2013 annual gathering: workshop #6c: residentially-based services collaboration and innovation in...

7/27/2019 2013 Annual Gathering: Workshop #6C: Residentially-Based Services Collaboration and Innovation in Continuity of Care

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Residentially Based Services Reform ProjectSAN FRANCISCO CONSORTIUM FOR RESIDENTIALLY

BASED SERVICES

FAMILY CONNECTIONS PROGRAM

COLLABORATION AND INNOVATION IN A CONTINUITY OF

CARE MODEL

SEPTEMBER 15, 2013


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Residentially-Based Services

Reform

California's Residentially-Based Services

(RBS) reform initiative seeks to transform

the state's group homes from long-term

congregate care and treatment, to short-

term residential stabilization and treatment

programs with follow along community-

based services to reconnect youth to theirfamilies, schools and communities.


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California Alliance of Child and Family Services

Stakeholders Workgroup

2004

family members

emancipated foster care youth

child and family advocatescounty and state public agency officials

representatives of the legislature

care provider representatives


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Framework for a new system of

residentially-based services

enhance services

expedite permanent family placement for

youth needing time in a residentialtreatment setting

reform the way group homes are utilized in

California, the range of services they offerand how they are reimbursed for these

services


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AB 1453

2007

California Department of Social Services (CDSS)

financial support from Casey Family Programs

creation of the RBS Reform Coalition

Sierra Health Foundation

Child and Family Policy Institute of California

AB 1453 legislation authorized selection of

counties that would, in partnership with privateproviders, implement alternative program and

funding models consistent with the RBS

framework document


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California Alliance of Child and

Family Services

family members

young adults who experienced residential

placements as youth, child and familyadvocates

public agency representatives

provider representatives


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Vision for Transformation

Transitions group homes from a structured often long-term living environment for

children to an intensive short-term intervention tasked with returning children to their

own homes or to another permanent and stable family setting in as short a time

possible.

Offers the range of behavioral and/or therapeutic interventions necessary to overcomemajor obstacles to children living in their own homes or other stable family setting,

including two new and critical categories of services (family support and post-

discharge).

Defines a number of major RBS program features, including comprehensive up-front

assessment of children by county placing agencies, matching of individual children'sneeds with an appropriate RBS program, family finding and engagement, along with

other effective program strategies.


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Demonstration Sites

San Francisco County (March 2011)

Sacramento County (September 2010)

Los Angeles County (December 2010)San Bernardino County (June 2010)


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Strategy - Guiding the Process

California Legislature

California Department of Social Services (CDSS)

County welfare directors

The State Department of Mental Health

Chief probation officers

Casey Family Programs

Child and Family Policy Institute of California

California Alliance

A team of consultants was brought together initially to provide needed

training and technical assistance to demonstration sites

An Executive Team makes overall project decisions, while LocalImplementation Coordinators champion RBS at the county level


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Collaborative PartnersSan Francisco Consortium

Internal

San Francisco County Human Services Agency San Francisco Community Behavioral Health St. Vincents School for Boys Seneca Center

Edgewood Center for Children and Families

External

Casey Family Foundation

California Department of Social Services California Alliance for Child and Family Consultants


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Mission, Goal and VisionMission of the San Francisco Consortium Family Connections Program: Interrupt, at the outset of involvement, the multiple placements and serially disrupted attachments

that characterize the lives of those children and youth in our child welfare, juvenile justice and mentalhealth systems

Goal of theFamily Connections Program: Act as a re-connection engine with a focus on permanency:

5 - 7 months in residential services and 17 - 19 months in community based services

Community based services support youth as they return home to family or kin, or during shortstays in intensive treatment foster care, other FFA or County foster placement

Model is designed to test the feasibility of creating a new, integrated and replicable treatmentoption for children or youth who traditionally have been served through extended group homeplacements, and their families

Three core services together in one continuous, coordinated and strength-based program:

residential treatment

family support

intensive behavioral health services

Vision of the Family Connections Program:

Children and youth with complex needs and situations will no longer have to experience oneplacement failure after another in the search for a match that works

Children and their families will get the help they need, when they need it, and in the places most likelyto help them achieve and sustain positive outcomes


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Guiding PrinciplesTheguiding principlesof the Family Connections Program:

All children and youth deserve a home, a family, a community, and a voice in their care

The function of an FCP is not to be a placement but to be a part of a process to return youth totheir families and communities as soon as possible

Families and kin in the broadest sense are the backbone of every child and youths life, andfamily must be the foundation upon which our interventions are constructed

The FCP is not the family for their enrolled children and youth. The job of the program is to find,engage, and empower positive family relationships

Children, youth and families must have access to the development of, voice in choosing thecomponents included in, and ownership for the accomplishment of their plans of care

Interventions must be strength-based, family-centered, individualized and culturally competent

Continuity and consistency of care, caring relationships and the locations of care are critical tosustaining long-term positive outcomes

Residential interventions must be short-term strategies designed to help children, youth andfamilies make progress on their road to permanency, safety and well-being


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Guiding Principles The FCP acts in partnership with children and youth and their families, as well as

other supportive adults and agencies and organizations in the community;

To support long term success, programs must insure that each young person andfamily establishes a network of supportive individuals and activities in thecommunities where they will be living;

The FCP must be flexible in offering a horizontal continuum of services that can be

accessed at any point or time by enrolled children, youth and families.

Throughout the service delivery process, young people and their families mustexperience themselves as drivers of the service planning process and be treated asexperts on their own strengths and needs;

Accountability for achieving progress and effective outcomes should become a keyelement of further system development; and,

One child one system: The SF Family Connections Program must develop a single,integrated, flexible and transparent system focused on insuring continuity andresolution to cross-system barriers.


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Target PopulationTarget Population

Between the ages of 6 and 16. Gender is not a criterion.

Currently in placement in an RCL level 12 or higher group home, or at risk of or pending placement inan RCL level 12 or high group home

Placement or pending placement in such an RCL due to a combination of family disruption, abuse andor dangerous behaviors that cannot be managed in other settings

Have an available family/kin or anyone else who can provide a permanent home and is willing toparticipate in the program

Although the child or youth has a parent or primary caregiver who is connected with and willing towork towards permanency, a permanency plan is unlikely to be accomplished within 6 months unlessintensive work takes place to resolve difficulties in attachment between the child or youth and his orher parents or other primary caregiver, and/or to address the challenges to reunification caused bythe child or youths persistent dangerous and disruptive actions that at present cannot be managed in

the community.

An average of 5 - 7 months is being used to allow for those clients who will need both more, or lesstime, in the residential component based on their individual needs


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Projected OutcomesChild and Family Outcome Measures:

Reduced lengths of stay in group care

Increased % of youth dis-enrolled to permanency (reunification with immediate family,adoption, legal guardianship with a relative or fictive kin, or living independently within asupportive community

Increase childrens proximity to their home and community

Improved placement stability for youth in group care

Decreased % of youth re-entering after dis-enrollment from group care

Families will have greatly expanded contact with their children while in the group homesetting

Enhanced wellness and health as measured by normed measures agreed upon by theevaluation subcommittee, e.g. Child and Adolescent Need and Services (CANS), YouthSatisfaction Survey (YSS) and YSS-Family

Participating youth are enrolled and actively participating in educational or vocationalprogram and/or employed at six months after dis-enrollment from RBS-including

community based aftercare services


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Key Innovations

To insure that children, youth and families are fully engaged in the effort to build and sustain strong

family connections, programs will have processes that support meaningful involvement, a servicedelivery environment that is supportive to family participation, and specific methods for maintainingconsistent engagement throughout the period of enrollment in the program.

Consistent and Collaborative Treatment

Family search, engagement, preparation and support

Flexible funding to support innovation

One Child and Family Team Across all Environments

Comprehensive Care Planning Unifying Residential and Community Treatment

Building Life Long Connections and Natural Support

Concurrent Community Work While in Residential

Crisis Stabilization Without Replacement (14 days)

Respite in the Community


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Care Components

The FCP consists of three care components:

A Residential Care Center

maximum of 6 RBS youth, anchored by milieu staff, and primarily funded through federal,state and county IV-E case rates.

also serves as a short term Crisis Stabilization for RBS youth and children

A Community Care Component

serving up to 14 children or youth and their families in both the residential center and inthe community,

anchored by youth and family support staff, care coordinators and family partners,

funded in part through state and county IV-E case rates and

in part through EPSDT fee for service billing.

A Clinical Care Component

serving all 14 children or youth

anchored by youth and family clinical care coordinators and mental health rehabilitationspecialists

funded primarily through EPSDT


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Treatment InterventionsEnvironmentally based interventions In the residential component of each FCP, these interventions are designed to provide short-term,

high-impact behavioral stabilization, assessment, and support

Intensive treatment and interventions The therapeutic component of each FCP will provide an array of intensive treatment and interventions

designed to help the child or youth and family understand and address the psychosocial andneurobiological drivers that may be contributing to (or resulting from) the disruptions that the familyhas experienced and is experiencing.

individual therapy

family therapy

psychiatric services

Medication

Day treatment services and Therapeutic Behavioral Services

Parallel services The FCP begins its relationship with the child or youth and family in the residential unit and the

family connections center on campus, but as quickly as possible begins to transition the locus ofsupport and services to the environment where the child or youth will be living upon completion ofenrollment.


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Follow-up and TransitionalSupport

Post-reunification support and services provided during the first few months following the child oryouths return home are a critical element in helping children or youth and their families lock in andadhere to the new ways of interacting

The in-home service team from the FCP will be there to provide ongoing treatment , instruction andsupport as needed

Transitional support - gradual reduction of the level of service involvement always based on theaction plans and modifications developed through the FST


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RBS System Flow Chart


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Residential component - $11,000 per month per child or youth and family. The percentage of therate that is IV-E allowable for IV-E eligible youth is estimated to be 92.62%.

Intensive Treatment Foster Care (ITFC placement) - $5581 per month, per child or youth andfamily. This is the current CDSS-approved rate for ITFC Level 1. The SFC believes that 60% of the

costs are IV-E allowable for federally eligible youth.

Community services - $3,500 per month, per child or youth and family. $3,500 is inclusive of anyfoster care maintenance costs paid by the county to a placement caregiver. Maintenance costs forfederally eligible youth are 100% federally allowable for foster home, relative, and non-extendedfamily member placements, and on average 67.5% allowable for treatment foster family agencyplacements.

Basic Components of the

Funding Model

F il C ti P


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Family Connections ProgramStaffing

Program Director:

Manage the development, implementation and operation of the FCP

Masters level or above., at least 5years experience, at least two as a supervisor or manager

Lead Clinician:

Supervise all behavioral health service plans, assessments and provide liaison with community mental

health services

Masters level or above, 3 years of experience, license required

Residential Supervisor:

Supervise the family specialists across environments. Will also provide oversight of the residential

component and coordinate program management with the program director and lead clinician

Bachelors level or above, at least 5 years experience, at least 2 as a supervisor or manager


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FCP Staffing

Consulting Psychiatrist: (contracted services):

Assistwith assessment and evaluation of children and youths needs as requested, consult with leadclinician and staff on intervention strategies, manage any medication issues that children and youthmay have if they do not have their own community-based prescribing psychiatrists

M.D., board certified child psychiatrist, at least 1 year experience working with children and youthwith severe emotional and behavioral needs

FCP Counselors/ Family Specialists:

Help to implement the behavioral health elements of the Comprehensive Care Plans in the residentialcomponent and in the community, support develop and use of improved family interaction and copingskills, participate in the Family Support Team meetings

Maintain the residential milieu, provide support, nurturance and structure for the residents, help themmanage their challenging behaviors

Bachelors level or equivalent experience at least 1 year experience working with children or youthand families


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FCP Staffing

Clinical Care Coordinators:

Facilitate the engagement process, strengths, needs and goals discovery, and the Family. SupportTeam process. Document the Comprehensive Care Plan developed by the FST, and coordinate itsimplementation. With the FST track service delivery the progress being made by children, youth andfamilies

Masters level, trained in facilitating strength-based, family-centered plan development and

coordination of service activities across multiple domains

Facilitator:

Facilitate child and family team meetings, take notes, and track progress on meeting objectives

Masters level, trained in facilitation, experience working with children and families preferred


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FCP Staffing

Family Partner:

Provide engagement and support for family members and youth, help them understand the nature ofthe program and insure that they have access, voice and ownership in the process of developing andimplementing the Comprehensive Care Plan, and help with facilitating accurate and effective child,youth and family input in the evaluation and continuing improvement of program services andoperations

Prior experience as a parent, family member or primary adult caregiver of a child or youth with

serious emotional and behavioral needs who received services through 1 or more of the countysystems of care, including child welfare, mental health and juvenile justice

Administrative Support Personnel/Scheduler:

Provide assistance with internal record maintenance, scheduling, obtaining needed external records,

provide quality assurance oversight of treatment record

Bachelors level or equivalent experience, at least 1 year of prior administrative supportexperience


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FCP Staffing

Family Finder/Foster Home Recruiter:

Duties include foster home recruitment for the two providers with FFAs, and will do family findingprimarily for the provider who does not run an FFA

Bachelors level, or equivalent experience

Quality Assurance Personnel:

Maintain files, support all QA functions

Bachelors level or above


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Lessons Learned

Obtaining County and State Approvals Be patient

Be specific

Alignment of the VA and funding model is critical.

Not too much information - just answer the question.

Show more patience

Challenge as necessary

Bay Area Consortium to One-County Pilot: Challenges of a Multi-County

Consortium Through a Request for Qualifications process, five counties and six providers were selected to

participate in the BAC demonstration site of the RBS initiative.

Perspectives Counties, providers, consultants

Agreements

Conforming to a structure

Compromise


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Two and Two Can Make Five

There is Opportunity in Every Crisis

Sending children home is not just a matter of doing a lot of therapy; children need

families

Funding usually follows programs; funding for families in residential treatment is

limited

Funding constraints form attitudinal sets: if we cant fund it, we shouldnt think about it

Child Welfare departments have a mandate to get children to permanent families


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Opportunity Contd.

Little ability to help families but high demand to place children in families creates crisis

Crisis creates the opportunity to blend funding and allow a new model

BUT


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Appropriate Clients vs Available Clients

Tremendous surge in the kind of client who needs high end care

New Program presents opportunity to loosen gridlock

High end care clients may not be the most appropriate, but they are the most available

Most available means longest time in care; attempts to find families have failed

Staff want to succeed in pilot; County wants to empty beds


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Clients and Families Need to Match

By the time clients enter the program, attempts to find extended family have been tried

and failed. Clients have often required years to stabilize before provider can safely

recommend to foster care placement.

Extended family members may be available but unable for many reasons.

Mobility Mapping helps to establish whos been important in the clients family. Mobility

Mapping is a tool developed by Kevin Campbell, LCSW, of the Center for Family

Finding and Youth Connectedness.


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Family Finding Pays Off

Families come from the extended family, from our foster care agency and from the

efforts of HHS, through its Family Builders unit.

Finding a family is only the beginning; helping the child to adapt to the family is a huge

part of the work. Long term out of home clients are not used to the intimacy of afamily. Staff members become the bridge between the client and the family.

Staff members develop their own hopes and fears about whether the family and the

child will be able to live with each other; the staff process is just as important at the

child and family process.

Unexpected family issues arise and staff members have to stretch their own roles to

meet the needs.

F il C ti th I l Y W t t


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Family Connections are the Inlaws You Want to

Have

The sheer number of service providers is tough to stomach for the family at first.

There are always adjustments with the hope that providers can be replaced by natural

community supports: friends, teachers, extended family, church members and

neighbors.

Accepting the need for help is critically important; making a new family is hard work

and does take a village.

Striking the balance between rescuing and teaching makes or breaks the case. Family

specialists and case managers join the family knowing that they will have to leaveagain; they become the inlaws who are always hovering.


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2013 annual gathering: workshop #6c: residentially-based services collaboration and innovation in...

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