Transforming Together-Building an Integrated System of Supp…

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Transforming Together Building an Integrated System of Supports

Transforming Together: Implementation Guide

Contents Building an Integrated System of

Closing.................................................. 44 What success looks like: A new Ecosystem of Care is emerging....................................44 Using Data and Community Engagement to Assess Needs and Gaps, Identify Priorities, and Measure Progress..........46 Introduction........................................... 46 The What..............................................46 The How...............................................46 Key Component: Co-Created Outcomes.....48 Stronger measurement of impact across systems................................................ 51 Tapping Parent and Youth Perspectives Creatively and Comprehensively...............53 Key Component: Well-Chosen Measures of Progress...........................................54 Key Component: Authentic Community and Family Participation.......................55 County Spotlight....................................58 The Case for Compensating Parents..........59 Recap: Strategies for Using a Community Needs Assessment to Inform Shared Outcomes and Measures.......................60 Using changes in systems, practices and data use to achieve better outcomes for families and youth................................62 What success looks like: Family and youth are co-designers of a new ecosystem of care. ..................................................... 64 Endnotes............................................... 67

Supports................................................. 1 Introduction. .......................................... 4 Why Integration Matters.........................4 About this Guide.....................................5 Why Change?...........................................7 The Case for Change.................................7 Moving from Siloed to Strategic..................8 California Policy Momentum.......................9 Fresno County: Building Access Through Trust and Integration......................................11 Resources for Implementation..............12 Supporting Systems Change—What this Guide Provides.......................................12 Four Chapters .......................................12 The Opportunity.....................................12 Neuroscience and Practice Inform a Whole- Child Definition . ..................................... 13 Research on Working Together for Whole- Child Success........................................15 Collective Impact....................................15 System of Care......................................16 Appendix: Outputs & Outcomes Framework. .......................................... 17 Establishing a Countywide Ecosystem of Care .....................................................20 Introduction........................................... 20 The What..............................................22 Key Components of an Ecosystem of Care Leadership Structure ..............................22 The How...............................................23 Engage in Existing Cross-Agency Efforts....23 From Host Agency to Shared Ownership....25 Create a Shared Vision and Clarify Roles....25 Moving Beyond Managing an Initiative to Leading Full Systems-Change...................28 Strategies for Building Cross-Agency Leadership and Collaboration ..................28 Building the Blueprint: How One County Mapped its Cross-Agency Meetings...........30

Chapter 1 Establishing a Countywide Ecosystem of Care

Transforming Together: Implementation Guide

Establishing a Countywide Ecosystem of Care Introduction Building a new Ecosystem of Care represents an opportunity for local agencies to transform how they collaborate, share resources and data, coordinate care and services, and partner with families and youth in ways that honor community wisdom and strengthen outcomes. The first step in building a new Ecosystem of Care must include securing broad, high-level county leadership support for this change and keeping leaders engaged and focused on steering the change process. The interagency leadership structures and functions required by California’s AB 2083 legislation on Children and Youth System of Care are unique among the state’s efforts to improve child and family services–and provide opportunities to broaden and deepen county efforts to create a fully accessible and effective continuum of services for at-risk families and youth. 1 Adopted in 2018, the legislation requires each county to develop and implement a Memorandum of Understanding (MOU) outlining the roles and responsibilities of the various local entities that serve children and youth in foster care who have experienced severe trauma.

Additionally, AB 2083 mandates the creation of an “Interagency Leadership Team” (ILT) in each county, bound by the MOU and charged with coordinating efforts to improve youth outcomes. Although the legislation focuses on youth in the foster care system, many state and local leaders have recognized its required structures as the most accessible interagency effort available in California for connecting child and youth-serving systems more broadly. Simply put, the Interagency Leadership Team is a model for expanded work statewide. As such, many California counties have begun leveraging this leadership team structure to support the essential “vision-structure- function” demand of other systems-change work.

Ideally, a well-established Interagency Leadership Team is positioned to be a central clearinghouse for all Whole Child efforts within a county.

Transforming Together: Implementation Guide

• Engage communities in existing cross- agency efforts . Include youth, families, Tribal leaders, and community voices in decision-making. • Create a shared vision and clarify roles . Help the ILT develop a unified, measurable vision and ensure clear roles, norms, and expectations for how agencies collaborate and make decisions.

This chapter provides suggested actions and tools for county teams to leverage, expand, and align the AB 2083 structure with other existing California initiatives. While AB 2083 offers a common and accessible entry point, the ILT/EAC approach (described below) can also stand alone as an effective organizing structure. In either case, the goal is to help counties design and sustain an Ecosystem of Care for all children and youth, including: • Identify and support a two-tiered leadership structure . Form an Interagency Leadership Team (ILT) to set vision and policy direction, and a second-tier Executive Advisory Committee (EAC) to execute and manage the cross-agency implementation and coordination.

Below is a sample graphic of California’s existing AB 2083 System of Care infrastructure and efforts which, united with aligned California efforts, can be expanded to realize an Ecosystem of Care :

To learn more of each of the above programs, click below:

• Expanded Learning Opportunities Program • BHSA Integrated Plan

• Schools as Centers of Wellness • Families First Initiative/ FFPS • CalAIM

Transforming Together: Implementation Guide

• Facilitating access to one another’s data outcomes and outputs . Sharing data allows partners to measure impact and streamline service delivery. One partner’s programmatic or fiscal impact is often visible in the outputs or “gains” of a partner agency. Note that while many outcomes can be shared and analyzed without any legal concern, some data sharing requires complex agreements or memoranda (which is also why a designated leadership body needs to be engaged in resolving any roadblocks). • Identifying or redeploying financial resources to sustain the otherwise isolated funding within any singular partner agency. • Tapping the wisdom and experience of peer leaders in adjacent departments within the system , who have a view of the whole to augment or clarify county or community needs. This collective wisdom allows a leadership team to recognize and sustain its transformative role. 2 • Co-developing and offering a new, comprehensive array of services and supports –allowing agencies and communities to address various needs collectively, develop the continuum of programs and services needed to keep children and youth at home, in school, and outside of youth corrections. This chapter–and the entire Implementation Guide–regularly refers to a decision-making structure with two separate but intertwined tiers that county leaders can deploy to support creating and implementing a new Ecosystem of Care: an Integrated Leadership Team (ILT) and an Executive Advisory Committee (EAC).

Systems change requires committted and sustained leadership. Collective impact, System of Care, Community Schools, and other research- informed practice approaches provide venues where leaders of partner organizations can develop and maintain a shared vision and goals and oversee cross-agency implementation.

The What Key Components of an Ecosystem of Care Leadership Structure Identify and support a two-tiered leadership structure

Systems change requires committed and sustained leadership. Collective Impact, System of Care, Community Schools, and other research-informed practice approaches provide venues where leaders of partner organizations can develop and maintain a shared vision and goals and oversee cross- agency implementation. We invite system leaders to be actively involved in guiding and sustaining the change process. Shared leadership, supported and anchored in a high-functioning leadership body, is essential for persevering through the numerous obstacles to cross-agency collaboration. Working together regularly, partners can successfully address common challenges such as:

Transforming Together: Implementation Guide

The How Engage in Existing Cross- Agency Efforts An inherent early tension in convening and recruiting an ILT, especially one focused on uniting the broader California children’s systems into one integrated Ecosystem of Care, is deciding who to tap and how large to make the group. The most critical factor in determining a leadership team’s composition is to have those with decision-making authority consistently present in meetings so that trust and shared accountability are built and sustained . But group size and representation can also either restrict or unleash the ILT’s capacity to execute its vision: If too small, the body cannot represent the full scope of need or services; if too large, the team will struggle to make decisions or implement agreements. In practice, most counties have found that an ILT composed of no more than six to nine members representing a diverse set of partners is most effective. Examples of members include: • The director or deputy-level staff from these agencies: Mental Health/Behavioral Health, Regional Center, Children’s Welfare, Juvenile Probation, and the County Office of Education. • Presiding judges: Judges often bring a unique perspective to the system and a unique capacity to influence a leadership team. In moments of difficulty, having a non-county authority to mediate and interpret can bring disparate views between other partners into synchrony. • Native Tribal authorities: California’s most recent System of Care design efforts (and the experience of many counties) point to tribal leaders as essential ILT participants. 3 • Family and youth representatives.

These two leadership groups play important, complementary roles: • The Integrated Leadership Team (ILT) , the first tier of the shared leadership structure, includes agency directors, chiefs and superintendents, parent/youth representatives, and (in some cases) community partner organizations. The AB 2083 legislation charges the ILT to establish a unified vision for the foster care system and ensure that individual agencies and community organizations collaborate to work toward this vision. Pursuing an effective Ecosystem, and any measurable return on investment, will require the county’s ILT to expand its vision to begin addressing the complete spectrum of child and youth service delivery issues and processes for a far larger set of youth in any particular county. The Executive Advisory Committee (EAC) , the second tier of the shared leadership structure, includes managers, deputy directors, and/or other senior leaders of departments or agencies who share responsibility for building the new Ecosystem. The EAC executes the vision of the ILT and manages the day-to-day work and decisions about achieving the county’s vision for Whole Child and community-centered care.

The most critical factor in determining a leadership team’s composition is to have those with decision-making authority consistently present in meetings so that trust and shared accountability are built and sustained.

Transforming Together: Implementation Guide

Directors and agency heads typically sit on the ILT, while deputies, assistant directors, and senior managers from the same agencies sit on the EAC. The examples below illustrate this tiered structure across systems.

• Leaders from other county departments and initiatives that interact with the behavioral health system, such as Human Assistance or Public Health and/or the local First Five Commission; and youth and parents who work closely with or are part of the target population for services. 4

Interagency Leadership Team Executive Advisory Council Role: Establishes a unified vision for the Ecosystem of Care and ensures that individual agencies and community organizations collaborate to work toward this vision Role: Executes the vision of the ILT and manages the day-to-day work and decisions towards achieving the county’s vision for Whole Child and community-centered care.

Sample composition: AB 2083 Signatories: Agency leads, judge

Sample composition: Designated deputies, assistant directors, senior managers from each partner agency

Sample roles: • Director/HHS or social services • Chief probation officer • County schools superintendent • Regional center executive director • Federal tribal representative • Parent representatives • Youth representatives • First 5 director • Court/presiding juvenile judge • Public health director Sample Processes & Functions: • Determining strategy and direction • Overseeing implementation and effectiveness of the system • Reviewing, assessing and responding to advisory team recommendations • Sharing updates with County Board of Supervisors • Ensuring the Operational Agreement reflects current practice

Sample roles: • Child welfare director

• Assistant/deputy chief probation officer • Associate superintendent of schools • Regional center system of care manager • Children’s manager/assistant director BHS/ MHP

• Federal tribal representative • Senior manager, public health • Managed care plan representative

Sample Processes & Functions: • Identifying system barriers and proposing solutions • Reviewing shares practices/policies and recommending improvements • Carrying out ILT directives for addressing trends and gaps in program design • Monitoring system performance through dashboard and other measures • Working to resolve system-level issues

Transforming Together: Implementation Guide

*Note: Roles listed are sample positions meant to illustrate levels of authority, not to imply duplication or role-splitting. Counties without a Health and Human Services Agency structure i.e., wherein public health, behavioral health, and child welfare all report a single Agency Director) should adjust by placing system directors in the ILT and deputies/managers in the EAC.

Equally important is recognizing that shared ownership takes time to develop. Early on, momentum often relies on a single host agency to organize and catalyze action. But over time, as trust builds and roles clarify, the shift toward collective responsibility becomes a critical milestone in the maturation of an Ecosystem of Care. Only when ownership is genuinely shared across ILT members can the system fully realize its potential for sustained, cross-sector transformation. Key Consideration: From Host to Shared Ownership • A host agency is often needed to initiate the work. • Shared ownership across ILT members is essential for long-term sustainability. • The transition from a single “spark” to collective responsibility marks an important stage in the ecosystem’s development. Create a Shared Vision and Clarify Roles Moving beyond collaboration to a genuinely integrated and sustained system of care requires awareness and vision. It demands changed mindsets and a willingness on the part of all partner agencies to behave differently. Leaders are positioned to understand that although authority and resource allocations often attach to a particular role or department, they can and must share the power and resources accompanying the position.

From Host Agency to Shared Ownership A common early question is: who convenes and sustains this work? In practice, counties have taken different approaches. Often, a “host agency”—such as the County Office of Education, the Health and Human Services Agency, or the Presiding Juvenile Judge— provides the initial spark by convening partners and coordinating early logistics. Framing this role as a host, rather than a lead, emphasizes that the host’s responsibility is to create space for collaboration, not to dominate decision-making.

Transforming Together: Implementation Guide

Transformative organizational leadership for interagency work is supported in California by a unique multi-agency document, the Integrated Core Practice Model Guide. This guide documents research-informed leadership behaviors that allow all partners to realize a more unified vision and act with joint accountability.

Through the survey, leaders from child- and youth-serving organizations rate the strength of their relationships with one another on a five-point scale, from co-exist to integrated. These ratings are used to conduct a network analysis and create a map that visually shows the connections between organizations. Lines represent relationships, and thicker, darker lines indicate stronger connections. This analysis provides insight into how strongly organizations collaborate, coordinate, or integrate in supporting children and youth behavioral health. Although responses are subjective and typically limited to the perceptions of a few (though ideally well- positioned) individuals within each entity, it helps start a conversation and illustrate the broader ecosystem that underpins CYBHI in California counties, highlighting opportunities to strengthen partnerships across sectors and build a more connected system of care for children, youth, and families.

Tool Spotlight : The activities to Establish Shared Understandings resource also offers facilitation exercises ILTs can use early in their work to build consensus on vision, clarify roles, and surface assumptions that may otherwise undermine collaboration and progress. Tool Spotlight : The Network and Ecosystem Experiences Survey (NEES) is a tool developed by Mathematica and the California Health & Human Services Agency (CalHHS) under the Children and Youth Behavioral Health Initiative (CYBHI). It is designed to better understand how organizations within the child and youth behavioral health ecosystem connect and work together.

Transforming Together: Implementation Guide

Moving Beyond Managing an Initiative to Leading Full Systems-Change The interagency leadership structure and function–and the Ecosystem of Care it works to develop–has value and impact well beyond any single initiative and should not be contingent on or driven by individual reform or opportunity. It must be institutionalized. Collective, cross-agency leadership facilitates individual agencies in transforming, aligning, and maximizing their deeply interdependent child, youth, and family initiatives and programs. We invite leaders to recognize that this Whole Child approach demands seeing and embracing every reform not as a narrow transaction or initiative between their department and the state or federal funding entity–exchanging dollars for compliance– but as an opportunity to fit the dollars into a continuum of wholeness, intentionally leveraging prior and future initiatives. Moreover, leaders have the opportunity to recognize that vision, structure, and functions to implement systems-change are all interrelated. The ILT cannot just focus on one element alone–its vision should inform and be informed by the system’s new functions; its structures should both hold and adapt in response to the vision; and its functions should be supported by and sustain the vision. The key for system leaders is to see this deep interdependence, and then patiently and persistently adapt their vision, structures and function through ongoing quality control and improvement towards realization of the collective legacy they want for children, youth and families.

Strategies for Building Cross-Agency Leadership and Collaboration In California, most policymakers and agency leaders agree that high levels of collaboration between organizations are necessary for improving systems and family and youth outcomes. However, collaboration and coordination are hard work: They require up-front time to synthesize different goals, assumptions, and approaches into a new, shared approach, and they require ongoing attention and problem-solving as new processes and activities are tested and rolled out. Tool Spotlight : Counties can review the examples of Successful Multi-Agency Collaborations to see how other jurisdictions have structured governance and partnerships. These case examples provide concrete illustrations of what cross-agency collaboration can look like in practice. To begin this hard work of developing a new Ecosystem of Care, agency leaders and ILT and EAC members can consider the suggestions below.

Collaboration and coordination are hard work: They require upfront time to synthesize different goals, assumptions, and approaches into a new, shared approach, and they require ongoing attention and problem-solving.

Transforming Together: Implementation Guide

1 Map and (re)form cross-agency leadership structures. In California, local leaders are required to regularly meet as part of existing state- sponsored or state-funded efforts and initiatives to support the Whole Child, in addition to the explicit engagement requirements from AB 2083. Thus, in naming a leadership group to coordinate the new Ecosystem of Care being created, leaders should first identify, map and connect existing local, county, and regional interagency structures–such as interagency leadership teams, community school teams, Mental Health Commissions, or Accountable Communities for Health–with one another and with parents and youth to form a collective and aligned organizational structure. Specifically: • Identify existing interagency leadership groups already working toward improved whole-child and youth services. Basic functional analysis tools and shared conversations within and across agencies will identify where overlapping efforts and initiatives exist, and where and how they can be reduced and redefined to help advance the work. Tool Spotlight: The Existing Interagency Workgroups resource can help counties map current cross- agency teams, spot duplication, and identify opportunities to consolidate meetings into more coherent structures. • Determine each leadership groups’ purpose, scope, initial objectives, and goals. • Identify participants for the county’s ILT and EAC structure and attend to the meaningful inclusion and participation of youth, families, Tribal experts, and local organizations.

• Invite the various tables/structures, through reporting and advising to the county’s ILT and/or EAC, to identify opportunities and redundancies and increase outcomes for all children and youth. • Evaluate and address the county education office’s unique ILT or EAC representation. County leaders need to adapt the scope of the existing ILT and EAC–or designate new structures–to focus on all youth, not only foster care youth. As these groups adopt and start to act on a broader vision for youth wellbeing, associate superintendents or leads from other parts of the county education agency should join to help design and sustain the work. To effectively build a coordinated and sustainable Ecosystem of Care for all children and youth in California, local leaders can connect and align existing interagency structures rather than continue working in silos (or create new ones). This approach not only fulfills the state’s legal and policy requirements but also leverages current efforts, reduces duplication, and ensures meaningful participation from families, youth, and community partners. By strategically mapping and integrating these leadership groups, counties can create a unified ILT and EAC structure that drives stronger outcomes and delivers on the promise of whole-child support.

Transforming Together: Implementation Guide

Building the Blueprint: How One County Mapped its Cross-Agency Meetings When a new leadership team stepped into place at the Alameda County Office of Education (ACOE), they found themselves As the spreadsheet grew, so did its value. “What it is evolving into is a tool that allows us to look at efficiency and if we’re utilizing

navigating a long list of inter-agency partnerships and meetings to which the office had previously committed. With a new superintendent, a fresh student services division, and many new leaders across divisions, the team wanted clarity about what to prioritize and what collaborative efforts were most critical. “We were really trying to understand the existing landscape around cross-agency work and meetings within the county,” recalled Chaun Powell, Senior Chief of Student Services. “That was really the catalyst for it.” As a first step, team members created a single spreadsheet that identified every cross-system/ cross-agency meeting that they knew existed, which agencies were attending them, a description of the meeting, and which ones they believed required ACOE’s presence. “We sent it out to each of our division leads that we knew led in areas connected to the system of care, or other county agencies (First 5) and had them populate the meetings they were part of,” Powell explained. “Then we still questioned if we had it all.” To fill any gaps, Powell and her colleagues brought the draft to the county’s newly formed Interagency Coordinating Council (ICC), which included leaders from probation, child welfare, social services, and First 5, as well as the county office of education. “We asked them, ‘Do we even have all the meetings here?’” Powell said. “The document evolved into a compilation of all the different cross-systems meetings happening.”

time in the best way possible,” Powell shared. The map revealed redundancies, such as multiple prevention-focused teams working in silos, often with the same attendees cycling through back-to-back meetings. “One day, I had three meetings. I walked into the first one, saw the people, then we all left early for the next meeting— and it was the same people again. Three times in a row. I thought, ‘what is going on?’” This visibility sparked important conversations about consolidation and coherence. For example, the county created a unified health steering committee after identifying duplication among health-related meetings. “We actually used that as a pilot to consolidate,” Powell said. Despite its eventual success, the process hasn’t been without challenges. “We were all new. We didn’t even know if we were talking to the right people,” Powell admitted. Getting others to prioritize the work required explaining the “why”—a critical step she now emphasizes to others. “If I could do it again, I would make the purpose and objectives clear from the beginning and put some real timelines in place.” Now, the spreadsheet is a living tool that continues to evolve. With regional centers and Alameda County Health recently added to the ICC, the team plans to refine the spreadsheet further. “Our next step is to explore opportunities to further simplify the structure where and if it makes sense—to combine more meetings and maximize time,” Powell said. “It’s all about creating coherence and better alignment for our systems (Big S) ecosystem of care.”

Transforming Together: Implementation Guide

2 Build trust and a united mindset through clear expectations System partners find alignment and unity toward collective impact when they trust each other; the greater the trust, the more readily solvable challenges will be. Tool Spotlight: The Activities to Establish Shared Understandings resource offers facilitation exercises that ILTs can use to build relational trust, surface assumptions, and establish common ground early in their collaboration. Leaders can help build trust through the ways they themselves commit and “show up.” Invariably, the trust between professionals necessary to transform a system will demand that leaders understand that accountability and responsibility for children are essential to solving the challenges at hand. How one sees, embraces and behaves toward those in and outside one’s agency has implications for system success. Many integrative efforts collapse when leaders are unwilling to compromise, share power, or recognize the value of the work of other agencies. Authentic alignment of vision and purpose does not occur without this transformative mindset effort. Many integrative efforts collapse when leaders are unwilling to compromise, share power, or recognize the value of the work of other agencies. Authentic alignment of vision and purpose does not occur without this transformative mindset effort.

Specifically: • Set the expectation that all partners commit to being responsive with their communications, attending meetings prepared, engaging during and after those meetings, and keeping their commitments. • Identify necessary conditions for systems- change work to be successful in the county. Although public systems are often not well-funded to conduct the “pre-work” of collective effort, leaders still must invest in determining if their respective agencies are “ready” to share responsibility, risk, resources, and rewards. Each partner should conduct a readiness determination by engaging in an honest and transparent dialogue, both internal to the organization and external with partners. • Establish a clear, shared vision (and eventually goals and objectives – more on this in Chapter 2) to guide leadership team deliberations and decisions. Consistent attention to the reality that all youth within the county deserve the most robust, accessible, effective support possible and that the system partners have an aligned set of goals is critical to that end. This clarity of collective purpose, intent, and outcomes can become the organizational glue of the partnership. Vision alone, absent the capacity to measure that vision’s impact, is unsustainable.

Transforming Together: Implementation Guide

• Agree to disagree. Some issues may not be solvable immediately regarding being and doing things together. At times, people must put problems aside to move on to areas of shared interest. However, it is equally critical to record those disagreements for future conversation so the team can revisit and resolve them later. • Create healing-centered spaces with grounding exercises and community care opportunities. Establish safety protocols including community members’ right to pause conversations that become re- traumatizing.

Transforming systems to better serve children and youth requires more than structural change—it demands a united mindset of trust, shared accountability, and a willingness to lead with humility and collaboration. Without these conditions, even the best-designed partnerships fail. When leaders commit to showing up consistently, sharing power, and aligning around a common vision for children, youth and families, they create the foundation for genuine collective impact and collective legacy. This mindset shift is not optional; it is the catalyst that enables agencies to move toward unified, sustainable solutions for all youth.

Transforming Together: Implementation Guide

Including Youth, Families, and Community Experts in County Leadership Teams California has rich resources and supports that provide an endless font of wisdom and living experience supporting shared leadership. Parents and youth with lived expertise can be found in all parts of the ecosystem and may be particularly present in local community-based organizations. Many systems use titles such as Peer Navigators, Cultural Brokers, Parent Partners or Youth Advocates, and in many cases, these experts’ capacities are grounded in and supported by evidence-informed practices, such as Promotoras or Promotoras de Salud. Authentic inclusion of parents, youth, and community experts requires attention to many factors. Research suggests that these guidelines can be helpful when forming or strengthening ILT and EAC efforts to ensure they include a broader community perspective: 5 ● Establish shared decision-making responsibility with youth, parents, tribal representatives, and community experts who have equal power in setting priorities and making decisions; ● Identify where partners in the system are already present and meaningfully incorporating parent and youth voices regarding system quality improvement and leadership. ● Identify potential revenues to expand and fund parent and youth voices in county system leadership (See Chapter 4 for additional details about shared governance funding). ● Adapt or create job descriptions for parent and youth participation and roles. Please see here for examples of Parent and Youth Job Descriptions. ● Identify potential persons with lived experience in the county/region/systems who, with proper support, might be interested and able to join the leadership team. ● Adapt agency processes to honor community communication styles and decision-making approaches. Provide training for agency staff on how to participate respectfully in community-led conversations and gatherings ● Develop a means to collect, analyze, and act on, in an ongoing way, youth and family input about the efficacy of the county/regional ecosystem towards identified shared goals and outcomes. ● C 6 reate a consistent method to orient youth and parents as they assume responsibilities and roles in the leadership structure. ● Community voice should be present from the very start. They should be included when determining the leadership groups’ purpose, scope, initial objectives, and goals. ● Ensure equitable and appropriate compensation for time, expertise and emotional labor; critically examine what the equity practice can and should look like in this compensation model. ● Ask: How do meeting formats, timing, and decision-making processes accommodate different cultural approaches, including Indigenous talking circles, African American call-

and-response dialogue, and Latino plática conversation styles? For additional guidance on Shared Governance, see Chapter 2.

Transforming Together: Implementation Guide

Including Non-Government Agencies and Community Organizations/Service Providers in County Leadership Teams In addition to the voices and wisdom of youth and parents, the ILT and EAC should amplify their work in partnership with key contractors, community-based organizations, and other non-government agencies. Interest holders should co-design the nature and scope of the public-private partnership for a whole-child system, and they can operationalize it in a few ways. Tool Spotlight : The Examples of Successful Multi-Agency Collaborations resource showcase ways counties have engaged CBOs and service providers as full partners in governance, offering models for shared accountability and public-private alignment. Having non-government entities as signatories to an MOU and active in a shared leadership agreement (or potentially having voting power if that is the decision-making model) can introduce complexities that require all partners to adapt. As mentioned above, all partners in the ecosystem must begin with a shared mindset that prioritizes improved outcomes for children, youth, and families. Individual agency and/or organization expectations or interests regarding who will do what in supporting children, youth, and families should not be primary drivers of the ecosystem design and/or implementation. Some ways to meaningfully achieve this desirable public-private leadership structure include: ● Incorporate CBO agency leaders as routine attendees, either as guests or participants in the work. Clarify their expected roles (and influence) early on and document these expectations in any system-wide agreement documents and in practice. ● Encourage CBO partners or contractors to submit annual or semi-annual reports to the ILT or EAC, sharing updates regarding the efficacy of programs, outcomes, impact, and community perspective. ● In larger counties, identify an informal CBO “liaison” who can attend the EAC or ILT meetings and participate and support the process. Liaison voting status should depend upon the structure of the community build. ● Establish semi-annual retreats, where the systems leaders and community partners spend time in strategy and dialogue to foster alignment and measure impact toward their shared goals, outcomes, and intentions. These longer engagements can provide rich opportunities to align visions and create shared solutions that enrich the entire ecosystem of support.

Transforming Together: Implementation Guide

Including Non-Government Agencies and Community Organizations/Service Providers in County Leadership Teams Existing county ILT/EAC structures across California do not always include education leaders, or, if they do, these leaders do not always represent or are not fully informed about the significant change work happening in schools to use CCSPP funding to expand necessary supports and services to more students. Given the strong alignment between the goals of California’s CCSSP and CYBHI efforts and the importance of smartly leveraging the funding these two programs provide communities, educators must be substantively involved in county ILTs and EACs. Ideally, system of care partners or non-education county agency leaders take the first steps to invite and engage education and community school leaders into county ecosystem leadership teams if the ILT or EAC does not reflect these perspectives. However, education agency leaders can also take proactive steps to become more engaged in cross-county agency deliberations and planning. These activities could include some of the following approaches: ● County and LEA Community Schools (CS) designers and developers/grant seekers can communicate their plans, progress, needs assessments, asset/gap analyses, and any early wins/milestones accomplished to their ILT or EAC teams. Ideally, whether official members of the ILT or not, county and district leaders should regularly present updates to system partners and request processes for ongoing sharing of information. ● County and LEA CS representatives can invite ILT members to develop a singular Release of Information or Authorization to Release or Disclose Information form for all schools and county partners. ● LEA programs should engage County Office of Education ILT representatives to seek a seat within the System of Care planning and oversight function. ● ILT/System of Care leaders should look for funding streams already allocated to or intended to support local schools and commit to long-term sustainable streams (opportunities include BHSA, JJCPA, Medi Cal/Short Doyle, etc.). [See Chapter 4 for additional guidance in this area.] ● Community Schools coordinators and county Medi-Cal budget personnel can work together to identify how the CYBHI Fee Schedule Program and other Medi-Cal expansion can help strengthen and sustain CS efforts to expand behavioral health services. [See Chapter 4 for additional guidance in this area.] ● S 7 ystem of Care leaders should invite their other contractors to engage and be aware of opportunities within the Community Schools development, to co-locate or leverage resources within or aligned with the CS efforts in that school.

Transforming Together: Implementation Guide

3 Update interagency agreements and MOUs to reflect the new, broader vision for all children and youth As described above, AB 2083’s required inter- agency MOU and formal and informal multi- agency agreements required by other state initiatives can be adapted and expanded to reflect a county’s new, broader aspiration for all children and youth in the County. The AB 2083 interagency MOU for System of Care outlines the intent and commitments of the participating partners in improving and coordinating family and youth services. This MOU also should capture the work of the ILT and EAC specific to the county, which may include revision of, consolidation of, and/ or alignment with existing interagency table agreements. In cases where an existing AB 2083 MOU is weak, underused, or overly legalistic, consider creating a new MOU. Samples and suggestions from other counties are readily available (see sidebar for some recommendations). Importantly, some form of agreement is needed to specify the shared vision partners are committing to and to identify the key functions each partner will be pursuing. When well written, the MOU aligns vision, identifies key functions and processes, and clarifies how to administer those functions and processes jointly.

Example

Santa Clara County adapts AB 2083 ( linked here ) in support of Whole Child/ Whole Student Integration When Santa Clara County departments and their partners serving children, youth and families began exploring a deepening of their partnership toward a more integrated system to support children and families, they looked to the Memorandum of Understanding (MOU) and emerging Interagency Leadership process required by California’s AB 2083 legislation as a model that also could help advance their overall vision for improving services for all families and youth. “We were already doing the visioning and collective work,” explained Patty Ramirez, a longtime leader of the effort. “So when AB 2083 came about, it was like, yes—let’s use that model to put on paper what we’re already doing.” In 2008, the county’s Board of Supervisors called on agencies to come together to better support children. They commissioned a new Cross Agency Service Team (CAST), a collaboration of county departments, school districts, community-based organizations (CBOs), and other partners. Together, they had sought to develop a strong partnership to serve children and families better; the work has evolved to what is now the vision of creating a “no-wrong-door” system of care. This work intentionally mirrored local schools’ Multi-Tiered System of Supports (MTSS) framework and was deeply influenced by systems change thought leaders like Peter Senge. “That foundational work is what allowed us to even envision what this work could look like,” Ramirez noted.

Transforming Together: Implementation Guide

The process of expanding the AB 2083 required MOU took time—nearly five years from the initial drafting to full implementation. “It has taken years to have all the agreements in place and to finalize our operational manual,” Ramirez said. “Now we’re in the early implementation phase of our agreements.” The MOU is held together by a shared vision, clearly defined agreements about interagency functions, and a strong commitment to collective accountability. County departments, including behavioral health, social services, probation, public health, First 5, the office of education and the San Andreas Regional Center all played key roles in its development. They were joined by parents and youth whose lived experience helped shape the work. “We even pay parents and are now working to bring in youth voice through paid internships,” Ramirez shared. However, sustaining alignment is not without its ongoing challenges. “There’s this constant creative tension,” Ramirez explained. “If we don’t hold tightly to the vision, people fall back into their silos—especially when new policies or budget pressures emerge.” To help address these tensions, the team revisits its shared logic model, holds regular retreats, and starts each agenda with a reminder of the shared goals. Looking ahead, Santa Clara’s ecosystem continues to evolve their MOU as new partners come to the table, including managed care plans. “At first, they weren’t part of the work,” Ramirez said. “Now they are, and they’re sharing data and identifying how we can help connect families to the services they offer.”

For other counties considering a similar path, her advice is simple but powerful: “Start with trust. Build relationships. Define your vision and your terms—even if it takes six months just to agree on what ‘prevention’ means for example. And take the time to build your blueprint. Don’t try to build the plane while it’s flying.”

Transforming Together: Implementation Guide

4 Establish and sustain recurring system operations and meeting norms Regular meetings of key partners are essential to keep efforts on track. They provide space to recommit to a shared vision, resolve disagreements, set next steps, monitor progress, hold partners accountable, and celebrate successes. Well-planned and well- implemented meetings of the key partners and leaders in the county are an essential mechanism for keeping the work moving.

Tool Spotlight: This Project and Implementation Tool can be used to help assess and track progress in your integrated system transformation or ecosystem. Tool Spotlight: The Ecosystem Action Plan below offers counties a month-by-month roadmap to guide meeting agendas and keep leadership teams focused on concrete steps. By linking recurring meetings to clear deliverables, the plan helps ensure discussions translate into action.

Transforming Together: Implementation Guide

Although not glamorous, how meetings of county leaders and partners work in practice– and what happens before and after meetings– is essential to achieving any success. Specifically: • Commit to frequent meetings–ideally monthly–for both the ILT and EAC. With the many commitments and busy calendars of leaders, it may be tempting to suggest that county ILT and EAC groups can meet just quarterly or even semi-annually. However, cross-agency collaboration experience in California and other states indicates that more regular and consistent meetings are a hallmark of successful systems-change efforts. This guidance is invaluable during the early months (or years) of design and implementation, when teams are working out key issues (and disagreements). If ILT members cannot meet every month, the EAC team must be empowered and supported to take on more responsibility (and decision-making) for transforming the system. • Call meetings by the right name. Name the meetings in ways that support the “wholeness” they are cultivating, as well as the connection of the system. Use nomenclature that supports the focus on creating a fully connected Ecosystem of Care, such as “Children and Youth Ecosystem of Care ILT” or “Children and Youth Ecosystem of Care EAC,” rather than “AB 2083 meeting” or “ILT meeting,” which can create confusion and lack of clarity on calendars. • Follow-up and follow-through. County leaders should ensure meeting routines (and responsibilities) support consistent and timely follow-up with minutes, lists of key decisions or next steps, and other reminders after meetings, as well as timely agenda creation and distribution before meetings.

Effective meetings are not just logistical necessities, they are the engine that drives sustained, coordinated systems change. When held regularly and designed intentionally, meetings help build momentum, foster accountability, resolve conflict, and reinforce shared purpose. Without consistent, well- structured engagement, even the most ambitious plans stall. Leaders who prioritize meaningful meeting practices—before, during, and after—create the conditions for trust, clarity, and collective action, ensuring that the Ecosystem of Care for children and youth continues to evolve and deliver real outcomes. 5 Use staffing strategies to reinforce the system’s collaboration How agencies delegate and deploy managers and staff to support the ILT, EAC, and cross-agency decisions is an opportunity to strengthen collaboration. Specifically: • Adapt or create roles/job descriptions for the ILT and EAC leadership team–clearly outlining the overall functions of the ILT and EAC, as well as the roles of each member. Designate the roles of lead participants, backup participants and any other key leaders who are not regularly part of the ILT or EAC. • Share recruitment, training, coaching, and supervision of staff. For example, ILTs in some California counties share hiring, recruitment, and orientation of key staff, even agreeing to form hiring panels for managers and directors from different agencies to inform each other’s recruitment efforts and ensure alignment with the overall, cross-agency vision for change.

Transforming Together: Implementation Guide

6 Pay attention to administrative support How counties staff and support their ILTs and EACs directly impacts the success of cross- agency collaboration. Thoughtful delegation, co-location, shared hiring practices, and aligned training are not just administrative choices, they are strategic actions that build trust, reinforce shared accountability, and bring the vision of a unified system of care to life. Even well-intentioned efforts can falter without the right people in the right roles, equipped with a shared mindset and common tools like the Integrated Core Practice Model. Effective staffing is the infrastructure that sustains momentum, breaks down silos, and ensures children and families receive timely, coordinated support. • Identify support persons who understand the county’s overall goals for change and coordination, possess the perspective and skills to interface with other busy administrative leads/contacts of ILT and EAC members, and can take responsibility for maintaining a shared set of files. These roles can be rotated or shared by all partners. • To help further supporting cutting through any perceived silos, cross-train and orient support staff to the vision of the leadership team. For example, some counties have created “System of Care Desk Guides” for their key support staff. • Identifying capable administrative and operational support professionals to provide meeting support and informational linkages between ILT partner agencies is critical to ongoing success. Consistent and regular agenda creation, calendaring of meetings, capturing of minutes, and follow-up tasks of the partners or meeting attendees are significant to establishing an “identity” for the system.

• Co-locate teams. When county staff from different departments are co-located or work closely with one another, decisions, supervision, and cross-team training can be both cost-effective and contribute to ensuring seamless and shared outcomes. Co-locating staff in cross-functional units and working teams has a powerful impact on how team members see and embrace their shared obligations for children and youth, breaking down informational and organizational bureaucracies that impede the effectiveness or timeliness of care. • Use the state’s Interagency Core Practice Model for children and youth (ICPM). While most partners may have existing practice model guidance, there can be conflicts in those practices’ theories, values and purposes. California has a unique ICPM Guide, which intentionally synchronizes and aligns the system of care into a uniform core practice model and provides a universal language and frame for teaming and engagement. A single, multi- agency model can prevent program drift, maximize resources, and ensure consistent practices for families that touch more than one service sector. Local ILTs are critical environments through which to oversee and coordinate the use of the ICPM.

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