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



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

1. ACHSA Workgroup Makes Significant Progress on Auditor-Controller Audit Handbook Revisions

2. Not Yet Rated: Wraparound Case Rate Workgroup Develops Model to Determine Provider Costs Relative to Single Wraparound Case Rate

3. DMH Reports on AB 3632, TAY, Juvenile Justice, and Katie A. at Children’s Providers Meeting

4. AB 12 Steering Committee Has High Hopes That It’s “Steering” in the Right Direction

5. Probation MDT Subcommittee Takes Action: Revising the MDT Action Plan and MDT Model

6. Wraparound Audit Workgroup Wraps Up on Duplication and Coordination Issues

7. Mental Health Odds & Ends

8. Child Welfare Nuts & Bolts

9. Upcoming ACHSA Meetings & Events

|ISSUE BRIEFS & UPDATES |

• ACHSA Workgroup Makes Significant Progress on Auditor-Controller Audit Handbook Revisions

➢ On October 7th, ACHSA hosted a workgroup meeting with mental health and child welfare agency fiscal experts to review the Auditor Controller’s response to ACHSA recommendations for the revision of the Auditor-Controller Contract Accounting and Administration Handbook.

Background

➢ For the first time in over ten years, the Los Angeles County Auditor-Controller is revising the handbook it uses to audit county contracted agencies.

➢ After back and forth negotiation, the A-C’s Audit Division agreed to incorporate ACHSA recommendations into the revised draft of the handbook, and thereafter postponed publication of the handbook until the feedback from ACHSA was received and analyzed.

➢ In December 2010, the ACHSA DMH Contractual/Administrative Committee, along with an ad hoc work group of ACHSA child welfare providers, reviewed the proposed new Auditor-Controller Handbook, and ACHSA submitted its feedback to Mike McWatters, Chief Accountant-Auditor at the Audit Division.

➢ Many months later, in mid-August 2011, the Auditor-Controller sent back its comments on ACHSA’s recommendations, along with a revised draft of the handbook. ACHSA scheduled the October 7th follow-up workgroup meeting with member agencies to review the Auditor-Controller’s revised draft and comments.

Auditor-Controller Response to ACHSA Recommendations

➢ Of the twenty-seven initial recommendations that ACHSA put forth, eight recommendations were clearly accepted, four recommendations were responded to in a manner which appeared to be acceptable, six recommendations were rejected, and the remaining nine recommendations were responded to in a manner which required further analysis and/or discussion.

➢ ACHSA and the workgroup members were overall quite pleased with the large number of accepted recommendations and related handbook revisions made by the Auditor-Controller.

Discussion of Outstanding Handbook Recommendations

➢ The workgroup discussed resolutions to the Auditor-Controller rejected recommendations and the other A-C responses that did not adequately address ACHSA’s original recommendations. The meeting discussion focused on the specific handbook language that the workgroup thought should be used in each disputed area.

➢ Examples of these issues included:

• Specifying the requirements for when the County can conduct an unannounced visit, audit, or investigation.

• Modifying the required use of odometer logs for County reimbursement of travel mileage to allow providers to use electronic mapping as an equivalent record.

• Excluding personal, employee-owned vehicles from record maintenance requirements.

• Revising the handbook to be consistent with DMH contracts on the prior written consent requirements for subcontractors, e.g., Contract Provider Technology Projects.

• Altering County requirements for written documentation for disbursements to comply with IRS rules of reimbursements.

Next Steps

➢ ACHSA has drafted a document with the proposed resolutions from the October 7th meeting. The document will be sent to the Chief Audit Division to follow up on any outstanding handbook recommendations. Once all of the outstanding issues have been resolved, we will report back to you in greater detail on their final disposition.

Please contact Bruce or TJ with any questions.

• Not Yet Rated: Wraparound Case Rate Workgroup Develops Model to Determine Provider Costs Relative to Single Wraparound Case Rate

➢ In response to continued concerns expressed by the ACHSA DCFS/FBS Committee, as well as the ACHSA Board of Directors, in regards to the projected amount of a single Tier Wraparound case rate, ACHSA has convened a Wraparound case rate workgroup. The workgroup includes Doug Johnson, Associate Director of the California Alliance of Child and Family Services and co-facilitator of the Wraparound redesign fiscal workgroup, and five ACHSA Wraparound agencies of varying sizes and Service Areas. Over the past eight weeks, the Wraparound case rate workgroup has convened two conference calls and one meeting.

ACHSA Holds Initial Conference Call to Discuss Case Rate Model

➢ On August 22nd, ACHSA held a conference call with the Wraparound case rate workgroup to begin discussing how to go about developing a case rate model. Bruce began the conference call by confirming the consensus of the workgroup in regards to three overarching principles:

1) The workgroup would focus on determining a single Wraparound case rate for a blended Tier Wraparound program.

2) The County has clearly stated that no additional money would be allocated to the Wraparound program.

3) The workgroup would discuss two distinct case rates for EPSDT eligible children and non-EPSDT eligible children.

➢ Workgroup members further agreed that placement costs should not be deducted from the agreed upon case rate.

➢ It was also mentioned that the fiscal workgroup had discussed the possibility of adding family finding as a component of Wraparound, thereby justifying an increased case rate. Bruce, however, expressed concerns in regards to the obligation of agencies to provide additional services in order to receive a supplemental rate.

➢ Workgroup members agreed that in order to reach an agreed upon proposed case rate, the workgroup would have to analyze provider costs associated with providing Tier I and Tier II Wraparound. The workgroup identified the main cost components which should be included in the cost analysis, and unanimously agreed that the bulk of provider costs (approximately 80%) would be attributed to staffing. The workgroup further agreed that costs should be reported separately as DCFS SB 163 activity and mental health activity.

➢ Variability in the cost of providing services depending on Service Area or size of agency was also discussed. The workgroup suggested that providers should report the Service Area(s) in which they provide services on their cost analysis spreadsheets.

➢ Ultimately, the workgroup agreed that two to three full-day meetings in September would be dedicated to reviewing cost data provided by agencies. The workgroup agreed that agency Executives or their designees, as well as financial executives, should participate in the workgroup meetings. Doug agreed to create a template based on the California Alliance’s work on the RBS Reform Pilot Project to organize the cost data being collected from workgroup members, the purpose of which would be to develop a financial model which would have the same case rate for children and families without regard to their status as Tier I or Tier II.

Workgroup Holds Conference Call to Review Draft Proposed Cost Model

➢ On September 12th, the Wraparound case rate workgroup held a conference call to review the draft cost analysis template prepared by Doug. The conference call began with ACHSA reiterating the workgroup’s agreement to work towards identifying a single overarching case rate with the following two caveats: 1) two distinct rates would be established for EPSDT and non-EPSDT eligible children; and 2) placement costs would not be removed from the case rate. The workgroup also reviewed its desired outcome – based upon the cost model to come to an agreed upon average cost per child upon which the case rate would be based.

➢ Doug walked the workgroup through the draft proposed financial model which was based on the assumption that the overall level of care and services needed by children and families from the current Tier I and Tier II populations is approximately the same, and therefore the costs of providing services to families is approximately the same.

• Accounting Period – Workgroup members were asked to report their costs for their most recent fiscal year.

• Children Served – For analysis and comparison, all costs would be converted into “per child per month” costs; therefore, it would be necessary to know the number of days of service provided during the accounting period. The total “days of service” for each provider could then be divided by 365 in order to determine the number of “child days” provided.

• Breakdown of Costs – Similar to the DCFS Tier I cost study completed last year, it was proposed to use the same basic five cost categories: 1) Direct Cost for Staff; 2) Direct Cost for Flex Funds; 3) Placement Costs; 4) Other Direct Costs; and 5) Indirect Costs. Doug, however, pointed out four important differences: 1) The new exercise would cover both Tier I and Tier II children and families. 2) Costs would be attributed to DCFS SB 163 activities and mental health activities. 3) Staff costs would be broken down by position title, wages, and benefits; and 4) Staff would be distinguished as staff (and their supervisors) providing direct care and treatment to clients and staff providing program support.

➢ Based on the actual cost data, the group agreed that it would build a “financial model” focusing on direct care staff and supervisors. The workgroup would then develop some standard agreed upon position titles with duties/responsibilities, and identify whether positions would be funded through the DCFS case rate or DMH funds. The workgroup also agreed that it would propose staff-to-client ratios for each direct care staff and supervisor position reflecting a reasonable “best practice” level. Finally, the workgroup agreed that it would propose average salaries and benefits for each position reflecting current wages and benefits being paid but adjusted to reflect what is necessary in the current labor market to recruit and retain qualified staff. This would therefore allow the workgroup to develop “per child per month” costs for each position category in the financial model which would reflect a proposed model for a program of Wraparound services for both Tier I and Tier II children and families.

➢ A new rate level proposal could then be built using the projected per child per month costs for direct care staff and supervisors and the average costs for other support staff, non-personnel operating costs, flex funds, and indirect costs.

➢ An outstanding question remained as to whether it would be possible, in the time available, to develop a standard breakdown of flex funds and other non-personnel direct costs in order to explain to the County what is included in each of those cost categories. Since the workgroup anticipated that the bulk of costs would be for personnel wages and benefits, a detailed description of costs included under flex funds and other direct costs might not be essential; however, Doug pointed out, greater specificity tends to give greater credibility to any program model.

➢ The workgroup members then reviewed the cost spreadsheet to identify any revisions and clarifications that would be needed prior to completion by the workgroup members.

• Direct Care and Treatment Staff and Supervisors – The workgroup agreed on the list of direct care position titles as described in the Wraparound contract: 1) Child and Family Specialist; 2) Child and Family Specialist Supervisor; 3) Program Manager; 4) Family Facilitator; 5) Parent Partner; 6) Parent Partner Supervisor/Coordinator; 7) Psychiatrist; 8) Clinical Supervisor; 9) Clinical Social Worker/Therapist; 10) TBS Counselor; and 11) Other.

• Program Support Staff – The workgroup agreed on the following program support position categories: 1) Administrative/Clerical; 2) Quality Assurance; 3) Trainer(s); and 4) Other.

• Flex Fund Expenditures – The workgroup agreed to categorize flex fund expenditures by the twelve Wraparound domains.

• Non-Personnel Operational Costs – The workgroup agreed on the following cost categories: 1) telephone; 2) office supplies; 3) conferences, meetings, in-service trainings; 4) building rents, leases, and mortgages; 4) building and equipment insurance; 5) utilities; 6) equipment purchases; 7) staff mileage/travel reimbursement; 8) vehicle operating expenses; 9) respite costs not included under flex funds (such as respite beds that are being saved and paid for, but not utilized); and 10) other.

• Indirect Overhead Costs – It was agreed that indirect overhead costs could be dually calculated as an amount and as a percentage of total costs attributed to an agency’s Wraparound program.

Round 1: ACHSA Holds First Workgroup Meeting to Review Preliminary Cost Data

➢ On September 27th, the workgroup held its first meeting to review and refine, as necessary, the preliminary cost data reported by agencies. At the outset of the meeting, the workgroup agreed that the preliminary cost data, which provided a basic understanding of the amount and type of expenditures, clearly confirmed that agencies spend the vast majority of their Wraparound money on staffing.

➢ Upon reviewing the preliminary summary data, as well as the agency specific data, the workgroup discovered several pieces of data which needed to be corrected by agencies:

• Agencies were asked to confirm that the reported “Total Number of Children Served” was an unduplicated count of the total number of children served during the 12-month period.

• Agencies were asked to confirm that “Children Receiving Services Funded by Mental Health” included the number of children receiving EPSDT funded mental health services only and did not include clients who access CGF in order to pay for mental health services due to Medi-Cal ineligibility.

• It was agreed that a field should be added for agencies to report on the number of Tier I and Tier II cases. The workgroup decided that it would later determine whether to include these numbers on the spreadsheet to be shared with the County.

• A couple of agencies noted that they needed to re-categorize appropriate contract staff, such as psychiatrists and clinicians, from direct care staff to program support staff. Doug agreed to revise the spreadsheet formula to disregard the benefits percentage for consultants and contractors (0%) which would draw the average benefits percentage down.

• One agency noted that it would need to confirm the accuracy of the amount of its flex fund expenditures (which appeared to be too low).

• A couple of agencies committed to remove placement costs from their non-personnel operational costs (which had been previously agreed upon by the workgroup).

➢ The workgroup noted the significant variation of the percentage of indirect overhead costs attributed to agencies – from 8.7% to 25.85% – and surmised that the variation could be attributed to the varying sizes of agencies in the workgroup.

➢ The workgroup also discussed possibly focusing on proposed outcomes rather than staffing requirements in order to instill flexibility in Wraparound practice. As an example, the workgroup discussed considering controlled lengths of stay for youth in Wraparound which would be similar to the RBS Pilot Project (e.g., graduating 60% of youth within 12 months as a possible performance standard).

➢ It was suggested that the workgroup review the current performance measures from the most recent Wraparound annual report to see whether the measures could somehow be connected to an adjusted case rate. It was agreed that the County would be especially interested in those outcomes which save money. At the same time, it was pointed out that the vast majority of Wraparound agencies have consistently met the performance standards, so performance data collected thus far has not distinguished agencies.

Next Steps

➢ Doug has revised the template to clarify the areas in question described above and agencies in the workgroup are busy reviewing and correcting their data, as needed. The next Wraparound case rate workgroup meeting will take place on October 19th.

Please contact Bruce or Jodi with any questions.

• DMH Reports on AB 3632, TAY, Juvenile Justice, and Katie A. at Children’s Providers Meeting

➢ LACDMH convened a Children’s Providers Meeting on September 28th to update providers on the transfer of AB 3632 services, TAY services, Juvenile Justice services, and Katie A.

AB 3632 Updates: MOUs, Recommendations for IEP Services, and Medi-Cal Certification for School Districts

➢ District Chief Paul McIver (Countywide Case Management Administration) presented on the transfer of AB 3632 services to schools. Although this process is becoming clearer, McIver said that the FY 2011-2012 will be a transition year.

➢ McIver reported that County Counsel and the Counsel representing LAUSD released a finalized Memorandum of Understanding (MOU) for school districts and agencies on August 19th, which can be used to allow providers to continue their services. The MOU is effective for July 1st, 2011 to December 31st, 2011, after which it will be extended month-to-month through June 30th, 2012, at which time agencies can no longer provide AB 3632 services.

➢ LAUSD announced that the school district will begin doing its own assessments, effective September 1st, 2011. Referrals to agencies may diminish for some time.

➢ With the repeal of AB 3632, the remaining legal codes—the Individuals with Disabilities Education Act (IDEA) and California Education law—for services provided by schools do not require mental health treatment or medication monitoring. The codes only dictate these essential services:

• Counseling and guidance services

• Psychological services

• Parental guidance and training

• Social work services (analogous to case management)

➢ School districts will now have the legal authority to provide official recommendations for IEP services. DMH recommendations will only be considered advisory and school districts may choose to accept or reject recommendations all or in part.

➢ McIver said that there will be a lot of variability in the ways in which school districts create a system for services. Some districts may assume responsibility for all or part of programs, whereas others may contract out services to agencies. Providers may need to prepare for school districts to take a narrow and specific definition of services.

➢ McIver collected questions and concerns from the meeting attendees about the current and future status of AB 3632 services. Providers can continue to email him these questions and concerns at pmciver@dmh.. DMH will publish a frequently asked questions document on the AB 3632 transfer of services after receiving all provider feedback.

➢ During the question and answer portion of the meeting, providers raised concerns about school districts pursuing Medi-Cal certification with DMH in order to deliver full-scope mental health services, including medication support. TJ followed up on the issue by contacting DMH for clarification. Chief Deputy Director Robin Kay stated, in an email response, that no new school districts are pursuing Medi-Cal certification. However, LAUSD and Pasadena Unified School District have existing small Medi-Cal contracts with DMH. McIver also responded in an email to say that LAUSD has indicated that the school district may want to expand its Medi-Cal contracts with DMH, but Pasadena Unified School District has not.

➢ McIver shared in his email that the California Department of Education (CDE) has encouraged school districts to consider all options for services, including becoming contractors of Medi-Cal services, contracting with existing Medi-Cal providers, or accessing an existing Medi-Cal program available to districts, the Local Education Agency Billing Option (LEABO)—a fee for service system, with low rates, that some districts have utilized historically for nursing services, occupational therapy, physical therapy, speech and language services, etc. McIver also said that school districts are most likely requesting information and training on Medi-Cal provider requirements via CDE, CMHDA, and the State Health and Welfare agency in order to make an informed decision about Medi-Cal services, rather than to necessarily become Medi-Cal providers.

➢ Finally, McIver stated that school districts are generally avoidant of any “medically necessary” services, including the medication support component, and are more focused on those which are “educationally necessary” as defined within the federal IDEA statute and regulations and California Education law.

TAY Updates: Permanent Housing, TAY FSP, and Flex Funds

➢ District Chief Terri Boykins (TAY MHSA) updated providers on Permanent Housing Programs for the TAY population. Housing was a large focus after the Mental Health Services Act (MHSA) Community Services and Supports (CSS) programs were implemented. In the summer of 2009, Daniel’s Village, a TAY housing program in Santa Monica with nine units, was developed; all units have continuously been occupied.

➢ Boykins reported that a new 20-unit development is being constructed in SPA 4 for TAY clients who are MHSA eligible, specifically CSS eligible. Boykins provided the MHSA Housing Certification Application to providers for the development. After submitting the application, DMH will certify the client and then send the application to the property management company. Boykins encouraged providers to include this application in client packets for their TAY population so that there are enough applicants to fill each unit in the development.

➢ To be eligible to apply for housing in this development, clients must be 18 to 25 years old and ready for permanent (not transitional) housing. Clients are allowed to live in these units until after they are 25 years old, if necessary; there will also be assistance to transition to adult housing facilities, if preferred. Clients can elect to receive supportive services on site or continue to receive services at the location of their service provider.

➢ DMH is working on creating more permanent housing developments for TAY clients throughout the county. Clients do not need to be receiving services in the SPA where the unit is located, as there is currently not housing units in every SPA.

➢ Boykins said that she and Deputy Director Sandra Thomas (TAY Systems of Care) will host a meeting for TAY FSP providers on October 18th in the Second Floor Conference Room of the DMH Commonwealth Office. Meeting topics will include FSP utilization, enrollment, authorization capacity, and program barriers.

➢ Thomas reported on flex fund shifting issues faced by TAY providers. Thomas said that there is currently an underutilization of TAY Flex Funds with providers using less than 50%. Despite this underutilization, providers have reported that they need more service dollars. Thomas and Boykins will present a plan for allocating up to 50% of unused Flex Funds to be used for service dollars at the October 18th TAY FSP meeting. In some cases, the lead District Chief and Boykins will need to meet with an agency to negotiate the use of those funds.

Juvenile Justice and Aftercare Program

➢ Thomas and Boykins also presented on updates to the Juvenile Justice and Aftercare Program, which resulted from ad hoc meetings for special populations during the PEI stakeholder process.

➢ The State Department of Mental Health allocated $2 million for the population of at-risk youth in the juvenile justice system; this is a small amount of money for the number of youth who are involved in this system.

➢ The $2 million will be leveraged to address the mental health needs of youth through an effective Aftercare Program with a direct service staff. The Aftercare Program will work to ensure continuity of care for youth discharged from residential programs. The Program will provide a multidisciplinary meeting with family members, the field Probation Office, and a mental health specialist in a structured setting, thirty days prior to the date of discharge of the youth. Outcome data will be collected from the program.

Katie A. Updates: Settlement and Cease of Wraparound Services for AB 3632

➢ DMH District Chief Greg Lecklitner (Child Welfare Division) presented on the recent proposed settlement in the State Katie A. lawsuit. The settlement, based on the assumption that EPSDT is an entitlement, puts forth two primary services models that will be funded through EPSDT: 1) Wraparound and 2) Treatment Foster Care.

➢ The settlement identified two focus service categories: 1) Intensive Home Based Services and 2) Intensive Case Coordination. DMH is working with Case Management Services (CMS) to develop a training manual for what types of clients are eligible for these services.

➢ The next step of the settlement is a month-long implementation planning process, indicating that significant movement is taking place in the lawsuit.

➢ The Shared Core Practice Model—similar to the Systems of Care Model—will act as an overarching framework for the services provided through the settlement. DCFS will hold many trainings on this model for providers.

➢ DMH is currently halfway through the baseline cycle of the Quality Service Review (QSR) for measurement of fidelity of services to the Core Practice Model. This graph indicates the results for QSR acceptable child and family status and QSR acceptable systems performance by Service Area. The results indicate that systems improvement is needed in the areas of engagement, teaming, strength and needs based understanding, and long-term view. Lecklitner provided a QSR Roll Out Schedule for the remaining Service Areas.

➢ DMH Program Head Angela Shields (Child Welfare Division) reported to providers that, effective immediately, no new AB 3632 clients will be admitted to Wraparound regardless of their Medi-Cal status due to the repeal of AB 3632. Current enrollees will continue to receive Wraparound services through June 30th, 2012. Shields later confirmed this information in an email. Providers can contact Angela Shields or Shirley Robertson with any questions.

➢ Lecklitner then discussed the Treatment Foster Care (TFC) Program for Katie A. clients. TFC is an alternative to group home care. There was a court order for the County to provide 300 slots. TFC utilizes the Multi-Dimensional Treatment Foster Care (MTFC) and the Intensive Treatment Foster Care (ITFC) models. There are currently 12 providers delivering TFC; agencies can call DMH or DCFS to identify which providers are in their Service Area. There are only 60 children currently enrolled in TFC.

➢ Lecklitner reported that Multidisciplinary Assessment Teams (MAT) DMH providers underutilized funds for the FY 2010-2011, whereas DCFS providers claimed 91% of their MAT allocation.

➢ Lecklitner also shared information on the Home Based Mental Health Services category of the settlement. These services will address the needs of children and their families through flexible intensity and a team model. Children and their families will be provided with clinical and rehabilitative services that promote safety, permanency, and stability.

➢ Finally, Lecklitner discussed the Urgent Mental Health Needs protocol now in effect. Specialized Foster Care (SFC) staff will determine urgent needs based on screening and review. If referred to a provider, SFC staff will notify the provider of the urgent status of a case. The provider must make reasonable efforts to open an urgent case within 3 business days of referral. Provider must complete the DMH Treatment Update for DCFS Children in Urgent Need of Mental Health Services form (MH 698) within one week and provide the original to DCFS Central Administration via fax using a HIPAA compliant process.

FSP Child Client Satisfaction Survey

➢ Dina Dutton and Kanchi Tate also reported on the results of the 2010-2011 DMH FSP Client Satisfaction Survey. The survey was completed by 180 families in 8 different languages. Families appeared to be highly satisfied with the services they received through their child’s FSP; a 2 to 3% increase in satisfaction was calculated in each area in comparison to the previous year’s survey results.

USC’s Southern California Clinical and Translational Science Institute (SC CTSI)

➢ Holly Kiger, a Research Navigator from the USC SC CTSI’s Office of Community Engagement, presented on her office’s efforts to create meaningful research projects and connect University researchers to providers in the community. Kiger provided a sample monthly newsletter from her office, which will be posted on the DMH website in the future.

➢ Kiger will be invited to present at future ACHSA committee meetings.

➢ The next DMH Children’s Providers meeting, scheduled for November 23rd, has been canceled due to the Thanksgiving holiday.

Please contact TJ or Kathrine with any questions.

• AB 12 Steering Committee Has High Hopes That It’s “Steering” in the Right Direction

➢ On October 6th, the Los Angeles County AB 12 Steering Committee convened its monthly meeting to discuss the status of AB 12 and how DCFS and Probation plan to move ahead with AB 12 implementation. DCFS Division Chief of Youth Development Services Harvey Kawasaki led the meeting along with Angie Schwartz of the Alliance for Children’s Rights.

The “State” of AB 12 at the State Level

➢ Many concerns and questions remain unanswered, despite the fact that implementation of AB 12 is less than three months away. The deadline to release the All County Letters (ACL) that serve to instruct counties on the implementation of AB 12 as it relates to eligibility requirements for the program, rate settings, and the movement of funds between THP-Plus and THP-Plus Foster Care have been delayed. Harvey informed the Committee that the Eligibility and Rates ACL is in the final stages of review. [Subsequent to the meeting, the Program Information ACL was released on October 13th].

➢ Committee members expressed concerns regarding the delay of the ACLs, noting specifically that delayed ACLs may also mean delayed implementation of THP-Plus Foster Care. Angie assured the Committee that the Alliance is currently advocating that the ACLs are released as soon as possible. Harvey asserted that a significant issue concerning THP-Plus Foster Care is a matter of being able to integrate the requirements governing THP-Plus Foster Care into current THP contracts. Pending the regulations outlined within the THP-Plus and THP-Plus Foster Care ACL, it is possible that the language found in the current THP contracts may postpone implementation of THP-Plus Foster Care in Los Angeles County until as late as 2014. Harvey noted that he has engaged in discussions with other counties regarding their approach to THP-Plus Foster Care but did not provide further detail as to what had been discussed.

➢ Harvey reported that some THP-Plus providers have expressed an unwillingness to participate in providing THP-Plus Foster Care due to the uncertainty surrounding fiscal support for AB-12.

➢ Harvey acknowledged that being a Title IV-E Waiver County adds to the complexity of the issue. Conversations concerning the County’s ability to draw funds outside of Title IV-E savings to pay for AB 12 implementation are ongoing, but it remains unclear, at this point, whether Los Angeles County will have the flexibility to do so.

➢ Members of the Committee asserted that THP-Plus providers may not be as resistant towards AB 12 if they were allowed the flexibility to move between THP-Plus and THP-Plus Foster Care. Harvey reasserted that until the ACL that governs the approval standards for THP-Plus Foster Care is disseminated, he cannot determine the extent to which THP-Plus providers can be flexible in that regard.

➢ Harvey commented that an AB 12 training plan is currently being developed at the state level. A meeting has been scheduled for October 13th, at which the training plan will be disseminated to all stakeholders.

➢ The Alliance, Angie reported, will co-host two AB 12 Summits in November to review implementation steps with community providers

Workgroup Discusses DCFS’ Plan to Implement AB 12

➢ Harvey shared DCFS’s draft implementation plan for AB 12 with the Steering Committee. He announced that the same plan had recently been shared with the Board Deputies during the September 28th Children and Families’ Well-Being Cluster meeting.

➢ Harvey highlighted several significant elements of the proposed plan. One of the first key elements concerns the case management of AB 12 youth. DCFS plans to establish permanency units in each Regional Office that will oversee a specialized AB 12 caseload. The main purpose of the permanency units will be to ensure that sibling contact and relationships are maintained for all youth eligible for and participating in AB 12. Harvey reported that until the permanency units and AB 12 specific caseloads are established, AB 12 youth will remain under the supervision of their current Children’s Social Worker (CSW).

➢ A second key element of the proposed plan is the charge for ILP Transition Coordinators (ILP TCs) to serve as technical consultants on all matters related to the implementation of AB 12. ILP TCs will be on hand for the first wave of AB 12 eligible youth to assist and train CSWs and SCSWs on ILP services. Harvey explained that in order to decrease the workload of ILP TCs, CSWs and SCSWs will assume responsibility for informing youth of ILP services following the first wave of AB 12 youth. ILP TCs, he commented, will then shift their focus to aftercare services.

➢ Members of the Committee expressed discontent with the proposed recommendation, noting that ILP TCs are better equipped to handle transitional services than average CSWs. Removing ILP TCs from that role, they argued, may negatively impact the success of youth currently preparing to transition from care.

➢ Harvey assured the Committee that ILP TCs will continue to assist and provide CSWs and SCSWs with best practice techniques as they prepare to work with young adults. Angie noted that a component of the curriculum currently under development by the State focuses specifically on the issue of working with young adults.

➢ The last significant element of the proposed plan is the designation of an AB 12 liaison for each DCFS Regional Office who will be: 1) responsible for AB 12 implementation within the region; and 2) representing the office at the countywide AB 12 Internal Committee monthly meetings. The Internal Committee is scheduled to begin convening in October; a meeting date has not been announced. Each AB 12 liaison, Harvey noted, will have the authority to make decisions or inform the Internal Committee of systemic issues concerning AB 12 implementation.

➢ Harvey noted that one significant issue requiring further discussion as the Committee moves forward concerns the fiscal impact that AB 12 is expected to pose to Los Angeles County. It was reported that the Los Angeles County’s contribution to fund AB 12 will not surpass the amount of savings realized through the KinGAP conversion and that the State will assume any costs that surpass those savings. Harvey reported that an AB 12 cost analysis was shared with the Board Deputies during the September 28th Cluster meeting. DCFS is currently revising the cost analysis, at the request of the Board Deputies who raised a number of concerns with the projection of savings. While the Committee reviewed the document, Harvey emphasized that the numbers are based on assumptions and may change pending the number of KinGAP cases for which DCFS is able to receive federal dollars.

Workgroup Discusses Probation’s Plan to Implement AB 12

➢ Jed Minoff of Probation provided a brief report on Probation’s plans to handle implementation of AB 12. Jed informed the Committee that Probation anticipates serving two populations of Probation youth – “450” Probation youth and “602” Probation youth.

➢ Probation will establish a specialized AB 12 DPO workgroup to supervise “450” Probation youth who choose to remain under court jurisdiction after their probation has been terminated. 602 Probation youth, those who are 18 years of age but remain on probation, will continue to be supervised by RBS DPOs.

➢ It is still unclear whether dual jurisdiction youth who are AB 12 eligible will be supervised by DCFS or Probation. The Steering Committee resolved to look into how WIC 241.1 protocol applies to this population.

➢ Jed reported that Probation is currently challenged with finding alternative residential placements for youth who choose to remain under court jurisdiction. Probation has assessed the possibility of foster care placements, but acknowledges the difficulty with finding prospective foster families willing to care for high risk youth. Jed reported that Probation is currently exploring additional placement options, including shelter homes and/or non-relative caregiver homes.

➢ Probation aims to solidify its implementation plan prior to the next Probation Provider meeting on October 28th.

The next Steering Committee meeting is scheduled for November 17th.

Please contact Marlena or Jodi with any questions.

• Probation MDT Subcommittee Takes Action: Revising the MDT Action Plan and MDT Model

➢ Probation Title IV-E Management Director Jennifer Kaufman and Probation Residential Based Services (RBS) Director Frank Imperial convened the second Multi Disciplinary Team (MDT) Process and Policy Subcommittee meeting on October 7th at Optimist Youth Home and Family Services. At this meeting, the subcommittee continued reviewing the MDT Action Plan (renamed the “Initial Case Conference”) and MDT Model.

Initial Case Conference (formerly MDT Action Plan)

➢ At the last subcommittee meeting on September 23rd, Jennifer and Frank had asked the subcommittee to review the Initial Case Conference along with the Needs and Services Plan and Foster Care Case Plan to identify areas of duplicative work for Probation and providers. The subcommittee determined that the best resolution to prevent repetitive work would be to remove the “objectives” sections from the Initial Case Conference. It was agreed that removing the objectives sections would preserve the goal of holding a mandatory case planning conference while removing duplicative paperwork burdens for Probation and group homes.

➢ The subcommittee expressed concern over the 14-day time frame of the Initial Case Conference, but ultimately concluded that this short timeline would be critical to best serve the youth. Frank noted his commitment to reiterate the importance of the 14-day time frame with regional RBS DPOs.

➢ The subcommittee discussed whether the youth’s family should receive a copy of the Initial Case Conference given the sensitivity of the issues discussed at this meeting. The subcommittee determined that the family should get a copy because the MDT should not shy away from addressing important issues with family members. Because a key purpose of the MDT process is to facilitate and support family reunification, it was agreed that families need to know why they are participating in the MDT process and how they can resolve family issues.

➢ Philip Solomon from Pacific Lodge agreed to send the subcommittee revised strength-based language for the “Individual/Mental Health/Substance Abuse Issues” and “Family Issues” sections in order to focus on the family’s needs rather than the family’s past issues.

MDT Model

➢ The MDT Model, which is an overview of the MDT process, outlines when meetings should take place beginning at day 1 through day 180 of placement, and identifies the roles of all of the MDT members.

➢ The subcommittee agreed to create cover sheets to accompany the MDT model. The cover sheets would clarify the required and optional participants for each meeting and the documents that each participant would be responsible to bring to each meeting.

➢ For youth with known medical issues, the subcommittee thought it appropriate to include a medical professional at the initial case conference and the discharge planning meeting. This person could assist with coordinating the medical treatment of the youth while in placement and the continued medical services after transition.

➢ Phase 1, called “Initial Case Conference”, comprises day 1 through 14 of placement in which the Initial Case Conference will take place.

➢ At the meeting, the language in Phase 1 stated that the group home would “assure that parents have transportation” to the MDT meetings. Jodi suggested the subcommittee change the language to reflect that coordinating transportation would be a joint responsibility of the group home and DPO. In response, Frank noted that the current group home contract includes language which requires group homes to provide transportation to parents. Jodi noted that she would review the group home contract to clarify this issue and forward proposed language to Probation in regards to coordinating transportation for parents.

➢ Jodi also requested integration of language into the model which clarified that DPOs would assist and support group homes should group homes encounter challenges in contacting and engaging parents. Probation agreed with this request and asked Jodi to forward language reflecting this point.

➢ It was agreed that parents would be allowed to participate over the telephone, although this would be a less than ideal level of participation by the parent. If parent is unreachable or unavailable to attend the meeting at all, it was agreed that the MDT should hold the MDT meeting without the parent. To this end, the subcommittee agreed on the importance of flexibility in the MDT meeting location to accommodate the parent, whenever appropriate and possible.

➢ The subcommittee refined the timeline to ensure the appropriate steps occurred during the proper phases of the MDT process. The group agreed that Phase 2 – “Mid-Term Review” – should occur from day 14 through day 120 of placement and Phase 3 – “Transition” – should occur from day 120 through day 180 of placement. It was further agreed that the final 30 days of Phase 3 (days 150-180) would be separately designated as Phase 4 or “Discharge Planning.”

Next Steps

➢ The subcommittee plans to share the draft revised MDT documents with the MDT Steering Committee at the next MDT Steering Committee meeting on October 14th.

Please contact Jodi with any questions.

• Wraparound Audit Workgroup Wraps Up on Duplication and Coordination Issues

➢ On September 29th, ACHSA convened a workgroup meeting with representatives from DMH, DCFS, and Wraparound providers to discuss issues faced in Wraparound audit processes.

Background

➢ In November 2010, ACHSA hosted a meeting with representatives from DMH, DCFS, and providers to review barriers to Wraparound expansion, which was covered in the December 15th, 2010 ACHSA Bulletin.

➢ During a follow-up meeting on May 31st, 2011, DMH Program Head Angela Shields (Child Welfare Division) agreed to convene a workgroup to develop recommendations to coordinate Wraparound audit/review efforts between DCFS, DMH, and the Auditor-Controller in order to avoid unnecessary duplication and ensure maximum collaboration. A detailed summary of the May 31st meeting can be found in the June 15th, 2011 ACHSA Bulletin.

➢ The article below includes the discussion and action items agreed upon at the September 29th workgroup meeting.

Overview of Current Wraparound Audit Processes

➢ The workgroup first discussed the various audit processes that agencies go through with different county departments, including DMH Wraparound Quality Assurance, DMH Service Area Contract Monitoring, DCFS, and the Auditor-Controller.

➢ Shields explained that the DCFS and DMH processes are meant to be more of program reviews, rather than audits. Providers shared that the impact level of these processes are about the same as an audit because of the length of time and work required.

➢ Workgroup members discussed the effectiveness of the Residential Based Services (RBS) audit process, renamed as a “Shared Learning Experience.” DMH, DCFS, and provider representatives agreed that this was a positive process because it took less staff time, was more conversational, and created a collaborative partnership between the Departments and providers focused on improving services. Shields said that the Departments would like to translate the RBS Shared Learning Experience model to the Wraparound audit process as much as possible.

➢ Wraparound providers said that although the Wraparound audit process has become increasingly collaborative, issues remain, particularly due to the sequential nature of the various program evaluations.

➢ Providers also discussed that the Auditor-Controller Wraparound audit process presents particular challenges, as it focuses on contract compliance more so than the other processes. One provider also said that it seems as though his agency has undergone an Auditor-Controller Wraparound Audit every year since 2007. DMH Wraparound Program Administration Supervisor Shirley Robertson (Children’s Systems of Care) said that these audits should be taking place on a three-year cycle so this is an issue to check in on.

Discussion of Audit Issues Identified by Wraparound Providers

➢ Duplication – Wraparound providers identified duplication as a key issue that occurs as a result of the various Wraparound audit processes.

• For example, providers said that the Auditor-Controller and DCFS both look at Human Resources information (TB tests, staff licenses, criminal clearance, files, etc.) during their Wraparound audits.

• Agency representatives also discussed the duplication that takes place during the accreditation process conducted by the Council on Accreditation (COA), which nearly combines all of the audit processes from each Department.

➢ Coordination Across Departments – A lack of coordination between the Departments leads to many of the issues faced by Wraparound providers during audits, including duplication.

• One provider recommended that the Departments coordinate with COA to consider an agency’s accreditation as a part of the Wraparound audit process. If coordination is not possible between the Departments and the COA, then the Departments should at least take into account the time and efforts spent by agencies during the COA accreditation process. TJ raised the point that coordination already takes place for hospitals, so it would make sense for the County to extend this policy to Behavioral Health, especially as a part of future integrated health services.

• The workgroup discussed coordination with DMH District Chiefs to ensure that the contract monitoring process is uniform across the different Service Planning Areas (SPAs).

Discussion of Possible Resolutions of Identified Audit Issues

➢ Coordination with the Auditor-Controller

• DMH and DCFS will work to coordinate with the Auditor-Controller to avoid duplication in audit processes, particularly in the review of HR personnel information, including TB tests and staff clearances. The Departments will work to have the Auditor-Controller share their audit information so that it does not have to also be pulled during Wraparound reviews.

• DMH is currently setting up a calendar for audit schedules for the FY 2011-2012, which will aim to improve coordination with the Auditor-Controller. The Auditor-Controller would be able to view and add to the calendar and even coordinate visits to agencies with DMH. The audit schedule calendar will enable the Departments to advise agencies of audits with significant notice and will help prevent sequential audits.

➢ Communication/Coordination with District Chiefs

• DMH will use the audit calendar to coordinate reasonable audit schedules with District Chiefs.

• DMH will also look at creating a tool with the Quality Assurance Division to make the contract monitoring process more uniform across different SPAs.

➢ Review of Redundancies Among Audit Processes

• Robertson and Shields are currently reviewing the four Wraparound audit tools to see where redundancies occur.

• In addition to the duplication of review of personnel files, DMH and DCFS will also look at redundancies that occur with EPSDT audits and the possible coordination of assessments between audits. Robertson said that it may not be possible to change assessments to all be the same, as a variety of samples provides a more thorough and valid view of programs.

• Robertson said that DMH has a meeting scheduled for October 6th at which they hope to present and discuss their recommendations.

➢ Coordination with COA

• As coordination with COA may be a lengthier process, DMH and DCFS will set a longer-term goal of giving agencies credit for accreditation during the course of their audits.

Next Steps

➢ ACHSA will check in with Shields during the first part of November to discuss progress made on these resolutions and to highlight any other areas of Wraparound audit processes needing improvement that may be raised.

Please contact TJ or Kathrine with any questions.

• Mental Health Odds & Ends

Netsmart Technologies, Inc. to be DMH IBHIS Vendor

In the October 11th Board of Supervisors Meeting Agenda, it was announced that Netsmart Technologies, Inc. will serve as the vendor for the DMH Integrated Behavioral Health Information System (IBHIS). The Board will vote on the approval of Mental Health Services Act (MHSA) funding for the IBHIS agreement with Netsmart at the October 11th meeting. Please see item #25 on page 21 of the agenda for more information.

The Guidance Center’s 10th Annual Skip Hinchman Memorial Symposium

The Guidance Center presents its 10th annual symposium – Help for the Helper: Self Care for Clinicians – for clinicians throughout Los Angeles and Orange Counties. This year’s symposium will take place from 10:00 a.m. to 3:30 p.m. on November 10th at the California Endowment and will focus on the tremendous hard work of therapists in the mental health community. Breakout sessions will feature experts in countertransference and boundary issues in therapy, self-care in field work, and stress reduction techniques. For more information and to register, visit the Guidance Center’s website or click here for the symposium brochure.

California Licensed Professional Clinical Counselor (LPCC) Licenses

Licensed Professional Clinical Counselor (LPCC) licenses are meant to cover the general practice of counseling, which includes psychotherapy. SB 146, recently signed by Governor Brown, adds LPCC to every state code where Licensed Marriage and Family Therapists are already referenced, including California Insurance Codes. The California Board of Behavioral Science (BBS) will begin processing applications for LPCC in January 2012. There are two paths to LPCC licensing: Grandparenting and Traditional. Please see this grid from BBS for details on education, experience, and examinations required for each path. The California Alliance of Child and Family Services has prepared this document for more information on LPCC licenses.

MHSA WET Loan Assumption Program Is Now Open!

The Department of Mental Health is pleased to announce that the application submission cycle for the Mental Health Loan Assumption Program (MHLAP) is now open and will remain so until December 10th, 2011. This program, administered by the Health Professions Education Foundation, affords applicants an opportunity to receive up to $10,000 for repayment of educational loans. Those awarded must enter into a commitment to continue working for one year in a “hard-to-fill/retain” position, as defined by the County of Los Angeles Department of Mental Health. To download an application and obtain additional information regarding the MHLAP program, please visit the MHLAP homepage or click here for the MHLAP Announcement.

• Child Welfare Nuts & Bolts

Latest DCFS Child Welfare Mental Health Services Division Update

The DCFS Child Welfare Mental Health Services Division has provided ACHSA with an update, as of October 5th, of the programs and initiatives that fall within the purview of this Division. Additionally, the Division has shared its October MAT Monthly Report and September Monthly Report to the Board of Supervisors on the DCFS Mental Health Screening Process.

THP-Plus Report Finds Youth Hold Ground in Difficult Economy

On October 10th, the THP-Plus Statewide Implementation Project released the THP-Plus Annual Report for FY 2010-11. This is the fifth year that the report has been developed by the project, which is a partnership between the John Burton Foundation, the California Department of Social Services and the Corporation for Supportive Housing. Data for the report was drawn from a statewide survey of THP-Plus providers conducted by the John Burton Foundation in July 2011 along with youth-level data from the THP-Plus Participant Tracking System.

According to the report, THP-Plus provided affordable housing and supportive services to 2,209 former foster youth over the 12-month period, a slight decrease from the 2,245 youth served in FY 2009-10. The majority of youth served were young women (61%); four out of five youth were between the ages 18 to 21 and 15% were custodial parents. The report also found that despite a difficult economy, youth in THP-Plus made measurable gains in their monthly income between entrance and exit. At entrance, the average monthly wage was $646, increasing to $1,043 at program exit. Additionally, the percentage of youth who reported having no income decreased from 25% at program entrance to 17% at program exit.

Despite this progress, there were a number of areas where youth demonstrated less forward momentum. For example, the rate of enrollment in a two or four year college increased only marginally from entrance to exit, from 29% at entrance to 33% at exit. Additionally, the rate of employment was virtually flat, increasing from 41% at entrance to 44% at exit.

For more information, download the full report at the THP-Plus Statewide Implementation Project website.

AB 212 Sets Re-Entry and Juvenile Probation Provisions for Extended Foster Care

On October 4th, Governor Brown signed Assembly Bill 212. AB 212 provides necessary administrative fixes to provisions originally included in AB 12. Most significantly, it addresses two areas: 1) re-entry into extended foster care; and 2) provisions for youth exiting juvenile probation.

The original mechanism under AB 12 for re-entry involved placing youth between 18 and 21 into a new status called “trial independence” but representatives from the federal Administration for Children and Families reviewed this provision and determined it was not in compliance with federal requirements. Given this, AB 212 redesigned the re-entry provision so that a youth who does not elect to participate in extended foster care is formally discharged from the dependency system. If the former dependent later changes his or her mind and would like to re-enter foster care, AB 212 allows the youth to sign a Voluntary Re-entry Agreement or petition the juvenile court in his or her county of residence.

The second major provision in AB 212 is related to youth in the delinquency system who may be eligible for AB 12 benefits. The original provisions in AB 12 were problematic in part because they required youth to remain in the delinquency system to access extended foster care. AB 212 solves this problem by creating a new jurisdictional status known as “transitional jurisdiction” that allows youth who are exiting the delinquency system and cannot safely return home, and who otherwise meet the requirements of AB 12, to access extended benefits without having to remain on probation. Youth who remain in foster care under the new transition jurisdiction status may be supervised by either the child welfare or probation agency and the dependency or the delinquency court.

AB 212 was designated as an urgency bill which means that it goes into effect immediately. The California Department of Social Services is now tasked with issuing All County Letters detailing the specifics of how these provisions are to be implemented.

With AB 194, Foster Youth Now Eligible for Priority College Enrollment

Assembly Bill 194 was signed by Governor Brown on October 4th. AB 194 creates priority registration for classes for current and former foster youth attending California’s public colleges and universities. Priority enrollment typically means that students are allowed to register early for classes. Currently, students with disabilities and veterans/active-duty military are the only populations granted priority enrollment by law at California’s public colleges and universities. Foster youth will now join this group. Foster youth often experience physical and emotional problems stemming from abuse and neglect that disrupt their learning and severely limit their educational outcomes. Less than 50% of foster youth exit care with a high school diploma; while most foster youth want to attend college, only 1 in 5 make it there; and only a mere 2 to 3% of foster youth graduate with a college degree.

Portrait of Private Agencies in the Child Welfare System: Principal Results from the National Survey of Private Child and Family Serving Agencies

Earlier this year, the National Quality Improvement Center on the Privatization of Child Welfare Services conducted the National Survey of Private Child and Family Serving Agencies in collaboration with the Child Welfare League of America and the Alliance for Children and Families. Principle results of that survey are contained in a recently released report which provides the first national portrait of private agencies serving the child welfare system. This report offers essential information outlining private agency characteristics, funding, service array, inter-organizational relationships, pressures on organizational maintenance, and performance measurement and management. Findings in this report will help to better understand the important contributions of the private sector in child welfare work and guide work to support stronger public/private partnerships. Additional publications based on more detailed analyses of these data will be forthcoming.

Synthesis of Research and Resources to Support at-Risk Youth

The Administration for Children and Families (ACF) recently released a report which provides a synthesis of research and existing ACF resources for serving at-risk youth. The report describes how at-risk youth are currently being served by ACF programs and by programs outside of ACF that have been shown to put youth on a path toward self-sufficiency. Based on the review of research and resources, the report identifies issues to consider in creating conceptual frameworks for developing and enhancing ACF programs that can or do serve at-risk youth.

Parenting Older Adolescents

The National Resource Center for Permanency and Family Connections recently posted an archived webcast which provides links to a PowerPoint presentation on permanency for older adolescents, a bibliography on parenting older adolescents, and a list of other relevant resources.

Join the Conversation

On October 19 at 2 p.m. central time, the Congressional Coalition on Adoption Institute (CCAI) and Fostering Media Connections (FMC) are hosting a webinar focusing on promoting educational success for foster youth. Cheryl Smithgall will share research conducted at Chaplin Hall at the University of Chicago examining how foster youth fare in public schools.

This forum will be webcast live at:

    

|UPCOMING MEETINGS & EVENTS |

|October |

|19 |FFA Strategic Planning/Policy Committee Meeting |ACHSA |10:00 AM to Noon |

|20 |ACHSA Luncheon |Millennium Biltmore Hotel |11:45 AM to 1:45 PM |

|21 |Adult Mental Health Policy Committee Meeting |ACHSA |10:00 AM to Noon |

|26 |DCFS/Family Based Services (FBS) Committee Meeting |ACHSA |10:00 AM to Noon |

|26 |Mental Health Contractual/Administrative (Steering) |ACHSA |1:30 to 3:30 PM |

| |Committee | | |

|November |

|1 |Probation Committee Meeting |ACHSA |10:00 AM to Noon |

|2 |ACHSA Board Meeting |ACHSA |10:00 AM to Noon |

|TBA |Foster Care Performance Measures Task Group Workgroup|TBA |TBA |

| |Meeting | | |

|TBA |Residential Based Services Performance Measures Task |TBA |TBA |

| |Group Meeting | | |

Association of Community Human Service Agencies

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

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

E-mail: mailbox@ / Web: [pic]

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October 15, 2011

Volume 8, Issue 18

ACHSA Mid-Month Bulletin

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