December 15, 2011 Volume 8, Issue 22

ACHSA ACHSA Mid-Month BulletinMid-Month Bulletin

Inside This Issue (click to go directly to the article):1. ACHSA Child Welfare CEO/ED Forum Dialogue with Interim DCFS Director

Philip Browning2. ACHSA Hosts Major Meeting with Los Angeles County SELPA Directors on

AB 3632/AB 114 Transition Plans and Challenges 3. A Morning of MAT: DCFS and DMH Convene Countywide MAT Providers

Meeting4. DMH PEI Team Visits ACHSA Children’s Mental Health Policy Committee 5. A Wave of Information: DCFS Title IV-E Waiver Update to Board of

Supervisors6. Learning from Jason K. to Implement Katie A. : Tim Penrod Meets with

Mental Health Providers at DMH Child Welfare Division Training 7. Child Welfare Nuts & Bolts 8. Mental Health Odds & Ends 9. Upcoming ACHSA Meetings & Events

NOTE: the ACHSA Update will be on a winter break hiatus until January 15th. Happy Holidays!

ISSUE BRIEFS & UPDATES

ACHSA Child Welfare CEO/ED Forum Dialogue with Interim DCFS Director Philip Browning

On December 9th, ACHSA convened its Child Welfare/Juvenile Justice CEO/ED Forum to discuss key issues of importance for ACHSA members and ACHSA’s ongoing relationship with DCFS with Interim DCFS Director Philip Browning. As reported in the November 1 st ACHSA Update, ACHSA’s child welfare Board members had convened a smaller meeting in early November with Philip and key DCFS managers including Deputy Director Rhelda Shabazz, Division Chief Karen Richardson, and Special Assistant Tish Dennis to provide an overview of the Association and to initially address some of the same concerns raised at the forum. Below is a summary of the significant issues discussed during the CEO/ED Forum.

Philip Speaks to Current DCFS Priorities

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Philip opened the conversation by admitting that DCFS has struggled to move forward with a number of activities due to the numerous changes in leadership over the last number of years.

He reported that the current priorities for the Department are: 1) the Title IV-E Waiver; 2) the Katie A. litigation; 3) preparing for AB 12 implementation for youth aging out of the foster care system; and 4) the development of a strategic plan, which is currently underway. Philip maintained that a Strategic Plan is essential for DCFS as it prepares for the arrival of a permanent Director and he is hoping that the Plan will be finalized by February of 2012.

Philip apologized for the fact that providers were not immediately included in the strategic planning process. He encouraged ACHSA and those in attendance to submit recommendations as to what should be addressed in the Strategic Plan as soon as possible, commenting that if something is important for DCFS to do in the future it needs to be included in the Plan.

Philip reported that the Department’s most pressing current issues are the Title IV-E Waiver and Katie A. The Katie A. Quality Service Review panel met on December 8th to audit several counties with regards to their approach of the terms outlined in the Katie A. settlement. The panel, Philip noted, criticized Los Angeles County for the large number of children currently residing in group homes. Los Angeles County currently has 175 children under the age of twelve placed in a group home facility. There is a strong push from the panel to reduce those numbers as soon as possible.

Bob Ketch of Five Acres commented that roughly one-third of the 175 children Philip alluded to are placed at Five Acres. Most of those kids, Bob noted, have had multiple psychiatric hospitalizations prior to being placed in a group home. Bob commented that the problem for most group homes is that they do not have the support that they need to transition the child back into the community and into a permanent family.

Other providers expressed similar sentiments, noting that there are children under the age of twelve for whom group home placement is essential and is, in most cases, the last resort.

Bruce later commented that it was important to remember how far DCFS has already gone to reduce the number of children in residential placement, that group homes were and would continue to be an important part of the continuum of care, and that decisions about the best placement for all foster youth must continue to be made on the individual needs of those youth.

Discussion of Group Home Placements Leads to Conversation About Importance of Aftercare

The discussion of reduced group home placements and shorter lengths of stay led Bruce to remark about the importance of aftercare services for

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youth leaving out-of-home care. He mentioned ACHSA’s recent Board meeting discussion and proposal

about promoting six months of aftercare services for every foster youth leaving care. ACHSA has already received support for this concept from the County’s Self-Sufficiency Workgroup, and is planning to make a presentation before the Children’s Commission on this subject in January.

Philip’s response was very supportive, and he spoke about his similar experience with six months of aftercare services in Alabama.

Update on Mandatory Dual Certification Previously, ACHSA had been told that the Board of Supervisors (BOS)

had agreed to eliminate the mandatory dual certification requirement for Intensive Treatment Foster Care (ITFC) families, and ACHSA had been asked to hold off on its advocacy to have it apply to all foster families. At the forum, however, Philip reported that the BOS approved that certain requirements be waived for ITFC families but simultaneously revised the recommendation to state that some adoption criminal clearances must continue. He emphasized that there continued to be a lot of confusion related to this issue, and criminal clearances specifically, on the part of the BOS.

Bruce informed Philip that ACHSA plans to conduct a thorough investigation into the nuances of the clearances required for certified foster families and adoptive families. Bruce noted that if there are found to be distinctions, ACHSA will work with Karen Richardson to put into place contract requirements to ensure the same level of safety related to foster parent clearances are there are relative to adoption clearances. AB 12 is a Priority, But the County Remains Unprepared

Philip reported that the County is currently reviewing 6,400 Kin-Gap cases to determine if they are eligible for federal funding. At the beginning of the year, it was anticipated that 80% of all Kin-Gap cases in the state of California would be federally eligible after the conversion. The number is actually less than half –roughly 45%.

Since funding for AB 12 is contingent on the amount of savings realized through the conversion of Kin-Gap cases, the Board of Supervisors (BOS) is now concerned that the County does not have the funding to provide an extra year of care for current foster youth. Philip noted that, as a result of realignment, DCFS does not anticipate receiving additional funding. There are large concerns within the Department that much of the funding will be provided to Probation or the Los Angeles Police Department to handle the influx of prisoners being transferred to the County.

Rhelda reiterated that the DCFS is working tirelessly to ensure that the Department is able to provide services to these youth when AB 12 goes into effect on January 1st.

When asked about the future of the THP-Plus program, Rhelda noted that

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$2.1 million has been set aside to fund a total of eighty-four beds among twelve providers.

Providers expressed frustration with the Department’s mismanagement of the THP-Plus program over the past year, alluding specifically to the fact that DCFS forced providers to cut the number of beds allotted for the program only months after advising them to increase the number of available beds. Providers urged DCFS to keep in mind that it is, essentially, the youth who suffer as a result of poor management as they are left without placements.

Philip admitted that he did not know enough about the situation to address it at that point in time but acknowledged that communication between DCFS and providers needs to be strengthened so that both entities are able to provide for the population that they are intended to serve.

ACHSA Expresses Concerns about Input into DCFS Documents and Philip Agrees Transparency and Collaboration are Key

Bruce noted an ongoing issue with DCFS related to the Department’s Contract Section which, he stated, has essentially gone “rogue”. As reported in the November 1st ACHSA Update, Philip was informed that contracts have been developed that contain language inconsistent with what the program model is supposed to look like. More often, contract language is developed without prior adequate input from providers into what the program model should be. Charles Rich of David and Margaret outlined several examples of problematic language in the current Emergency Shelter Care (ESC) Statement of Work (SOW).

On a related note, Bruce alluded to the Department’s investigative report on the Out-of-Home-Care Investigation Section. He noted that ACHSA was initially informed that it would be allowed to review and provide feedback on the report before its submission to the BOS. ACHSA, however, was recently informed by Karen that it would not be able to do so until after the BOS has reviewed it. Bruce commented that such an action falls outside the definition of collaboration. While ACHSA and the Department may not ultimately agree with the content of the report, Bruce noted that providers should at least be aware of what is being included.

Philip acknowledged that he was not clear why ACHSA shouldn’t see a preliminary copy before its submission to the BOS, in the interest of transparency, and he noted that a draft of the report should be shared so long as it did not contain any confidential information.

Please contact Bruce or Hillary with any questions. ACHSA Hosts Major Meeting with Los Angeles County SELPA Directors on AB 3632/AB 114 Transition Plans and Challenges

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On December 13th, ACHSA joined DMH in hosting the Los Angeles County SELPA Directors at ACHSA to enter into a dialogue on the transition from AB 3632 to AB 114, focusing on the current transition planning process and the issues and challenges associated with that process.

In attendance at the meeting were 28 ACHSA AB 3632 providers, DMH Chief Deputy Director Robin Kay along with Children’s Bureau Acting Deputy Director Bryan Mershon and Paul McIver from the AB 3632 program, and the representatives from nine different SELPAs, including LAUSD, Long Beach, Pasadena, East San Gabriel Valley, Puente Hills, Santa Clarita Valley, Mid-Cities, Whittier Area Cooperative, and ABC/Norwalk-La Mirada.

Setting the Stage The meeting began with introductions and a welcome from ACHSA’s

Executive Director and Robin Kay. This meeting was presented as a follow up to the productive meeting held last February when the future of the AB 3632 program was as of then unknown. The dialogue which occurred at that time was helpful in ensuring continuity in the program through the end of last fiscal year.

Now, it was deemed important to continue that dialogue to determine where various SELPAs were in the planning process for the transition required by AB 114 and its shift of school-based mental health services funding from DMH to Los Angeles County school districts.

In addition to wanting to hear from the SELPAs generally how the transition process was proceeding, ACHSA and DMH had agreed upon a list of issues related to the transition that they specifically wanted to discuss with the SELPAs, including: 1) rates for services; 2) the future of medication support services; 3) continuity of care; and 4) districts’ development of specific IEP language.

Introductory Comments from the SELPAs Margaret Cherene from the Santa Clarita Valley SELPA, an informal

spokesperson for the SELPA group, began by making some general comments. She noted that the SELPAs had more questions than answers right now, and that they were in the middle of their planning processes. Accordingly, they were very happy to be a part of this conversation with DMH and the ACHSA providers, and they were aware of their need for ongoing support in order to be able to continue to properly serve eligible students and families.

Ms. Cherene then presented a list of questions that the SELPA Directors had come prepared with, which she was later asked to present to the group for discussion along with the issues previously identified by DMH and ACHSA. The SELPA questions somewhat overlapped those issues

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and included the following: 1) Can agencies separate their staff that provide education related counseling services under IDEA from those providing mental health services funded by Medi-Cal? 2) Can school districts contract for Wraparound services but negotiate what they will and will not pay for? 3) Can school districts that have Medi-Cal eligible students simply refer them to agencies without strings, providing the educationally related counseling while the agencies provide all of the Medi-Cal funded family therapy? 4) How will agencies transition students and families to the new school-based therapists/counselors if they will no longer be serving them as of July 1st?

In response, Bruce noted that the questions could be covered within the context of the later discussion of the specific issue areas that had been previously identified by ACHSA and DMH.

Ms. Cherene next mentioned that she had brought with her guidance documents from the California Department of Education, which she distributed to the group. These are guidelines that the SELPAs are using to help assist them with their transition planning. Ms. Cherene noted that the eligible services listed in the document on related services were deliberately broad and vague.

Most districts are in the process of taking mental health language off of the IEP and replacing it with educational language (e.g., replacing “individual therapy” with “educational counseling”). There was also reference made to a crosswalk document that had been developed by the State SELPA organization. [ACHSA is attempting to obtain this document and will share it at a later time.] Paul McIver from DMH commented that the California Mental Health Directors’ Association had concerns about this document related to Medi-Cal guidelines and so had never endorsed it.

Roundtable Discussion of SELPA Activities The dialogue then formally began with the SELPAs being offered the

opportunity to share what was happening in their respective areas in terms of communications given to providers and the status of specific transition plans being developed for either January 1st or July 1st.

Margaret Cherene began with an update on the Santa Clarita Valley SELPA. Her SELPA has written an RFP, which was mailed out to their current AB 3632 providers. Responses are due by February 1st, and they hope to have a final decision made by the end of February. The SELPA is not yet sure if there will be only one or more than one provider selected. The effective date of the new program will be July 1st. Ms. Cherene is hoping to hire a person to help develop new program guidelines and assessment protocols, as well as train school psychologists.

Diane Kloosterman next provided an update for LAUSD, which is currently in the process of creating new guidelines, procedures, and assessment instruments, and training new counselors. They are also in the process of changing IEP language from medically based to

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educationally based. She noted that LAUSD is working with their General Counsel to make sure that the laws are being implemented appropriately. They are looking at a July 1st transition date. Importantly, Ms. Kloosterman stated that while families can select their own providers now under the current MOU with DMH, LAUSD is in the middle of a planning process to use only their own staff for service delivery after the July 1st transition date.

Connie Withers from the Puente Hills SELPA noted that her SELPA is relatively small, covering only two school districts and with relatively few AB 3632 services provided. They have hired two new staff to deal with the transition, and are talking with current families, two of which intend to remain with their current providers as they are on track to graduate. Ms. Withers noted that her area may be considered to be somewhere in between the Santa Clarita (contracted out) and LAUSD (centralized control) models, as they are considering an array of services offered by different entities, some contracted out and some provided on their own.

Discussion of Rates for Services Bruce made it clear to the SELPA Directors that when ACHSA’s AB 3632

providers had met at ACHSA, they were in firm agreement that they would need to continue to get paid in the future at their current Medi-Cal rates in order to comply with Medi-Cal rules and avoid potentially serious and significant liability upon audit.

Ari mentioned that the SELPAs may be familiar with the rates they have negotiated with DMH, which might not be the same as the rates than providers are contracted at (which could be lower), particularly without the added DMH overhead costs.

Margaret Cherene made the comment that there is a perception that the money received by the school districts is very generous, particularly in relation to what DMH had been getting, but that the way the money was allocated resulted in huge winners and huge losers. This allocation was made based on ADA rather than prior usage of funds, and so some school districts that had done very little previously will be receiving “a bounty of money,” while those districts with large numbers of students in residential care “will be screwed.” Districts are also very nervous about the State taking away funding in the future. Both of these factors have had an influence on the desire of school districts to pull their kids back.

Robin mentioned that the California Mental Health Directors’ Association had been successful in arguing for allocations of funds based on usage, and offered, along with ACHSA, to possibly assist with the allocation issue. We will await further word from the SELPAs on this.

Bruce then returned the conversation to the first SELPA question (above) regarding whether agencies can separate their staff that provides education related counseling services under IDEA from those providing mental health services funded by Medi-Cal. The answer was a clear no, again based on issues of liability; even if agencies wanted to do this, they

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really can’t. This led to a further discussion of Medi-Cal rules generally, and Robin agreed that DMH would put on a future training for the SELPAs in this area.

Bruce answered the third SELPA question regarding school districts simply referring Medi-Cal eligible students to agencies without strings with the same answer, highlighting the advocacy concern of having DMH continuing to provide the entire match for Medi-Cal services even though the districts are now funded to provide this match. This would force DMH to curtail services elsewhere, which is not acceptable.

Making a separate important point relative to future school district usage of internal staffing resources versus current agency Medi-Cal providers, Bruce noted that even without considering EPSDT, school districts that couldn’t bill Medi-Cal would have to find a way to deliver services 50 percent cheaper than the amount they would normally pay agency providers in order to compensate for the lost 50 percent Medi-Cal match they could otherwise draw down. Then factoring in EPSDT would significantly magnify even more how much cheaper districts would be forced to deliver services on their own in relation to the amount of savings they would lose by not continuing to use Medi-Cal eligible providers. [Of course, this would not apply to LAUSD and Pasadena, both of whom are current DMH Medi-Cal providers.]

The conversation turned to the SELPA’s question number two regarding Wraparound services. Bruce mentioned that this was an area that ACHSA would certainly be interested in assisting with. There was agreement to arrange for an ACHSA proposed workgroup on wraparound, to help develop a workable model, which would include DMH, DCFS, the SELPAs, some AB 3632 providers, and ACHSA.

Discussion of Medication Support Services TJ highlighted the background on this issue, which is a significant area

for concern among the special education advocates. He noted that the guidance from the State in this area has been very vague, and that the language that has been presented in the State guidelines is legally ambiguous. The advocates are taking the position that children who are currently receiving these services cannot have them discontinued abrupty.

Margaret Cherene stated that the SELPAs are expecting litigation in this area to help clarify future responsibilities.

Bruce made the point that unless there was something in the no longer applicable AB 3632 state law that provided a mandate in this area in excess of what was already mandated by federal IDEA law, medication support would and should continue as it has been under the federal law mandate.

Discussion of Continuity of Care Issues ACHSA raised the question as to what will happen after June 30 th for

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current clients that agencies are seeing, if the districts decide not to continue to contract for new cases with their current providers. Will districts at least pay for current clients until their course of treatment has been complete? If not, will there be some provision for the transition of these current cases after July 1st?

LAUSD commented that they are in the process of transitioning these cases back to the district right now, with discussion taking place in current IEP meetings based on the changes in the law. At the same time, Bruce asked what would happen if there are still some children who are in the care of agencies as of June 30th.

The Puente Hills SELPA responded that they would need to look at these children on a case by case basis, and that this would need to be an IEP team decision. This seemed to be the sense of other SELPAs in the room as well. However, Margaret Cherene warned that to allow that to happen there would still need to be a contract in place to authorize payment.

This triggered a comment from Bruce that ACHSA agencies may need to stop taking new cases soon if they are not confident that they would be paid for the entire course of treatment. When Paul McIver then stated that DMH has lots of money this fiscal year and there is an incentive to spend every penny of it, Bruce reiterated the prior comment about the need to protect agencies financially and the fact that agencies would need to make individual business decisions, which was concurred in by the providers in the room.

One SELPA noted that it would be important for districts to have discussions about this with the agencies they are working with.

Robin expressed serious concern about this issue, particularly given that most kids who are seen in this program get more than six month of treatment, based on the Department’s desire to have agencies continue to serve these youth. However, ACHSA again took the general position that agencies would at some point not take new cases unless the district and/or the Department would pick up funding past June 30th or develop a mutually agreeable transition plan.

There was agreement that future discussion would need to take place on this issue, and that DMH would facilitate such discussion at the time of its Medi-Cal training, mentioned above.

Districts’ Development of Specific IEP Language Bruce expressed the concern about some districts’ development of

blanket language that is not child specific (e.g., individual or group therapy cannot exceed “x” number of minutes per month). At the same time, he noted that this issue probably would not be resolved in this meeting.

It was understood that this issue would need to be addressed with the individual school districts and perhaps the special education advocates.

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Discussion of Next Steps It was agreed that the following activities would take place: 1) Connie

Withers from Puente Hills SELPA would coordinate with meeting of the Wraparound workgroup with ACHSA; 2) DMH will organize the Medi-Cal training, to include future discussion about the payment/June 30th

transition issue ; 3) ACHSA and some AB 3632 providers may attend the January 30th SELPA Directors’ meeting in Long Beach.

For additional information, please contact Bruce or TJ.

A Morning of MAT: DCFS and DMH Convene Countywide MAT Providers Meeting

On November 21st, the DMH and DCFS convened the first annual Countywide Multidisciplinary Assessment Team (MAT) Providers Meeting. As you may recall, when ACHSA had met with DMH Clinical Program Head Angela Shields and DCFS MAT Program Manager Laura Andrade in February of this year, ACHSA had requested that DCFS and DMH hold countywide MAT provider meetings in addition to the ongoing MAT SPA level meetings, to which DMH and DCFS had agreed.

Where Did MAT Come From? ACHSA Harkens Back to Origins of MAT After a brief welcome by Christy Maeder of the DMH MAT Program

Administration, Bruce shared an overview of the history of the MAT program. He noted that MAT was one of the first advocacy projects of ACHSA as a merged association of child welfare and mental health providers.

In 2000, ACHSA began working with DCFS and DMH to develop a model for comprehensive assessments of children entering out of home care. Bruce acknowledged key Departmental staff at the time including John Hatakeyama and Gary Puckett of DMH, as well as Romalis Taylor, Eric Marts, and Marilynne Garrison of DCFS. Two years later, the group had agreed upon a model, originally known as “Model Assessments System for Children Under Jurisdiction of Los Angeles County” and later shortened to simply “Multidisciplinary Assessment Team.”

After initial delays in implementation of the model due to determination of costs and changes in DCFS leadership, the model was piloted with 10 to 22 children in Service Area 6. Later, ACHSA, along with Laura, approached the Katie A. panel to highlight the MAT model, emphasizing the necessity of proper initial assessments of children in order to prevent multiple placement failures. ACHSA also advocated in regards to the utilization of MAT to inform placement decisions and to hold DCFS accountable to link children to necessary services.

Bruce explained that MAT was initially developed as a three-stage model involving: 1) screening; 2) comprehensive assessment; and 3) re-assessment. Initially, the MAT developers debated whether the County

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or the MAT agency should complete the screening of children; however, this responsibility eventually rested on DCFS. MAT today focuses on the comprehensive assessment stage of the original three-stage model, as the re-assessment activities are now completed through other DCFS team meetings.

What’s Up with MAT? DMH Provides MAT Updates Christy reminded meeting attendees that the MAT Summary of Findings

Report had been recently revised and distributed, and a question had been added to the Alternate Placement section in regards to the placement recommendation of the MAT team. She emphasized, as specified in the SOF report itself, that the placement recommendation would be non-binding, as DCFS, and not the MAT team, would be responsible for the final placement recommendation to the court. Further, if the MAT team could not agree on a recommendation, then no recommendation need be made in the report. Bruce noted that the necessity of a placement recommendation had been one of the primary motivators of the original MAT model in order to prevent multiple placements of children throughout the system. He noted that MAT agencies with any questions or concerns could contact him directly to discuss this section further.

Christy also noted that the MAT SOF Guidelines had also been recently revised and distributed. She recognized that the SOF guidelines are now longer than the SOF itself; however she noted the importance of the comprehensiveness of the guidelines in providing clear direction to MAT agencies as to how to consistently complete quality MAT assessments.

In addition, the DMH MAT Quality Assurance Checklist and DMH MAT CSW Interview Guide have been revised in order to reflect principles of the Core Practice Model and Quality Service Review (discussed below).

Christy announced several upcoming MAT trainings on MAT documentation and “MAT 101” (soon to be web-based), birth to five (infant mental health), strengths and needs, and self care and vicarious traumatization.

Finally, Christy noted that an updated version of the MAT Frequently Asked Questions would be distributed shortly. DMH and DCFS had purposefully deferred distribution of the FAQs in order to address any questions raised at the November 21st meeting.

Next Steps: DMH Notes MAT Improvement Needs Christy described several systemic areas in need of improvement within

the MAT program, which would be addressed by the MAT Best Practices Workgroup (to be reconvened on a quarterly basis): Ensuring that MAT findings are integrated into the children’s case

plans Capacity issues (including waiting lists and barriers to linkage) Cultural competency (including language and translation problems)

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Ensuring that the MAT Quality Improvement (QI) process is meaningful

Training needs, particularly in the area of children 0 to 5 years of age Out of county cases (assessment and linkage needs)

Looking Good: DMH Notes System-wide MAT Successes Likewise, Christy noted several areas of system-wide MAT successes:

Timely, strengths-based assessments and faster linkage to needed services

Improved communication, collaboration and teaming between families, DMH and DCFS

Addressing mental health and other unmet needs Earlier diagnosis of critical mental health and medical conditions Earlier access to mental health and medical services for children and

families Successful incorporation into the CSAT process Reunification of families and stabilization of placements Enhanced outreach and engagement Better placement decisions

MAT Services and Outcomes Laura provided an overview of the children served by MAT based on

gender, age, ethnicity, and language. She also shared data regarding the number of MAT referrals per fiscal year, noting that the significant increase in the number of referrals in FY 2009-10 could be attributed to the DCFS MAT staff who were added to the program that year. Laura projected that the MAT program will serve over 5,000 referrals in FY 2011-12. Laura noted that the greatest number of MAT referrals come from the Metro North and Vermont Corridor DCFS Regional offices, followed by the Compton and Torrance offices.

Likely the most compelling data shared by Laura during her presentation related to the positive outcomes for MAT assessed children one year following their MAT assessments. 38% of these children experienced just one placement during the year following their MAT assessments (as compared to the Departmental average of two or more placements). 31% of MAT assessed children experienced two placements during the year following their MAT assessments. Laura noted that the 14% of children who experienced four or more placements were likely older youth, as well as dual diagnosis youth with mental health and substance abuse issues. In addition, 34% of MAT assessed children were receiving mental health services one year following their MAT assessments.

Laura hopes to complete a comparison study with children in the system who did not receive MAT assessments. DCFS is currently looking into obtaining permission from the dependency court to complete a wide scale MAT evaluation of this nature.

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County Shared Core Practice Model and Quality Service Review Anabel Rodriguez, DMH MAT Program Head, provided an overview of

the County Shared Core Practice Model (CPM) and Quality Service Review (QSR). Anabel explained that the CPM is a practice framework shared by DCFS, DMH, and Probation which describes the practice of front-line child welfare and mental health staff in working with children and families, and promotes improved systems performance for child welfare and mental health outcomes.

The key CPM values and principles include: Child Protection & Safety Permanent, Lifelong, Loving Families Strengthening Child and Family Well-Being and Self-Sufficiency Child-Focused, Family-Centered Practice Community-Based Partnerships Cultural Competency Best Practices and Continuous Learning

The CPM strength needs practice wheel reflects a continuous cycle of engaging, teaming, assessment, planning and intervention, and tracking and adapting.

In addition, the QSR process is designed to “co-evolve” along with the CPM. A passing score on the QSR is exit criteria for the Katie A. lawsuit. Anabel shared a detailed overview of the five-day QSR process which involves an in-depth case review of front line Departmental practice as interpreted by certified QSR reviewers. Thus far, ten DCFS Regional offices have undergone the QSR. At each Regional Office, a random sample of 12 to 14 cases have been reviewed, families have been interviewed, and peer interviews conducted, in order to identify areas of successes and challenges.

The scoring of the QSR has shown that the County is performing well in the areas of safety, living arrangements, and health/physical well-being. On the other hand, several systemic challenges have been identified, including teamwork, assessment, and long term shared vision.

Anabel noted that all stakeholders are welcome to participate in or observe the QSR process. Interested MAT agency representatives may contact Anabel at anrodriguez@dmh.lacounty.gov for additional information.

MAT Questions & Answers Next, a general MAT Question & Answer period which included

questions pre-submitted by MAT agency representatives and a few additional questions presented at the meeting, took place. Key questions and answers are listed below.

Question: What happens when the minute order does not address ongoing mental health services and biological parents are not available to sign releases, as sometimes the original minute order only indicates

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the need for a MAT assessment? Answer: A limited minute order usually results when a Children’s Law

Center attorney does not wish to allow the full MAT language in the minute order. In other words, the CLC attorney may allow language for an assessment, but not treatment and release. In these cases, the MAT assessor should first notify the DCFS MAT coordinator in regards to the child’s specific needs. The DCFS MAT coordinator will request that County Counsel follow up with the CLC attorney. The MAT assessor may also contact the CLC attorney directly. Should the MAT assessor encounter difficulties in getting in touch with the CLC attorney, the CLC investigator may assist.

Question: Can we allow more billing time for the new SOF document? Answer: Current discussions are underway in regards to an increased

DCFS MAT allocation. [Please see the November 15 th ACHSA Bulletin for a detailed article in regards to this issue.]

Question: How should we bill for a MAT Child who does not meet medical necessity? 

Answer: The MAT agency may bill its services to the DCFS allocation; however, decisions in regards to EPSDT billing relate to the level of risk that an individual agency is willing to take.

Question: What are some strategies for completing the MAT Assessment within the expected time frame?

Answer: Immediately team with the CSW and seek assistance from the DCFS MAT coordinator without delay, as needed.

Question: How can teaming and communication between MAT assessors and CSWs be improved?

Answer: Be specific when contacting CSWs in regards to the information that is being sought. Cc: the DCFS MAT coordinator when emailing the CSW. Constructively follow up with the SCSW and DCFS MAT coordinator when a CSW is not responsive. Continue creating high quality SOFs so that CSWs recognize the value of MAT. It was requested that the email address of the CSW be included on the MAT referral, which Laura agreed to implement. At ACHSA’s suggestion, Laura also agreed to distribute a CSW email address roster to all MAT agencies.

Question: How does a MAT assessor complete an assessment of a child receiving mental health services at the time of the referral?

Answer: It is possible for the MAT assessor to provide an addendum to the existing mental health assessment if such assessment was recently completed; however, presenting duplicative assessment questions to children and families should be avoided. The MAT assessor should

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consult with the DCFS MAT coordinator on unusual or special cases where this issue arises. According to the DMH Specialized Foster Care Guidelines, the MAT agency should contact the treatment agency so that the MAT agency can be placed on the Client Care Coordination Plan. If the treatment agency is not responsive to the MAT agency’s request, Jennifer Hallman of the DMH Quality Assurance Division has offered to be of assistance.

Question: How can the MAT agency link clients to mental health services when mental health agencies are currently accepting only children who fit into one of the EBP categories?

Answer: Bruce acknowledged that the entire children’s mental health system has been transformed. He suggested that the MAT administration identify when this issue arises and use this information to create additional resources. DMH further suggested that MAT agencies should network with mental health agencies in their Service Areas to familiarize themselves with the contracts and funding sources of various agencies. It was agreed that this issue should be further discussed at future MAT Best Practices Workgroup or MAT Service Area meetings.

MAT Service Area Updates The next portion of the meeting was dedicated to MAT updates from

DMH or DCFS coordinators from each of the Service Areas. Consistent themes across Service Areas included capacity issues, particularly for children 0 to 5 years of age and Spanish speaking families. Service Areas on the fringes of the county also reported capacity issues related to serving children residing out of county. In addition, several Service Areas reported a general lack of CSW understanding as to the usefulness of MAT assessments for younger children.

Five Acres Shares MAT Success Story The morning meeting ended with a presentation by ACHSA member

agency Five Acres on a MAT success story involving two young children, 0 to 5 years of age, working towards successful reunification with their birth mother.

Burned Out or On Fire? In the afternoon, meeting attendees attended a presentation by Betsy

Haas of Esteemed Human Development International on Burn Out and Self Care.

Click here for the comprehensive PowerPoint presentation summarizing the information discussed at the November 21st meeting.

Please contact Bruce with any questions.

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DMH PEI Team Visits ACHSA Children’s Mental Health Policy Committee

The ACHSA Children’s Mental Health Policy Committee had a special meeting on December 14th with a guest speaker panel featuring five representatives from DMH: Deputy Director Bryan Mershon (Children’s System of Care), District Chief Debbie Innes-Gomberg (MHSA Implementation Unit), OMA Program Manager Kara Taguchi, District Chief Lillian Bando (PEI Administration Unit), and PEI Outcomes Lead Robert Byrd. The meeting featured a Q&A session between providers and the guest panel regarding PEI implementation updates and issues.

EBPs and Training The Committee asked the guest panel about potential flexibility in adding

more types of EBPs for the 0-5 population. Bando said that DMH is not looking to add any more EBPs at this time. Currently, Los Angeles County has implemented 37 out of the total 51 EBPs in the County plan, which were vetted and selected through an application process. Although the Department has added more programs on occasion, such as MAP, Bando said that they are currently focusing on evaluating existing programs. The Department does not want providers to continue implementing more programs before providers know how they are doing in their current programs.

Providers responded that this raises a serious capacity issue for the 0-5 population, as this service population continues to grow, partially because of MAT assessments. Bando said that the Department is trying to address capacity issues by offering more training, particularly additional CPP trainings between May and June of this year. Additionally, DMH is creating a training schedule, which will include a number of trainings that were not previously offered.

Bando announced that DMH will also be increasing training dollars in contracts to fund new training and replacement training. If providers don’t need more training, then there will be ways to utilize those dollars for community education. She said that the increase will be implemented for the current fiscal year. More information about the increase in training dollars will be discussed at the Quarterly PEI Providers Meeting scheduled for January 31st and at an upcoming budgetary meeting.

EPSDT Audits Innes-Gomberg shared a bulletin from the State DMH that discusses the

plan for EPSDT audits. The bulletin states that EPSDT chart reviews will be integrated with Adult Outpatient chart reviews. The EPSDT chart reviews will no longer be reviewed by using a statistically valid sample

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size and will be conducted without extrapolation. Please click here to view the bulletin.

Outcome Measures Providers asked the guest panel about the possibility of altering the

requirement to collect clinical outcomes measures within a 14-day window because it has proven to be cumbersome and is resulting in missing data.

Innes-Gomberg said that when they instituted this requirement, they tried to pick a time frame that would be indicative of the first phase of treatment. Taguchi also said that the PEI Outcomes Unit is working to thoroughly evaluate unable to collect data and is in the final validation process for this data. Once this process is completed and the data is more fully understood, there may be more flexibility to change the time frame requirement, if necessary.

A provider raised concerns about the outcome measure for the CORS model. Because CORS is a crisis model of only six weeks, the questions on the outcome measure that focus on ongoing problems do not make sense for the model and do not show progress.

Taguchi said that outcome measure for CORS is in an interesting place because they have not yet acquired the BASIS-24 for the model for clients 18 and above. For children, the only measure is the YOQ. She said that they are probably unable to shift the general measure to accommodate the CORS model because they want to be able to look at data across the whole PEI population.

Innes-Gomberg asked providers to send them suggestions for better scales and they will assess them to determine if there is a way to correct this issue.

Another provider asked about the opportunity for agencies to get reports on data submitted to the Outcome Measures Application (OMA).

Taguchi said that data sets have been available to agencies through the OMA since February 2011. Any staff with access to the IS can get reports from the OMA and run analysis on their agency’s data. She said that there is an OMA folder in agencies’ Secure Internet File Transfer (SIFT) data.

Innes-Gomberg said that DMH will issue a memo to all providers on this because many agencies still seem to be having questions about accessing data reports.

Taguchi also said that they will work with CIOB to set up training to help familiarize staff with the OMA data sets. Additionally, there is an OMA users group that providers can attend. Providers should email PEIOutcomes@dmh.lacounty.gov for more information on the users group.

MHSA Funding Buckets and Flexibility

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The guest panel addressed providers’ concerns about needing to serve a range of children under PEI and its related funding streams as a result of the transformation and the increase of PEI EPSDT dollars. Providers asked about ways in which DMH could help clarify guidelines and definitions for PEI funding sources, which represent different levels of care.

Innes-Gomberg said that they understand that providers often face issues of backing services into funding streams. Byrd volunteered to create a workgroup to pursue this issue further. He said that they are open to exploring ways in which DMH can help clarify this issue for providers.

Taguchi said that they tried to clarify this issue early on, but that it is very difficult to do with children’s services. There can be a range of services within a particular funding source and it is challenging to map this out for children’s services.

Innes-Gomberg said that from a statewide perspective, MHSA wasn’t intended for what occurred in Los Angeles County. However, she said that with the realignment of the State DMH under AB 100, there may be more flexibility to change some of the existing guidelines.

A provider asked about an issue in which TAY FSP providers are asked to accept/receive private insurance referrals, inform them of the costs to receive FSP services, and then refer them back to their insurance provider, which results in a waste of program time and energy.

Innes-Gomberg said that the Children’s System of Care is open to exploring ways to streamline this process for providers. However, ultimately their commitment is to serve consumers. If providers are encountering difficulties in this process, Innes-Gomberg encouraged them to speak with their service area navigators, as providers and navigators are expected to work together to help clients through this process. For billing issues faced in this process, providers should contact RMD for more guidance.

MAP: 40% Implementation Cap and Supervisor Trainings The Committee raised questions about the MAP 40% implementation cap

and the possibility of altering it, particularly given the impending elimination of the State DMH and its associated oversight duties.

Innes-Gomberg clarified that although AB 100 has turned oversight responsibility from the State to counties, a stakeholder process is still required in Los Angeles to alter the MHSA plan. She said that in terms of the 40% cap, the Department is discussing circumstances in which providers could go beyond that cap.

Mershon said that there are currently no finalized plans to alter the cap. A concern from the Department is that MAP is not an EBP, but a combination of services. MAP outcomes data will have a big part in determining the possibility of flexing the existing cap.

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Innes-Gomberg said that there is currently an outcomes issue related to using MAP because providers are billing to PEI but they not claiming an EBP for MAP services, or they are billing for an EBP that they are not doing. If proper practices aren’t selected when reporting outcomes, there are very large implications for data and understanding how money is being spent.

The discussion of MAP led the guest panel to ask providers about the lack of participation in MAP supervisor trainings. Bando reported that DMH scheduled eleven supervisor trainings this past fall and had to cancel all but three of them due to low attendance.

Mershon asked providers about the lack of interest in signing up supervisors for the MAP supervisor trainings. There was a previous large interest in these trainings so DMH hurried to schedule them, only to cancel most of them.

Providers shared that the one-year time frame to submit portfolios for the supervisor and the six staff they subsequently train is very difficult to meet and discourages providers from having more supervisors trained.

Byrd clarified that the one-year time frame is just the subscription that DMH has purchased. If agencies need to go beyond that time frame, they can extend the deadline by paying a nominal fee after the year has ended.

Please contact TJ or Kathrine with any questions.

A Wave of Information: DCFS Title IV-E Waiver Update to BOS

In June 2011, DCFS and Probation presented to the Board of Supervisors an overview on their respective performances. The presentation included background information on the Waiver, a fiscal overview, waiver initiatives, key outcomes, outcomes of waiver strategies, Title IV-E investments, and the next steps.

Background Under Federal law, Title IV-E of the Social Security Act provides foster

care maintenance payments for children placed in out-of-home care. In 2004, California proposed that the Federal government waive certain Title IV-E requirements for counties that elect to participate in a Title IV-E Capped Allocation Demonstration Project (the Waiver.)

The five-year Federal Demonstration project began on July 1, 2007 and is scheduled to end on June 20, 2012. Los Angeles County received a one-year extension through June 20, 2013.

Previously, requirements only allowed funding for services when children were removed from their homes. With the Waiver, funding could be used flexibly to provide services while children remain at home.

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Waiver funding is provided as a capped allocation based on each county’s pre-waiver average expenditures over a three year period (FY 2002-03 through 2004-05), and any unspent funds are required to be reinvested back into child welfare services.

Background - Targeted Outcome In July 2007, the County’s child welfare and juvenile probation systems

began implementation of the Waiver to improve services and community support by engaging and involving children and families in a more individualized preventive approach. The County’s hope was to achieve the following outcomes:

Improved child safety - By increasing the number and array of services to allow more children to remain safely their homes, the County would expect reduced recurrence of maltreatment.

Increased permanency - Through provision of intensive, focused, individualized services, the County expects increased reunification within twelve months, more adoptions within twenty-four months, less reentry following reunification, and greater placement stability,

Reduced reliance on out-of-home care - By ensuring that individualized case planning and appropriate community alternatives are in place, the County expects to reduce the number of children in out-of-home care as well as the average days in placement.

Child & family well-being - With timelier social worker visits, regular medical and dental exams, and more sibling placements, the County expects enhanced well-being for children and families.

Waiver Fiscal Overview The Waiver funds 51% ($921 million) of the DCFS FY 2010-11 budget

and 17% ($120 million) of Probation’s FY 2010-11 budget. The Waiver excludes the following programs: KinGAP, General Relief

Ineligibles (GRI), Seriously Emotionally Disturbed (SED) Children/Adolescents, and Emergency Assistance (EA).

In FY 2009-10, DCFS had a staff increase of less the one percent resulting from new positions funded by the Waiver. In the same fiscal year, the three bureaus in Probation that receive Waiver funding had a one percent decrease in total positions.

The County Waiver investment chart calculates the County’s revenue minus expenditures to determine the amount of Waiver money available for reinvestment. The County then took the amount available for reinvestment, added the cumulative surplus from the previous year, and subtracted the cost of investment to calculate the balance of Waiver money available for reinvestment during the next fiscal year. In FY 07-

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08, the balance was $25.5 million. In FY 08-09, the balance was $76.6 million. In FY 09-10, the balance was $66.2 million. In FY 10-11, the balance was $38.8 million. In FY 11-12, the balance was negative $10 million. The negative $10 million does not account for expected State and Federal reimbursement for the group home rate increase.

Waiver Initiatives Prior to the Waiver, DCFS social workers implemented a continuum of

strategies to better serve children and families. The following continuum shows strategies implemented by social workers from the time a referral is received through continuing services:

1. Point of Engagement (POE): Emphasis on keeping children at home whenever an effective safety plan can be arranged.

2. Structured Decision Making (SDM): Use of consistent and validated tools to assess child safety and risk and family strengths and needs, to guide the creation of a safety plan or make decisions whether to remove children from their homes.

3. Team Decisions Making (TDM): Multi-disciplinary teams meet to partner with families at critical times to make placement decisions when imminent risk is present, at removals, replacement and before reunification.

4. Family Preservation Services (FP): An integrated, comprehensive approach to strengthening and empower families who are at risk or are already experiencing problems in family functioning, with the goal of assuring optimal development of children in a safe and nurturing environment.

5. Concurrent Planning: Intense efforts to safely reunify children quickly while concurrently acting with urgency to connect children with other forms of permanency (adoption, guardianship) should they be unable to return home.

6. Wraparound: An integrated, multi-agency, community-based program that provides strength-based, family-centered care to high-need children with mental health and behavioral challenges.

7. Permanency Partners Program (P3): Specially trained workers reconnect the longest waiting, least connected youth to extended family members or assist them in identifying a family they can chose to join.

DCFS created Waiver initiatives to achieve the outcomes discussed above. The following is a list of initiatives with their expected outcomes:

TDM, including Permanency Planning Conference (PPC) and Emergency Response Command Post (ERCP) to achieve reduced out-of-home care. This will require a $10.7 million investment.

Youth Permanency (YP) units and Promoting Safe and Stable Families (PSSF) to increase permanency. This will require an

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$8.6 and $1 million investment, respectively. Up-front Assessments (UFA) and Prevention Initiative

Demonstration Project (PIDP) to improve child safety. This will require a $31.6 and $9.8 million investment, respectively.

Probation also created Waiver initiatives to meet priority outcomes. Functional Family Therapy (FFT) & Multi-Systemic Therapy (MST) are both intended to reduce out-of-home care. This will require a $2.1 million investment. Cross-Systems Case Assessment and Case Planning (CSA) and Prospective Authorization and Utilization Review (PAUR) are intended to increase permanency. This will require a $1.2 and $0.6 million investment, respectively.

Key Waiver Outcomes DCFS looked at outcomes for improved child safety, increased

permanency, reduced out-of-home care and child and family well being.

Improved Child Safety For improved child safety, the number of child referrals rose and fell

sporadically throughout 2010. In January ’10, there were 11,004 referrals and in January ’11 there were 13,159. The referrals reached a low of 10,889 in July ’10 and a high of 13,734 in Oct ’10. The number of removals stayed very consistent ranging from 834 in January ’10 to 847 in January ’11. The percent of removals from home was consistent with the national average of 7%.

In 2007 when the Waiver Demonstration Project began, the percent of children served with no recurrence of maltreatment was 93.3%. That number rose to a high of 94.6% in 2007 and fell to a low of 93% in 2010. Since 2007, the percent of children served with no maltreatment in Foster Care dropped slightly from 99.81% to 99.47%.

Increased Permanency Probation increased permanency by decreasing the number of children

re-entering following exiting Probation foster care from 13.5% in FY 2005-06 to 9.8% in FY 2008-09. Probation defines reentry to be when any youth, including those who go to a Probation camp/hall or reunify with their family, returns to Probation foster care system following exit.

In 2007, 96.4% of DCFS youth exited to permanency. In 2010, 96.2% of DCFS youth exited to permanency. Further, in 2007, 61.2% of youth reunified in twelve months versus 66.9% in 2010. The rate for adoptions within twenty-four months stayed consistent ranging from 24.6% in 2007 to 25.3% in 2010. Reentry following reunification rose from 9.1% in 2007 to 12.3% in 2010.

Placement stability for youth in care eight days to twelve months went from 87.3% in 2007 to 85.9% in 2010. For youth in care twelve to fourteen months, placement stability went from 72.1% in 2007 to 67.6%

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in 2010. For youth in care more than twenty-four months, placement stability went from 39% in 2007 to 38% in 2010.

Out-of-Home Care Probation youth placed in out-of-home care rose and fell sporadically

from 2007 to 2010 ranging from 1,684 to 842. Youth placed in group homes closely mirrored the overall number of youth in out-of-home care ranging from 1,611 in 2007 to 787 in 2010.

For DCFS, children in out-of-home care fell from 20,518 in 2007 to 15,650 in 2010. The average number of days in placement fell from 1,252 in 2007 to 902 in 2010. The number of children in group homes was 1,252 in 2007 and 902 in 2010. Child & Family Well Being

The percent of timely social worker visits rose from 89.8% in 2007 to 94.5% in 2010. The percent of all or some siblings placed together in Foster Care rose from 68.4% in 2007 to 72.8% in 2010.

Outcomes of Waiver Strategies With the priority outcome of reduced out-of-home care, TDM

Permanency Planning Conferences (PPC) were held from July 2007 through December 2010. Of 1,555 PPC placements 33% were placed in family-based settings, 29% were placed in the same or higher level of case (of 55 placements in this category, 53 were placed in the same level of care, and two in a higher level of care), and 26% of children were placed in a lower level of care.

For increased permanency Youth Permanency (YP) units were in three offices from July 2007 to December 2010. For 473 youth, 59% increased connectedness, 25% were placed in a reduced level of care, and 8% were returned to their parents’ home.

In an effort to improve child safety, a total of 7,966 families with 21,906 children received Up-front Assessments (UFAs) during the referral investigation. Of the 7,966 families, 11% were referred for Alternative Response Services and 22% were referred for Family Preservation Services. Of the 21,906 assessed children, 11% were promoted to a case and received the following services: Voluntary Family Maintenance, Court Family Maintenance, Voluntary Family Reunification, or Family Reunification.

Also for improved child safety, the PIDP addressed the spectrum of child abuse prevention. The eight PIDP networks worked to prevent child maltreatment through the implementation of three integrated core strategies: 1) building social networks through community organizing, 2) increasing economic opportunities and development, and 3) increasing access to beneficial services, activities, resources and supports. FY 2009-10 outcomes show PIDP children were more likely to exit foster care and have their cases closed, and their families were less likely to

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receive a new referral.

Other Title IV-E Investments Wraparound increased permanency with fewer, less restrictive

placements. An analysis showed that 68% of the children in the Wraparound group were in less restrictive placements (foster families, relatives, or guardians), compared to 26% in the control group. The analysis was conducted during FY 2008-09 for cases that remained open for at least twelve months. Wraparound graduates were less likely than children discharged from RCL 12-14 to have one or more out-of-home placements. The average length of stay for the Wraparound group was 134 days and 248 days for the control group. The Wraparound group stayed an average of 46% fewer days in out-of-home care. The average placement cost was 78% less for the Wraparound group, in comparison to the control group.

PSSF helped with improved child safety by reducing the number of substantiated referrals. PSSF includes four components: Family Support (FS), FP, Time limited Family Preservation (TLFP), and Adoption Promotion and Support Services (APSS). 98% of children who received FS did not have recurrence of substantiated abuse within twelve months. From FYs 2005-06 to 2008-09 the percent of FP cases that were terminated with a subsequent substantiated referral steadily declined from 23.7% to 14.4%.

Child Abuse Prevention Intervention and Treatment (CAPIT) provides preventive direct service activities to increase safety, permanency and well-being of children and families. Both PSSF/CAPIT redesign will be tracked using a data system and all program participants will be entered. BIS will use the program and CWS/CMS data to determine the following program outcomes: 1) recurrence of maltreatment, 2) Exits to Permanency, and 3) Timelines to Permanency.

DCFS, in collaboration with Casey Family Programs and Los Angeles’ research community, is developing a comprehensive evaluation of Family Preservation Contracted Services. The scope and design of the evaluation are being developed and will include 1) an evaluation of child and family outcomes, 2) measure of contracted agency performance, and 3) gaps in current services.

P3, between 2004 and 2011 served 4,432 youth with the goal of achieving permanency. Of the 4,432 youth, 36% now have a legally permanent plan identified, 9% have returned home to a parent and had their child welfare case closed, 6% who were previously opposed to adoption are not involved in adopting planned, and 18% have has their case closed with a life long connection.

Next Steps On December 13th the Board of Supervisors (BOS) met to approve the

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enhanced and expanded strategies for the Waiver. The BOS vote will determine whether or not to approve expenditures in the amount of $11,491,000 for DCFS and $2,957,000 for Probation for the FY 2011-12.

The BOS also voted whether or not to increase funds for the current Fiscal year and extend the term of eight Prevention Initiative Demonstration Project (PIDP) contracts for a total cost of $1,250,000 for Fiscal Year 2011-12, financed by Title IV-E Waiver reinvestment funds, using 36% Federal revenue, 33% State revenue, and 31% Net County Cost. Further, the BOS will vote to execute the additional one-year extension for the eight PIDP contracts for the period of July 1, 2012 through June 30, 2013, and, if necessary, the optional six-month period of July 1, 2013 through December 21, 2013. Lastly, the BOS will vote to execute amendments to increase or decrease the maximum annual PIDP contract sums for the estimated cost of future unanticipated work within the scope of the contract not to exceed 10% of each maximum annual contract sum provided that applicable Federal, State, and County contracting regulations are observed; and sufficient funding is available.

Click here for the comprehensive PowerPoint presentation summarizing the information discussed at the June 8th meeting. Please contact Hillary with any questions. Learning from Jason K. to Implement Katie A.: Tim Penrod Meets with Mental Health Providers at DMH Child Welfare Division Training On December 6th, the DMH Child Welfare Division convened a training

with mental health providers to discuss “Intensive Home-Based Mental Health Services Within Child and Family Team Practice.”

The meeting featured guest speaker Tim Penrod, the CEO of Child and Family Support Services, Inc., a provider of community-based direct support services in Arizona. Penrod has been very involved in the implementation of the Jason K. settlement agreement in Arizona, particularly in the area of planning and providing for home based services and supports.

DMH District Chief Greg Lecklitner (Child Welfare Division) facilitated the meeting’s discussion. Lecklitner said that he hoped it would serve as a dialogue between providers and Penrod about his experience in relation to creating a service strategy for the State and County Katie A. cases.

Home-Based Services of Jason K. and Katie A. The settlement agreement for Jason K. v. Eden in Arizona was approved

in 2001. Under the settlement agreement, the Arizona Department of Health Services (ADHS) and the Arizona Health Care Cost Containment

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System (AHCCCS) must foster the development of a children’s behavioral health system that delivers services to Jason K. Class Members, Medicaid-eligible youth under the age of 21 who are identified as needing behavioral health services. For more information on the Jason K. settlement agreement, please click here to view the ADHS website.

Jason K is analogous to Katie A. v. Bonta in California. The Katie A. settlement agreement created three types of services for youth in foster care or at risk of removal from their families: Intensive Care Coordination, Intensive Home-Based Services, and Treatment Foster Care. Although the Court approved the County’s settlement agreement in July 2003, the State’s settlement agreement was not approved until December 2011. For more information on the Katie A. settlement agreement, please see the October 1 st ACHSA Update .

Penrod provided meeting attendees with a timeline of the Jason K. settlement implementation and a summary chart of approaches to the two settlements in California and in Arizona.

Penrod discussed his background with the Jason K. settlement implementation which began with the settlement’s pilot, the 300 Kids Projects. Penrod focused his presentation on his involvement with the system design of the Generalist Direct Support Services, or the home-based services component of the Jason K. settlement.

Penrod distributed the Generalist Direct Support Provider Readiness Inventory to meeting participants, which is used to assess provider preparedness to deliver home-based services. He said that some providers in Arizona self deselect from providing these services after seeing certain guidelines, such as emergency response to initiate a hold or willingness to drive clients in vehicles. Thus, Penrod said that there are varying levels of preparedness encountered with providers when establishing home-based services.

Two Programs of Care: Discussion of Arizona Medicaid vs. California’s Medi-Cal

Penrod and providers engaged in a discussion about Arizona’s Medicaid program. Penrod said that the State’s Medicaid program includes a relatively expansive set of billable services. Additionally, many inclusive subcategories were created under rehab and support services by the Centers for Medicare and Medicaid Services (CMS) after the Jason K. settlement agreement was reached.

Penrod noted that the workforce that delivers services in Arizona is largely paraprofessional, including parent partners and parent professional staff, to allow for flexibility in foster youth’s treatment. Penrod said that although there were initially a few billing limitations, many services provided by paraprofessionals are now billable to Medicaid.

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Providers at the meeting shared that there are many billing restrictions within California’s Medi-Cal, particularly for services provided by parent partners and other paraprofessional staff. Providers also discussed that they can only bill for talking time, not listening time in meetings.

One provider asked about Medicaid rates in Arizona. Penrod said that the State sets recommended rates that are not used; all of the contracting providers set their own rates. Providers discussed how this aspect of Arizona’s system of care is very different than that in California.

Utilizing a Paraprofessional Workforce As a high percentage of Arizona’s workforce is paraprofessional, Penrod

asked meeting attendees about the disadvantages and advantages of working with paraprofessionals. A heated discussion ensued in the meeting, as some of the meeting participants were parent partners.

Some meeting participants discussed challenges they have encountered when working with paraprofessionals. Issues discussed included: trying to practice outside of their scope, being reticent to complete hotline reports due to a lack of additional education/background knowledge, and being unable to identify specialty issues in families (e.g., mental health, substance abuse, etc.).

Other meeting participants shared that they found it disheartening to hear others discredit the experience that parent partners bring to service delivery and only place value on formal education.

On the other side, Penrod discussed difficulties faced when working with professionals in home-based services and field-based services. He noted that professional staff often need to back away from their formal education and training in these service delivery settings. Penrod said that all of the factors discussed affect training and development of staff.

Penrod then presented on recruitment, training, and supervision of staff. He said that his agency does not advertise available staff positions to professionals or applicants with a certain level of training; they instead focus on soliciting applicants with characteristics that are necessary to deliver home-based services. He added that training of a successful workforce begins with the recruitment process.

In order to provide home-based services, Penrod said that staff must be willing and trained to provide non-traditional, creative, and interactive methods to work with foster youth. Penrod mentioned an example of a provider who worked with a client to create a landscaping business. To achieve this goal, his agency focuses training activities on assisting staff in learning to interact with youth as opposed to solely talking to them.

When working with a paraprofessional staff, Penrod said that supervision, documentation, and support are all important elements in ensuring appropriate and successful service delivery.

Please contact TJ or Kathrine with any questions.

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Child Welfare Nuts & Bolts

Who is Jerry Powers? Please click here for more information about the new Chief Probation

Officer, Jerry Powers.

Congressional Caucus on Foster Youth Formally Launches, Seeking Input from Child Welfare   System

The Congressional Caucus on Foster Youth, co-chaired by Representatives Karen Bass (D-CA), Tom Marino (R-PA), Jim McDermott (D-WA), and Michelle Bachmann (R-MN), has now formally launched.  The stated goal of the Caucus is to reduce the number of children in foster care “by proactively strengthening families and supporting permanency through adoption and kinship care.”  The four co-chairs are joined by 32 other Congressmen and Congresswomen from both parties who are official Caucus members.

One of the first actions the Caucus will take is to travel the country on a Listening Tour beginning in 2012 to hear from those involved in the child welfare system directly.  The tour’s schedule has not yet been developed and Caucus members are soliciting ideas of places to go and people to meet in order to better understand the child welfare system’s current issues and needs.  Please contact the Caucus and share your suggestions.

The Casey Foundation’s Guide to Working with Children of Incarcerated Parents

The Casey Foundation recently released a guide for child welfare providers and social workers about working with children of incarcerated parents. The guide, “When the Parent is Incarcerated: A Primer for Social Workers,” builds a case for the development of programs and policies designed to specifically address the needs of children in the child welfare system with incarcerated parents. The primer includes discussions of policies and protocols on time of arrest, data collection, communication with the incarcerated parent, the Adoption and Safe Families Act, Re-entry planning and issues of domestic violence. There is also a section discussing the Corrections System which includes information on immigrant parents and deportation proceedings.

Child Welfare Realignment On November 29th, the California Department of Social Services (CDSS)

held a meeting to brief advocates on the status of child welfare

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realignment and provide insight on how child welfare programs may be affected by realignment. According to the Deputy Director Greg Rose, this was one of many discussions the CDSS will be holding with stakeholders regarding realignment.

Realignment is a policy adopted by the CA State Legislature in July 2012. The policy shifts several functions from the state to the county level. It also directs a portion of the state sales tax directly to counties. The state functions that have been “realigned” total $6.4 billion and include court security, adult offenders, public safety grants, mental health services, substance abuse treatment, child welfare programs, adult protective services and California Work Opportunity and Responsibility to Kids (CalWORKs). Realignment is a response to the multi-billion dollar state budget deficit. By removing $6.4 billion from the State General Fund through the realignment of these seven state functions, the California was able to reduce the level of funding Proposition 98 constitutionally required California to provide to public schools by $2.1 billion.

At the November 29th CDSS meeting, two topics were discussed: what changes may occur in child welfare under realignment as realignment is currently structured, and what changed may occur when the state legislature revisits the realignment structure in 2012. Advocates expressed many concerns on these issues. One concern regarding alignment as it is currently structured is that counties will elect to discontinue formally state-funded and state-administered programs that are no federally mandated, for example THP-Plus, Extended ILP, Substance Abuse/HIV Infant Program, and CASA. Another concern is how realignment will be structured when the state legislature develops the “financial architecture” of realignment for 2012-13 and beyond. Questions remain about whether counties will be authorized to shift funds between accounts or whether the accounts will continue to have “firewalls” preventing such shifting. In August 2011, the Legislative Analyst’s Office released a report recommending that the legislature “limit the number of constraints it imposes on county ability to move funding among programs.”

Mental Health Odds & Ends

Healthy Way LA (HWLA) Enrollment and Pending Medi-Cal or SSI Applications

DMH RMD released a bulletin announcing that clients are not eligible to apply for Healthy Way LA (HWLA) if they have an application pending for either Medi-Cal or Supplemental Security Income (SSI). Clients may not apply for HWLA if they have an application for either Medi-Cal or SSI that has not received an initial denial or approval. If a client’s application is denied for Medi-Cal or SSI, the client should bring the

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denial letter to be placed in the client’s financial folder if they would like to apply for HWLA. The client can then be screened for HWLA eligibility. Current HWLA clients who apply for Medi-Cal or SSI are ineligible for HWLA as of the application date for Medi-Cal or SSI. Please click here to view the bulletin for more information on HWLA enrollment and disenrollment.

CCCMHA Public Policy Call Focuses on State Budget and Realignment On Tuesday, December 13th California Council of Community Mental

Health Agencies (CCCMHA) hosted their bi-monthly public policy call with Executive Director Rusty Selix who focused on the future of the State budget, proposed revenue and the impact of realignment on mental health.

Selix began the call by informing the group that while there are lots of initiatives proposed for November 2012 to raise taxes, the Governor’s proposal, with 60% voter approval, will likely be the only one to go forward. A revenue generating initiative, if passed by the voters, would ease pressure to make any additional cuts to mental health.

Governor Brown filed a ballot initiative on Monday asking California voters to increase taxes on themselves to generate more money for schools and public safety. The initiative would temporarily increase taxes on the rich and raise the statewide sales tax by half a cent, to 7.75 percent. The proposal would raise about $7 billion a year for five years.

On Tuesday, the Governor announced an additional $1 billion in midyear cuts to schools and social services, as the state's revenues fell about $2.2 billion below assumptions included in the budget he signed last summer. The cuts Brown announced Tuesday are lower than previous estimates by the state's legislative analyst, which will allow the state to avoid deeper cuts to public schools. The lower revenue will trigger automatic midyear reductions to public school programs, universities and colleges, Medi-Cal managed care and in-home support for seniors and the disabled, to take effect Jan. 1.

The Governor's January Budget is expected to be released on January 10th following a press conference scheduled for Wednesday, January 4th. The budget is expected to outline a permanent funding source for the Realignment initiated last year. Selix expressed his overall optimism for MH funding and the State Budget going in to the New Year.

Selix discussed the proposed elimination of State DMH, saying there are still no details on any plans and no Deputy Director for MH/SA at DHCS has yet been hired. While extensive plans for newly created State Hospitals have been released there is no plan for structure or monitoring of community mental health at this point.

The California State Association of Counties (CSAC) released a Draft Paper on December 13th on the Realignment and related structures. The CSAC paper advocates a position which would allow counties a 10% transfers from one public safety pot to another pot. Selix is of the

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opinion that we can live with this proposal given there are other protected streams of MH funding. There is strong opposition, however, from the sheriffs who do not want to risk having their funding reduced at all. Selix foresees a fight between county governments and the sheriffs and he expects a resolution in the Legislature within the next 6 months.

UPCOMING MEETINGS & EVENTS

December

CANCELED

FFA Strategic Planning/Policy Committee Meeting

ACHSA 10:00 AM to Noon

CANCELED

Adult Mental Health Policy Committee Meeting ACHSA 10:00 AM to Noon

CANCELED

DCFS/Family Based Services (FBS) Committee Meeting

ACHSA 10:00 AM to Noon

January4 ACHSA Board Meeting ACHSA 10:00 AM to Noon

10 Probation Committee Meeting ACHSA 1:00 PM to 3:00

PM 12 Children’s Mental Health

Policy Committee ACHSA 1:30 PM to 3:30 PM

18FFA Strategic Planning/Policy Committee Meeting

ACHSA 10:00 AM to Noon

19 Mental Health CEO/ED Forum Hillsides 10:00 AM to Noon

20 Adult Mental Health Policy Committee ACHSA 10:00 AM to Noon

Association of Community Human Service Agencies1200 Wilshire Boulevard, Suite 302, Los Angeles, CA 90017

Tel: 213-250-5030 / Fax: 213-250-5040E-mail: mailbox@achsa.net / Web: www.achsa.net