MIAMI-DADE COMMUNITY-BASED CARE ALLIANCE



MIAMI-DADE COMMUNITY-BASED CARE ALLIANCE

February 7, 2013

Meeting # 1

The meeting of the Miami-Dade Community-Based Care Alliance was held Thursday, February 7, 2013 at 8:30 a.m. by Honorable Rosa Figarola and Jeri B. Cohen at 401 NW 2nd Ave. Room N1007, Miami, Florida, 33128.

BOARD MEMBERS:

Imran Ali Miami-Dade County Community Action and Human Services Department - PRESENT

Betty Alonso The Miami Foundation – PRESENT

Bart Armstrong Children Legal Services - PRESENT

Charles Auslander Children’s Trust - PRESENT

Mark Buchbinder Consultant - ABSENT

Judge Jeri Cohen 11th Judicial Circuit Court – PRESENT

Morris Copeland Juvenile Services Department – ABSENT

John Dow South Florida Behavioral Health Network - ABSENT

Jessica Allen 11th Circuit GAL Program – PRESENT

Judge Rosa Figarola 11th Judicial Circuit Court – PRESENT

Terria Flakes Department of Juvenile Justice - ABSENT

Rhea Gray ACHA Medicaid – ABSENT

Esther Jacobo/Gilda Ferradaz Department of Children & Families - PRESENT

Honorable Cindy Lerner Village of Pinecrest - ABSENT

Alexsa Leto 16th Circuit GAL Program - PRESENT

Brett McNaught Educate Tomorrow - PRESENT

Maritza Moreno Foster Parent Association South – PRESENT

Catherine Penrod Switchboard of Miami - ABSENT

Chassah Perez United Way of Miami – PRESENT

Isabel Perez-Morina Advocate Program - ABSENT

Lucy Piñeiro Child Advocate - ABSENT

Jackye Russell Early Learning Coalition - PRESENT

Judge Mari Sampedro-Iglesia 11th Judicial Circuit – PRESENT

Bernardo Suarez Miami-Dade Police Dept. - ABSENT

Mark Zaher/Sylvia Godoy Miami-Dade County Public Schools - ABSENT

CBC STAFF:

Michelle Breuer CBC Alliance Executive Director

CBC ALLIANCE MEETING

Welcome & Introductions

Judge Figarola welcomed everyone to the meeting and announced that she would be leading the meeting until Judge Cohen arrived. Michelle announced that Sherria Williams from the Miami-Dade State Attorney’s Office will not be able to serve on our board any longer so we are looking for a new representative from SAO and she introduced Jessica Allen the new director of the Guardian ad Litem Program who will be sitting on the Board instead of Sonia Ferrer. Jessica told the board that she has moved to Miami ten years ago to go to the UM School of Law, was with the GAL program for 6 years, started as a program attorney in Judge Lederman’s court for four years and was promoted as a supervising attorney last year, interim Circuit Director since November 2012 and the Guardian ad Litem Circuit Director officially for a week. She can provide any information on the Guardian ad Litem Program as necessary.

Action Items

Review and Approval of Agenda and Minutes

The minutes from the December 6, 2012 meeting were reviewed. The minutes were unanimously approved.

Presentations

APD – Lauren Fuentes

Esther Jacobo asked Lauren to introduce the Agency for Persons with Disabilities (APD) topic to the board. The Department was approached by APD because they have a number of families living in assisted living environments where the parents are APD clients but they also have children. We have done data analysis and the majority of those families have had contact with the Department. APD work with parents but does not have enough funding and resources to serve the children. We had some initial conversations about how can we better serve these clients. Many of these APD clients were foster youth so how do we work with our current foster youth that may become these APD parents as adults.

Representatives from the APD spoke on behalf of the population. The APD works in partnership with local communities and private providers to assist people who have developmental disabilities and their families. APD also provides assistance in identifying the needs of people with developmental disabilities for supports and services so they can live in their own home. Services include financial support, child care and other services related to their specific disability. The main consumer is the person diagnosed with the disability but they can have 2 or 3 children whom are not our clients although we look at the entire family and provide supportive services and referrals. We need to coordinate our work with DCF more efficiently. The individual feels that because the children are not in the realm of the APD services they cannot receive assistance for their children and they usually feel angry because of this, they really want help for their children.

Ann de los Pozas from Our Kids informs that they had a meeting with APD to identify the gap. Esther thought it would be important to bring this issue to the CBC Alliance since the board had voted to work on prevention in December. Our Kids would like to pursuit this project with the CBC Alliance Board’s support. A parent with a daughter with disability who lives at her home, she recognized that there are many more services and support that children’s with disabilities needs. Ms. Sanchez explained to the Board a voluntary reading program that she thinks would be very useful and are on the infant stages of being discussed. In the past children with disabilities were being placed in adult institutions for care because they could no longer be cared for at home and that really worried her. She had been invited to participate in the Education Excellence Advisory Committee in my daughter’s former school. The school even though it serves only severely special needs student because of the scoring system set up by the state it is rated as an F school. That’s when it occurred to her that parents of children with disabilities could volunteer to read to these children for one hour a week and serve as a bridge between the governmental agencies and the families.

Judge Figarola shares that there are cases, very tragic, that cannot be reunified because of the mother’s mental health illness, which is not her fault and yet these children are in danger and there certainly is a shortage of services. This could be an excellent point to bring in to our CBC Alliance Retreat. Please take note that the Retreat date changed to April 4, 2013 and she hopes that every member participates.

Quality Assurance plans/reports, Andrea Mendez, Our Kids

There have been many changes in the Quality Assurance process overseen by the Family Safety Office over the past 2.5 years. In addition to all the QA activities that Our Kids does in collaboration with DCF and the agencies we also do side by side and base reviews. Every quarter Tallahassee picks a universe of cases stratified according to agencies and to in-home and out-if-home and we choose a sample of cases to review. In 2010 and 2011 we had selected two tools in an online portal to review 8 of those selected cases. It is a strict file review of approx.143 questions. If things were missing from the file we can contact the agency or the court. Changes to the tool were commenced by the QA team in Tallahassee who also became interested in utilizing interviews and the Quality Service Review (QSR) process. One aspect of the statewide QA is to prepare for 5 year federal audits. At a federal level, they full perform file reviews as well as interviews. The CFSR is undergoing many changes, Florida is a pilot site and we currently have provided a lot of information to them. Each CBC sent information to Tallahassee and Tallahassee has formulated a plan and provided this information to the Children’s Bureau. They are going to give us feedback on this. If the Children’s Bureau can look at our QA system and see that it is adequate, then it would not be necessary to perform a site visit. Every CBC in Florida has done interviews and stories. Feedback needs to be delivered in a way that it can be heard, a lot of this is in communications styles. This new approach would represent the state better. Last year we were informed that we needed to use the Quality Services Review (QSR) which is a very intensive process compared to other reviews. There might be a case that needs the reviewer to contact 5 people, other cases 15 persons need to be contacted and it is very necessary that the contact is face to face. Tallahassee developed a tool that mimics the indicator in the QSR which is accessible online. It takes a long time to organize these interviews and compile the information, write the stories and enter many questions. It is very time consuming, just like doing the CFSR but QA staff found the process very worthwhile and continues to use it. This year the local QA team was informed that we have to go back to the QA tool and standards which were updated by a team that was selected to go to Tallahassee to update the tool. 21 cases per quarter and add 2 QSR per quarter. 92 cases will be reviewed. 8 of those will be with an intensive review process. In addition to the compliance file review we still want to give the case managers an attempt to discuss the case with them. The nomenclature has changed so it was difficult to compare the 3 fiscal years. Areas in need of improvement: Family Engagement, Promoting Case Progress, Permanency, Academic Status, Teaming and Partnering, Collaboration around the state with teamwork is a big problem. Areas of Strength: Safety, Overall Physical Health and Parent/Caregiver Functioning. Greatest strength is Engagement and it is suspected that SDM tools, supervision and case ownership workgroups, Family Team Conferences and meeting the family at shelter hearings are reason for this excellence. The QA team has all of the reports, all of the stories and a QA plan available for the board members if they would like to access these. Stories need to explain factors that contributed to success or to have not succeeded and provides a prognosis and practical steps. We try to review open cases so feedback can be used. Our Kids is looking at the permanency issue in regards to agency and to the courts and can share these findings with the Board by June of this year. Betty Alonso states that this kind of information is really useful when we are looking at these types of reports so that we can all have a better grasp of the story behind the data. Charles Auslander thinks that it is great that this work is being done. One of the justifications of having a lead agency is that a lead agency is not directly on the field all the time they have the ability to aggregate and analyze this kind of information qualitatively and quantitatively. Wouldn’t it be great ideally if Our Kids can take this, take some lessons from it and see how that works to improve the efforts in the field amongst the various direct service providers. This can be one of the good things to have a lead agency structure. This is beginning to show in a serious way that Our Kids is stepping into this, I hope that you are able to develop it in a way that you can make it directive towards practice.

Evelyn hopes so too. They have taken the list of the children that have been reunified between a 0-4 period and the FCMAs are going out back there to help reinforce some of these reunifications to make sure that they don’t come back. We are identifying these families to do additional work to help support reunification to avoid reunification. Once we have the information we have to be able to do something about it and incorporate it.

SDM Update, Evelyn Meltz, Our Kids

Our Kids has been using a set of structured, evidence-based tools called Structural Decision Making (SDM) since 2009, introduced them to DCF in 2010, and they were very involved in the process. These are a set of 6 safety and risk tools. In 2011 the State decided to bring a different tool. They brought in an organization called Action for Child Protection to develop a tool. Our Kids felt that this went against the SDM tool. We introduced them to the Children’s Resource Center. This prompted many discussions on what are the right tools for Florida. The State partnered with the CRC on developing the right tool including part of the SDM model without compromising the SDM tool. There is 30 years of research behind SDM which gets lost with this hybrid tool. Recently CRC walked away from the table because the tool was completely changed and they cannot be used as stand-alone tools. The SDM tools are one page long and they take 5 to 7 minutes to get completed. The Family Functioning Assessment tool is a very significant assessment that takes around 20 minutes which has many tools embedded in it so you cannot take one tool and use it during the life of the case as needed. The FFA is self-populating a lot of the information for some of these tools. We have asked that these tools be allowed to stand alone as they are; that they can be used as worksheets as the JR and case plan updates worksheets. The only tool they agreed to not touch is the risk tool.

Gilda Ferradaz understands that this is still being discussed; no final decision has been made.

Judge Cohen informs that she initially talked to the Secretary and Pete Digre for 3 hours the difference between the tool they wanted to use and the SDM tool. The DCF staff gap analysis was faulty and the Secretary admitted it. They promised that because SDM was evidence based it was going to be used statewide. DCF wanted the other tool and all of a sudden they are altering the SDM tool and the CRC cannot be a part of it because they cannot put their name on something that has been altered. We explained that Our Kids paid approx. 500,000 dollars for this tool, the tool works, DCF is using it, everybody likes it, what you are using is not evidence-based, in fact it failed in Arizona. We cannot get a straight answer from DCF and don’t know why they want to change this tool. DCF is on an implementation timeline that won’t work, it is too quick, they have nothing on paper yet they are implementing in a month or two. The CBCs around the state all voted to use SDM. Three votes were done because they did not like the result but finally have to accept that the CBCs want to go with it and now people in Tallahassee are tearing the tool apart.

Gilda explains that Esther wanted the Board to know that she is in communication with Pete to try and resolve this issue. In a process like this DCF needs to listen to opinions from all over the state and this is what is going to happen.

Other counties do not have SDM so FFA is better than whatever they have but in this county we have been using SDM for a long time and we really wanted to be heard about something that works and why it works. It is important to listen to other organizations around the country that have successfully been implementing this for years.

Local DCF has been advocating very much for SDM, including Glenn Broch that has been very involved.

Gilda states that the Alliance tables this and give her the opportunity to continue to work on this.

Judge Cohen thinks that the Alliance and the Judges have the right to know what is going on.

Shannen Davis states that prevention providers can also support the cause by advocating that they are using it in the real world and it is working.

The SDM tools should not only be used in our system but in the prevention piece.

Stephanie Wickers from Our Kids is involved with the transformation project in DCF and the argument is that the tools should inform the assessment but what is happening is that by doing assessment it is filling out the tools for you, and it should be the other way around. These tools have been used in 40 different states and in 5 countries.

Judge Cohen believes that to use a tool, to embed something in a system and spend all that money without piloting is misguided.

Reports

CBC Alliance 2012 Budget Report, Michelle Breuer, CBC Alliance

Michelle presented on the CBC Alliance 2012 Budget including funding for the Operational Expenses of the CBC Alliance and the Annual Regional Conference budget originated from the conference registration fee. The overview shows the revenue from the CBC Alliance funders, The Miami Foundation and The Children’s Trust; and the Expenses for the Executive Director and Transitional Youth Coordinator salaries, administrative expenses, fiscal agent fees and computer expenses. The 2012 Regional Conference revenue includes sponsors and in-kind contributions and the complete cash expense detail. It also includes the expense detail from the registration fee; conference revenue comparison per agency; by number of attendees per agency and the annual conference analysis for the last 3 years including registration fee, contribution and sponsors. The presentation ended by thanking the 2012 Cofnerence Sponsors and the members of the Regional Conference Sub-commtitee headed by Mr. Imran Ali as Chair and Jennifer Scoff as Co-chair.

Judge Cohen states that we could use some corporate sponsors for this year’s Regional Conference, it seems to her that there would be corporations that would want to do this, they need to give away charitable monies and this is a great conference and they get advertising so let’s think of which corporations we might want to tap into.

Michelle explains that the Regional Conference SC meetings have not started yet but the committee will surely discuss elevating the registration fee to 20 or 25 dollars.

If any member would like to look at the numbers in more detail Michelle can send the presentation via email. If any one has any ideas about additional funding aside from what we already receive at the CBC Alliance the group’s suggestions are welcome because with current funding only salaries and a few other expenses are being covered.

We visited and had a meeting at the Miami Airport Convention Center so we are exploring it as a possible venue for this year’s conference.

OTHER BUSINESS

At the last meeting there was a suggestion by Cindy Lerner of creating a mechanism to bring volunteers and more community members to this meeting so I am organizing a meeting with Jessica Allen - GAL, Candice Maze - FCR, the Foster Parent Associations, Educate Tomorrow and Youth Shine to make this happen.

There is a new initiative that was started by the School Superintendent Carlos Carvahlo and Mayor Carlos Gimenez regarding youth safety after the Sandy Hook tragedy. They formed 4 workgroups to work on these issues and I was invited by one of our board members, Morris Copeland from the JSD, to participate in one of these groups and they will meet every Friday at 10 a.m. I will send you the information so that you can participate of these community meetings.

Judge Cohen informs that Judge Leifman brought this initiative in through another initiative we are doing. This is a nationwide effort, they go into the public schools, teachers, cafeteria workers, bus drivers anybody in the schools to recognize any sign of mental illness or emotional disturbance in children, how to handle, how to talk to them and how to refer and apparently within the last year every employee in the school is going to be trained. It is a mental health initiative. It has worked very well in other parts of the country.

Michelle included a printed copy of the 2013 CBC Alliance calendar for the full board meetings and the executive committee meetings. She asked the members to please save the dates. At the last Executive Committee meeting we decided that the retreat is going to take place on the next date of a regular CBC Alliance meeting on April 4, 2013 and members need to block 3 hours from their calendars. The retreat leaders would like to do the meeting at the TCT/United Way building.

Chassah Perez from United Way informs that she will try to make this possible.

Judge Cohen explains that we have a lot of children that go from placement to placement, they run, they are involved in sexual exploitation, drugs, etc. and in order to send them to residential facilities you need to have recommendation of a qualified evaluators who are usually psychiatrists or psychologist who are paid by Magellan the funder of the facilities and this is a huge conflict of interest. They usually find that the child has a primary substance abuse problem that makes them ineligible because mental health is not their primary issue or that their behaviorally and conduct disordered that would not enable them to get into a facility. Judge Hanzman has a girl who was dually diagnosed, if this happens there is a 75% chance that they are also co-occurring and that substance abuse and mental health together and it is difficult to say what the primary is, but that is what they do. First of all it doesn’t say that it has to be a primary it just says that there has to be an emotional or psychological disturbance. It made the front page of the Miami Herald. It is Magellan Health that creates the problem. Because of his detailed very erudite order we are finally going to see some change this so that children can be admitted. He wrote a 38 page order so we all owe him a debt of gratitude, well written, well thought out order. We should send his order around in case anybody wants to read it. I have sent it statewide as well.

I was in Chicago the last couple of days with SFBHN and this is the most exciting thing. We are working with OTSUKA a Japanese healthcare and drug company and IDEO, David Kelly started it. It is probably the most exciting and large designing company in the world, they have people in their staff anthropologists, cognitive psychologists, engineers, science people, they are all over the world, Chicago is their hub and they work out of this space, they are all in their 20 and 30s, all hipsters, wear big black glasses, short skirts, it is so fabulous, how the other half lives, the workspace is surrounded by glass, outside they have their vegetable gardens and their tandoori ovens and huge kitchens where they cook all kind of vegetables, all walls can be written on, everyone is artsy and smart, ivy league educated, I was so impressed and they just sit around and think about design, engineering, cars, products, my cel phone they put it though a 3D printer and you could print out widgets and all kinds of things, it is amazing. With conjunction with IBM, all free, they are coming up with a connected mental health system for the public mental health and substance abuse system in Miami-Dade County. They are designing a system that talks to each other with a pass card so people that access different agencies they will have a card that they can swipe we will have their entire history, medication history, we will have peer counselors. They have done hundreds of hours of interviewers here, with consumers, it is very friendly, they are designing this holistic electronic records system so that everybody is going to be talking to each other. It is going to help the different providers what is going on and the courts will have access to it, the Public Defender, JMH, DCF, all records have been given to them so they can integrate them. Across the state now every mental health entity in SFBHN has to use a utilization management system and these cost millions of dollars but now we are going to be using the IDEO, OTSUKA, IBM system for free and that will be our utilization management, it is the first of its kind in the world, Miami-Dade County is the first pilot. We have Judge Leifman to thank for that, he is the one that found them, brought them in, negotiated with them. The Secretary was not very inclined them to do it but has now signed off on it and I really think that this is going to transform the way we do business in Miami-Dade County with mental health and substance abuse. If you would saw the system you would think you died and went to heaven.

Right now it is only for adults but the sky is the limit, we can expand it to children, once the software is there we can expand it. It is going to include 57 public health and substance abuse agencies and then we are going to expand out. We are starting the pilot with 15 and it is starting this month of February 2013. It is the most exciting thing. These creative persons are not part of a bureaucracy of a hierarchy they are just thinkers, creative, young and have energy. It is inspiring, this is the next generation and the technology, what is going to take over, it is incredible.

There was a suggestion that we had a member orientation brought up by Judith McCullough but the leaders of the retreat have decided to separate the retreat form the orientation because it will only be 3 hours and we want to maximize the time for the retreat. The orientation will be postponed for a later date.

PUBLIC COMMENT

ADJOURNMENT – Judge Cohen

Where upon the meeting was ADJOURNED at 10:30 a.m.

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