Department of Human Services

Transition Specialist Design Event

Transition Troopers February 24 through February 28, 2014

Sponsors

Mike McInroy and Dawn Turner Social Work Administrators

Department of Human Services

Transition Troopers Jan

Team Members: Holli Miller, DACFS Policy; Kathy Berns, Northern SA TPS; Tai Brooks, Eastern SA TPS; Teresa Jacobs, Cedar Rapids SA TPS; Jan Huff, Des Moines SA TPS; Kim Marks, Western SA TPS; Doug Wolfe, DACFS Policy; Lisa Hamar, Northern SA Ongoing SWCM; Ann Williams, Des Moines SA Supervisor; Steve Sherman, Northern SA Supervisor; Joanie Havel, Youth Policy of Iowa; Wendy Havemann, ISU Trainer for “Dream Team” Process

Facilitators: Matt Haynes, Quality Improvement Bureau; Ann Hogle, Quality Improvement Bureau

Scope Joanie

Design a standardized, efficient, and clear statewide role for Transition Planning Specialists (TPS), serving on behalf of eligible DHS youth from the time they turn 16 years of age until the time they become ineligible for DHS services, to include any prioritization of cases and tracking process.

Goals Kim

• Develop a finalized implementation and communication plan by 5/1/2014

• Provide statewide training/communication regarding the new process by 7/31/14.

• Fully implement the new process, guidance materials, data capture tools, etc. by 8/1/14.

Objectives Lisa • Develop a process that timely and effectively promotes

all eligible youth be provided meaningful transition planning fundamentally based on their input, develop a secure sense of permanency, develop informal supports, and be provided necessary services and connections to aftercare options.

• Streamline any and all processes/procedures we can and clearly detail standardized steps.

• Document the new process in map and text formats to use for reference immediately following the Design Event.

Objectives Lisa • Clearly define and prioritize standard responsibilities and

expectations for all TPS’s statewide, to include any assistance provided to Case Managers and the development of community resources.

• Explore possible implementation of assessing and prioritizing cases eligible for transition planning to ensure those with more significant barriers to permanency do not fall between the cracks.

• Improve communication with both internal and external partners, ensuring TPS’s serve as transition planning experts and liaisons in their own Service Areas.

Objectives Lisa • Develop standardized communication and guidance

documents related to the new process.

• Clearly define the role of Policy and their interface with TPS’s.

• Explore the development of a centralized Transition Planning SharePoint.

• Review the current design and use of the TPS Tracking Log in SharePoint, making changes to design and protocol as necessary.

Objectives Lisa • Develop a communication and implementation plan for

the new process and expectations.

• Develop a Field supervisory structure to ensure the new process and expectations are implemented and sustained statewide, to include oversight of TPS, Social Work Case Manager, and Social Work Supervisor expectations.

Clear objectives

Team process

Tight focus on time

Quick & simple

Necessary resources immediately available

Immediate results (new process designed by end of

week)

Kaizen Methodology Matt

• Trends • Legislators listening to youth – more laws • Youth driven plans • Age 26 – Average transition age • ACA • More troubled teens • Increase drugs and trauma and mental health cases • New federal mandates (unfunded) • Adult mental health systems in constant change (how to handle) • Integrated Health Homes • Takes 2 years to enact Federal mandates • Data should drive decisions – is it accurate? • Technology – i.e. mobile apps – social media • Misinformation on Web • Relationships more fluid (supports)

Trends Holli

S = STRENGTHS W = WEAKNESSES O = OPPORTUNITIES T = THREATS

SWOT Ann

• TPS’s • YTDMs • Changing and adapting to meet youth’s needs (engagement) • More resources – stipend, ACA to 26, After Care, AMP, ETV, Foster

Care Grants, Dream Team • SW more aware of transition planning • Judges becoming more aware of transition planning • Better at connecting children to adult services • CRSA APPLA workers (specialized) • Polk Adoption better at transition planning • Legal Aide helping in WSA, more awareness overall • Community Awareness is increasing • DHS Better about asking for other’s help

Examples of Identified Strengths Doug

• SWCMs too high caseloads – No time to transition plan – No expertise in transition planning – Not enough in APPLA workers (Only CRSA 25 case max)

• Court system not involved • Unable to work with education system • Kids leave care without diploma/GED • SWCMs not trained to present transition planning to youth

– Regs change continually – Adult services changes – Inconsistencies in counties

• Out of state PMICs (lack of in-state services) – Kids on sex offender list

• Inconsistent practices with transition planning across the state • JCO is ½ of this population

Examples of Identified Weaknesses Doug

• JCO and DHS Consistency in transition planning • Explain to the child welfare system what the transition planning

specialist’s role is • Clarity of roles • Simplify for youth • Youth always are the center of transition planning – a voice • SWCM and TPS work better together

– Decrease frustrations both ways

• Transition planning is NOT AN AFTER-THOUGHT • Supervisor’s engagement – supervised by one person? • Not just DHS (educate the courts, supervisors, ,providers, and

foster families, etc.) • Transition planning happens 100% of the time – build upon the

number that occurs, starting with the age of 16

Examples of Identified Opportunities Doug

• Continued animosity between SWCM and TPS • Retention of SWCMS/TPS • Not listening to TPS

– Youth lose out – Fall through the cracks – Homeless youth – In just system – Not connected to adult services – Not eligible for PAL, etc.

Examples of Identified Threats Doug

• TPS having more contact with youth • SWCMs do not have enough time • More training for SWCMs/providers/JCS/Supervisors due

to lack of knowledge • TPS take over (all of it) • Improve Part C/Transition Plan • More Emphasis on Dream Teams • More checklists and desk aides/guidelines • More understanding about the SAL program and desk aide

for system entry • Start transition planning earlier at age 16 • Specialized worker outside of the TPS that holds more

knowledge and focuses on these youth

Survey Themes Tai

Examples of Brainstorming Ideas Wendy

Training/TPS role

• Regularly schedule visits to local offices to present transition planning information and staff cases

• Promote community events for transitioning youth Youth-Centered Meetings

• Starting at 16 – offer youth-centered meeting to every youth and schedule follow-ups

Assign one supervisor for all TPS and have a lead SWA assigned/SWA sponsor for Transition Planning.

• A SWA is assigned to transition (1 SWA to supervise all TPS) (someone that is passionate about Transitioning

• Identifies – Impact to

customer – Difficulty

implementing

• Helps to rate/ rank solutions to resolve issues while identifying ease of implementation

I III

II IV

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M

P

A

C

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De-selection Process Wendy

D I F F I C U L T Y

New Process Teresa and Kathy

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Timeframes – Communication Plan Ann

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SBT Approval of recommendations – March, 2014 Training materials developed – by May 1, 2014 TPS/SWCM train supervisors – in May, 2014 TPS/SWCM train at unit/team meetings within the service areas – in June and July 2014 (TPS/SWCM will travel to these meetings) Complete roll out - by August 1, 2014

Homework Doug

Item Description Person Responsible Due Date

1 TPS will create power point and handouts explaining TP process and timeframes for SWCMs and JCOs - for training. Ensure in training that sups really develop a sense of what goes into transition planning for youth – not just compliance with elements. TPS to develop training for providers to include expectations. Train field regarding how to enter Casey Life Skills assessment. Explain the role and expectations of Aftercare Preplanning Services to SWCMs and JCOs in training. Training will include connection to Adult Services and timeframes. Communicate availability of tools and resources to field. What are the elements of a GOOD TP, no matter where it resides? Train providers on how to use CLSA to help work with youth on areas of need and provide resources. Need training for workers and supervisors as to when to apply for waivers.

TPSs 4/30/2014

2 Group Transition Committee into regions to minimize the number of review teams. TPS will discuss in their Sas with Sups, etc. TPSs 5/1/14

3 Tweak communication and implementation plan. Check with SWAs regarding when best to rollout. Steve/Ann 5/1/2014

4 Revise TIP binder, provide in different formats (hard copy, flash drive), get youth input on new TIP binder TPSs 12 Mnth

5 Develop a checklist for file (on youth 16+) - the one utilized by SWCM and SWCM sup to track required activities. (Ensure checklist includes requirement of 90 days prior to 18 to conduct TP review and changes as needed), TPS/SWCM will review scenario sheets with youth. Address Health Care Proxy issue.

Steve/Kathy 30 Day

6 Update Eligibility cheat sheet to include E-MIYA for TPS and case managers. Holli/Doug 30 Day

7 Create Practice Guide (Blue Sheet) for field on transition - contact Margie. ("benefit to caseworkers" as part of it), determine what qualifies under “youth centered meeting.”

Ann 30 Day

8 Youth friendly handout with scenarios. Kathy 30 Day

9 Standard language in initial/followup email reminder to SWCM and Sup. Kim 30 Day

10 Standardize email that notifies folks to prepare for TC review. Teresa 30 Day

11 Ensure TPSs develop (training) solid understanding of MH redesign, role of CPCs, waivers and waiver contacts, Joint Tx Planning Conferences, Magellan supports. Ann will discuss this with TPS Sups.

Ann 30 Day

12 Ensure upper management understands importance of specialized worker worker. Further define specialized worker recommendation.

Doug 30 Day

13 TPS advises to build and test system. Matt 30 Day

Team Member Experience

Teresa Steve Kathy

Comments

Matt Haynes Lean Facilitator - Lead, Department of Human Services, Bureau of QI

Ann Hogle Lean Facilitator, Department of Human Services, Bureau of QI

We welcome your questions and comments!