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Understanding Katie A and the Core Practice Model

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1 Understanding Katie A and the Core Practice Model
Introductions In this webinar you will receive an overview of the Katie A lawsuit and the settlement which resulted in the development of the Core Practice Model Jennifer Cannell, MSW Regional Training Manager 1

2 Learning Objectives Describe the main components of the Katie A lawsuit Learn the shared purpose of CWS and BHS Identify children who are part of the class and sub-class Describe the main components of the Katie A lawsuit including precipitating events, time frames and the settlement agreement They each have a shared vision to strive to improve the lives of children and families. Sub class Identify 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

3 Purpose and Goals of CWS
Keep children safe and preserve families Ensure children have well-being needs met Help children who cannot remain with their families to have a permanent loving family Make accurate decisions Ensure children have well-being needs met including educational, medical, dental, emotional and psychological needs Make 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

4 Purpose and Goals of BHS
Support recovery, resilience and well-being Provide integrated services Educate the community Promote the safety of children an youth in the community Support 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

5 BACKGROUND Class Action Lawsuit filed 2002 against CA Social Services and Health Departments as well as Los Angeles County Settled statewide Dec. 2011 ISSUES: Failure to assess mental health needs Inadequate mental health services Poor foster care placements-overuse of congregate and shelter care Lawsuit 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

6 WHO IS KATIE A? 2002-14 year old Caucasian female
Placed in foster care at age 4 Mental health assessment at age 5 37 different placements She was a 14 year old girl at the time the lawsuit was filed She was placed into foster care at age 4 We 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 services One 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.

7 KEY THEMES Shared needs of children and families-shared practice and responsibility Coordinated Comprehensive Community based The 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 counties FTM SOP This is an opportunity to increase communication and collaboration. To deepen, enhance and improve. 7

8 The Settlement December 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

9 Class and Subclass Class 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 services The settlement agreement identified the class and subclass of children to be served Class 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 services The 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 needs 9

Every county was asked to complete a readiness self assessment and a service delivery plan and submit them to the state The 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

11 Learning Collaboratives
Implementation of Learning Collaboratives Learning 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 Solano The 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.

12 Core Practice Model Values and Principles
Children are protected from abuse and neglect Services are needs driven and strength based AND are individualize for each child/family Services are delivered through a multi-agency approach Youth/family voice and choice are present throughout the process Services are a blend of formal and informal resources Services are culturally respectful of child and family Services are provided in family’s community Children have permanency and stability 12


14 Elements of the Core Practice Model
Teaming with Families Components and Activities Services Teaming with families: the CPM is grounded in the value of team partnerships with families utilizing Trauma Informed Practice The CPM is comprised of 5 primary components and activities: Engagement Assessment Service Planning and Implementation Monitoring and Adapting Transitions Services: 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

15 TEAMING Protects against individual bias impacting decision
Promotes decision and plans that rely on the voice of the child and family Increases family participation in developing plans Results in better informed decisions and plans Values 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 team 15

16 The Child and Family Team
Creates a vision with the family and works toward developing or achieving that vision CFT meeting is one of the several ways that will exist for CFT members to communicate Team begins with child, youth, family and extended family and extends to informal and formal supports 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 the way they team Informal supports include: friends, coaches, neighbors, faith based connections Formal 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

17 Start with the End in Mind
This didn’t happen overnight It took practice and patience Lots of learning along the way

18 5 Key Components Engagement Assessment
Service Planning and Implementation Monitoring and Adapting Transition 18

19 ENGAGEMENT Is 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 relationships At every point in a child and family’s involvement with CW and MH successfully engaging everyone involved is a key ingredient for promoting positive outcomes It 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 felt At 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

20 ASSESSMENT In the CPM, the term “assessment” includes both assessment done by child welfare and the more formal mental health assessment done by a mental health professional a continuous process In 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 professional Should be comprehensive enough to obtain information about the relevant events and behaviors that brought the children and families into services The 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.

Create and tailor plans Build on the strengths and protective capacities Flexible and Responsive to meet issues and needs Services 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 caregivers The 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.

22 MONITORING & ADAPTING Continuous monitoring and evaluation the plan
Plans should clearly reflect current family needs and circumstances Monitoring 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 CFT Progress shall be documented Plans are adapted based on the changing needs of the child/family Achievement 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.

23 TRANSITIONS Moving from formal supports to informal supports
Planning and preparation When 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



26 NEXT STEPS Continue sharing knowledge and ideas for improving system
Improve on what is already working Identity training, facilitation, and technical assistance needs Know that everyone is learning together It is a team effort

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