Inside This Issue (click to go directly to the article):
Inside This Issue (click to go directly to the article):
1. Big Changes Afoot! DMH Introduces Provider Reimbursement Changes
2. ACHSA Monitors Development of Probation Group Home Monitoring Process
3. ACHSA Meets with DMH and CEO to Get A Better Understanding of County Budget Process and the Development and Tracking of the County DMH Budget -- Part 3 of 3 Parts
4. Wraparound Expansion Workgroups Raise More Questions than Answers
5. "Whatever" is the Watchword as DMH MHSA Workforce Education and Training (WET) Advisory Committee Begins to Shape Upcoming County WET Plan for FY 09-10 and Beyond
6. SOWhat’s up with the Statement of Work? ACHSA Continues Discussions with DCFS Regarding Outstanding Issues in the Wraparound SOW
7. DMH Stakeholder Delegates Meet to Discuss PEI and MHSA Innovations
8. DCFS Updates ACHSA on Family Preservation Program
9. May the Workforce Be With You – Report Details Findings of the California Consumer Employment Summit
10. Probation Restructuring Steering Committee Steers Clear of Placement Practice Model and Focuses on Practical Changes
11. Mental Health Odds & Ends
12. Child Welfare Nuts & Bolts
13. ACHSA News
14. Conferences & Events
15. In the News
16. Upcoming ACHSA Meetings
|KEY ISSUES |
• Big Changes Afoot! DMH Introduces Provider Reimbursement Changes
At a February 20th, 2009 contract providers meeting at St. Anne’s, Los Angeles County Department of Mental Health officials shared updates on the budget and transformation, as well as new changes to the Department's Financial Responsibility Requirements and provider contract Financial Exhibit. Welcoming providers to the meeting, Deputy Director Robin Kay said, “The Department is committed to transparency, partnership, and collaboration in developing protocol, policies and procedures.”
Certified Public Expenditures, Reimbursement of Providers, and Changes in the Financial Exhibit
The highlight of the meeting was a presentation by Administrative Deputy Lyn Wallensak on provider reimbursement changes being proposed by the Department to meet necessary legal requirements related to Certified Public Expenditures. Until February 2008, DMH had always forwarded claims for Medi-Cal services to the State prior to paying contractors. The claims were accompanied by a State certification form that had two separate elements: 1) confirmation that medically necessary services had been provided to eligible beneficiaries; and 2) confirmation that the county had sufficient local match for FFP drawdown. However, in early 2008, the federal Centers for Medicare and Medicaid Services (CMS) notified the State that this certification did not meet federal regulations to draw down FFP, and the State notified County DMH. It was determined that federal regulations require that the public agency make the expenditures prior to claiming FFP, and the timing of County payments to contractors and State claiming of FFP was non-compliant.
To temporarily mitigate the problem, State and DMH negotiated a ‘bifurcated process’ that accommodated both federal regulations and DMH legal entity contract language, which states that DMH pays providers on “approved claims.” Under the bifurcated system, DMH has submitted claims to the State with the first certification (medical necessity, eligibility) and then after paying providers, DMH has submitted a second certification asserting that it has made the “certified public expenditure,” or CPE.
The bifurcated process has had several flaws. For example, the State requires DMH to certify the entire EOB file, and the EOB files contain multiple providers and multiple fiscal years. So if one contractor were to require a contract amendment to either increase a type of funding or increase the maximum contract amount, DMH would be delayed from making the CPE for the entire EOB file until those contract issues were resolved, affecting all contractors. During Fiscal Year 2008-09, DMH was unable to make CPE on all claims until very recently, due to several providers who needed contract amendments for FY 07-08 services, delaying the County’s receipt of $164 million in Federal revenue.
After the State's upcoming implementation of SD/MC Phase II, the bifurcated process will no longer be an option, so the financial provisions of the legal entity agreement must undergo significant changes to ensure compliance with CPE beginning July 1, 2009. DMH will also need to significantly change its internal processes to accommodate revisions, including how and when payments are made to contractors, how dollars are allocated in contracts, strict enforcement of maximum contract amounts, and the anticipated phasing out of cash flow advances. All providers must enter into new contracts starting July 1st, 2009 with one, two, or three year terms.
In order to make these new changes, DMH intends to simplify accounting of funded programs by implementing IT solutions to help facilitate payment processes, allow contractors and the county to more accurately gauge the status of contractors in relation to maximum contract amounts, and reduce the number of contract amendments. These changes should also result in more timely receipt of FFP for the County and more timely payments to contractors for all funded programs.
Major Changes in Payments
▪ Most significantly, these changes mean that starting July 1st, 2009, DMH will pay providers every two weeks, with 26 payments a year.
▪ All services will be paid on claims submitted to the IS system if they clear IS edits and are within contract amounts. Contractors will be paid sooner for Medi-Cal services; Medi-Cal, Healthy Families, and MAA claims that are subsequently denied or disallowed by the State will be “recouped” against the next payment.
▪ Contractors will have no more than 5 months after the month of service to submit a claim without a valid late code; and no more than 11 months after the month of service to submit a claim with a valid late code. Payments to providers prior to adjudication will result in additional “lag time” between the contractors’ entry of a claim into the IS and submission to the State.
▪ DMH will not automatically shift denied claims to another funded program. Contractors will need to positively resubmit denied claims to Medi-Cal or other funded programs depending on the reason for denial.
▪ For more information on payments, please view the Flowchart for Revised Payment Procedures for Contractors.
Major Changes in Funding
Contract amounts and the Financial Summary will be based on gross program dollars. This will eliminate barriers and simplify financial tracking and payments; however, as a result, contractors will no longer have the option to shift CGF funds. DMH will need to increase staff, but their goal to have a 1:1 relationship between IS Plans and “Funded Programs” will allow DMH to utilize IT solutions to facilitate payment and keep the number of staff needed in the Provider Reimbursement Unit from snowballing.
Major Changes to the Maximum Contact Amounts (MCA)
Maximum Contract Amounts and Funded Program Amounts will be strictly enforced. Contractors will not be allowed to exceed contract amounts during the year or at settlement. Contractors will need to establish provisional rates that closely approximate actual costs. They may ask DMH to consider contract amendments to adjust funding among programs. They will need to monitor claims against maximum contract amounts and funded programs and notify the county once they reach 75% of their contract amount.
DMH will institute additional contract monitoring by program, fiscal, and contract staff. Issues with the timing of denied/voided claims versus new approvals will have to be accommodated, depending in part on State adjudication timelines under SD/MC-II. Providers and DMH may also face issues with cost report settlement and Medi-Cal adjudication.
Cash Flow Advances Eliminated
Cash flow advances will be eliminated after 2009-10, and the repayment period of unearned 2009-10 CFA will be extended. CFAs interfere with DMH’s ability to monitor contract levels for individual programs and funding sources. The belief is that more timely and frequent payments will eliminate future need for CFAs, although this is certainly an open issue and of major potential concern for contract agencies.
Public Comment Period on DMH Legal Entity Agreement – Attachment II – Financial Exhibit A
Lyn distributed the new February 20th, 2009 draft of Financial Exhibit A (Financial Provisions) of the LEA which incorporates the proposed provider reimbursement changes referenced above. Public comments are officially due by March 13th, 2009 at 5 P.M., although ACHSA has already received a commitment from DMH to provide an extension as necessary.
Next Steps
At ACHSA's request, Robin Kay has agreed to establish a joint ACHSA/DMH workgroup to identify and attempt to resolve operational issues that need to be addressed as a result of the proposed changes to the Financial Summary. The workgroup met last Friday, and is scheduled to meet again on March 5th, when the proposed contract language changes will be reviewed. We will provide an update on these meetings in our next newsletter.
If you have any questions, please contact Bruce or Marissa.
• ACHSA Monitors Development of Probation Group Home Monitoring Process
Since the beginning of this year, ACHSA has been working diligently to clarify and refine the monitoring/quality assurance (QA) process for Probation group home providers. This article summarizes ACHSA’s discussions with Probation to eventually reach agreement on a monitoring process for the first year of visits.
First, in January, Probation announced its intention to begin unannounced group home monitoring visits. Upon ACHSA’s objection to unannounced visits, Probation then agreed to contact providers beforehand in order to schedule any visits. Probation expressed its intention to begin monitoring visits in February and March. Probation distributed draft questionnaires for one youth and parent and a draft monitoring tool to be used during its visits. ACHSA created a workgroup to review the questionnaires and tools and submitted feedback to Probation.
At the January 30th Probation Provider Subcommittee Meeting, ACHSA later learned that Probation intended to conduct quarterly monitoring visits. At the meeting, Probation shared eight-page Quarterly and Annual Inspection Checklists which it intended to use to conduct these inspections. Upon learning of the quarterly visits and new inspection checklists, ACHSA asked Probation to delay all monitoring visits in order to give ACHSA time to review the new tools and develop recommendations as to both the tool and process. ACHSA convened a workgroup that ultimately concluded that the process was more problematic than the tool itself. ACHSA forwarded the following concerns to Probation:
1. ACHSA objected to quarterly inspection visits, especially for providers that have only a handful of probation youth. In comparison, we pointed out that DCFS and the Auditor-Controller (A-C) have agreed to only conduct a SINGLE, ANNUAL combined monitoring visit for DCFS youth.
2. ACHSA requested that Probation defer to DCFS to monitor agencies whose primary population is DCFS children.
3. ACHSA objected to Probation’s plan to begin monitoring without an inspection manual in place to clarify and guide the inspection visits, although we agreed that Probation could continue to hold its “meet and greet” sessions with providers, that didn’t involve monitoring, until an inspection manual and protocol was agreed upon.
4. ACHSA requested that Probation meet with the A-C, DCFS, and ACHSA to jointly review the monitoring tools so as to eliminate duplicative audits. ACHSA emphasized that it had previously approached the Board of Supervisors regarding this issue for DCFS providers and the Board supported ACHSA’s position that the A-C and DCFS should not conduct multiple, duplicative audits.
On February 18th, immediately following the Probation Steering Committee Meeting, ACHSA met with Probation in order to discuss our above concerns regarding the tool and process. The meeting included several provider and Probation representatives, as well as California Community Care Licensing (CCL).
Lisa Campbell, Director of Placement Permanency/Quality Assurance (PPQA), explained the two purposes of the monitoring visits: 1) to get to know group homes better by visiting the sites and becoming familiar with the programs; and 2) to foster a collaborative relationship between Probation and providers to avoid problems getting out of hand and to fix any problems with Probation as quickly as possible.
In order to attempt to support the Department’s plans for quarterly visits, Lisa reviewed the Group Home Contract which states that group homes shall monitor quarterly for compliance with Title 22. ACHSA pointed out that a group home’s responsibility for its own quarterly internal monitoring does not support quarterly visits by Probation. Lisa then referred to Title 22 to support Probation’s monitoring plans. ACHSA further clarified that Probation does not have inspection authority under the Title 22 Regulations that apply only to CCL, which was confirmed by the CCL representative at the meeting. Lisa pointed out her belief that Probation monitoring is also supported by the Adoption and Safe Families Act and Title IV-E funding regulations. The providers clarified their recognition that Probation is entitled to conduct monitoring visits, while further explaining their concern with the process, rather than the authority, of the Department.
ACHSA pointed out that many agencies are already monitored by the A-C, DCFS, and DMH. Providers reiterated that Probation’s primary concern should be outcomes and whether children are being served properly, questioning the need to monitor agencies that are fully compliant on a quarterly basis. Lisa continued to insist that Probation do quarterly visits during the first year, and she emphasized that “monitoring” is a soft term that did not have to amount to an audit or inspection. Providers, however, expressed concern with the checklists that heavily relied on inspections of the agency’s physical plant, emphasizing that several monitoring agencies inspect their physical plant but no agency reviews their programs and services. Accordingly, the group decided on the process below for QA visits during the first year of monitoring.
The first visit, to be conducted between February 2009 and April 2009, will be a “walk through” visit where the monitor will tour the facility. The monitor may bring the annual inspection checklist to take notes and to familiarize himself/herself with the facility. The visit will last between 30 to 90 minutes.
The second visit, to be conducted between May 2009 and July 2009, will be a Quality Assurance visit that will focus on the provider’s program. The monitor will interview one child that has been placed at the agency for less than one month, the child’s parent, and group home staff that are familiar with the child, using a one-page questionnaire that has been jointly developed by Probation and providers. During the visit, the provider will give Probation a list of three children from which Probation will choose one to interview. The visit will address such questions as what is and is not working with the agency’s program and whether the provider needs any additional technical assistance from Probation. The visit will last between one to two hours.
The third visit, to be conducted between August 2009 and October 2009, is the same as the second visit, except that the monitor will interview a child that has been placed at the agency for over 4 months. The fourth visit, to be conducted between November 2009 and January 2010, is a formal monitoring visit. Probation will use the annual inspection checklist to review both the provider’s program and the physical plant. Probation will contact the provider before the visit to determine whether the provider prefers that Probation coordinate its visits with DCFS and the A-C or not.
Probation plans to make four visits during the first year. After the first year of monitoring, Probation will engage providers in discussion to decide how to move forward with any future monitoring.
For further information, please contact Jodi.
• ACHSA Meets with DMH and CEO to Get A Better Understanding of County Budget Process and the Development and Tracking of the County DMH Budget -- Part 3 of 3 Parts
Part 1 of our three-part article (see December 1st ACHSA Update) provided an overall explanation of the DMH budget development process and a discussion of the timeline for the budget process. Part 2 (see December 15th ACHSA Update) focused on the answers provided to ACHSA's questions related to DMH expenses and revenues, including how the final DMH budget is broken out, what the DMH expense categories are, how the Department calculates its revenue, and how the Department budgets its staff positions and reflects COLAs.
Part 3, our last installation, will explore the answers provided by DMH to ACHSA's remaining miscellaneous budget related questions, including those related to accrual of interest, process for DMH shifting of funds between budget categories, and how DMH and the CEO track expanses and revenues relative to budget.
Question No. 1 -- Is the budget broken down somewhere by directly operated and contracted programs?
In the County budget, contracted services are included as part of Services and Supplies. Supplemental documents allow the Department to track directly operated versus contracted services. [Note: ACHSA has requested a copy of these supplemental documents but has yet to receive them.]
Question No. 2 -- What is the Department's cost allocation methodology?
The Department uses an equitable distribution method (based on estimated time spent) for allocating costs both on its cost report and the indirect cost rate proposal approved by the Auditor-Controller each year.
Question No. 3 -- Does DMH stay under the SMA and, if so, how?
At its own legal entity level, the current costs exceed SMA. While DMH can go over the SMA, DMH does not get reimbursed for those costs, which must get absorbed somewhere.
Question No. 4 -- Does DMH produce information similar to what contract agencies are required to provide in their negotiation packages for the development of the DMH budget? If not, why not?
No. The negotiation packages are a tool by which DMH and the County are able to monitor services that are contracted. DMH monitors its directly operated programs by other means (e.g., STATS program, Internal QA process, and Performance Based Contracting).
Question No. 5 -- What is the interest accrued, if any, on unspent funds by category?
Interest is only accumulated on Mental Health Services Act funds (in a special fund) and is budgeted and spent on MHSA programs. Since DMH makes payments prior to being reimbursed, the County General Fund must front the money, which results in a loss of interest to the County as a whole. [Note: DMH said they closed the 07/08 fiscal year with $400 million in MHSA revenue accrual.]
Question No. 6 -- Is there a public approval process (i.e., BOS) when the Department shifts funds between categories?
The CEO, under delegated authority, may authorize DMH to shift up to $250,000 per quarter (it's the same amount for every County department) from one category of expenditure to another (e.g., from salaries and employee benefits to services and supplies). Amounts greater than this, or if the adjustment would result in an overall increase to the department’s appropriation, require Board of Supervisors’ approval.
Question No. 7 -- How do DMH and the CEO track DMH expenses and revenues relative to budget?
Departments are required to submit Budget Status Reports to the CEO based on actual expenditures and revenues in December, February (as part of proposed budget), April and June. The budget status report uses both actual expenditures and projections for the remainder of the fiscal year. Internally, many individual budget items are tracked and updated monthly by the responsible areas. Examples include revenues for FFP and SGF based on approved units of service for directly operated and contracted programs, contract expenditures to approved contract amounts, charges from other County departments, and other services and supplies.
Question No. 8 -- What is the time frame between the receipt of State settlement money and County settlement with providers?
Settlement amounts for the MHP as a whole may or may not result in additional funds to the County. The State usually issues the settlement letter in May (for usually two fiscal years prior). To the extent that the State determines the MHP owes the state and federal government monies, they generally offset it within 60 days. To the extent money is owed to the MHP, the receipt of the actual funds may be delayed for several months or longer.
The County actually begins calculating the individual settlements before the letter is received based on information downloaded from the State system. The settlement process overall takes approximately six months, although the length of time is generally applicable to agencies who owe funds to the County and payments to agencies is usually made within 2 to 3 months.
If you have any questions, please contact Bruce.
|ISSUE BRIEFS & UPDATES |
• Wraparound Expansion Workgroups Raise More Questions than Answers
As reported in the February 15th ACHSA Mid-Month Bulletin, at the January ACHSA Family Based Services (FBS) Subcommittee Meeting, the County described its plans to allocate an additional 2,800 Tier II Wraparound slots (749 slots for MHSA youth and 2,051 slots for all other Tier II youth) dedicated to DCFS youth. The County described its plans to gradually expand the Wraparound program, at the rate of 50 additional slots per month, beginning in May 2009. On February 13th, ACHSA convened a workgroup to discuss ACHSA recommendations to the County as to how to integrate the expansion of Wraparound slots into the current Wraparound rotational system. The workgroup developed a list of questions – which ACHSA has provided to DCFS and DMH – that must be answered before any plan for expansion is created. The workgroup also brainstormed regarding general draft recommendations, including:
1. Create and use an even rotation system that considers special needs (which need to be described in detail) and the geography of the child. A provider's self-referral of a client into its own Wraparound program should substitute its turn in the rotation system.
2. Do not allow additional Wraparound providers in SPAs until the current provider capacity is maximized (25 Tier I cases and 25 Tier II cases) and/or until the Wraparound program is fully expanded.
ACHSA has not yet provided these draft recommendations to DCFS and DMH as the final recommendations will largely depend on the County’s response to our unanswered questions regarding the Wraparound expansion.
On February 24th, DCFS convened its own workgroup to begin discussing plans for the Tier II Wraparound expansion. At the meeting, DCFS described its new plan to expand by 75 additional Tier II Wraparound slots per month, beginning in May. At this rate, the Wraparound program will be fully expanded in a little over three years. The 75 monthly slots will be divided as follows – 50 slots will be dedicated to MHSA youth and 25 slots will be dedicated to all other Tier II youth. The referral criteria for the two types of Tier II slots will be the same. A provider must be both an FSP and Wraparound provider in order to access the 50 MHSA slots. DMH noted that 22 of the 34 Wraparound providers are FSP providers. Of the 749 MHSA slots, 523 slots will be allocated to children (under 15 years old) and 226 slots will be allocated to Transition Age Youth. The County has allocated more slots to children in order to emphasize its intent to use Wraparound services as a prevention tool in order to avoid deeper involvement for children in the child welfare system. Once the 749 MHSA slots have been fully allocated, DCFS and DMH will continue to expand by 75 general Tier II slots per month until the expansion is complete.
The workgroup focused on two questions: 1) How will the additional slots be allocated between SPAs? and 2) How will the additional slots be allocated within the SPAs? DCFS and DMH deferred the first question to the next meeting where additional data regarding SPA Wraparound and FSP needs will be presented and discussed. The workgroup concluded that the second question largely depends on the answer to the first question, but began brainstorming regarding the second question nonetheless. The following options were discussed: 1) Distribute all Tier II cases to one provider in each SPA each month; 2) Develop two separate rotation systems for Tier II MHSA cases and all other Tier II cases; and 3) Determine a child’s funding (MHSA or non-MHSA) based on whether the provider in the rotational system is an FSP provider.
DCFS anticipates six different avenues or mechanisms through which children will be referred to Tier II Wraparound: 1) MAT; 2) DCFS/Services Linkage Specialists (Voluntary Family Reunification and Voluntary family Maintenance); 3) TDM/RMP; 4) DCFS Family Maintenance/Family Reunification; 5) Tier I referrals (through the ISC team); and 6) Provider/CSW referrals. The first four types of referrals must go through the Wraparound DCFS liaisons. Michael Rauso, DCFS Division Chief of Multi-Agency Services, has been making presentations to DCFS Regional Offices in order to market the Wraparound expansion of Tier II slots.
The providers reiterated the difficulties connected to the requirements that Facilitators and Parent Partners are full time and exclusively devoted to Wraparound. Providers proposed allowing Tier II Facilitators and Parent Partners to handle Tier I cases, as well as different programs that require the same level of attentiveness, such as FSP, until providers are able to ramp up to full capacity. The providers also pointed out that some agencies are maxed out on Wraparound staffing and do not necessarily have Tier I staff that are available to cover Tier II cases during the ramp up, therefore the latter request is imperative.
DCFS also noted that DCFS and DMH miscalculated the EPSDT allocation for Wraparound cases. As you may recall, DCFS originally indicated the EPSDT allocation for Tier II Wraparound cases would be $2589 (with a case rate of $1250). The CFT workgroup then decided to adjust the EPSDT allocation to $2246 in order to make the EPSDT allocation uniform across Tiers. At the Tier II Workgroup Meeting, DCFS and DMH indicated that the EPSDT allocation was miscalculated and the allocation would be an amount between $2,000 and $2,200. After the meeting, ACHSA has since followed up with Michael who confirmed the EPSDT allocation will still remain in the amount of $2246.
The DCFS Tier II Workgroup will meet again on March 12th to study existing Wraparound and FSP SPA needs and to continue working on developing a Wraparound expansion plan.
For further information, please contact Jodi.
• "Whatever" is the Watchword as DMH MHSA Workforce Education and Training (WET) Advisory Committee Begins to Shape Upcoming County WET Plan for FY 09-10 and Beyond
Normally, you will not hear ACHSA comment on the proposed elements of a County Plan with the comment "whatever," but that's exactly happened at the most recent County DMH WET Advisory Committee meeting. And, perhaps surprisingly, ACHSA's lead was followed by many of the other Advisory Committee members. What was the cause for this approach?
Working with Serious Informational Limitations and Under Timeline Pressures
As indicated in our last WET article, the Advisory Committee has been asked, in effect, to approve a new County plan in almost no time whatsoever while going in blind -- without knowledge of State action on the last WET Plan; without any information from County DMH regarding the effectiveness of the Action Plans that were to be funded with WET dollars this fiscal year; and with the Department failing to assist in the development of detailed strategic implementation plans (with associated staffing and other costs identified) for each of the general 21 Action Plans. So when Dr. Southard then also instructed the Advisory Committee to get all of the remainder of the County's total $60 million (in actuality $55 million, as the FY 08/09 Plan called for the expenditure of $5 million) allocated by next fiscal year, there appeared to be no other choice but to make a number of hopeful "best guesses" as to how to allocate the County's future WET dollars.
Prior to this meeting, ACHSA staff had recommended to the ACHSA Board the following percentage allocation breakdown amount the five major WET expenditure categories provided by the State (see attached definitions): 1) Workforce Staff Support -- 10%; 2) Training and Technical Assistance -- 15%; 3) Mental Health Career Pathway Programs -- 30%; 4) Residency and Internship Programs -- 20%; and 5) Financial Incentive Programs -- 25%. The combined 75% allocation to the workforce development areas was consistent with ACHSA's own WET plan emphasis. In addition, it was recommended, most importantly, that ACHSA insist that any County WET Plan at this time be approved only with the proviso that it may/would be amended once there was a better understanding of the more detailed implementation plans, their associated cost data, and data on relative cost effectiveness.
WET Advisory Committee Takes ACHSA's Recommendation and Reviews DMH Proposed Allocation
It was the adoption of this latter principle by the WET Advisory Committee that led to ACHSA's "whatever" approach. The Committee also reviewed an Allocation Spreadsheet which included recommendations made by DMH as to how to allocate funds among the previously approved 21 Actions Plans over the next four fiscal years.
Starting with the Workforce Staff Support area, the Committee agreed to allocate a total of 10% of the total $60 million in WET funding over the life of the County's WET Plan, consistent with the ACHSA recommendation. Moving to Training and Technical Assistance, the Committee agreed to: 1) maintain the MHSA Public Mental Health Workforce Immersion Program as currently funded, at $225,000 per year over a total of five years; and 2) fund a web based Learning Management System (to expand its use for contract agencies) at a total of $225,000 over five years. The specific funding for the remaining Training and Technical Assistance Programs -- Licensure Workshops, Recovery Oriented Supervisor Trainings, Interpreter Training Program, and Training for County Partners -- was not agreed upon. However, the total recommended five year allocation for Training and Technical Assistance programs came to $2,406,000, or only about 4% of the total $60 million.
In the area of Career Pathways, agreement was reached on five year total allocations for the following areas: 1) Intensive Mental Health Recovery Specialist Training Program - $5,433,750; 2) Expanded Employment and Professional Advancement Opportunities for Consumers - $3,546,428; 3) Mental Health Career Advisors (for individual consumers and family members working in the mental health system) - $4,603,252; 4) High School Through University Career Pathways - $625,000; 5) Market Research and Advertising Strategies for Recruitment (ACHSA's Proposal) - $400,000; and 6) Faculty Immersion Program - $500,000. Specific funding amounts were not agreed upon for Expanded Employment and Professional Advancement Opportunities for Parent Advocates and Family Member Advocates. The total recommended five year allocation for Career Pathways came to $20,600,600, or about 34% of the total $60 million.
The area of Residency and Internship Programs was the most unsettled. It includes 3 of the 21 Action Plans: 1) Recovery Oriented Internships Development; 2) Psychiatric Residency Program; and 3) Student Training and Certificate Programs. No specific allocations were agreed upon, although the total recommended five year allocation was $6,887,000, or about 11 1/2% of the total $60 million.
The last area, Financial Incentives, included agreed upon five year allocations for the following two Actions Plans: 1) Tuition Reimbursement Program - $3,250,600, and 2) Stipend Programs - $12,590,000. No agreement was reached on allocations for 20/20 and/or 10/30 Programs, or for Loan Forgiveness Programs. The total recommended five year allocation for Financial Incentives came to $24,260,000, or about 40% of the total $60 million.
Next Steps and Implementation Plan Development
The Committee concluded by briefly beginning discussion of the development of implementation plans for the eight Action Plans for which funding had been allocated for FY 2008-09, pending State DMH approval. Several of these Plans are already in process -- Public Mental Health Workforce Immersion; Intensive Mental Health Recovery Specialist Training Program; Expanded Employment and Professional Advancement Opportunities for Consumers; Faculty Immersion Program; and Stipend Programs. DMH agreed to begin work on drafting implementation plans for Interpreter Training and Community Partner Training, and ACHSA volunteered to work on drafting the implementation plan for Market Research and Advertising Strategies.
For additional information, please contact Bruce.
• SOWhat’s up with the Statement of Work (SOW)? ACHSA Continues Discussions with DCFS Regarding Outstanding Issues in the Wraparound SOW
As reported in the December 15th ACHSA Mid-Month Bulletin, ACHSA forwarded a letter to DCFS on December 17th, 2008, outlining each of its outstanding issues in the Wraparound SOW and proposed language, as well as the rationale for each change. Below is a summary of the Department’s January 30th response to ACHSA’s letter as well as ACHSA’s current positions based on discussion at the Family Based Services (FBS) Subcommittee Meeting on February 23rd:
• Definition of Parent Partner – ACHSA objected to the exclusion of foster parents from the definition of Parent Partner, arguing that foster parents can be just as effective Parent Partners as other primary caregivers. In addition, ACHSA reiterated that the pool of prospective Parent Partners available to agencies is very limited today.
DCFS Response: In response, DCFS responded that foster parents cannot express the same “I’ve been there and we will get through this.” sentiment to the parent or primary caregiver of a Wraparound child. DCFS committed to help providers to address the limited pool of prospective Parent Partners.
ACHSA Position: The FBS Subcommittee suggested asking DCFS to grandfather in current Parent Partners who are foster parents. DCFS has since informed ACHSA that no providers are currently using foster parents as parent partners; therefore ACHSA will accept the exclusion of foster parents from the definition of Parent Partner.
• Definition of Tier I (Tier I Rate) – ACHSA initially requested that the rate be “based on average cost to provide Wraparound services.” DCFS objected to this language as an “open-ended financial commitment,” even though the exact same language is in the current Wraparound contract. After discussion at the November FBS Subcommittee meeting, ACHSA agreed to omit this language as long as DCFS agreed to revisit the rate based on actual cost, using a methodology agreed upon by ACHSA and DCFS, in one year. ACHSA also asked that “plus EPSDT” be added to the rate provisions for both Tier I and Tier II because the case rates do not include EPSDT.
DCFS Response: DCFS committed to another “actual cost data report” to be completed by the beginning on 2010 and will develop a joint provider/County workgroup to discuss the methodology as to how information will be collected and reported. DCFS did not add “plus EPSDT” to the definition of Tier I, arguing that some Tier I Wraparound clients do not have EPSDT and the language “plus EPSDT” implies every enrollee should receive EPSDT. DCFS agreed to add “plus EPSDT” to the definition of the Tier II case rate as EPSDT is an eligibility requirement for Tier II.
ACHSA Position: ACHSA was pleased to see the Department's agreement to accept ACHSA's proposal on revisiting the rate in one year, and will accept the exclusion of “plus EPSDT” from the definition of Tier I (since in reality EPSDT will be provided as appropriate anyway).
• Definition of Transfer – ACHSA argued that the definition of transfer should include the language “and it reflects the best interest of the child, as determined by the CFT.”
DCFS Response: DCFS agreed to add language to this provision that states transfer must reflect “the best interest of the child,” but not “as determined by the CFT.”
ACHSA Position: ACHSA will accept this compromise language that references “best interest of the child.”
• SPA Specific Requirements for Facilitators and Parent Partners – ACHSA continued to strenuously object to the requirement that Facilitators and Parent Partners are SPA specific. ACHSA agreed that Facilitators and Parent Partners need to be dedicated to their community and knowledgeable about community resources, but did not agree that this commitment should be determined by SPA boundaries. ACHSA argued that the layout of Los Angeles County does not lend itself to maintaining SPA specific Facilitators and Parent Partners, and SPA boundaries do not ensure that services will be any more effective.
DCFS Response: DCFS agreed to remove the SPA specific requirement for Facilitators and Parent Partners and instead require that Parent Partners serve geographically adjacent SPAs.
ACHSA Position: ACHSA will agree to accept the compromise requirement that Facilitators and Parent Partners work only on cases in adjacent SPAs.
• Full Time and Exclusive Requirements for Facilitators and Parent Partners – ACHSA argued that the requirement that Facilitators and Parent Partners are full-time and exclusively devoted to the Wraparound program is an impractical mandate for providers that is not necessary for producing positive outcomes. Further, ACHSA argued that the requirements did not consider providers’ limited resources and availability of individuals to fill these roles. ACHSA instead proposed that DCFS include the language “full-time equivalent,” which would still require that providers continue maintaining the mandated ratios. In sum, ACHSA agreed to accept the Parent Partner ratios as long as DCFS agreed to eliminate the SPA specific, full-time, and exclusive requirements.
DCFS Response: DCFS did not remove the full time and exclusive requirements for Facilitators and Parent Partners. DCFS argued that if an employee is hired in Wraparound, the employee needs to be trained and dedicated to Wraparound, and if the employee is hired for another program, his or her availability would be compromised. DCFS based this argument in its expectations for the new expansion (Tier II) with the identified need and large number of referrals planned.
ACHSA Position: ACHSA continues to object to this requirement.
• CANS Assessment – ACHSA argued that providers should administer the CANS assessment once per year, as opposed to every six months, as requested by DCFS.
DCFS Response: DCFS continues to insist that providers administer the CANS assessment every six months as the CANS will be used to identify the strengths and needs of the family in conjunction with the 6-month Plan of Care review.
ACHSA Position: ACHSA will agree to accept the administration of the CANS assessment every six months, as this is currently required in the FFA and group home contracts.
The full time and exclusive requirement for Facilitators and Parent Partners is the primary outstanding issue within the Wraparound SOW. On March 5th, ACHSA plans to hold a conference call with Michael Rauso (DCFS Division Chief of Multi-Agency Services Division), Susan Kerr (DCFS Senior Deputy Director), and Lisa Parrish (DCFS Deputy Director of Bureau of Resources) to review and seek resolution on this issue.
For further information, please contact Jodi.
• DMH Stakeholder Delegates Meet to Discuss PEI and MHSA Innovations
On February 18th, 2009, the DMH Stakeholder Delegates convened to hear an update on the status of the State budget; receive an update on the PEI Funding Allocation by Service Area; hear the final guidelines for the MHSA Innovations Plan and provide feedback on a proposed timeline and work structure; and hear about the status of various Los Angeles County MHSA plans. Delegates primarily discussed the funding allocations for Prevention & Early Intervention and the planning processes for Innovations.
Prevention and Early Intervention
Dr. William Arroyo, Regional Medical Director, sparked a spirited debate when he shared the Prevention and Early Intervention (PEI) Funding Allocation and Distribution by Service Planning Area. At the previous Stakeholder Delegates Meeting on January 21st, 2009, delegates voted between three PEI funding allocation methods: Population Statistics, Population and Poverty statistics, or the Modified State DMH PEI Allocation Formula. After much discussion between the second and third options, the second option was selected through a voting process and the Stakeholder Delegates recommended that the County use Population and Poverty statistics to determine the allocation method for Prevention and Early Intervention.
Dr. Arroyo shared the Service Area PEI Allocation Estimates for FY 09-10 with the Stakeholder Delegates. SPA 2 (San Fernando) is estimated to receive the most funding, approximately $20.5 million, while SPA 1 (Antelope Valley) will receive the least funding, $3.5 million. Some delegates were upset to learn that SPA 6 (South) would only receive $12 million -- less funding than five of the eight other SPAs would receive -- despite the Fall 2008 “Vulnerable Communities in Los Angeles County: Key Indicators of Mental Health” Service Area Data Profile indicating that SPA 6 has the youngest population in the county, several underserved cultural populations, low education attainment, and widespread poverty and lack of assets.
These delegates were concerned about the fairness of the allocation, arguing that the citizens of SPA 6 have very high need, yet will receive significantly less funding than SPA 2, which will receive the most funding despite the San Fernando Valley’s higher than average median household income. Arroyo reminded delegates that the weighting ratio was not only based on poverty population, but also general population, and SPA 2 is the most populous service area in Los Angeles County.
Arroyo also shared the MHSA PEI Statewide Projected Revenues with the Delegates. The expected State PEI revenue for FY 09-10 is about $330 million out of the $1.3 billion MHSA will receive in total. Both numbers are estimated to fall over the next three years, though, with PEI revenue dropping approximately $75 million every year through FY 12-13, likely due to the economic crisis.
With state budget cuts to MHSA looming, County DMH wants to finish the PEI plan as soon as possible and send it to the State to allocate--and hopefully lock down--PEI funding for Los Angeles County. With that in mind, it is unlikely DMH will modify the PEI funding allocation method and risk delaying the PEI plan any further.
MHSA Innovations
Scuttlebutt has it that MHSA PEI and Innovations are first on the State Budget chopping block, but at the Stakeholder Delegates Meeting, Dr. Rod Shaner, Medical Director, shared an overview of the proposed purpose, requirements, and development of Innovations work plans. The proposed Guiding Principles for Developing Innovations Plans included:
▪ Learning Focused: Programs present new practices to further the primary goal of learning and increase the array of creative and effective approaches to mental health services.
▪ Consistency with the MHSA Principles: Community collaboration, cultural competency, client and family-driven mental health systems, wellness, recovery, resiliency, and integrated service experience.
▪ Time Limited: Timelines allow limited yet sufficient time for development, implementation, and learning to occur, while also allowing for efficacy and feasibility of the Innovation to be assessed.
Innovations Work Plan funding would be used to encourage the development of novel, creative and/or ingenious mental health practices that contribute to learning. They would also be developed through a stakeholder informed process, in order to better serve underserved and inappropriately served communities. These new mental health practices and approaches would also be easily replicated and adapted to other populations and other counties if proven to successfully serve a specific population.
Dr. Shaner then shared the six requirements of Individual County Developed Innovation Work Plans. Innovations plans must be consistent with the definition of innovation, contributing to learning rather than the primary focus of providing a service. Secondly, the projects must be designed for voluntary participation. The project must meet the essential purposes of innovation and counties must select one or more of the following purposes for each innovation: increase access to underserved groups, increase quality of services and outcomes, promote interagency collaboration, and/or increase access to services. The scope of the innovation is also an important factor -- LA County innovations may address the unmet need of age group populations, neighborhoods, regions, etc. while initiating, supporting, and expanding collaboration and linkages. Counties are encouraged to publicly communicate results from these plans at community meetings, forums, etc. They are also required to report on progress through annual reporting and a final innovations report upon completion of the work plan.
Innovations funding is $20 million over the course of 2 years. At the County’s discretion, 5% of CSS and 5% of PEI funds may be used to continue successful Innovations Projects beyond Innovations funding limitations. Agencies may request up to 10% of the available funding for Innovation in their initial work plan submission, although they are also expected to leverage resources and collaborate with community partners. Funds not requested in the original work plan can be requested in subsequent updates or through the beginning of a new work plan. Innovations funding is subject to a three year reversion requirement.
Innovations Planning and Implementation has a three year timeline, not including the final report, running from July 1st 2009 to June 30th, 2012. Soon, DMH will hold pre-meetings with stakeholders to begin developing some of the process. Innovations identified through and supported by stakeholders during a previous Community Program Planning Process (CPP) can also be considered for funding through the current Innovations Local Review Process. A draft work plan will be circulated for a 30 day comment period and then reviewed during a public hearing conducted by the local Mental Health Board.
Dr. Shaner wanted delegates to remember these important points:
▪ A practice or approach that has been found to be successful in one setting cannot be funded as an Innovations project for a different setting, unless it has been changed in a way that will contribute to the learning process. For example, simply planting a Wellness Center in an area that currently does not have one would address unmet needs, but as it would not contribute to the learning process it would not qualify for Innovations funding.
▪ Innovations projects may include Prevention & Early Intervention (PEI) strategies, but these strategies must be components in an array of services distinctive from PEI requirements.
▪ Innovations projects may initiate support and are encouraged to expand collaboration and linkages between systems, organizations, and other practitioners not traditional to the mental health system.
Dr. Shaner then shared the LAC DMH MHSA Innovations Plan Proposed Planning Process: Work Structure and Timeframe, which includes County DMH’s three planning principles: multi-stakeholder inclusion, efficiency in the creation of the plan, and maximization of the impact of funding through the carefully focused selection of a small number of programs with high impact potential in critical areas of the public mental health system in Los Angeles County. It was felt that one way to maximize the plan’s impact is to focus on a limited number of significantly unserved, underserved, and/or inappropriately served populations -- particularly the overlapping focal populations of indigents/uninsured, homeless, and underrepresented ethnic populations. Delegates expressed concerns that the focal populations were too limiting, but Dr. Shaner reassured them that these Innovations would be designed with the intent to eventually apply them to several different populations, and that proposed programs for each focal population should have a high degree of integration with proposed plans for other focal populations.
For more information, please contact Marissa.
• DCFS Updates ACHSA on Family Preservation Program
On February 23rd, ACHSA’s Family Based Services (FBS) Subcommittee hosted Harvey Kawasaki, Division Chief of DCFS Community Based Support Division, to discuss the Family Preservation (FP) program and answer pre-submitted questions from member agencies.
Harvey provided an overview of FP in the context of the Title IV-E Waiver Capped Allocation Demonstration Project (CADP) before answering members’ questions. As noted in the February 1st ACHSA Update, DCFS and Probation gave a presentation to the Board of Supervisors at the end of 2008 regarding the progress of the Title IV-E Waiver Capped Allocation Demonstration Project (CADP) during FY 2007-08. On February 3rd of this year, the Board of Supervisors approved the second edition of the County’s CADP Implementation Plan for FY 2008-09 and 2009-10. This Implementation Plan allows DCFS to expand and/or implement its second sequence CADP strategies/initiatives, which include the execution of FP contract amendments and budgetary adjustments.
Echoing the County’s February 3rd letter to the Board regarding the second edition of the CADP Implementation Plan, Harvey noted that DCFS had established an upfront assessment program in the DCFS Compton office to better serve families by obtaining immediate and thorough assessments of their needs. The purpose of such assessments is to both reduce child detention rates and shorten the timeline to family reunification by initiating the development of the child’s safety plan. This was achieved by utilizing experts in the areas of mental health, substance abuse and domestic violence to provide comprehensive assessments and, when appropriate, connecting families to treatment and ancillary services in the community, including expanded FP services, rather than taking children into care. During this second sequence of Waiver initiatives in FY 2008-09 and FY 2009-10, DCFS will amend its contracts with FP agencies throughout the County to expand the use of upfront assessments to all regional offices to reach approximately 5,000 assessments of high risk families in FY 2009-10. FP Services and the use of Alternative Response Services to connect families to treatment and ancillary services by approximately 500 additional slots in FY 2009-10. With this in mind, Harvey proceeded to answer the following questions:
Question #1: How does DCFS plan to ensure that CSWs accompany providers to jointly assess the families for initial upfront assessment referrals? As we expressed to you in our letter last month, safety is the primary concern of providers who cannot send one staff alone to assess families in potentially volatile situations.
Answer: During business hours, the CSW will initially visit the family in order to determine the level of the family’s needs. The CSW will not refer volatile families to agencies for upfront assessments. During command post hours, the DCFS Emergency Response Worker will accompany the agency to visit all upfront assessment families. The Department encourages agencies to request that the CSW accompany agency staff if they feel uncomfortable conducting an assessment alone.
Question #2: What is the amount of hourly reimbursement for provider staff (both licensed and unlicensed)? How will DCFS respond if this reimbursement is determined to be inadequate, considering factors such as travel time, travel costs, three-hour response timeframe?
Answer: DCFS will reimburse agency staff at the rate of $70 per hour for licensed staff and $60 for non-licensed staff. Relatedly, the Department has not yet determined how to resolve reimbursement claims made by FP agency staff during visits that result in incomplete upfront assessments due to uncooperative families as this issue did not arise during the pilot project. DCFS plans to ask the Auditor-Controller to clarify if there are any reimbursement rates that need to be updated for FY 2009-10 and to raise the issue pertaining to billing for travel time.
Question #3: If the provider is called into the home for an assessment and the children are detained and the CSW wants the provider to assess the adults, does the provider proceed and complete the assessment? Will the provider be reimbursed for this assessment?
Answer: Yes, the FP agency should proceed with such the assessment of the adults and DCFS will subsequently reimburse the agency.
Question #4: What is the possibility of increasing the current FP caseload with the additional upfront funding given to agencies for this fiscal year?
Answer: Due to the manner in which DCFS is implementing the FP contract amendments this fiscal year, Harvey plans to allow FP agencies to flexibly utilize upfront assessment funding for other slots in their FP caseload for the remainder of FY 2008-09. This is because DCFS does not expect FP agencies to be able to initially fully utilize upfront assessment funding solely for FP slots generated by such assessments. Beginning July 1, 2009, however, DCFS will not be as flexible.
Question #5: In the contract amendment it states that FP agencies will be also doing upfront assessments for the command post. In reality, only those agencies that volunteered will be doing this. How will the contract be amended for those agencies that are not conducting upfront assessments for the command post and only regional upfront assessments?
Answer: DCFS does not intend to change the contract language to mandate command post upfront assessments, but will only ask those FP agencies that have volunteered to conduct such assessments.
Question #6: How will the federal curtailment of the Promoting Safe and Stable Families (PSSF) program affect FP providers in Los Angeles County?
Answer: Harvey noted that the federal government has reduced funding for PSSF by a total of $986,000. In addition to FP, Funding for PSSF is used for state programs that assist in family reunification, family support, and adoption support. Although DCFS was able to use CADP reinvestment savings to cover the reduction during FY 2008-09, the Department will be forced to reduce funding equally across the four core services of PSSF beginning July 1, 2009. The Department expects this reduction to result in the loss of an estimated one (1) FP slot per agency.
Question #7: What are the expectations of FP agencies that receive referrals for upfront assessments from DCFS late in the afternoon?
Answer: Harvey encouraged FP agencies to be prepared to have staffing available to conduct upfront assessments on short notice, but that agencies should be in communication with the ARA of their respective DCFS Regional Office.
For additional information, please contact Adam or Jodi.
• May the Workforce Be With You – Report Details Findings of the California Consumer Employment Summit
The California Network of Mental Health Clients and the California Mental Health Directors Association released the summit report and findings of the October 2008 California Consumer Employment Summit. Entitled "Welcoming Diversity and Recovery in the Workforce", this summit was the first statewide conference to focus on strategies to employ persons with experience of mental health issues in the mental health system itself. Two hundred and fifty attendees from across California participated in the summit, representing a wide range of stakeholders in the mental health community, including clients, families, cultural brokers, transition-age youth, service providers, administrators, policymakers, and others. ACHSA's Mental Health Policy Assistant Marissa Lee facilitated a World Cafe Table Workgroup on the employment needs of transition-aged youth alongside other youth Steering Committee Members from the California Youth Empowerment Network.
The summit focused on strategies to engage clients in meaningful employment by increasing and expanding the practice of hiring, supporting, and retaining new, diverse, and underused consumer employees -- a large step in reducing stigma and discrimination in mental health systems and the larger community.
Plenary Panels and Workgroups
The first plenary panel, "Valued Lived Experience," discussed the value employment brings to a consumer's wellness and recovery, the experiences and knowledge they are able to bring to their work, and the challenges they face managing stigma and discrimination in their workplaces. Participants shared positive action strategies promoting dignity and mutual respect. The second plenary panel discussed how agencies and employers can change to be inclusive by recognizing and assessing the strengths and assets of individuals with lived experience seeking to enter the mental health workforce. Panel members discussed the recovery model in the workplace, employment possibilities, and challenges. The third panel, "Real Engagement in Meaningful Employment," explored strategies for expanding and enlarging the pool of consumers included in opportunities for employment and leadership. Topics covered included: redressing inequalities, organizing, and engagement competencies.
Second day activities included a plenary panel titled "Consumer Leadership," which addressed the unique and sometimes conflicting pressure consumers experience in workplace leadership roles, including what challenges and successes agencies have encountered in integrating consumer leadership at the level of executive management. Much of the second day was filled with 15 World Cafe Roundtable Workgroups discussing several topics, such as diversity, consumer run programs, training and educational standards, pre-employment strategies, reducing stigma and discrimination, and more.
Emerging Best Practices in Consumer Employment
The Summit Report classified some of the findings into a "Table of Emerging Best Practices in Consumer Employment." This document described key needs and issues, as well as resources and approaches to the issues. In planning and preparing for consumer employment, the employer must develop a strong understanding of the Americans with Disabilities Act (ADA) employment rights, and reasonable accommodations. They must collaborate with Human Resources, and identify goals and timelines for diversifying the workforce to include more consumers, and commit resources to funding these new positions. They must also commit resources and identify strategies to provide benefits counseling, and establish partnerships and collaborations to create more career pathways. Agency leadership must promote consumer employment and a critical system value, and provide training to current staff to reduce stigma and create a comfortable work environment.
In order to better recruit and hire consumers for the mental health workforce, agencies must articulate job requirements and actively recruit and support consumers from different backgrounds, such as those from ethnic communities, transition aged youth, and older adults. Recommendations for training a new mental health workforce include: adopting training and core competency standards, providing peer-driven training, job preparation training, on-the-job training and supported employment, and providing support for career pathways. Agencies can also conduct advocacy to increase federal and state funding for vocational programs.
In order to support and retain consumers in the workforce, agencies can check in periodically with employees, support them in developing a work-life balance and maintaining recovery, monitor the implementation of reasonable accommodations, and provide continuous quality improvement and post-employment support. At the same time, positive work policies -- flexible schedules, attractive workplaces, and empowering and supportive environments -- should beneficially impact the entire mental health workforce.
For more information, or to read the entire report, please visit the CMHDA website.
• Probation Restructuring Steering Committee Steers Clear of Placement Practice Model and Focuses on Practical Changes
On February 18th, Probation convened the Placement Restructuring Committee Meeting to continue to discuss changes in the Placement Services Bureau related to the Placement Practice Model. Jitahadi Imara announced that effective March 1st, he will no longer be the Probation Deputy Director of Special Services and will instead be overseeing the juvenile halls and camps as the new Deputy Director of Juvenile Institution Services. Jitahadi thanked the Steering Committee for fostering better stakeholder relationships with Probation. Reaver Bingham, Probation Bureau Chief of Adult Field Services and former Superintendent of Central Juvenile Hall, will replace Jitahadi as the new Deputy Director of Special Services. Jitahadi encouraged the Committee to continue ongoing collaboration and invited ACHSA to participate in the monthly Probation Placement Managers’ Meetings in order to enhance transparency and eliminate miscommunication. Jitahadi also asked that ACHSA continue to include Probation in the bi-monthly ACHSA Probation Committee Meetings for the same purposes.
Cross-Systems Assessments
Jitahadi noted that Probation needs to consistently share its upfront cross-systems assessments with providers. He asked whether it would be possible for the provider to pick up the assessment report when the provider retrieves the youth from the juvenile hall. Ideally, he proposed that the Probation ZIP Officer meet with the provider to review the report when the provider picks up the child from the juvenile hall. The providers pointed out that the ZIP Officer should speak with the person at the group home that develops the child’s treatment plan who is not necessarily the person that picks up the youth from the juvenile hall. One provider proposed that group home clinician call the ZIP Officer immediately after the youth has been placed in order to integrate the assessment information into the child’s treatment plan.
Group Home Intake and Orientation
Jitahadi explained Probation’s plan to move all youth on suitable placement orders to Central Juvenile Hall by mid-April. Each youth will be moved to Central the day after he/she receives a suitable placement order. Probation decided to do this for several reasons: 1) The pharmacy is at Central Juvenile Hall; 2) DMH plans to move its three cross-systems assessment psychologists to Central; 3) Placement DPOs will visit the youth in person before making a decision as to which placement to refer the youth to.
Probation expressed concern regarding the 800 AWOLs (which reflected approximately 400 children, some with multiple AWOLs) last year. Probation surmised that the large number of AWOLS was due to the following reasons: 1) The placement youth were not prepared to go to placement; 2) The placements were not receiving all of the necessary information regarding the youth; and 3) Probation needed to develop a standard process to refer children to appropriate group homes. Jitahadi committed to developing a workgroup to include Probation and the Intake Directors of the Steering Committee providers in order to review the juvenile hall intake process, identify challenges, and refine the process.
Group Home Programs and Practices
Jitahadi reiterated that youth should be assigned to group homes based on the youth’s needs and the group home’s services. Jitahadi would like to study how Probation refers children to group homes to determine whether Probation has a good knowledge and understanding of the placements. Jitahadi committed to convene a workgroup to include Probation and providers in order to develop a standard process by which to refer youth to group homes. The workgroup will review the process by which Probation identifies services and assigns youth to group homes. Lisa Campbell, Director of Placement Permanency/Quality Assurance (PPQA), also expressed Probation’s desire to develop a better understanding of group homes through its monitoring process. ACHSA confirmed that Probation is currently using the ACHSA provider matrix. Probation will review the matrix and ask non-ACHSA providers to forward information so that all providers are consistently reflected in the matrix.
Educational Transitions
Jithadi asked the Los Angeles Unified School District (LAUSD) coordinator to describe programs that assist youth who are transitioning home from placement. The LAUSD coordinator described two special LAUSD programs for Probation youth – the Neglected/Delinquent/At Risk Youth (NDAY) Program and the Camp Returnee Program. The NDAY Program, staffed by psychiatric social workers, teacher assistants, and counseling aides, currently provides evening tutoring courses to children in eighty-eight group homes. The Camp Returnee program has ten pupil services counselors to assist with school placement and transition issues for youth who are returning to the district from camp. LAUSD noted that placement youth should also be able to receive services through the Camp Returnee Program. Probation and LAUSD will work together to determine how placement youth will access these resources. LAUSD emphasized that an educational transition plan prior to release from placement is imperative.
Placement Practice Model
The Committee briefly discussed the current status of the Probation Placement Model. Probation explained that the Practice Model is a living document that the Department is currently using as a guiding philosophy as it moves forward with restructuring. In light of the general nature of the Practice Model, ACHSA objected to specific language in the Model regarding the length of residential placement authorizations. ACHSA also objected to statements in the Model that residential treatment has, in general, failed to address the needs of Probation youth. Probation expressed its willingness to carefully review the Practice Model document with providers in order to make necessary changes.
Small Tests of Change
Probation described two of its ongoing small tests of change. PPQA is conducting a small test of change by creating a parent orientation program for parents in the Lynwood area. Placement to Community Transition (PCT) Services is also conducting a small test of change based on suggestions from the Steering Committee Transition Subcommittee for aftercare services and established principles of transition. PCT has created the Community Transition Program – which includes a Probation Transition Liaison that visits group homes to hold transition meetings that include the youth, family, and group home. ACHSA reiterated its concerns regarding the small tests of change, including how the department plans to prioritize its work, who will coordinate the small tests of change, and how Probation will ensure that anything is accomplished.
For further information, please contact Jodi.
• Mental Health Odds & Ends
MHSA Implementation Unit Program Support Bureau
The Los Angeles County Department of Mental Health has created the MHSA Implementation Unit, part of the Program Support Bureau and located at 695 S. Vermont Avenue on the 15th floor.
The MHSA Implementation Unit will oversee the implementation of MHSA Community Services and Supports Plan. As MHSA is integrated into the service network, the unit intends to work across age groups, Service Areas, and MHSA programs to establish continuity and consistency of approach. This unit will also oversee FSP and other MHSA outcomes, including working with providers to ensure FSP data is valid and reported in a timely manner. The unit is currently overseeing the development of FSP outcome reports and the migration of Caminar data into DMH’s Outcome Measures Application (OMA.)
Staff include Debbie Innes-Gomberg, Ph.D., Kara Taguchi, Psy.D., and Jason Huang, Ph.D. The Unit looks forward to working collaboratively with providers to capture the positive results achieved through our MHSA programs.
For additional information, please contact Marissa.
• Child Welfare Nuts & Bolts
Inter-Agency Meeting with Judge Nash
On February 20th, Judge Nash, Presiding Judge of the Children’s Court, convened his monthly inter-agency meeting. Several issues related to both the Dependency and Delinquency Courts were discussed, but two items in particular drew ACHSA’s attention: 1) Decentralization of Processing of Petitions to Seal Juvenile Records; and 2) Los Angeles Countywide Disproportionate Minority Contact (DMC) Reduction Plan 2008.
By early April 2009, the Juvenile Court will decentralize the process by which individuals can file petitions to seal juvenile records, allowing for the submission of paperwork at the various court districts. CCL plans to distribute informational brochures regarding youth rights pertaining to the sealing juvenile delinquency records. Agencies are encouraged to contact the youth’s social worker or DPO for additional information. In addition, the youth may also want to contact their attorney or CASA. In the meantime, please click here to access additional information on this issue.
Judge Nash also provided an overview of the Los Angeles Countywide Disproportionate Minority Contact Reduction Plan 2008. The Corrections Standards Authority (CSA) awarded a three-phase grant, designed to assist Probation Departments to understand how to identify DMC, and to equip Probation with the tools and resources to provide leadership in collaboration with juvenile justice system partners and stakeholders working on DMC reduction. The first phase of the grant focused on DMC infrastructure and education (including the training of Probation staff and the development of infrastructure for data collection and analysis for the reduction of DMC). The second phase targets outreach to create a collaborative made up of traditional juvenile justice system stakeholders and community representatives, to assist with the development of a countywide juvenile justice DMC reduction plan. The third phase seeks to implement the plan developed in Phase Two.
The plan contains specific recommendations, including: 1) Create a Committee to Revise the Krisberg Scale; 2) Develop Consensus on the Purpose of Detention; 3) Develop New Alternatives to Detention; 4) Begin a Pilot Program to Notify Youth of Court Appearances; 5) Designate a Full Time Staff Member to Lead the Project; and 6) Conduct Further Analysis on Probation Violations and Warrants. With respect to community engagement, the plan recommends that the collaborative subcommittee include community representation at future meetings. The area surrounding the 90044 zip code has been targeted as a pilot area to begin community outreach.
For additional information please contact Adam.
DCFS and CLC Contact Information
We would also like to share copies of the Children’s Law Center (CLC) of Los Angeles Employee Roster and the DCFS Administrative Directory.
|ACHSA NEWS |
ACHSA has hired Thomas Hill as its new Mental Health Policy Director. TJ, as he is called, comes to ACHSA from the Disability Rights Legal Center. TJ is a graduate of University of Arizona, where he obtained his Bachelor of Arts degree in Psychology. TJ then received his Juris Doctor degree from the Washington University School of Law.
TJ has officially stared ACHSA as of March 2nd. We are very excited about having added TJ to our dedicated and hard working staff, and we hope that you will make him feel welcome. You may reach TJ through phone: (213) 250-5030 extension 105, or through email at thill@
|CONFERENCES & EVENTS |
• Weekend Computer Camps
January – June 2009
Los Angeles County Office of Education and Los Angeles Community College Foundation are partnering with Foster Youth Services to offer computer weekend camp (2 ½ days) to provide students with the ability to learn how to use the computer and Microsoft Office software in which to complete their school work, learn viable job skills and desktop skills which are a necessity for today’s successful young adults. If you have youth to participate, please call Kim Bradley of The Community College Foundation at: 213-427-6910 Ext. 222 or 916-418-5154. Or you may email her at: kbradley@. Please click here for additional information and the computer camp schedule.
• Web Seminar: Supporting Foster Youth on Campus
March 3rd
California College Pathways is holding a free educational web seminar on March 3rd from 10:00 to 11:30 a.m. to present the finding of the first-ever statewide annual report of campus support programs in California, released in January 2009. This training will be of particular interest for those who would like to learn about what California public campuses have programs that support the unique needs of former foster youth. It will also be relevant to those interested in learning about what assistance these programs provide and how the campus support program movement has developed over the last 10 years. Information to be provided in the training will include: To register, click here. Ample time will be provided to answer your questions. For more information, contact Jenny Vinopal at (562) 951-4734. To learn about California College Pathways, visit .
• Where are the Fathers? Relational Approaches for Domestic Violence Exposure in Early Childhood
March 6th
Alicia F. Lieberman, Ph.D. will be conducting this seminar on March 6th from 8.30 a.m. to 4 p.m. in Culver City. Seating is limited to register now! $150 Registration (light breakfast and lunch included), $160 with CEUs (MFTs and LCSWs). Please mail payment and registration form to: WIN, Attn: Rachel Ford, 5721 W. Slauson Ave., Suite 200, Culver City, CA 90230 Questions? RachelF@, 310.846.4100 x 6131. For additional information, please refer to the event flyer.
• Nestle LA Urban League College Scholarship Opportunity
March 11th: Application Deadline
The Los Angeles Urban League and Nestlé are pleased to announce our 4thAnnualYouth Leadership College Scholarship and we are reaching out to you to solicit your support in helping us to make sure that the youth and families in the communities we serve are aware of this opportunity. Through the generous support of Nestlé, the Los Angeles Urban League has the opportunity to provide seven (7) college-bound youth with additional financial support to pursue their higher education goals. TheLos Angeles Urban League hopes that you will support us in this effort by distributing this information to the Principals and College Counselors of your high schools, as well as to the parents and community members of the district that you serve. The application deadline is March 11, 2009 at 5:00 p.m. Please refer to the scholarship announcement, application, and flyer so that you can easily forward this information. The application can also be found online at: event. If you have any questions or need additional information, please feel free to contact Ms. Cheryll Cooks at (323) 292-8111, Extension 612.
• National Nutrition Month Workshop
March 20th
The University of California Cooperative Extension (UCCE) in Los Angeles County is helping local families make healthy food choices during difficult, financial times. On March 20, 2009, Los Angeles residents are invited to celebrate National Nutrition Month with UC Cooperative Extension and learn how to save time and stretch their food dollar during an interactive workshop, “Making Every Dollar
Count: Saving Money on Food.” The event will take place in Cooperative Extension's community demonstration kitchen from 8:30 to 11:00 am. Participants will be able to observe cooking demonstrations on quick, healthy and affordable meals and they will taste the delicious results that their families are sure to love. The workshop will be conducted by staff from the Expanded Food and Nutrition Education Program (EFNEP) and the Food Stamp Nutrition Education Program (FSNEP). For more information, contact Brenda Roche, nutrition, family & consumer science advisor at (323) 260-3299, bkroche@ucdavis.edu.
• S.A.F.E Course
March 31st – April 1st
McKinley Children’s Center will be hosting a course on Structured Analysis Family Evaluation (SAFE) from 9:00 a.m. to 4:30 p.m. from March 31st through April 1st in San Dimas, CA. SAFE provides a structured methodology as well as state of the art tools for social workers to describe, evaluate and strengthen families in a uniform, comprehensive and sensitive fashion. Class size is limited to 30 participants. For registration information, contact Kelly Cleary, kelly@. For additional information, please refer to the informational flyer.
• 2009 CIMH IT Conference
April 22nd – 23rd
The California Institute for Mental Health will host the Ninth Annual National Information Management Conference and Exposition: Addressing the Needs of Mental Health, Alcohol and Other Drug Programs on April 22-23, 2009 at the Crowne Plaza Hotel in Anaheim, California. More information about the program and how to register can be found by clicking here. This is the longest-running and largest informatics conference in the United States for the behavioral health care field. Each year approximately 400 attendees attend and over 25 software vendors exhibit. The program features over 40 presenter experts who will address information management issues as they pertain to mental health, alcohol and drug programs. The keynote presenter is Dr. Jon White, Director of Health Information Technology for the federal Agency for Health Research and Quality.
|IN THE NEWS |
• Emergency Room Doctors Sue the State of California, Los Angeles Times, 1/28/2009
• Safe Haven Kids Finally Got the Right Help, Omaha World Herald, 2/1/2009
• Efforts Meeting Initial Goal of Housing Skid Row’s Most Vulnerable, Los Angeles Downtown News, 2/2/2009
• Mental Illness Alone is No Trigger for Violence, The Associated Press, 2/2/2009
• State Officials Work on Final Items in the Budget, San Francisco Chronicle, 2/2/2009
• L.A. County Hires Firm to Search Juvenile Halls with Drug Sniffing Dogs, Los Angeles Times, 2/4/2009
• Programs Available for Emancipated Foster Youth, San Ynez Valley Tribune, 2/5/2009
• Revolt Brews in Counties, Sacramento Bee, 2/5/2009
• Furloughs in California Close Many State Offices, New York Times, 2/7/2009
• Suicides: Watching for a Recession Spike, Time Magazine, 2/9/2009
• Protect Mental Health, Pasadena Star News, 2/11/2009
• Probation Department Begins Layoff Process, Los Angeles Times, 2/12/2009
• California Must Not Turn Its Back on the Mentally Ill, San Jose Mercury News, 2/12/2009
• L.A. County Probation Department Suspends Aggressive Billing of Guardians, Los Angeles Times, 2/14/2009
• California’s GOP Lawmakers should do the Budget Math, Los Angeles Times, 2/16/2009
• Budget Constraints Hitting David and Margaret Home Hard, Contra Costa Times, 2/17/2009
• State Stalemate Sets Up Fiscal Calamity, Associated Press, 2/17/2009
• Legislature Adjourns with No Budget; Governor Prepares to Lay Off 10,000, Los Angeles Times, 2/17/2009
• Approved Budget will not end County’s Lawsuit against State, Contra Costa Times, 2/19/2009
• L.A. County Pushes for More Money for Juvenile Justice, L.A. Now, 2/19/2009
• Children in the Mental Health Void, New York Times, 2/19/2009
• Panel OKs Plan for Post-Foster Home, Contra Costa Times, 02/19/2009
• Budget Update on Regional Centers and Special Education, California Progress Report, 2/24/2009
• Health Care Costs to Top $8000 per Person, Associated Press, 2/24/2009
• O’Donnell Grants Rookie Star an ‘American’ Dream, USA Today, 3/1/2009
|UPCOMING MEETINGS & EVENTS |
|MARCH |
|3 |Probation Committee Meeting |ACHSA |11:00 AM to 1:00 PM |
|4 |ACHSA Board of Directors Meeting |ACHSA |9:30 AM to 11:30 AM |
|6 |Foster Care Performance Measures Task Group Meeting |ACHSA |10:00 AM to 12:00 AM |
|6 |Group Home Performance Measures Task Group |ACHSA |12:30 PM to 2:30 PM |
|10 |Monthly IBHIS Workgroup |RESCHEDULED: TBA |
|11 |Children’s Mental Health Policy Committee Meeting |Dubnoff Center |1:30 PM to 3:30 PM |
| | |10526 Dubnoff Way | |
| | |North Hollywood, CA 91606 | |
|12 |DCFS Committee Meeting |Star View Community Center |9:30 to 11:30 AM |
| | |5420 North Figueroa Street | |
| | |Highland Park, CA 90042 | |
|18 |FFA Strategic Planning/Policy Committee Meeting |ACHSA |10:00 AM to Noon |
|19 |ACHSA CEO/ED Forum |Hillsides |10:00 AM to Noon |
| |[Mental Health] |940 Avenue 64 | |
| | |Pasadena, CA 91105 | |
|23 |Family Based Services Subcommittee |ACHSA |10:00 AM to 11:00 AM |
|25 |Mental Health Contractual/Administrative Meeting |ACHSA |1:30-3:30 PM |
|27 |Adult Mental Health Policy Committee Meeting |ACHSA |1:30 PM to 3:30 PM |
| | | |Afternoon Meeting Time |
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:
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March 1, 2009
Volume 6, Issue 4
ACHSA UPDATE
A bi-weekly briefing of the Association of Community Human Service Agencies
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