Cross-System Services & Supports

RCCMHC provides care team coordination, whole-family supports, and therapeutic supports for families with complex needs or multi-system involvement, families experiencing barriers to service, underserved, under supported and marginalized families.

Our Objectives

1) Enhance coordination and reduce duplication across systems, 2) Increase access to therapeutic supports- especially service gaps, 3) Improve school attendance; improve youth mental health symptoms, 4) Reduce use of emergency services or out of home placement related to youth mental health, and 5) Reduce adverse family experiences (caregiver stress, unemployment, delayed medical care, eviction or homelessness, inability to afford expenses etc.)

Population of Focus

Youth must live in Ramsey County or be affiliated with a school district in Ramsey County.
Qualifying youth must have a mental health diagnosis or must be struggling with emotions/behaviors that may put them at risk for a mental health diagnosis in the future.
Youth who would benefit from a "whole family" care-team approach. In particular: families with complex needs or multi-system involvement, families experiencing barriers to service, underserved, under supported and marginalized families.

Our Approach

Our overall approach to Cross System Services and Supports was developed by local families/community and is grounded in the Whole Family approach to wellbeing.

The Whole Family Approach is a term that our families started using back in 2013. It was described in our documentary film Children's Mental Health: The Whole Story as a multi-generational service approach built on the
understanding that children live, grow, and thrive in families. It is supported by DHS through the MN Whole Family Systems Initiative as an evidence based practice.

Key elements of this philosophy are: 1) Families can be a source of risk and resilience, 2) One size does not fit all, 3) Services are individualized, flexible and holistic, 4) Child and adult service systems work together.

Our Care Coordination and Therapeutic Services are aligned with the following research-informed approaches and best practice recommendations:

Teaching Families to Fish: How to Support Families as Care Coordinators recommends that care coordination services should be purposely designed to support families’ preferred role as principal care coordinator.

Evidence- based mental health interventions for youth and families. Practice Wise, American Academy of Pediatrics (under age 5), MN's list of evidence based services

Our approach to Youth and Family Screening is based on A Strengths-Based Approach to Screening Families for Health-Related Social Needs (Center for the Study of Social Policy; 2018)

Six recommendations include: 1) Involve families and communities in the development of screening tools and protocols. 2) Screen for both risk factors and protective factors. 3) Set person-centered screening priorities within the universe of health-related social needs. 4) Ensure that screening is conducted by care team members trained and supervised in strengths-based approaches. 5) Recognize that screening for health-related social needs is not risk-free for families, and proceed accordingly. 6) Acknowledge family-level risks and strengths in a broader historical context

Initiatives and Programs

Multisystem Care Team Coordination and Whole-Family Support

When more intensive support is needed, RCCMHC's Family Support Specialists and Peer Coaches provides free direct services for the whole family.

Youth and family psycho-social screening, comprehensive resource navigation, appointment setting, Care Team Coordination, Resilience Coaching
Care Teams include collaboration with schools, county, local therapeutic service agencies, hospitals and primary care, youth and family service agencies, and basic needs providers.
Tools such as our "All In One Place" Family Care Organizer and Multisystem Care Plan.

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Therapeutic Services

School Linked Mental Health cooperative agreements increase access to Rapid Access and short-term therapeutic services for RCCMHC client families.
Our Nonbillable Services Bank is a first-come; first served funding source for local agencies working across systems to fill specific service gaps as identified by the Governing Board.
Innovative Service grants support and identify effective practices that address existing gaps or emerging mental health needs for youth and/or families in Ramsey County.
RCCMHC is exploring other ways to increase access to therapeutic services such as vouchers for underinsured families or mental health supervision for school MH-SPED benefit etc.

Ramsey County Children's Mental Health Collaborative

Working across systems and with families to support children's mental health.