of children and youth behavioral health services. It’s another opportunity to gather representatives from LMHAs, state agencies, families, and youth to have input into the behavioral health system as a whole — including the Texas System of Care.
So, what are some of the overarching goals for the Texas System of Care going forward?
K.L.: We are looking at expanding the approach as far as possible, and then sustaining that work afterwards when the grant funding is finished. In an ideal world, every community would have a system of care regardless of where they live in the state. They would have access to a comprehensive array of these services and supports that are all infused with the system of care values. And then each community would have the capacity to collaborate across systems and agencies to come together to identify and address needs and barriers.