Inside This Issue (click to go directly to the article):



Inside This Issue (click to go directly to the article):

1. ACHSA Renews Its Meetings with the DMH Executive Management Team

2. Get Out the Calculator: DCFS Issues Second Annual Preliminary Performance Scorecards for Group Homes and FFAs

3. Learning From Your Peers: ACHSA IBHIS Panel Features Members’ EHR-S Experiences

4. Dr. David Sanders Asked by Board of Supervisors to Analyze the Integration of Multiple-Agency Planning to Improve Lives of County Children and Families

5. Is Your FSP Program Cash Strapped? Children’s Mental Health Committee Discusses FSP Concerns, Among Other Issues, with DMH Deputy Director

6. DMH and DCFS Host Training on EPSDT Billing for Wraparound Providers

7. The Train To DMH Performance Based Contracting Continues On Track

8. Who’s Your Daddy? CII Hosts a Conference on the Importance of the Involvement of Fathers

9. New Reports on Mental Health Services Act (MHSA) Progress Statewide

10. DCFS and Probation Host Training on the New Needs and Services Plan/Quarterly Report Template

11. Mental Health Odds and Ends

12. Know Your Resources – DCFS Has Public Health Nurses Willing to Assist You

13. Updated CLC Roster

14. Conferences & Events

15. In the News

16. Upcoming ACHSA Meetings

|KEY ISSUES |

• ACHSA Renews Its Meetings with the DMH Executive Management Team

On Monday, ACHSA Board members and staff renewed their meetings with the DMH Executive Management Team, after a lengthy hiatus. The members of the DMH Executive Management Team included Acting Chief Deputy Director Robin Kay, Deputy Directors Dennis Murata and Debbie Innes-Gomberg, Chief Information Officer Bob Greenless, Chief of Contracts Richard Kushi, and Gurubanda Singh Khalsa. The key issues that were discussed included:

MHSA Full Service Partnerships (FSPs) Technical Assistance and Monitoring

Robin stated that since MHSA performance requirements were written into the RFS solicitations and provided clear preferred expectations, DMH felt that they could be easily transferred into monitoring guidelines, similar to the AB 2034 program. Accordingly, DMH will be meeting with all agencies with FSP programs to monitor their performance relative to these expectations. According to Debbie, the spirit in which these visits will be taking place is to try to support providers in delivering services and to share best practices. There will be a two-part process: 1) a self-assessment completed by the agencies; and 2) a follow up visit by DMH age group leads and District Chief staff, to get both perspectives.

DMH is currently envisioning a review of three separate documents during its monitoring activities: 1) an FSP staffing roster to ensure proper staffing ratios; 2) a provider pre-site visit questionnaire, to attempt to determine where an agency might be struggling and what assistance it might need from DMH; and 3) a review of FSP program performance based criteria. Debbie stated that the monitoring visits will be piloted first at several County directly operated and contract agency program sites. There has been no determination made yet as to how frequent these monitoring visits might be, and DMH will be looking for input on this from ACHSA.

MHSA Field Capable Clinical Services (FCCS)

Robin mentioned that DMH has yet to complete its final guidelines for the delivery of FCCS, although she has been very pleased with the expansion of these services as part of the budget/MHSA transformation process. DMH will be setting up a workgroup meeting shortly to discuss FCCS outcome measures and asked for names of possible ACHSA representatives.

Desired Meeting with CEO and DMH on DMH Budget

Bruce explained that over the years questions continually have arisen regarding how the Department develops its budget and then tracks its budget expenditures. These questions obviously become more pronounced during times of budget crisis. While ACHSA initially considered investing in a consultant in an effort to obtain more information in this area, it decided that it would be better, and more direct, to simply meet with DMH and the CEO to get a better understanding of the budget. Robin noted that this request fit together nicely with one of the Department's new organizational values -- transparency. She agreed to arrange a meeting with ACHSA, DMH, and the Department's CEO representative David Seidenfeld.

ACHSA Review of DMH New or Revised Policies/Procedures

Bruce provided some background information on this agenda item, noting that as far back as a September 2007 email from Gurubanda to Robin and Dr. Southard ACHSA had requested a "routine review and comment period for new and/or revised policies and procedures," to assist and enhance the development/revision process. Dr. Southard had then committed to such a review process at a later ACHSA Board meeting, as long as the policy or procedure was within the purview of the Department. However, DMH had yet to develop a concrete procedure for developing and disseminating its draft policies and procedures for input.

Robin noted that, interestingly, the Department had just established an internal policy review committee. The committee was addressing two separate issues: 1) old policies and procedures, some of which have been around since 1980 or so, which need to be reviewed for current appropriateness; and 2) the process for the development of new policies. DMH was also considering the question as to which documents rise to the level of policies, as opposed to just program guidelines or recommended practices. Current practice is for recommended policies to go directly from the Department's internal committee to Dr. Southard, skipping both ACHSA and other key DMH staff. Robin agreed that this needed to be changed. The status of this item will be reviewed at the next ACHSA/DMH Executive Management meeting.

Rate Setting Process for FY 2008/09

Richard stated that the rate setting packet from the Department is usually sent out in March prior to the beginning of the fiscal year. However, next fiscal year has been complicated by the fact that the State has refused to provide any guidance to the counties until the State budget is passed. According to Richard, State DMH does not want to risk the possibility that provisional rates will exceed the SMA. He did agree that once the State budget is resolved, DMH will act expeditiously to send out anything they receive from the State within a couple of days, and will also work with their District Chiefs to try to streamline the approval of the rates.

September 15th Cost Report Extension

ACHSA raised the age old issue of provider's difficulty in getting their cost report data in by the DMH deadline, based on when they receive the Department's 13th run IS data. Gurubanda made it clear that while the Department would not move the September 15th deadline unless "something extraordinary" happened, agencies would be told again that they could use their own data. DMH will get out a written confirming memo on this shortly.

Other Miscellaneous Issues

The remaining issues discussed included: 1) adding MAA to agency contracts (isn't going to happen any time soon); 2) ACHSA participation in regular DMH MHSA planning meetings for joint problem solving; 3) and DMH's efforts to address the State's concerns regarding the certification of Medi-Cal claims.

For additional information, please contact Bruce or Wendy.

• Get Out the Calculator: DCFS Issues Second Annual Preliminary Performance Scorecards for Group Homes and FFAs

DCFS is close to completing the second annual group home and FFA scorecards which reflect agency’s 2007 performance. Minimal modifications have been made to the 2007 performance measures, performance standards, operational definitions, and actual scorecard as described below.

• Performance Measures – no changes were made to the actual measures. DCFS has agreed to add qualifying language to the new contract which highlights the work and decision-making process of the Performance Measures Task Group (PMTG) and allows for more flexibility in modifying the performance measures.

• Performance Standards – some changes were made to the performance standards for the 2007 scorecards. For those measures in which the actual collective 2006 performance exceeded the 2006 standard, the standard will be the average of the 2006 standard and the actual collective 2006 performance. For example, the placement stability measure standard for FFAs in 2006 was 90% and the actual performance was 94.7%, so the 2007 standard is now 92.3%.

• Operational Definitions – the operational definitions for FFAs and group homes were originally developed in response to a lack of understanding of the performance measures written in the contract. The definitions were designed to more fully explain the details of the performance measures, such as what the data reflects and who is included in the analysis. The definitions have been revised for 2007 to more clearly articulate the performance measures based on a better understanding of the data and data collection process.

• Scorecard – the format and content of the scorecards have been slightly modified. On the first page of the scorecard, which includes descriptive information for each agency, the data collection formula for the average age of child and average length of stay was modified to more accurately reflect the population that was served during the calendar year. The second section of the scorecard, which includes a summary of the monitoring visits, remains the same except for the addition of a noteworthy finding when an agency uses a client satisfaction survey. The third and final section of the scorecard, the performance matrix, now includes two years of actual performance data for the agency (CY 2006 and CY 2007). A few footnotes were also added below the matrix to explain some nuances of the data.

DCFS informed ACHSA that it is on track to issue individual agency preliminary scorecards by Friday, June 27th, so providers should have received their scorecard and supporting documents electronically by the time this publication goes to print. DCFS also plans to mail the scorecard and supporting documents to agencies. If agencies do not receive a copy of their group home and/or FFA scorecard, they are encouraged to contact their monitor to request a copy.

Once agencies receive a copy of their preliminary scorecard, they will be asked to review and verify the information in the scorecard, including the descriptive information at the beginning of the scorecard, the summary of their monitoring review(s), and the actual performance data at the end of the scorecard. Agencies will be asked to contact their DCFS monitor if they dispute any of the information included in the scorecard, and preferably submit their rationale in writing. The monitor will then review the agency’s reason(s) and make adjustments accordingly. If at any time during the ‘appeals’ process the agency is not satisfied with the communication with its monitor, the agency is encouraged to contact the monitor’s manager to resolve the dispute. Agencies can also contact ACHSA if further assistance is needed. Since agencies received some of their data for review in May and had an opportunity to submit an appeal to DCFS for those specific performance measures, hopefully the scorecard review process will not be as long and cumbersome this year as it was last year.

Similar to last year, DCFS also plans to host a FFA and Group Home Forum to explain this year’s scorecard process with providers as well as answer providers’ questions. Once the dates have been finalized, ACHSA will share them with its members. The PMTGs also plan to develop a summary report highlighting the system-wide performance of group homes and FFAs on each of the performance measures, which will probably be shared with the Department Executives and the Board of Supervisors’ Children’s Deputies like last year. ACHSA members are encouraged to attend the next PMTG meeting on Friday, July 11th at ACHSA’s offices (10 am-noon for FFAs and 12:30-2:30pm for Group Homes) to stay informed and involved in the scorecards.

For further information, please contact Amanda.

• Learning From Your Peers: ACHSA IBHIS Panel Features Members’ EHR-S Experiences

ACHSA hosted its third Integrated Behavioral Health Information System (IBHIS) Panel Presentation on June 16th, featuring the experiences of different member agencies and their staff in the IBHIS transition process. The following individuals participated on the panel:

• Monica Davis, Chief of Evaluation Services, Mental Health America-Los Angeles

• Bill Fujihara, Director of Clinical Services, Social Model Recovery Systems

• Michael Guitron, Director of Information Systems, Pacific Clinics

• Steve Gunther, Chief Operating Officer, St. Anne’s

• Lynnae Hernandez, Director of Fiscal Services, BRIDGES Inc.

• Jan Llewellyn, Chief Operating Officer, Foothill Family Services

• Sharon Sharp, Director of Systems Management, Hillsides

• Sandra Sternig-Babcock, Chief Executive Officer, Dubnoff Center

• Steve Talavera, Chief Financial Officer, Los Angeles Child Guidance Clinic

Facilitated by ACHSA IBHIS consultant Keely McGeehan, the meeting began with Bill Fujihara discussing the EHR-S budgeting process at Social Model Recovery Systems. Bill noted that the biggest challenge was taking an inventory of staff’s computer and technology skills. The budgeting process started with a meeting of the senior management team, which decided to bring Keely on board as a consultant. With Keely’s help, the agency created a modified budget based on the potential rearranging of staff responsibilities and prioritization of system features that the agency needed first. Bill acknowledged that the budgeting process was relatively smooth given Keely’s expertise. Social Model Recovery plans to look at mid-range vendors via vendor demonstrations in September.

Similarly, Steve Gunther noted that St. Anne’s had retained Keely as a consultant to assist with the EHR-S process. Prior to retaining Keely, Steve had initiated a vendor demonstration for senior managers to understand the potential of EHR-S in improving the agency’s effectiveness and efficiency. The agency’s EHR-S budgeting started with an all day discussion that included the CEO, billing staff, and program directors. St. Anne’s had initially favored a high end product, but since it opted out of some optional features, the agency is now looking for a mid-range product. Steve also shared that a subset of St. Anne’s board members formed a finance committee to look at the cost and liabilities associated with its EHR-S process.

Keely next asked Lynnae Hernandez to detail BRIDGES’ approach to EHR-S. Lynnae stated that her agency had solicited vendor recommendations from other ACHSA members. BRIDGES decided to select a web-based product, since agency staff believed that this type of product would mean fewer problems with backing up data on the system. Since the agency operates a residential program, Lynnae stated that it did not need a vendor that could handle high volume billing. Moreover, the agency factored in the agency’s maintenance fee once its allocation of the MHSA Technology fund was used up. In the end, the agency selected Exym as its vendor.

Since Los Angeles Child Guidance Center is currently in the testing stage of the Electronic Data Interchange (EDI) process, Keely asked Steve Talavera to elaborate on what lessons the agency has learned during this process. Steve commented that LACGC had originally allocated some money for dedicated project management staff, but there was a delay in bringing a full time project manager on board. The initial agency team working on this project consisted of IT staff, MIS staff, the Clinical Director and Steve. Similar to other agencies, all these different team members were juggling multiple roles and responsibilities. Now, LACGC is planning to hire an individual to lead the project who will be ultimately responsible for the system, hopefully within the next month.

Jan Llewellyn and Sandra Sterning-Babcock also shared Foothill Family Services’ and Dubnoff Center's experiences in selecting a project manager for the EHR-S transition process. Originally, Foothill Family Services was considering transitioning an existing therapist at the facility who liked computers to the project manager position. Instead, Foothill hired an individual who has a background in technology, databases, and project management experience in health care. Dubnoff Center collected different sample job descriptions to help the agency craft its project manager job description. Since Dubnoff has already completed a detailed agency inventory and is in negotiations with a vendor, Sandra felt that this would be an ideal time to bring a project manager on board.

Speaking from experience as the appointed project manager for the EHR-S transition process at Mental Health America-Los Angeles, Monica Davis talked about the importance of balancing different staff interests. Monica has been overseeing the IT Department for the last three years and is currently tasked with ensuring the agency’s transition to EHR-S. This position is challenging because it requires the ability to sift through different staff needs when it comes to electronic systems. In order to better understand staff’s needs, Monica asked each department to send her a “wish list” of features they wanted to include in the ideal EHR-S product. Monica emphasized the importance of the project manager in understanding all the competing interests while prioritizing agency needs.

In terms of Hillsides’ experience, Sharon Sharp noted that the agency had the challenging task of trying to integrate eight systems, including schools as well as DMH. Hillsides first detailed its workflow process, which served as the basis for how the agency determined the EDI rollout. Sharon anticipates that Hillsides will first migrate data into the new system and then train intake staff to populate the new system. The billing department will be the next agency group to transition to this new system. Sharon hopes that Hillsides will “go live” agency wide by September.

As the largest mental health agency, Pacific Clinics has a large volume of both users and transactions. It also has a very strong Information Technology Department led by Michael Guitron. Staff first developed technical questions for all the vendors and looked at the different vendors’ experiences. This process allowed Pacific Clinics to narrow down the field of vendors from 6 to 3. Because of the large number of users, upgrading desktops would be too costly. This was one of the factors in Pacific Clinic’s decision to go with an Application Service Provider (ASP) model. Mike also emphasized the need to have clinical staff buy into the selected product. When users “buy in” to the selected product, they have a closer link to the application of the system and it makes implementation easier for the agency.

If you have questions about the EHR-S process, please email Keely McGeehan at EHRQuestions@. The next Panel Presentation on “The Electronic Healthcare Record System (EHR-S), from the Users’ Perspective” will be on July 11th at St. Anne’s from 9:30 AM – 12:30 PM.

For more information, please contact Wendy.

|ISSUE BRIEFS & UPDATES |

• Dr. David Sanders Asked by Board of Supervisors to Analyze the Integration of Multiple-Agency Planning to Improve Lives of County Children and Families

ACHSA recently received a copy of a report back to the Board of Supervisors from the CEO's office detailing the analysis and recommendations of former DCFS Director, Dr. David Sanders, in response to a motion by Supervisor Antonovich instructing the CEO to work with Dr. Sanders and Casey Family Programs to develop recommendations for "an effective health and human services model for Los Angeles County to better integrate its multiple-agency planning and implementation efforts to improve the lives of the County's children and families."

The report back, in this reporter's opinion, is a very interesting study in "personal turf protection." Dr. Sanders does a masterful job of deflecting responsibility for prior Departmental deficiencies, and the CEO's job does a masterful job of telling the BOS why it doesn't really need to implement Dr. Sanders' recommendations because, "[f]ortunately, much of what Dr. Sanders describes in his letter is well underway."

Dr. Sanders Highlights the "L.A. Experience"

Dr. Sanders, now that he has left DCFS, mentions that "the performance of the Department of Children and Family Service (DCFS) has fallen short of the Board's expectations for several years." He specifically references historical poor performance in the areas of assuring safety in foster care, assuring timely permanency, and "a variety of other areas." At the same time, Dr. Sanders points out that "during the past five years, DCFS has demonstrated progress in many areas." Most importantly, however, Dr. Sanders is careful to point out that, in addition to the improvements made while he was the Director, "during my tenure as DCFS Director it was my contention that the Department's progress would eventually slow or plateau due to fundamental structural issues in the County." The only word that came to mind to describe that last point was, wow!

Dr. Sanders' Analysis of the New County Structure

Dr. Sanders then goes on to explain the Department's "limited or no ability to affect problems contributing to child endangerment," as well as evidence of the Department's "authority and resource limitations and structural challenges," after which he provides an analysis of the County's new organizational structure and recommendations for change. Dr. Sanders makes two primary recommendations:

1) Create a Health and Human Services Cluster, aligning all staff and services necessary for child safety under one cluster, which would result in the realignment of Child Protection, Mental Health, Public Social Services, Community and Senior Services, and Public Health Services. In such instance, the authority, responsibility and accountability for child safety would rest with the Deputy CEO of the cluster. As an alternative to this recommendation, to the extent it cannot be implemented, Dr. Sanders proposes to assign authority over all child safety resources to the DCFS Director.

2) Assign responsibility for Title IV-E resources to one Deputy CEO, "to assure the necessary oversight and accountability for outcomes achievement required by the waiver." The major implication here would be to not have DCFS and Probation Juvenile Services split into two clusters, which they are currently.

CEO's Response to Dr. Sanders' Casey Family Programs Report

Not surprisingly, the CEO's response, while courteously agreeing in principle with Dr. Sanders' recommendations, makes no attempt to actively move forward with them, the rationale being that the CEO is already moving in that direction in multiple ways. At the same time, the CEO does agree to "further study" the recommendations, while also stating that it is important to make sure that "the County proceed with caution."

Separate and apart from the CEO's response to the report, there is included in the report back to the BOS an interesting reference to the focus of the Children and Families Well-Being Cluster over the next few years. In addition to the expected priorities of Katie A. and the Title IV-E Waiver, its other two priorities are stated to be youth that cross over from DCFS into the juvenile justice system, and determining the feasibility of developing a Centralized Case Management system to better serve health and human service clients.

For further information, please contact Bruce.

• Is Your FSP Program Cash Strapped? Children’s Mental Health Committee Discusses FSP Concerns, Among Other Issues, with DMH Deputy Director

At its most recent June 18th meeting, the Children’s Mental Health Committee welcomed DMH Deputy Director of Child, Families & Youth Administration Olivia Celis, Acting District Chief Bryan Mershon, and Program Head Gita Cugley as guest speakers. The majority of the dialogue with the guest speakers centered on concerns previously expressed by member agencies that the agency costs of providing adequate services to a MHSA Full Service Partnership (FSP) client exceeds the FSP slot allocation that was approved by the MHSA Delegates. DMH FSP data show that the average cost per agency for providing services to one FSP client totals $20,000 per year, excluding flex funds or family funds. This is a significant differential from the original planning estimate of $14,000 for each Child FSP slot. In addition to the County generated data, several contract agencies’ individual data records show even a larger differential between agency costs and the FSP slot allocation.

Potential Sources of Additional Funding for FSP Slots

Acknowledging the frustration of the member agencies, Olivia stated that one potential source of funding for increasing the FSP slot allocation is a carryover of $1.5 million (on-going funds) in the original Community Services and Supports Plan (CSS) that was to be for co-occurring disorder training within children’s system of care. During the initial CSS planning process, the expectation was that this $1.5 million allocation would be integrated into services within the next three years. Since this has not happened, Olivia and her team are currently figuring out how to maximize the $1.5 million. Initial data analysis shows that the $1.5 million could potential draw down $13-$14 million in EPSDT. However, any departure from the initial purpose of the $1.5 million must be approved by the MHSA stakeholders. One committee member asked if a portion of the CSS growth funds could be set aside to address the above FSP concern. Olivia responded that the growth funds are a potential funding stream; however, any allocation for children’s system of care would also need to be approved by the MHSA stakeholders. Olivia hopes to first convene a subgroup of children’s providers to discuss the possible use of the $1.5 million.

FSP Slots Targeted for Indigent Care?

One Committee member wanted to know if DMH is planning to set aside any Children’s FSP slots for indigent clients. Olivia replied that slots specifically for indigents could be considered as part of the $1.5 million allocation. However, it is important to note that if the entire $1.5 million is used for indigent slots, the money will not go very far because indigent slots are not matched like EPSDT or Healthy Families. This dialogue on FSP brought up a larger policy issue about the Department’s position on how flexible FSP is supposed to be. If children’s providers become more vocal about advocating for increased funding for FSP slots, other age group providers would likely want the same increase for their FSP slots.

Regarding the potential increase for the FSP rate per slot, Olivia posed a question about whether the need of an FSP client remains the same over time. She argued that as an FSP client stabilizes, the acuity of services needs would start to drop off, resulting in less intensive services in the long term. A few member agencies stated that this has not been the experience with their FSP clients. Since FSP is a relatively new program, Olivia stated that the Department was comparing FSP and Wraparound data to see if there are similar or diverging trends. On a separate note, Olivia also mentioned that the Department is struggling with how best to move forward with Family Support Services within the FSP allocation. Currently, County data shows that only $119,000 out of the total set aside of $3.5 million for Family Support Services has been used.

Olivia Highlights Other DMH Child, Family & Youth Administration

Specialized Foster Care has recently moved to Olivia’s jurisdiction. Bryan Mershon will be assisting District Chief Greg Lecklitner with different components of the Katie A. Corrective Action Plan (CAP). Consistent with Adrienne Olson’s presentation at the last Children’s Mental Health Committee meeting, Olivia noted that one of her priorities is to ensure countywide Multi-disciplinary Assessment Team (MAT) implementation. Additionally, given the differences between Wraparound and Full Service Partnerships, DMH and DCFS are looking at how to bridge this gap through the implementation of the Child and Family Team (CFT) approach, currently rolled out in Arizona. A joint DCFS and DMH work group is currently discussing a blend of case rate, flex fund, and EPSDT funds to implement CFT countywide.

Largely as a response to concerns expressed by contract providers about the litany of programs and the “unfilled” capacity in programs such as Wraparound and Full Service Partnerships, DMH sent a one page survey to children’s providers in early spring to measure each agency’s capacity. A few contract providers complained about having to fill out the survey, so DMH has decided that if agencies are having difficulties obtaining program referrals, they need to talk to their respective District Chiefs and email Bryan Mershon at bmershon@dmh..

Lastly, Bryan provided an update on the status of budget transformation as it relates to Field Capable Clinical Services (FCCS). He is currently reading through the proposals of agencies that will transform programs to FCCS. Bryan is hoping to solicit further details from some agencies about their focal populations and the community organizations that the contract providers will be partnering with to deliver FCCS. Bryan also reported that Acting Deputy Director Carlotta Childs-Seagle will be sending out a memo to agencies in a few weeks about a FCCS meeting in mid July.

If you are an FSP provider that has not turned in your data comparing your agency’s costs of providing services to FSP clients to the FSP slot allocation, please send information to Bryan Mershon at bmershon@dmh.. Please remember to also send a copy to Wendy at wwang@.

For more information, please contact Wendy.

• DMH and DCFS Host Training on EPSDT Billing for Wraparound Providers

Building on the success of the DMH-sponsored Multi-Disciplinary Assessment Tool (MAT) EPSDT billing training for providers last fall, DMH finally agreed to develop a similar training for Wraparound providers. Since the beginning of the Wraparound program, the focus of the training for providers has been on the Wraparound model and process rather than on maximizing an agency’s capacity to bill to EPSDT. None of the trainings offered to providers up until this training have discussed EPSDT billing, which may be one of the reasons why in the 2007 Wraparound Annual Report it stated that nine out of the 34 Wraparound providers were not billing EPSDT and of those who were billing EPSDT they were not fully maximizing its capacity.

In response to this gap in training, and at the urging of DCFS to fully utilize other funding sources, a public-private workgroup of DMH staff (lead by Norma Fritsche and her assistant Jennifer Eberle), DCFS staff, and Wraparound providers met for several months to develop relevant training materials and tools for Wraparound providers to use to increase their understanding and knowledge of EPSDT billing. Since Wraparound has been operational in Los Angeles County and the state of California for several years, there was a wealth of expertise to build on and utilize.

EPSDT Training Tools for Wraparound Providers

The heart of the training focused on three vignettes which summarized each critical phase of the Wraparound process: Engagement, Implementation, and Transition. Each vignette began with a summary of the client, an explanation of the involved staff, and any relevant family history. The next section included case notes summarizing the various actions of the Wraparound staff that involve the client and family. The final section of the vignette included a matrix which highlighted the activities that were described in the case notes as either ‘Relatively Low Risk of Medi-Cal Audit Disallowance’ or ‘Higher Risk of Medi-Cal Audit Disallowance.’ The vignettes provided specific examples for Wraparound staff to use in documenting their case notes and billing to EPSDT.

In addition to the development of the vignettes, the work group also developed a document that specifies the Wraparound procedure codes specific to the program. They also created a guide for the different Wraparound staff claiming codes depending on the type of staff (e.g., LCSW or MFT, Mental Health Rehabilitation Specialist, or Other Unlicensed staff) that is working with the client and billing to EPSDT.

Next Steps

While the reviews from the providers of the training have been mixed, most agree that this type of training is long overdue and a step in the right direction. However, further training and discussion between DMH and providers is still needed, and the work group is still meeting to review and revise the tools that were developed, as well as considering the development of other tools as needed.

For additional information, please contact Amanda.

• The Train To DMH Performance Based Contracting Continues On Track

At the June 18th DMH Performance Based Contracting Work Group meeting, participants revisited the issue of whether there should be one countywide benchmark for all agencies for each outcome measure. The two alternative options being considered are: to establish different benchmarks for agencies of different sizes or to establish individual agency benchmarks for each of the outcome measures. This question emerged from last month’s discussion on the first outcome measure under the Access to Services category. The benchmark for this first outcome measure, which was originally based on the national average, states: “system wide 46% or more of clients are seen within 7 calendar days of discharge from an acute psychiatric hospital.” Participants expressed concern about how to objectively categorize agencies by size and were reluctant to establish any benchmarks without first reviewing data. Thus, the work group decided to table this discussion until the fall.

The work group then considered whether to exclude the Public Guardian clients from the data for the first outcome measure where “clients received continuity of care by having documented contact within 7 calendar days of discharge from an acute psychiatric hospital.” One justification for excluding this group of clients is that cases are frequently opened up by the Public Guardian’s investigative unit that lead to temporary conservatorship. Work group members agreed to exclude Public Guardian clients for right now; however, this issue may be reconsidered in the future. Similarly, members argued for exclusion of urgent care clients, since admission to urgent care centers is not the same as hospitalization in an acute psychiatric hospital. The conversation soon morphed into a discussion about COS and whether agency staff doing COS with a client within 7 calendar days of discharge from acute psychiatric hospital should be part of the data used to determine the outcome measure noted above. Everyone concurred that it was important to capture this data somehow and incorporate it into the outcome measure.

The next topic of conversation centered on how to improve the most recent May State Outcome Survey and field based survey process. One work group member noted that the State Outcome Survey was tedious in terms of the number of questions. Other members emphasized the importance of agency staff educating clients and family members before the start of the survey period. Since the survey was not translated in all of L.A. County’s threshold languages, work group members believed that this affected the overall response rate. Unfortunately, only the State has the authority to translate the survey into additional languages. Otherwise, all “unauthorized” translations are considered invalid.

Lastly, work group members looked at the outcome measure where “client received continuity of care via documented contact within 30 calendar days from time of discharge from mental health residential treatment program/institutional setting.” The work group suggested that “residential treatment program” and “institutional setting” be further defined. DMH reported that there is no existing report that contract providers can reference to obtain relevant information to this outcome measure. Therefore, DMH is proposing to create another report, similar to the I.S. 410 Report, as a tool for contract providers to use. ACHSA member agencies responded that adding more reports for agency staff to check contradicts the underlying philosophy of this entire work group to create mechanisms that are “cost neutral." This message was conveyed clearly to DMH staff to pass along to the DMH Executive Management Team (EMT).

Based on the meeting, a draft of recommendations was generated for the DMH EMT’s consideration.

For additional information, please contact Wendy.

• Who’s Your Daddy? CII Hosts a Conference on the Importance of the Involvement of Fathers

On June 12th, just days before Father's Day, the Children's Institute, Inc. (CII) hosted the 2008 Fatherhood Conference: In Harms Way, the Fatherhood Solution. For the sixth year, CII has hosted this national forum to raise awareness and advocate for the critical role that fathers play in the healthy development of their children. Research studies show that without their fathers, children are five times more likely to be poor and two to three times more likely to use drugs. Girls specifically are three times more likely to be unwed teenage mothers. Three out of four teen suicides come from fatherless environments, 90 percent of runaways come from fatherless homes, and about 70 percent of men in prison come from fatherless homes. Of particular concern are children who have been involved with the child welfare system and often have minimal to no contact with their father.

Overview of the Fatherhood Conference

This year's conference highlighted how nurturing the special relationship between a father and child contributes to that child's healthy development. Topics discussed included an overview of the research, working with incarcerated and deployed fathers, involvement of fathers in children’s early childhood development, and incorporating fathers into domestic violence treatment. The conference welcomed national and local speakers, including the Rev. Gregory J. Boyle, founder and Executive Director of Jobs for a Future/Homeboy Industries; Ken Canfield, founder of the National Center for Fathering; and the Honorable Michael Nash, Presiding Judge of the Los Angeles County Juvenile Court. There was also a very special and outstanding performance by actor Daniel Beaty, known for his one man performance "Emergency."

An overarching theme discussed and addressed was the stigma attached to fathers and the lack of overall outreach to include them in treatment programs with their children. The presenters at the conference highlighted the success that their agencies have had in engaging and working with fathers in their programs. Locally in Los Angeles, we have two well-respected model programs.

Highlighted Fatherhood Programs

CII’s Project Fatherhood program was launched in 1996 and is one of the first programs to specifically target the involvement of fathers. Project Fatherhood's primary goal is to increase the involvement of fathers in child rearing and to enhance the parenting skills of fathers so that they can help their children grow into healthy and responsible adults. Project Fatherhood’s clients may include fathers who are facing poverty, homelessness, a familial history of single parenthood, violence, physical abuse, substance abuse, recent or long-term lack of employment, or limited experience in interacting with their children. CII offers assessment and case management, a unique peer mentor program and Men in Relationships Group (MIRG). The support group is the core component of the program. All of these components work to provide the necessary tools to build healthy relationships between fathers and their children.

In response to the escalating problems and unmet needs of gang-involved youth, Father Greg Boyle launched the Jobs for a Future (JFF) program in 1988 to develop positive alternatives for this population, such as job employment, education, and day care. In 1992, Father Boyle expanded JFF to launch its first business, Homeboy Bakery, to create an environment that provided training, work experience, and the opportunity for rival gang members to work side by side. Today Homeboy Industries’ includes five enterprises: Homeboy Bakery, Homeboy Silkscreen, Homeboy Maintenance, Homeboy/Homegirl Merchandise, and Homegirl Café, which provide an array of comprehensive services. At the conference, Father Boyle highlighted one of their most exciting programs called Baby and Me. Once a week, homeboys bring their child(ren) with them to a two-hour class to learn more about parenting and bonding with their children. Father Boyle shared that it is one of their most popular programs and that the fathers look forward to every week. Not only is Homeboy Industries a gang intervention and prevention model, it is also a fatherhood development model.

For additional information on the research and other fatherhood programs across the county, contact CII’s Project Fatherhood , the National Fatherhood Initiative , or the National Center for Fathering .

For more information, please contact Amanda.

• New Reports on Mental Health Services Act (MHSA) Progress Statewide

Recently, the State Department of Mental Health and the State Department of Finance published two separate reports focused on the progress of the Mental Health Services Act statewide. In addition, new DMH Chief Deputy Director Elaine Bush attended the most recent CCCMHA meeting and presented an overview of recent activity at State DMH, most particularly in relation to MHSA. This article will attempt to highlight the most important and interesting elements and findings of those reports and that presentation.

State DMH Has Seen Tremendous Growth with MHSA

Perhaps quite surprisingly, State DMH is now the fourth largest State department, behind only Education, Corrections, and Health Services, with a $6.2 billion statewide mental health services budget. More than 660,000 Californians now receive county mental health services in their communities, 430,000 of whom are Medi-Cal consumers. [Interestingly, EPSDT alone has grown from $100 million in 1994-95 to over $1 billion in FY 2007/08.] Due to MHSA and Jessica's Law, dealing with sexually violent predators, State DMH has seen a great deal of growth in its own operations in a short period of time, which Ms. Bush acknowledged has created significant management challenges. At the same time, she emphasized the importance of addressing these challenges collaboratively with the Department's major stakeholders, including private providers.

MHSA Progress Highlighted in State DMH Update

State DMH reports that as of the second quarter of FY 2007/08 (based on individual county reports), over 67,000 persons had been served by MHSA System Development services, such as peer support, education, advocacy, and mobile crisis. Over 86,000 persons had been served by Outreach and Engagement Services, and 13,738 individuals had participated in Full Service Partnerships. The total state investment in Community Services and Supports (CSS), which combines these three areas, has risen to $1.2 billion through this fiscal year.

The MHSA revenue source generated more than $2 billion in additional dollars for mental health services through the end of FY 2006/07, and the State expects to have it generate an additional $1.5 billion in FY 2007/08, and another $1.5 billion in FY 2008/09. As of May 2008, $12.7 million had been committed for Local Planning; $2.1 billion had been committed to CSS; $345 million had been committed to Capital Facilities and Technology; $307 million had been committed to Prevention and Early Intervention; $106 million had been committed to Workforce, Education & Training; and $123 million had been committed to State Administration.

MHSA Challenges Identified in State Department of Finance (DOF) Report

Not all has worked well with regard to MHSA implementation. In a relatively critical June 3, 2008 report to the Legislature, State DOF determined that while the CSS Plan review and approval process was consistent with the MHSA, it was "cumbersome and lengthy. Additionally, fund distributions to the counties have been untimely." State DOF also found that "a documented plan of the MHSA development and implementation does not exist, resulting in a staggered implementation of components, delayed issuance of component guidelines, and fund distribution not in compliance with the MHSA." Finally, the report goes on to say that "entities involved lack effective communication and coordination, and roles and responsibilities are not clearly defined and communicated."

State DOF makes the following recommendations, among others, in its report:

1) Create a strategic development and implementation plan which includes clear guidance on component integration, performance measures, and program monitoring efforts.

2) Develop and document a funding distribution plan and ensure funds are distributed to counties timely and in compliance with the MHSA.

3) Develop regulations that define roles and responsibilities of each entity involved in the MHSA and communicate roles and responsibilities to affected parties.

4) Revise CSS plan review and approval guidelines to eliminate repetitive and redundant requirements, and allow for customization of templates to fit the specific needs of the community being served.

5) Allow counties to submit integrated Plans based on broad concepts rather than exact details.

For additional information, please contact Bruce.

• DCFS and Probation Host Training on the New Needs and Services Plan / Quarterly Report Template

At the end of May, DCFS and Probation hosted a second round of trainings for group homes and FFAs on the new Needs and Services Plan/Quarterly Report template. Once the new group home and FFA contract is finalized this November, providers will be required to use this standardized template. Last summer, DCFS hosted a joint training for providers on the new template and encouraged providers to begin using it [click on this link for a summary of last year’s training in the August 1st ACHSA Update]. The collaborative work group that developed the template agreed that ongoing training on the new template would be needed as the contract date nears and everyone is required to use it.

While there were no significant content-related changes to the template distributed at last year’s training, small changes and improvements have been made to the new template. The most exciting change for providers is that the new template includes the capacity to conduct spell check. Other changes included expanding different text boxes and lines to allow for more writing in the designated space. At the training, county staff from DCFS and Probation as well as a few providers reviewed the various aspects of the new template and expectations for completing it. They created a sample completed template for demonstration purposes as well as provided a template with instruction boxes to aide the worker.

During the training, providers highlighted a few areas that needed further clarification:

• LARRC Assessment – providers noted that the current LARRC assessment matrix included in the template is not consistent with the actual assessment and therefore cannot be completed. Probation agreed to review this section with their senior managers and either update the matrix to match the assessment tool or remove it from the template.

• CSW/DPO Visits with the Child – providers noted that they are not required to document County Worker’s contact with the child and they often do not know when the County Worker visits the child. After reviewing the new contract language, DCFS agreed that this is not a requirement in the contract, and they plan to remove this section from the template. Providers are encouraged, however, to note in the visitation section if the County Worker has been remarkably absent in their visitation with the child and communication with the provider.

• Emancipation Preparation Contract – county staff stated at the training that providers would have to complete the Emancipation Preparation contract every three months. However, ACHSA shared with DCFS the language in the current and new contract which states that the County Worker, not the provider, is responsible for completing the Emancipation Preparation Contract with the youth every six months. In addition, the contract language is only specific to DCFS youth and not applicable to Probation youth. Therefore, the template will be revised to state that this is only applicable to Probation youth and that providers should request a copy of the contract from the County Worker.

• Special Incidents Reports (SIRs) – county staff stated at the training that providers were required to include details of each incident reported during the quarter. However, the template clearly states that providers only need to report the number of special incidents that a youth had experienced during the quarter and not the specific details. DCFS agreed to clarify this information in the comments box for providers.

DCFS agreed to email to providers the finalized template, which will reflect the above changes. They also agreed to include a sample of goals that are measurable and attainable for providers to use in the development of individualized goals for children, since this was one of the most significant problem areas identified during the monitoring reviews. Technical instructions that explain how to utilize the spell check feature as well as other technical aspects of the template will also be included in the email to providers. DCFS recently confirmed that all of the final changes to the template have been completed and they anticipate emailing it to providers by July 1st.

For further information, please contact Amanda.

• Mental Health Odds and Ends

In order to address the concerns expressed by member agencies regarding the timely receipt of their Cash Flow Advances in July 2008, ACHSA has talked with DMH and was successful in getting DMH to commit to a time frame for the release of CFAs on a flow basis during the weeks of July 1st and July 7th. If you need to have your CFA expedited, please email DMH Acting Chief Deputy Robin Kay at rkay@dmh. with your request and payroll deadline. In addition to emailing Robin, you must have already followed the requirements laid out in the Legal Entity Agreement. Please copy Wendy at wwang@ on your request to Robin.

The State Department of Mental Health released Information Notice 08-15, dated June 23rd. in an attempt to clarify questions regarding the funding of mental health rehabilitation services for children in the AB 3632 program (Specialized Education Pupils Program). The memo offers a few alternative sources of funding for AB 3632 children that need mental health rehabilitation services as outlined in their IEPs. If you have further questions, please contact Stacey Wofford at (916) 651-0995 or stacey.wofford@dmh..

NIMH has sent out a Request for Information seeking input on strategies to enhance suicide prevention efforts within the emergency medicine department setting. They are determining public mental health research questions and would like input from multiple stakeholders, including private and public mental health service systems, regarding the diverse needs of emergency department patients, as well as effective strategies with regard to their potential to reduce suicide attempt or re-attempt rates within 12 months of being seen.  Responses will be accepted through Friday, July 25th.  Please see: the NIMH's RIF website for specific details.

• Know Your Resources – DCFS Has Public Health Nurses Willing to Assist You

Maria Lieras, DCFS' Nurse Manager, and Nancy Montoya, DPH's Foster Care Nurse Manager, have provided a contact list for the Department of Public Health's (DPH) Health Care for Children in Foster Care Public Health Nursing Supervisors, who oversee the Public Health Nurses (PHNs) that serve DCFS children placed in out-of-home care.    Providers that serve and work with DCFS foster care children are encouraged to contact a PHN if and when health-related issues arise with clients that need further assistance.

• Updated CLC Roster

The Children’s Law Center (CLC) of Los Angeles has distributed an updated employee roster as of 6/6/2008.

|CONFERENCES & EVENTS |

• Western States Youth Services Network Presents STREET OUTREACH Skills Training

July 14th – 15th

The Street Outreach Training will be held Monday and Tuesday, July 14-15, 2008 at the LA Conservation Corps, 1400 Spring Street, Los Angeles, CA 90012. This one and a half-day training will highlight the Los Angeles Youth Network (LAYN) Street Outreach Program. This training is interactive and will use small group work and role-playing. Registration fee $250. WSYSN members receive a 10% discount. Bring two staff and get the third one free. The training includes lunch on the first day, morning and afternoon refreshments. Please direct questions and comments to Nancy Fastenau or Vicki Allen at Western States Youth Services Network, (707) 763-2213 or email at WSYSN@. For additional information, please see the event flyer and registration form.

• DCFS Independent Living Program Presents Celebration II

August 21st

Any youth who is eligible for ILP, has received a High School diploma or GED in 2008, and has not participated in Celebration I or Success is Our Future, is eligible for this event, which will take place in the Globe Theatre at Universal Studios Hollywood. Spaces are limited. First come, first served. You MUST bring a copy of your High School Diploma/GED certificate and a picture ID. If you have any questions, please contact Youth Ombudsman, Onitsha Thompson at (626) 229-3583. Please call your ILP Coordinator for participation by Friday, July 11, 2008. Transportation arrangements will be made by your assigned ILP Coordinator. For additional information, please refer to the event flyer.

• LACOE FYS to Sponsor Foster Youth Conference

August 21st

Los Angeles County Office of Education (LACOE) Foster Youth Services (FYS) plans to sponsor a free and interactive conference for youth and caregivers to discuss information and training for foster and probation youth entering and leaving high school. A maximum of approximately 300 youth and caregivers are expected to participate and will be accepted on a first-come, first-served basis. Lunch will be provided. Registration forms are not yet available so interested parties are encouraged to call (213) 637-3104 A.S.A.P. For additional information, please refer to the event flyer.

|IN THE NEWS |

• Pretrial Detention is Preventive Detention for Many Minority Youth, American Chronicle, 5/1/2008

• Colorblind Adoptions Test Children, Los Angeles Times, 5/31/2008

• Assessing the Economic Costs of Serious Mental Illness, The American Journal of Psychiatry, 6/2008

• Foster Children Carve a Bright Future, , 6/5/2008

• Parents Question Pasadena Man's Death at County-USC, Los Angeles Times, 6/5/2008

• Parks vs. Ridley-Thomas, Continued, Los Angeles Times, 6/5/2008

• Health Care - Coalition Plans Coordination on Mental Health, North Bay Business Journal, 6/9/2008

• In Latvia, New York Couple's Adoption Plans Hit a Regulatory Brick Wall, Los Angeles Times, 6/9/2008

• Justice Department Official Awards $500,000 Grant to Golf Group, ABC News, 6/9/2008

• The War on Obesity Targets Toddlers, Wall Street Journal, 6/10/2008

• Golf Tourney for Foster Teens, San Gabriel Valley Tribune, 6/11/2008

• Abandoned Boy Suffered 'Unbearable' Abuse, , 6/13/2008

• L.A. Foster Kids Get Free Preschool, , 6/13/2008

• 2 Women Arrested in 'Unbearable Abuse' of 5-Year-Old Boy, Los Angeles Times, 6/15/2008

• 2 South L.A. Women Concocted Scheme to Hide Torturous Child Abuse, Authorities Say, Los Angeles Times, 6/17/2008

• A World Away, New Rules Put an Adoption on Hold, New York Times, 6/17/2008

• L.A. County Supervisors Demand Report on Child Torture Case; A Third Woman is Arrested, Los Angeles Times, 6/18/2008

• Boy was Subject of '05 Claim, Los Angeles Times, 6/19/2008

• Officials - Abused Boy Let Down by Social Agencies, , 6/19/2008

• Officials Criticize Bureaucracy for Failing Boy, San Diego Union-Tribune, 6/19/2008

• Caretakers Saw Early Signs that Boy was Being Abused, Los Angeles Times, 6/20/2008

• Child's Torture Exposes System's Cracks, CBS News, 6/20/2008

• Boy's Abuse was No Secret, Los Angeles Times, 6/21/2008

• Plenty of News -- and Reader Reaction -- to Get the Blood Boiling, Los Angeles Times, 6/22/2008

• Grand Jury LA's Child Welfare System Failing, San Francisco Gate, 6/24/2008

• Child Abuse is Everybody's Business, Huffington Post, 6/25/2008

• Ex-Foster Kids No Longer Alone, Los Angeles Daily News, 6/25/2008

• L.A. County Supervisors Want Overhaul in Monitoring of Abuse Cases, Los Angeles Times, 6/25/2008

• Los Angeles Still Homeless Capital of United States, Imperial Valley News, 6/25/2008

• Judge Rejects Court Order to Improve VA's Treatment for Post-Traumatic Stress Disorder, Los Angeles Times, 6/26/2008

• Three L.A. Women Plead Not Guilty to Boy's Torture, Associated Press, 6/26/2008

• Families Walk to Help Kids Find New Homes, The Signal, 6/28/2008

• Feds OK State Child-Support Tracking, San Diego Union-Tribune, 6/28/2008

• Seized Baby Dies in Foster Care, Los Angeles Daily News, 6/28/2008

• Hospital Staff More Likely to Screen Minority Mothers, Los Angeles Daily News, 6/29/2008

• Officials Call for System Overhaul in Drug Screening of Moms, Los Angeles Daily News, 6/29/2008

• Social-Worker Shortage Strains Department, , 6/30/2008

|UPCOMING MEETINGS & EVENTS |

|JULY |

|1 |Probation Committee Meeting |ACHSA |11:00 AM to 1:00 PM |

|2 |ACHSA Board of Directors Meeting |ACHSA |9:30 to 11:30 AM |

|4 |HOLIDAY |OFFICE CLOSED |

|4 |Foster Care Performance Measures Task Group (FC PMTG)|RESCHEDULED – New Date: July 11th |

| |Meeting | |

|4 |Residentially Based Services Performance Measures |RESCHEDULED – New Date: July 11th |

| |Task Group (RBS PMTG) Meeting | |

|8 |IBHIS Work Group |ACHSA |10:00 AM to Noon |

|9 |ACHSA Children’s Mental Health Policy Committee |Dubnoff Center |1:30 PM to 3:30 PM |

| |Meeting |10526 Dubnoff Way | |

| | |North Hollywood, CA 91606 | |

|10 |DCFS Committee Meeting |Star View Community Center |9:30 to 11:30 AM |

| | |5420 North Figueroa Street | |

| | |Highland Park, CA 90042 | |

|11 |Foster Care Performance Measures Task Group Meeting |ACHSA |10:00 AM to Noon |

|11 |Residentially Based Services Performance Measures |ACHSA |12:30 to 2:30 PM |

| |Task Group Meeting | | |

|11 |ACHSA IBHIS Panel #4: |St. Anne’s |9:30 AM to 12:30 PM |

| |“EHR-S Users’ Perspective” |2nd Floor | |

| | |155 Occidental Blvd, | |

| | |Los Angeles, CA | |

|16 |FFA Strategic Planning/Policy Committee Meeting |ACHSA |10:00 AM to Noon |

|17 |ACHSA General Membership Meeting |Hillsides |10:00 AM to Noon |

| | |940 Avenue 64 | |

| | |Pasadena, CA 91105 | |

|23 |Mental Health Contractual-Administrative Committee |ACHSA |1:30 PM to 3:30 PM |

| |Meeting | | |

|25 |ACHSA Adult Mental Health Policy Committee Meeting |ACHSA |10:00 AM to Noon |

|28 |Family Based Services Subcommittee Meeting |ACHSA |10:00 to 11:30 AM |

Association of Community Human Service Agencies

1200 Wilshire Boulevard, Suite 302, Los Angeles, CA 90017

Tel: 213-250-5030 / Fax: 213-250-5040

E-mail: mailbox@ / Web:

[pic][pic]

-----------------------

July 1, 2008

Volume 5, Issue 12

ACHSA UPDATE

A bi-weekly briefing of the Association of Community Human Service Agencies

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download