Presentation on theme: "Understanding Katie A and the Core Practice Model"— Presentation transcript:
1Understanding Katie A and the Core Practice Model IntroductionsIn this webinar you will receive an overview of the Katie A lawsuit and the settlement which resulted in the development of the Core Practice ModelJennifer Cannell, MSWRegional Training Manager1
2Learning ObjectivesDescribe the main components of the Katie A lawsuitLearn the shared purpose of CWS and BHSIdentify children who are part of the class and sub-classDescribe the main components of the Katie A lawsuit including precipitating events, time frames and the settlement agreementThey each have a shared vision to strive to improve the lives of children and families.Sub classIdentify the core values and principles of the Core Practice Model to be implemented across Child Welfare Services (CWS) and Behavioral Health Services (BHS)Identify the core values and principles of the Core Practice Model
3Purpose and Goals of CWS Keep children safe and preserve familiesEnsure children have well-being needs metHelp children who cannot remain with their families to have a permanent loving familyMake accurate decisionsEnsure children have well-being needs met including educational, medical, dental, emotional and psychological needsMake accurate decisions: the decision that CW staff make lead to the safety of kids and strongly impact the outcome goals of safety, permanency and well-being
4Purpose and Goals of BHS Support recovery, resilience and well-beingProvide integrated servicesEducate the communityPromote the safety of children an youth in the communitySupport recovery, resilience and well-being through prevention, treatment and early intervention of mental health and substance abuse.Provide integrated services for people with mental conditions or co-occuring mental health and alcohol and drug issues.Educate the community on mental health needs and to address the stigma and misconceptions related to mental health
5BACKGROUNDClass Action Lawsuit filed 2002 against CA Social Services and Health Departments as well as Los Angeles CountySettled statewide Dec. 2011ISSUES:Failure to assess mental health needsInadequate mental health servicesPoor foster care placements-overuse of congregate and shelter careLawsuit filed by a class of advocates on behalf of the young adults ho had aged out of foster care in LA county.There were 5 other children named in original lawsuit. Seeking improved access to mental health services and Therapeutic Foster Care for children in or at risk of placement in foster care group homes.LA county settled right away and has been adapting services to serve these children.Plaintiffs alleged that had mental heath conditions been identified, assessed and adequately treated, the need for restrictive placement settings would have been ameliorated.5
6WHO IS KATIE A? 2002-14 year old Caucasian female Placed in foster care at age 4Mental health assessment at age 537 different placementsShe was a 14 year old girl at the time the lawsuit was filedShe was placed into foster care at age 4We know mom at times was homeless and dad incarcerated.When she was 5 years old her caregiver asked for help to address her needs and early assessments indicated that Katie had been exposed to trauma and needed specialized services to address emotional and behavioral needs.She moved through 37 different placements in the 10 years she spent in foster care including four group homes, 19 stays in psychiatric facilities and 7 stays in shelter care. She did not receive trauma treatment or individualized mental health servicesOne of the key worries highlighted by Katie A’s story and by the lawsuit is the fact that children in need of behavioral health treatment often move to higher levels of care including group homes or institution such as a psychiatric facilities if they do not receive the services to help address the underlying issues to reduce their symptoms.The lawsuit highlighted negative consequences of using these types of care as placements instead of as interventions to help children return to a family setting.
7KEY THEMESShared needs of children and families-shared practice and responsibilityCoordinatedComprehensiveCommunity basedThe Katie A settlement agreement is between county child welfare services and county behavioral health services.It is essential these services work together to meet the needs of children in care.Use of teams is an important value in this model when assessing, planning, tracking, adapting and supporting care.Acknowledge the complexity of needs that requires increased intensity, supports and scope of services.Trauma needs to be recognized and treatment provided.While there have been a number of efforts made and there are some services to support families who touch both of these systems, there is an opportunity for increasing communication and coordination of services across CW and BH.Ask for examples of what is already working in countiesFTMSOPThis is an opportunity to increase communication and collaboration. To deepen, enhance and improve.7
8The SettlementDecember 2011: Settlement Agreement was reached and the state was asked to take specific action.The court retains jurisdiction of the case until December 2014.Counties are expected to and will continue efforts over the next several years to improve collaboration and services on behalf of foster youth.8
9Class and SubclassClass members include: children with an open CW case who are at risk of placement in foster care.Subclass: children with an open CWS case who are full scope Medi-Cal eligible and meet the medical necessity criteria for specialty mental health servicesThe settlement agreement identified the class and subclass of children to be servedClass members include: children with an open CW case (both court ordered and voluntary) who are at risk of placement in foster care.Subclass: children with an open CWS case who are full scope Medi-Cal eligible and meet the medical necessity criteria for specialty mental health servicesThe class will be served with the CPM approach, CPM activities and mental health services, as needed. The subclass will be served with the CPM approach, CPM activities, Intensive Care Coordination, and Mental Health services which may include Intensive Home Based Services.Currently, implementation is only focusing on the subclass: youth with intensive mental health needs9
10IMPLEMENTATION Http://www.dhcs.ca.gov/Pages/KatieAImplementation.aspx Every county was asked to complete a readiness self assessment and a service delivery plan and submit them to the stateThe Core Practice Model guide articulates a family-centered approach that is intended to improve coordination and collaboration among behavioral health, child welfare and the children, youth and families involved with the child welfare system who have behavioral health needs.The guide includes key practice components for engagement, assessment, service planning and implementation, monitoring and adapting and transition.To provide practical guidance and direction for county CW and MH agencies, other service providers, and community/tribal partners who will be implementing the CPM when working with children and families involved with child welfare who have or may have mental health needs.The CPM guide is the first step in articulating the values, core components, standards of practice and activities for a cross-system Practice Model in CA.This guide identifies specific required components that support the standards and expectations for practice behaviors by child welfare and mental health staff.It is intended to facilitate a common strategic and practical framework that integrates service planning, delivery, coordination and management among all those involved in working with children involved in multiple service systems.All counties, agencies and individuals that serve children and their families in both child welfare and mental health will use this practice model.The CPM is about working together to improve outcomes for child welfare youth and families, a value that CA has articulated in both CW and MH initiatives over the last several decades.The purpose of the Medi-Cal Manual is to provide mental health plans and medi-cal providers it information concerning the provisions of three covered specialty mental health services for those children/youth who are members of a class of children covered by the settlement agreement.This manual is only applicable to for Intensive Care Coordination (ICC), Intensive Home Based Services IHBA), Therapeutic Foster Care TFC) and Child and Family Teams (CTM).10
11Learning Collaboratives Implementation ofLearning CollaborativesLearning Collaboratives are intended to be a series of regionally-based learning sessions for county-level implementation teams coordinated by a Statewide Leadership Team comprised of MH and CW from each participating county.Identified BAA cohort counties: CCC, SF, SC and SolanoThe Learning Collaborative proposal recommends that each cohort county select a small number of individuals to participate in a Statewide Leadership Team that will guide statewide implementation and a larger number of people to serve on local Implementation Teams to guide county-level implementation.The Statewide Leadership Team will articulate state-level priorities for the Learning Collaborative, identify common barriers to implementation, and specify training and implementation tools to assist with statewide implementation, among other duties.County-level Implementation Teams will plan, direct, and monitor implementation efforts in their respective counties, in some cases drawing upon workgroups previously developed by local agency leaders and community partners.
12Core Practice Model Values and Principles Children are protected from abuse and neglectServices are needs driven and strength based AND are individualize for each child/familyServices are delivered through a multi-agency approachYouth/family voice and choice are present throughout the processServices are a blend of formal and informal resourcesServices are culturally respectful of child and familyServices are provided in family’s communityChildren have permanency and stability12
14Elements of the Core Practice Model Teaming with FamiliesComponents and ActivitiesServicesTeaming with families: the CPM is grounded in the value of team partnerships with families utilizing Trauma Informed PracticeThe CPM is comprised of 5 primary components and activities:EngagementAssessmentService Planning and ImplementationMonitoring and AdaptingTransitionsServices: it also included specific services that may be used to support children in care who are a part of the sub class including intensive care coordination, Intensive Home Based Services and Therapeutic Foster Care.14
15TEAMING Protects against individual bias impacting decision Promotes decision and plans that rely on the voice of the child and familyIncreases family participation in developing plansResults in better informed decisions and plansValues children and families as partners.Teaming has a historically been a practice in SW, CW and MH. The CPM seeks to support SW and MH staff in increasing and enhancing he way they team15
16The Child and Family Team Creates a vision with the family and works toward developing or achieving that visionCFT meeting is one of the several ways that will exist for CFT members to communicateTeam begins with child, youth, family and extended family and extends to informal and formal supportsTeaming has a historically been a practice in SW, CW and MH. The CPM seeks to support SW and MH staff in increasing and enhancing the way they teamInformal supports include: friends, coaches, neighbors, faith based connectionsFormal supports: educators, MH, CW, Probation, service providers, community based orgs.The CFT are the people on the team and the SFT meeting is the vehicle that the CFT used to communicate an coordinate their work.The CFT will work together at meetings to identify strengths, needs, and develop action plans for the child.The CFT will work together in mtgs to id, recognize an draw on the natural resources and support from the family’s culture by developing mtg strategies and plans in the context of the family culture.Trauma informed practice slide.16
17Start with the End in Mind This didn’t happen overnightIt took practice and patienceLots of learning along the way
185 Key Components Engagement Assessment Service Planning and ImplementationMonitoring and AdaptingTransition18
19ENGAGEMENTIs the process of using a family-centered and strength-based approach to partnering with families in making decisions, setting goals, and achieving desired outcomes.Is rooted in respect for the child youth and family, as well as their culture, family dynamics, and individual experiences.Family engagement is a family-centered and strengths-based approach to partnering with families in making decisions, setting goals and achieving desired outcomes.Engaging Families is the foundation of building trusting and mutually beneficial relationshipsAt every point in a child and family’s involvement with CW and MH successfully engaging everyone involved is a key ingredient for promoting positive outcomesIt is important to recognize how challenging engagement process can be, particularly among minority cultures and families dealing with serious mental illness and/or SA.The historical impact of racism and historical trauma within groups such as African Americans and American Indians is still deeply feltAt every point in a child and family’s involvement with CW and MH – whether it is the initial contact; the initial assessment process, service planning, monitoring or transition – successfully engaging everyone involved is a key ingredient for promoting positive outcomes
20ASSESSMENTIn the CPM, the term “assessment” includes both assessment done by child welfare and the more formal mental health assessment done by a mental health professionala continuous processIn the CPM the term ASSESSMENT includes both the assessment activities that are done by CH, which include screening for MH needs, and the more formal MH assessment that is done by a MH professionalShould be comprehensive enough to obtain information about the relevant events and behaviors that brought the children and families into servicesThe process from screening to assessment for MH needs to actually getting services when needed will vary from county to county. Counties should make this process as efficient, integrated and seamless as possible, minimizing the time it takes and number of individuals a family has to meet.
21SERVICE PLANNING & IMPLEMENTATION Create and tailor plansBuild on the strengths and protective capacitiesFlexible and Responsive to meet issues and needsServices rely on the child and family voice and the consensus of the CFT to guide the planning and implementation – with the overarching goal of child and family safety, well-being and stable living within the community.Creating and tailoring plans to build on the strengths and protective capacities of the family members, in order to meet the individual needs for each child and family.Strength-based individualized plans specify the goals, objectives, roles, strategies, resources and timeframes for coordinated implementation of supports and services for the child, family and caregiversThe plan should build on the protective capacities of the family, are culturally responsive and are flexible and respond to the changing needs of the child and family.With a focus on the child’s safety and well being.Services should be coordinated across providers and agencies, be complimentary, consistent and coordinated. Via both formal and informal support and provided in the least restrictive setting.
22MONITORING & ADAPTING Continuous monitoring and evaluation the plan Plans should clearly reflect current family needs and circumstancesMonitoring and adapting are part of the practice of continually monitoring and evaluation the effectiveness of the plan while assessing current circumstances and resources.Plans are monitored by the CFTProgress shall be documentedPlans are adapted based on the changing needs of the child/familyAchievement should be celebrated by the CFT.CW will have to overcome the obstacle presented by case plans being incorporated into court orders, making it more difficult to revise the plans as circumstances change.
23TRANSITIONS Moving from formal supports to informal supports Planning and preparationWhen the child, parent and other members of the CFT agree that the goals have been reached and the child will be safe and stable in his or her family and community, the formal system is no longer needed.Transitions of moving from formal to informal support and services requires specific preparation and planning to support the child and family.When planning for transition, keep in mind that children and families may not exit both systems at the same time. Careful and well-planned transition includes strong network of informal supports.For transitions to be successful, careful planning and preparation is required, starting early in the child and family’s involvement with the system
26NEXT STEPS Continue sharing knowledge and ideas for improving system Improve on what is already workingIdentity training, facilitation, and technical assistance needsKnow that everyone is learning togetherIt is a team effort