2 Introduction Presented By: Together Georgia (GAHSC) Department of Human Services (DHS)- Residential Child Care (RCC)- Office of Provider Management (OPM)Department of Juvenile Justice (DJJ)2
3 Who Should Attend Applicants for the Licensing of: Child Caring Institution – (Group Homes)Outdoor Child Caring ProgramsChild Placing Agency (Foster Care, Adoptions)Children Transition Care Centers (CTCC)3
4 Who Should NOT Attend Day Care Center Operators Foster Parent wantabe’sAdult Personal Care Home ApplicantsPsychiatric Hospital Applicants4
5 Steps to Provision of Services Presentation Organization 1. Organizational Capacity and Needs Assessments2. Licensure3. Contracting with the State4. Referrals and Payments5
6 www.gahsc.org ♦ email@example.com ♦ 404.572.6170 Organizational Capacity and Assessment of Needs♦ ♦6
7 Perspective: How Children/Youth Come into Care State PlacementAbuseNeglect / DeprivationTermination of Parental Right (TPR)DelinquencyPrivate Placement7
8 Perspective: Characteristics of Children in Care DFCS Room Board and Watchful OversightBase / Traditional careBase with Additional Watchful OversightBase with Maximum Watchful OversightSpecialty Base Watchful OversightSpecialty Maximum Watchful OversightSpecialty Medically Fragile Watchful Oversighthttps://www.gascore.com/content/page.cfm/12/out_of_home_care8
9 Perspective: Georgia’s Priorities Family StabilizationLeast RestrictiveCommunity Based ServicesAppropriate Length of Stays for out of home careReunification whenever possible – safety of the childPermanency – minimize trauma9
10 Perspective: Georgia’s Preferred Out-of-Home Placement Hierarchy In-Home with Bio FamilyRelative Kinship CareFoster CareGroup Homes10
11 Perspective: Federal Review Oversight Child and Family Services Review (CFSR)PermanencySafetyWell-being11
12 Research Service Needs Licensure does not ensure a contract or placement of childrenhttps://www.gascore.com/content/sitemap.cfm12
13 Matching Needs with Services Child Placing Agency– An agency that recruits, supports and places children in foster homesChild Caring Institution – Group home or other congregate care environment where facilities are built for the placement and care of children13
14 Matching Needs with Services Child Placing – An agency that recruits, supports and places children in foster homesFirst placement priority for state.75% of all foster children go into this placement.Per Diem determined by level (basic to therapeutic) Generally lowest paid per day per child rates.14
15 Matching Needs with Services Child Caring Institution – Group home or other congregate care environment where facilities are built for the placement and care of children.This is last placement choice for children with basic needs.Only 14% of all foster children are placed in these facilities.15
16 Matching Needs with Services Outdoor Child Caring Programs – Programs using a wilderness model for care and treatment of children.These are wilderness programs for children.Most are considered treatment facilities.Few of these facilities are being used for placement.Requires over 500 acres in land.State very reluctant to contract with new providers.16
17 Matching Needs with Services What License should I pursue? Child Placing Agency (CPA) (Foster Care)Private Family centered Child CareFew Capital CostsHigher Reimbursement to Cost ratioHigher Percentage of children entering careRequired to be “not-for-profit”Child Caring Institution (CCI)(Group Homes)Campus focused Child CareHigh Capital CostsLower Reimbursement to Cost ratioLower percentage of children entering careNo requirement for “not-for-profit.”17
18 Develop the “BUSINESS PLAN” The Plan versus Good Intentions-Board Facilities-Budgets Legal Issues-Constituency -Policies & ProceduresIs there a need for the service you are wanting to provide in the geographical area you are wanting to operate?18
19 Board Development (Not-for-Profit Only) Should you be a Not-for-Profit (501 c 3)?For-ProfitPersonal profit and benefitPersonal managementOwnership of assetsRisk of own resourcesNot-for-ProfitCommunity ownership and controlCommunity support though contributionsRisk of community resources19
20 Board Development (Those who are accountable for the organization) Truism - An organization is as strong as its Board.Choose people who can provide expertise in a variety of areas (finance, marketing, social services).Go beyond friends and family(choose people who will provide open and honest feedback)Valued stakeholder in community20
21 Not-for-profit Organization (Nearly all are 501(c)(3) Internal Revenue Service (IRS) Regulations for securing tax deductible contributionsTakes at least 1 year to secureA knowledgeable person can do it without lawyer21
22 Executive Director (One who manages the organization) Choose person of experience, integrity, responsibility and historyBalance of vision-focus and businessRemember he/she will represent your organizationThey will be held accountable to carry out your policies and procedures22
23 Staff & Personnel (Your most valuable asset/liability) Truism - Your program is as good as your weakest link.A thorough background check is essential.“Would you let these folks care for your child?”23
24 Budgets and Budgeting Budget Development ExpensesStaff--Base PayBenefitsInsurance--Property, Casualty, & LiabilityFoodClothingTransportationOtherIncomeState FeesContributions-nonprofit onlyCharity giftsGrantsEndowments24
25 Budgets and Budgeting Medical Care Covered by Medicaid – Nearly all children in residential care qualify for Medicaid.25
26 Budgeting/Rate Setting Placement providers are paid a per diem for Room and Board and Watchful Oversight (RBWO)CCIs - Group HomesBase $104.87AWO $132.85MWO $187.30Maternity home $104.87*Second Chance $104.87Teen Development $ *plus $62.97 for the infant, total of $167.6926
27 Budgeting/Rate Setting Placement providers are paid a per diem for Room and Board and Watchful Oversight (RBWO)CPAs – Child Placing Agencies (Fixed Payment to Agency – excludes payment to foster parent)Traditional $22.08Base WO $29.89Max WO $41.27SBWO $46.35SMWO $71.07SMFWO $83.4327
28 Budgeting/Rate Setting Placement providers are paid a per diem for Room and Board and Watchful Oversight (RBWO)CPAs – Child Placing Agencies (Payment to Foster Parent based on age of child)0-5 years of age $15.046-12 years of age $17.0013+ years of age $19.3628
29 Budgeting/Rate Setting Truism – Quality care resulting in good outcomes will be your best option for successSecuring adequate funding remains one of the top priorities for any administrator.Without money, services can not happen.The State is usually your #1 customer/payerIn Georgia there are only a handful of For-Profit agencies29
30 Fundraising Grants for Startup Very few Often only to Existing Groups Need 501(c)(3) status – Not-for-ProfitAnticipate 18 months for start up supportBuild constituency30
31 Policies & Procedures (Provides the why and how of the organization) Develop P&P around licensing and contract rules and regulations.Consult someone who has successfully done residential child care.They should make sense to all who must operationalize them.Train on them.Follow your P&P in all ways at all times.Keep them current.31
32 Your Facilities (CCI) Fire Inspection - # 1 Problem Area Most Expensive to CorrectState Regulations,County Interpretationsand Enforcement32
33 Your Facilities (CCI) Community Support - # 2 Problem Area Build Support CarefullyIf negative, hard to overcomeUse community leaders to leadTruism- Work hard to overcome “not in my backyard” mindset33
34 Your Facilities (CCI) Zoning – The “Tip Off” to the Community -- Required before Licensing -- Zone for “a licensed childcare institution for six or more unrelated children” -- Key Stakeholder of community can help with this34
35 Reporting Requirements Child Abuse Reporting RequirementsStuff will happen - Self-reportThe law requires you to report abuse and neglectAlways report, even if not certain of issue.Preserve your relationship with State by dealing with integrity35
36 Additional Consideration to Delivery of Services Performance Based PlacementDeliverables and OutcomesData Management, Documentation and ReportingCompetitionExperienceAccreditation36
37 Working with the State Oversight Residential Child Care (licensing) Office of Provider Management (DFCS contract)PEASKenny A (Fulton and DeKalb Counties)37
38 Working with the StateSome Steer The State is our partner in caring for children. Their role is regulatory and contractual. Respect it.Others Row Our role is providing services to children. Together we work to provide the best care for children.38
40 Steps to Provision of Services: Step Two - Licensure40
41 New Provider Orientation Presenter: Rhonda James, DHS—Office of the Inspector General, Residential Child Care UnitPresentation to: GAHSC New Provider OrientationDate: Quarterly (2nd Tuesday of the Month)Georgia Department of Human Services
42 Vision, Mission and Core Values Stronger Families for a Stronger Georgia.MissionStrengthen Georgia by providing Individuals and Families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults.Core ValuesProvide access to resources that offer support and empower Georgians and their families.Deliver services professionally and treat all clients with dignity and respect. Manage business operations effectively and efficiently by aligning resources across the agency.Promote accountability, transparency and quality in all services we deliver and programs we administer.Develop our employees at all levels of the agency.
43 DHS Office of Residential Child Care Services LICENSE CATEGORIESCCI--Child Care Institution also known as a group home.CPA--Child Placing Agency…foster care services and adoption (both domestic and international)…Home study OnlyCTCC--Children Transition Care Center—medically fragile children.OCCP--Outdoor Child Caring Program—Wilderness Camp…requires 10acres of land per child.Maternity Homes/Second Chance Homes—home for pregnant mothers and mothers and babies.Runaway and Homeless Youth Programs(RHYP)—a registered program.DETERMINE WHICH TYPE OF PROGRAM YOU WANT TO BE.
44 Applying for Licensure All CCI’s, CTCC’S. OCCP’S & MATH, RHYP—must obtain local zoning and fire approval before submitting an application.Download the application https://dhs.georgia.gov/forms-and-applicationsFamiliarize yourself with ORS rules and regulations and develop a working knowledge of the meaning and intent of the rules.Develop policies and procedures to address each rule.Prepare your agency for compliance with the rules and regulations.
45 STAFF QUALIFICATIONS FOR CCI Director—master’s 2-years of related experience or Bachelor’s degree and 4-years of related experience.Human Services Professional—provides the case management…bachelor’s degree approved field and 2-years of experience or a master’s degree in approved field of study.Child Care Worker—must be at least 21 years of age and have a HS Diploma or a GED.
46 PHYSICAL PLANT FOR CCIWater/Sewage…If the home operates on a septic tank must submit Environmental Health Inspection or copy of city water bill.Bedrooms--63 sq.ft. per resident for double occupancy and 75 sq.ft. for single occupancy.Must document space capacity to serve at least six residents not to exceed 16.Must document a food service permit if providing care for thirteen(13) or more residents.
47 PHYSICAL PLANT FOR CCI (cont.) Bathrooms--one sink/toilet per 8 residents and 1 shower per 10 residents.There must be a separate bathroom for staff.A staff member may not enter into a resident bedroom to access the bathroomAn initial on-site inspection is completed and observed for SAFETY FIRST—INSIDE AND OUTSIDE.
48 STAFF QUALIFICATIONS FOR A CPA Director--must have a bachelor’s degree and 2-years of related experience unless they are providing the clinical case supervision.Case Worker Supervisor (Social Service) Master’s Degree and 2-years of related experience in a CPA.Case Worker—Bachelor’s degreeThere are no physical plant requirements for a CPA.
49 STAFF QUALIFICATIONS FOR CTCC Director--Master’s degree or higher in nursing; social work or other health related fields and two years of experience working with medically fragile children.A licensed registered nurse, physician, other licensed health care professional with at least five years of experience working with medically fragile children.
50 Staff Qualifications for CTCC cont. Human Services Professional—bachelor’s degree in social work with two years experience or a master’s degree.There shall be sufficient staff members on duty at all times to assure each child proper care according to his/her needs. When children are present at the center, there shall be at least one awake RN on duty.
51 Physical Plant for CCTC Water/Sewage…If home operates on a septic tank must submit Environmental Health Inspection or copy of city water bill.Bedrooms--63 sq.ft. per resident for double occupancy and 75 sq.ft. for single occupancy.Bathrooms--one sink/toilet per 6 residents.One shower per 6 residents.Separate bathroom for staff.
52 Physical Plant for CCTC (cont.) Staff may not enter into a resident bedroom to access the bathroom.All centers serving residents dependent on a wheelchair or other device for mobility shall have:--At least two exits, remote from each other, accessibleto child with easily negotiable ramps.--All doorways and halls shall accommodatewheelchairs.--At least one bathroom of sufficient size toaccommodate a wheelchair and assisting staff.
53 Maternity Home (Basic and Second Chance Services) Maternity home--is an agency providing care within any six-month period, to more than one (1) pregnant woman, either before, during or within two (2) weeks after childbirth. Providing care to pregnant youths through 21 years of age. Services are limited to eight weeks of services…unless providing Second Chance Home Services.Second chance home--means a licensed maternity home that provides full-time residential care, support and supervision to pregnant and parenting youth through 21 years of age and their child(ren) that is expected to last for more than an eight (8) week period following delivery. Program services include parenting skills, such as child development, education, job training, transitioning to independent living, family budgeting, health and nutrition, and other skills to promote residents’ long-term independence and the well-being of their child(ren).
54 Maternity Home (Basic and Second Chance Services) The director must possess a Masters or RN Degree and two years of related experience or a Bachelor’s Degree and four years of related experience.The Human Services Professional (HSP) Must possess a Master’s Degree in social work, psychology, childhood education, education counseling and psychology, nursing or healthcare, or a related field or a bachelor's degree and either have two (2) years experience in a field related to the type of residents served or be supervised by another human service professional with a master's degree in one(1) of the above disciplines.There shall be at least one HSP for every 16 residents in care including the infants.
55 Maternity Home (Physical Plant) The sleeping room shall not be less than 75 square feet per resident in single rooms, and not less than 63 square feet per resident in multiple roomsThere shall be at least one (1) lavatory with hot and cold water, one (1) toilet and a bathtub and/or shower for every four residents.A nursery is not required by these rules, however, maternity homes that include nurseries must meet the following additional requirements:The nursery shall be large enough to allow a minimum of 30 square feet of floor space and 300 cubic feet of air space per infant.There shall be separate toilet and bath facilities for the residents and staff.
56 Runaway and Homeless Youth Programs Effective July 1, 2011, RCC is also authorized by law to register Runaway and Homeless Youth Programs (RHYP)(O.C.G.A. § et. seq.)Runaway and Homeless Youth Programs (RHYP) - currently licensed child welfare agencies or 501(c)(3) organizations that serve children under 18 years old who have run away and/or are homeless.
57 Runaway and Homeless Youth Programs The agency must submit a description of the range of services provided, the manner in which those services are provided to youth and a statement that the Services that are provided to youth, are limited to 72 hours.The agency must submit operational policies and procedures.Must have at least one staff member who is licensed.There is an annual registration fee of $25.
58 Criminal Records Check Law The director and owner of each license type must both document a satisfactory criminal records check (fingerprints—live scan)All other employees must be in compliance with the law.If any employee’s check reveals any crime, person cannot be hired until resolved and cleared through the Office of Inspector General’s.Any person acting in the absence of the director must meet the qualifications of the director and document a satisfactory CRC.
59 Waivers & VariancesThe department at its discretion may grant a waiver or variance of specific rules upon application being filed.A variance may be granted upon the applicant showing that a particular rule or regulation would cause an undue hardship.A waiver may dispense entirely with the enforcement of a rule or regulation upon showing that the purpose of the rule or regulation is met through equivalent standards.
60 Licensure ProcessSelf Assess for rule compliance and completed application materials.Submit application with all necessary local approvals if required. (zoning, fire inspection, CO, etc.)Initial on-site Inspection scheduled—an office conference for a CPA. If approved, a Temporary License is issued for 12 months.Annual re-licensing inspectionsFollow-up InspectionsComplaints/ Self-reported incidents
61 LICENSURE Obtaining a license through the Office of Residential Child Care does NOT guarantee acontract with other state agencies or departmentsto serve children and adolescents.
63 Steps to Provision of Services: Step Three - Contractual Process for Providers63
64 New Provider Orientation Presenter: DFCS, Office of Provider ManagementPresentation to: GAHSC New Provider OrientationDate: October 8, 2013Georgia Department of Human Services
65 Vision, Mission and Core Values Stronger Families for a Stronger Georgia.MissionStrengthen Georgia by providing Individuals and Families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults.Core ValuesProvide access to resources that offer support and empower Georgians and their families.Deliver services professionally and treat all clients with dignity and respect. Manage business operations effectively and efficiently by aligning resources across the agency.Promote accountability, transparency and quality in all services we deliver and programs we administer.Develop our employees at all levels of the agency.
66 Becoming a New RBWO Provider The RBWO Provider process is handled through the Department of Families and Children Services (DFCS) Office of Provider Management (OPM)The process applies to agencies seeking to obtain a RBWO Provider contract as a Child Placing Agency (CPA) or Child Caring Institution (CCI)Agencies seeking a RBWO Provider contract with DFCS must have an applicable CCI or CPA license from the Residential Child Care
67 New RBWO Contract Deadlines and Effective Dates As of April 2013, the start of FY2013, The Office of Provider Management established new contract deadlines and effective dates.There are two (2) contract lifecycles within a fiscal year:July 1stOctober 1stProvider Deadline to Submit Application and supporting documentsOPM Review and Approval DeadlineContract Effective DateNovember 30thJanuary 31stJuly 1stFebruary 28thApril 30thOctober 1st
72 Provider Information Sheet Interested providers should review the applicable New Provider Information Sheet.New CCI Provider Information SheetNew CPA Provider Information Sheet
73 3 Ring Binder RBWO Application RCC License Agency’s Policies & ProceduresAgency’s Training PlanOrganizational ChartBudgetW-9Evidence of Criminal Records CheckVendor Form (along with voided check)Insurance ($1 million per occurrence/$3 million aggregate policy limits)*ExceptionMalpractice/Professional LiabilityCommercial General LiabilityCommercial Umbrella PolicyWorkers Compensation Insurance (if plans are to employ 3 or more employees)Business Auto Policy (*$1million per occurrence/$1 million aggregate policy limits)
74 Available Resources RBWO Provider Service Needs List FY2014 RBWO Minimum Standards for CPAs and CCIsDHS Map of Counties by RegionRBWO Contract Deadlines and Effective Dates MemoPrevious Trainings and Upcoming Trainings
75 Contact InformationAfter reviewing the Becoming a New ProviderInformation online,interested providers with questionsshould contact:The Office of Provider Managementvia
77 Department of Juvenile Justice Division of Community ServicesServes to Protect the Citizens of Georgia by Providing Prevention Services, Court Services and Supervision, Treatment and Rehabilitation of Youthful Offenders.77
78 DEPARTMENT OF JUVENILE JUSTICE Avery D. Niles, Commissioner78
79 MISSION:Our Mission is to protect and serve the citizens of Georgia by holding young offenders accountable for their actions through the delivery of services and sanctions in appropriate settings and by supporting youth in their communities to become productive and law-abiding citizens.VISION:OFFER HOPE AND YOUTH CHANGE. DJJ will lead the nation in preparing young people in its care to develop and sustain productive lives.
80 Division of Community Services 4 DJJ Regions – NW, NE, SW, SERegional Placement Specialists: Direct Oversight of all Contracted Residential Providers licensed as Child Caring Institutions & Child Placing AgenciesNW – Margaret Cawood SW – Archie HermanNE – Victor Roberts SE – Jeffery Alligood
81 Characteristics of Children in DJJ’s Care Average Age - 13 (range is from 10-22)Mostly MalesMost Common Offenses - Property & StatusOppositional - Lack Impulse ControlCommon Mental Health Diagnoses - Conduct Disorder, Depression, PTSDSubstance Abuse Issues81
82 Services to Children in DJJ’s Care During FY 2010 – 44,502 and FY ,226 youth were served by the Department of Juvenile Justice.82
84 Services PurchasedAgency determines what services to sell (or give away) to the private individual or corporation(usually another state.)The nature of these services is determined on the ability to provide those services within the Licensing framework and approved levels of care.84
85 Characteristics of Children in Private Placement Determined by agency’s mission and ability to care for the child.And Agency’s ability to serve85
86 Approval Process of Vendors and Marketing Client Application Process-- Licensing allows an agency to provide out-of-home services. Within the rules of Licensing, each agency develops their own application process.Contract Approval Process -- There is no approval process save Licensure.86
87 Private Placements Referrals and Payments Referrals - Referrals are made by private individuals or agencies or another state. This referral network is determined by the agency.Payments - Payments are negotiated with each referring party.87
88 Referrals and Payments Private Placements usually include:a charity basisanother StateInsuranceprivate pay88
89 In Conclusion: Steps to Provision of Services 1. Organizational Capacity and Needs Assessments 2. Licensure3. State Approval Process for Vendors4. Marketing to Referral Sources,DFCS, DJJ, Private Sector89
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