Davidson Conference Center December 1, 2008 9:00-4:00 PM 3415 South Figueroa Los Angeles CA 90089
MEETING PURPOSE To bring together DCFS, DMH, CEO and other partners to… 1. understand the Katie A. Strategic Plan’s components; 2. provide focused feedback on the implementation of three components of the Katie A. Strategic Plan; 3. build greater ownership over the implementation of the Katie A. Strategic Plan.
WELCOME MIGUEL SANTANA, Deputy Chief Executive Officer, Children and Families' Well-Being SHEILA SHIMA, Deputy Chief Executive Officer, Health and Mental Health Services
AGENDA: MORNING I. WELCOME & OVERVIEW 9:00-9:15 II. STRATEGIC PLAN OVERVIEW 9:15-10:30 High-Level Context High-Level Plan Components III. SERVICE ACTIVITIES 10:40-12:00 MH Screening and Assessment MH Service Delivery Data and Tracking of Indicators
AGENDA: AFTERNOON IV. AFTERNOON ACTIVITIES 1:00-1:25 V. IMPLEMENTATION PLANNING 1:35-3:05 Break Out Sessions VI. PRESENTATION AND INTEGRATION 3:20-4:00 VII. ADJOURN 4:00
RECOGNITIONS 9. Specialized Foster Care Managers’ Meeting 10. Interagency Placement Review Meeting 11. Intensive In-Home Mental Health Services Meetings 12. CFT/Finance Workgroup 13. CSAT/Referral Tracking System Workgroup 14. EPSDT Determination Workgroup 15. MAT Coordinators Meeting 16. MAT Steering Committee
AGREEMENTS 1. A learning opportunity among ‘experts’ of different parts of a complex system; this not a training… 2. Some components of the Plan need your feedback—hence this is an invitation to co-craft elements of the Plan that still need work. 3. Play an active role in understanding concepts and giving feedback.
PRESENCE PRINCIPLES 1. Those who show up are the right ones. 2. When it starts is the right time. 3. Whatever happens is the only thing that could’ve. 4. When it’s over, it’s over…
TRISH PLOEHN, MSW, Director, Department of Children and Family Services MARVIN J. SOUTHARD, DSW, Director, Department of Mental Health BRANDON NICHOLS, Senior Deputy County Counsel, Social Services Division
BACKGROUND: 2002 CLASS ACTION LAWSUIT FILED AGAINST THE STATE AND LOS ANGELES COUNTY ALLEGING: 1. Failure to assess mental health needs. 2. Inadequate mental health services. 3. Placement disruptions. 4. Over-reliance on congregate care. 5. Institutionalization—MacLaren Children’s Center.
BACKGROUND: JULY 2003 Los Angeles County entered into a Settlement Agreement resolving the County-portion of the lawsuit. The Settlement Agreement required the County to make systemic improvements to better serve members of the class.
KATIE A. CLASS MEMBERS 1. Are in the custody of the Los Angeles County DCFS in foster care or who are at imminent risk of foster care placement by DCFS; 2. Are eligible for services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program;
KATIE A. CLASS MEMBERS 3. Have a mental illness or condition that is documented or, had an assessment been completed, could have been documented; and 4. Need individualized mental health services to treat or ameliorate their illness or condition.
SETTLEMENT OBJECTIVES 1. Promptly receive necessary individualized mental health services in their own home, a family setting, or the most homelike setting appropriate to their needs; 2. Receive care and services needed to prevent removal from their families or dependency or, when removal cannot be avoided, to facilitate reunification, and to meet their needs for safety, permanence, and stability;
SETTLEMENT OBJECTIVES 3. Be afforded stability in their placements, whenever possible; and 4. Receive care and services consistent with good child welfare and mental health practice and the requirements of law.
HISTORY: THREE PLANS 1. ENHANCED SPECIALIZED FOSTER CARE (SFC) MENTAL HEALTH SERVICES PLAN  Pilots in three Service Planning Areas 2. CORRECTIVE ACTION PLAN (CAP)  Modifications required by the Court 3. KATIE A. STRATEGIC PLAN  Comprehensive five-year plan
Legal Background and Context !The “Bottom Line” ! !Why Moving Forward and Making Progress is Critical! & !Why Partnership and Engagement (DMH, DCFS, CEO, Community Partners, Providers, Stakeholders etc. is KEY!
What are the Components of the Plan: Questions, Questions and more Questions… KATIE A. STRATEGIC PLAN: CONTENT A (Brief) Panel Discussion
Katie A. Strategic Plan: High Level Overview Does any-ONE have a question they’d like to ask?
E X I T (Beginning With End In Mind) 1 Successful completion of meaningful Strategic Plan. 2 Acceptable progress on indicators. 3 Passing score on a Qualitative Service Review.
QUALITATIVE SERVICE REVIEW CHILD STATUS INDICATORS 1. Safety 2. Stability 3. Physical & Emotional Well- Being 4. Learning & Development 5. Prospects for Permanence SYSTEM PERFORMANCE INDICATORS 1. Child & Family Engagement 2. Team Coordination 3. Planning & Assessment 4. Implementation 5. Tracking & Adjustment 6. Cultural Accommodations
Katie A. Strategic Plan: High Level Overview Continued Does anyone else have a question they’d like TWO ask?
FUNDING OF SERVICES $ TITLE IV-E Funds EPSDT Dollars COUNTY General Funds MHSA Funds
Katie A. Strategic Plan: High Level Overview Continued THIRD time is a charm….Who else has a question they’d like to ask?
Katie A. Strategic Plan: High Level Overview Continued Does anyone else have a question FOUR leadership?
TRAINING A. CORE PRACTICE MODEL KEY OUTCOMES Safety, Permanence; Child Well Being FIVE TENETS 1. Engaging Families 2. Teams around Families 3. Teams Gather Info & Develop Assessments 4. Teams Create Individualized Plans 5. Tracking & Adapting Plans Based on Results B. COACHING & MENTORING CORE CONSTRUCTS 1. Engagement & Team Preparation 2. Plan Development 3. Implementation 4. Transition. C. TRAINING SUPPORT & RESOURCES FOCUS 1. Supports Key Strategic Plan Elements (CSAT/CFT). 2. Joint Overview and Orientation Training. 3. Support CSAT and Related Processes and Protocols 4. Training and Coaching CFT Implementation.
Katie A. Strategic Plan: High Level Overview Continued Does anyone else have a question for leadership? # 5
ACTIVITIES DATA & TRACKING OF INDICATORS MENTAL HEALTH SCREENING & ASSESSMENT MENTAL HEALTH SERVICE DELIVERY
DATA AND TRACKING OF INDICATORS (Insuring We Know What’s Happening) and REFERRAL TRACKING SYSTEM (The System that will be in place to do this) 1. TIMELINESS OF MENTAL HEALTH SCREENING 2. ASSESSMENT 3. REFERRAL TO SERVICE 4. PROVISION OF SERVICES 5. DURATION OF SERVICES 6. OUTCOMES TIED TO SERVICES
THREE TRACKS TO SCREENING KATIE A. CLASS MEMBERS 3. ALL EXISTING-OPEN CASES MH SCREENING BY CSW, WITH EXCEPTIONS 1. ALL NEWLY DETAINED CHILDREN MAT ASSESSMENT WITHIN 45 DAYS 2. ALL NEWLY OPENED NON-DETAINED CASES MH SCREENING BY CSW
C S A T: PURPOSE 1. To coordinate DCFS and DMH non-line staff to rapidly receive screenings and/or referrals to ensure service linkage. 2. To integrate ‘siloed’ services and programs into CSAT through clear policies and procedures for all operational responsibilities. 3. To use a data tracking system to regularly monitor progress on indicators (i.e., timely delivery of screening, assessment, referral linkage, full utilization of resources, etc.).
C S A T: PARTNERS DCFS, DMH, DPH AND DPSS STAFF… 1. CSW 2. Service Linkage Specialist 3. DMH Co-Located Specialized Foster Care Staff 4. MAT Staff 5. Team Decision Making Staff 6. Resource Utilization Management/Resource Utilization Liaisons 7. Youth Development Specialists 8. Permanency Partners Program (P3) Staff 9. Adoption Safe Families Act Staff 10. Linkages Co-Located Staff 11. Educational Liaisons 12. D-Rate Coordinators 13. PHN
MENTAL HEALTH SERVICE DELIVERY CHILD AND FAMILY TEAMS (CFTs) INTENSIVE IN- HOME MENTAL HEALTH SERVICES EXPANSION OF WRAPAROUND SERVICES
Katie A. Strategic Plan: High Level Overview Continued We have time for one LAST question. ? # 6
KATIE A. STRATEGIC PLAN High Level Summary MENTAL HEALTH SCREENING & ASSESSMENT MENTAL HEALTH SERVICE DELIVERY DATA AND TRACKING OF INDICATORS ACTIVITIES FUNDING OF SERVICES TRAINING CASELOAD REDUCTION SUPPORTS EXIT CRITERIA AND FORMAL MONITORING PLAN EXIT
REFLECTIONS STRUCTURE Select a facilitator (who keeps group focused and makes sure everyone gets a chance to speak). Select a recorder of key points. QUESTIONS 1. What did you like about what you heard? 2. What questions do you have?
Screening, Assessment and Service Delivery: “As the Caseload Churns” (An Activity) Objectives: Better understand key decision points (mental health screening/assessment and service delivery components looking at 3 “points of entry/service”) Connect these with existing resources Identify key places where input is needed Engagement, feedback and clarification Some Guidelines Basic case information only Track thoughts, questions and ideas for processing later Keep child, family member and CSW role at the forefront Engagement, Teaming, Tracking, Improving….
Activity: “The Flow” Prologue: “Decisions/Decisions/Decisions” Key Concepts: Mental Health Screening Tool (MHST), Referral Tracking System, Coordinated Services Action Team (CSAT), 3 Families Family # 1 Jackson-Washington Family (Detention Required) Family # 2 Jefferson Family (Case Opening/No Detention) Family # 3 Evans Family (Triggering Event and/or Case Plan Update Due) Act I Scene 1:Background/ Initial Assessment: Safety/Risk Assessment Act I: Scene 2: Team Decision Making and Mental Health Screening Act I: Scene 3: Mental Health Assessment Act I: Scene 4:Mental Health Services Linkage Act II: Mental Health Service Delivery/Tracking of Indicators ( A “Walk- Through”) Epilogue: Reinforcing Key Points, Table Discussion and Report Out
Decisions, Decisions, Decisions! Handout At Your Tables Review 3 Referrals (A) Initial Referral ------to-------(B)-Successful Case Closure Question One: Pick one of these scenarios and list 7-10 major decision/intervention points that will have to be made during the time from referral to case closure. Question Two: Pick one decision/intervention point on your list. Brainstorm below your ideas on the tools, resources and supports that a CSW currently has available to help them make this decision.
Scenario # 1 Today’s date: _____________: CPHL Call: “Hello, I’d like to make a referral regarding Joe Jackson and La Trecee Washington. They are currently running around the neighborhood completely unsupervised since early this morning. Both children have serious behavior problems. Parents are into drugs and are nowhere to be found.” Date: (12 months from today): _________________ Judge: “Joe Jackson and La Trecee Washington are discharged as dependents of the court and the petition is dismissed.”
Scenario # 2 Today’s date: _____________ CPHL call from Law Enforcement: “Hello, I’d like to request that a Social Worker to respond to the Pacific Shores Motel. We have two children Brianna and Maria Jefferson (ages 15, and 7) in custody. We may have to arrest their mother for child endangerment and resisting arrest.” Date: (6 months from today) _________________ CSW: “Mrs. Jefferson, you’ve done very well. I’m pleased to see all of these support systems in place and your case is officially closed.”
Scenario # 3 Today’s date: ____ CPHL (Level 12 Group Home) “This follows up on previous referrals/phone calls on Marco Evans. He continues to physically assault both staff and residents when he gets angry and upset and broke a window during his last outburst. Due to his large stature, (5’11’ and 290 lbs), GH staff are unable to protect themselves and the other residents. We are requesting his immediate removal. He has two siblings (Samuel and Josephine) who are also in foster care and their court hearing is coming up” Date: (12 months from today):__________________ Judge: “Marcos, Samuel and Josephine Evans are discharged as dependents of the court and the petition is dismissed.”
Decisions/Interventions – Resources and Supports Decision Intervention Point ? Tools Resources and Supports ?
Decision Points-Tools/Resources (Some Examples) IN PERSON RESPONSE? ALLEGATION SUBSTANTIATED? SAFETY DECISION? ASSESSMENT OF FUTURE RISK (CASE OPENING OR REFERRAL)? COURT DECISION? ASSESSMENT/CASE PLAN: WHAT SERVICES ARE REQUIRED? DISPOSITION OF CASE? (RE)PLACEMENT DECISION? RE-ASSESSMENT/PLAN MODIFICATION? PERMANENT PLAN, CASE CLOSURE? Other KNOWLEDGE, VALUES, SKILLS SUPERVISORS, COLLEAGUES (Internal/External) SERVICE PROVIDERS, CARE-PROVIDERS, CONSULTANTS LAWS TEAMING STRUCTURES AND STRATEGIES POLICY GUIDELINES DECISION MAKING AND ASSESSMENT TOOLS CASE PLAN AGREEMENTS RESEARCH Other
TOOLS RESOURCES AND SUPPORTS: MENTAL HEALTH NEEDS MENTAL HEALTH SERVICES AND THE MEANS TO TRACK PROGRESS ?
MH SCREENING & ASSESSMENT Key Concepts: (A Reminder) Mental Health Screening Tool (MHST), Referral Tracking System, Coordinated Services Action Team (CSAT) 3 Families Family # 1 Jackson-Washington Family (Detention Required) Family # 2 Jefferson Family (Case Opening/No Detention) Family # 3 Evans Family (Triggering Event and/or Case Plan Update Due)
Family # 1: Washington-Jackson Case Detention Imminent/Required: All Other Controlling Interventions Exhausted) Father: Dale Jackson (25) Mother: Rhonda Washington (25) Child: Joe(Jackson (6), Child: La Trecee Washington (6) CSW: Narration
Family # 1: Washington-Jackson Case Key Steps/Key Points Act I Scene 1:Background/ Initial Assessment (SDM, Other) Act I: Scene 2: Team Decision Making and Mental Health Screening Key Points: TDM, HUB and MAT Referral, Consent/Eligibility, Referral Tracking System, CSAT Accessed Act I: Scene 3: Mental Health Assessment Key Points: MHST Completed (HUB), MAT Assessment/Summary of Findings, CSAT Accessed Act I: Scene 4:Mental Health Services Linkage Key Points: MAT Support for CSW and Service Linkage, CSAT Engaged
Family # 2 The Jefferson Case (Non-Detained: Controlling Interventions Implemented ) Mother: Dorothy Jefferson Father: Ralph Jefferson (whereabouts unknown) Child: Briana Jefferson (15) Child: Mariah Jefferson (7) CSW Narration
Family # 2 : The Jefferson Case Key Steps/Key Points Act I Scene 1:Background/ Initial Assessment (SDM, Other) Act I: Scene 2: Team Decision Making and Mental Health Screening Key Points: TDM, MHST Completed, Service Linkage Specialist and CSAT Engaged, Consent/Eligibility, Referral Tracking System, Act I: Scene 3: Mental Health Assessment Key Points: Co-Located Staff Engaged, Assessment, CSAT Engaged, Act I: Scene 4:Mental Health Services Linkage Key Points: Co Located Staff, Service Linkage Specialist and (appropriate) CSAT Support Provided
Family # 3 The Evans Family (Triggering Event and/or Case Plan Update Due) Mother: Theresa Evans Father: Sam Dearden - Deceased Child: Marcos Evans – (13) Child: Samuel Evans – (9) Child: Josephine Evans – (17) CSW Narration
Family # 3 : The Evans Case Key Steps/Key Points Act I Scene 1:Background/ Initial Assessment (SDM, Other) Act I: Scene 2: Team Decision Making and Mental Health Screening Key Points: TDM/RMP Process Utilized, Service Linkage Specialist, CSAT Engaged, MHST Completed (if not receiving MH services), Consent/Eligibility, Referral Tracking System Act I: Scene 3: Mental Health Assessment Key Points: Co-Located Staff, CSAT Engaged Act I: Scene 4:Mental Health Services Linkage Key Points: Service Linkage Specialist, CSAT and Co Located Staff Engaged
The “Pause Button” Debriefing the Role Players Thoughts, Reactions AND APPLAUSE!
Epilogue: A Table Activity Matching Points of Entry --- Key Process Steps Step One: Match the Point of Entry With Corresponding Process Steps Step Two: Match Terms With Definitions
DCFS STUDY Those who graduated from the Wraparound Program were 36 times less likely to have another placement episode than those leaving RCL 12+ facilities that did not receive Wrap services, despite having roughly comparable placement rates before and during their respective treatments.
CHILD & FAMILY TEAM 1. Engagement of child, family, formal and informal support systems. 2. Identifies needs and strengths. 3. Develops plan for child and family. 4. Supports plan implementation. 5. Modifies plan, as needed. 6. Transitions to informal supports (i.e., family, church, etc.).
INTENSIVE IN-HOME MENTAL HEALTH SERVICES -Guided by CFT -Services based on needs and strengths. -Evidence-based and best practice. -Mental health and rehabilitation services. -Whatever it takes approach. -Home/field-based services. -24/7 availability. -Flexible funding.
LESSONS LEARNED CO-LOCATION INTEGRATION REFERRAL POPULATION NAVIGATIONLINKAGE COMMUNICATION MAT PLATFORM
SPA-LEVEL APPROACH ART LIERAS: Co-Location ROBERTA MEDINA: Integration and Referral Population ANA SUAREZ: Navigation and Linkage JACQUELYN WILCOXEN: Communication and MAT Platform
CO-LOCATION REFERS MAINLY TO KEY ‘PHYSICAL’ ASPECTS OF COLLABORATION… 1. Spaces are visible and accessible, versus tucked in the corner; and physical configuration of units; 2. Sensitive about displacing others while moving in co-located staff; 3. Infrastructure: mail, telephone, computers, etc.; 4. Locks on cabinets and chart storage; 5. Physical presence of staff (duty schedules).
INTEGRATION DIFFERENT PROGRAMS AND SERVICES SUPPORT A COMMON VISION, MISSION, AND VALUES… 1. Staff commit to shared mission, goals, and practice (‘ALL of us help kids walking through the door…’); 2. Align programs with different funding requirements; 3. Clear roles and authority lines; 4. Conditions: need enough time to work out the above areas incrementally; on an informal basis; and top- down and bottom-up processes.
REFERRAL POPULATION CLEAR CRITERIA AND PROCESSES REGARDING TARGET POPULATION… 1. Eligibility criteria: e.g., children in foster care, detained, open case, placed in/out of SPA, etc.; 2. Policies and procedures from beginning to end; 3. Providers implement shared policies and procedures; 4. Address common ‘structural’ issues, i.e., EPSDT, consent, medical necessity, Court v. Voluntary...
NAVIGATION OBTAIN KEY INFORMATION AND MAP RESOURCES FOR CHILDREN AND FAMILIES. 1. Gather key documents, such as Medi-Cal, consent, program eligibility, etc.; 2. Utilize co-located staff; 3. DMH: Foster Care Navigators; Service Area Navigators.
LINKAGE ENSURING APPROPRIATE AND TIMELY SERVICE CONNECTION… 1. Make referral and verify that linkage occurred; 2. Maintain documentation of what happened after linkage; 3. Address overlaps in service; 4. Feedback loop to CSW; 5. Address challenges: initial assessment versus ongoing treatment; following up to linkage beyond initial referrals.
COMMUNICATION CREATE EFFECTIVE STRUCTURE OF COMMUNICATION AND DECISION-MAKING… 1. Central administration and regional administration; 2. Lateral communication/across Departments (i.e., Probation; DMH; DCFS; etc.); 3. Vertical communication within Departments; 4. Communication across SPAs; 5. A structure for decision making, not just communication.
MAT PLATFORM 1. Key component of MH Screening & Assessment; 2. Currently implemented in SPAs 3 and 6; and in all other SPAs by end of fiscal year; 3. Can be a point of focus for DMH, DCFS, and DHS staff to build and expand partnerships to ensure screening and assessment and service linkage for newly detained children; 4. Can help prepare non-pilot offices for easier roll-out of CSAT and other Strategic Plan components.