Continuum of Care Reform Overview OVERVIEW AND BACKGROUND History - - PowerPoint PPT Presentation

Continuum of Care Reform Overview

OVERVIEW AND BACKGROUND

History of CCR

• All children live with a committed, permanent and

nurturing family with strong community connections

• Services and supports should be individualized and

coordinated across systems and children shouldn’t need to change placements to get services

• When needed, congregate care is a short-term, high

quality, intensive intervention that is just one part of a continuum of care available for children, youth and young adults

• Effective accountability and transparency drives

continuous quality improvement for state, county and providers

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Vision

Key Strategies

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• Child and Family Teams (CFTs) drive case planning, placement

decisions and care coordination

• New licensing requirements for FFAs and STRTPs:

– Limit use of residential care – Must have an identified ability to meet the varied needs of children (i.e. “core services”) including mental health services – Must be nationally accredited

• New approval requirements and restructured rate system for

caregivers provides for a single residential rate and a varied “level

• f care” home-based rate
• Local collaboration between Child Welfare, Mental Health,

Probation, and Education to provide integrated services

RESOURCE FAMILY APPROVAL

Placement prior to RFA

Compelling Reason :

• Based on unique needs of a child including maintaining family connections
• After Home Environment Assessment is completed
• Permanency assessment completed within 90 days unless documented good

cause exists Emergency Basis :

• Must be with relative or nonrelative extended family member
• Requires WIC 361.4 assessment:
• CLETS, CACI & walk-through
• Live Scan within 10 days of CLETS or 5 days of emergency placement
• RFA application and Home Environment Assessment must be initiated within 5

business days

• Comprehensive assessment completed within 90 days unless documented good

cause exists



Emergency placement can happen pre or post dispo (FYI 17-03; WIC 361.3(a)(8)(A) & 361.45)

RFA Vision

• A family-friendly and child-centered

caregiver approval process

• Streamlines and eliminates

duplication of existing processes

• Unifies approval standard for all

caregivers

• Prepares families to meet the needs
• f children in foster care
• Allows seamless transition to

permanency

Overview

• f RFA

Process

Receive a RFA orientation Undergo criminal clearances and background checks Undergo home environment assessment Participate in 12 hours preapproval training and 8 additional hours within the first year (some counties/ FFAs may require additional training) Complete a health questionnaire or screening for applicants Participate in a family evaluation (previously called Psychological Assessment) Receive a written report of the resource family

Home Environment Assessment

An assessment of the home and grounds, outdoor activity space, and storage areas of the applicant’s home Criminal background check (and any necessary exemptions) of each applicant and all adults residing in,

• r regularly present in, the home.

Total number of children cannot be more than family can properly care for – and shall not exceed 6 children.

Exception: Exceptional circumstances including but not limited to the need to place siblings together WIC § 16519.5(d)(2)

Permanency Assessment

• Verification that an applicant completed pre-approval training–

minimum of 12 hours (8 post-approval hours annually)

• A Family Evaluation which is a comprehensive inquiry into the

applicant(s) will include:

• Risk

Assessment

• Motivation
• Applicant’s

past and present experiences

• Understanding
• f the needs of

children in care and ability to meet those needs

NOTE: When the applicant is a relative/NREFM, the family evaluation shall consider nature of relationship between the applicant and the child. WIC § 16519.5(d)(3) NOTE #2: The applicant’s preference to provide a specific level of permanency shall not be a basis to deny an application. WIC § 16519.5(g)(5)(A)(i)(II)

Additional RFA requirements

Health Questionnaire or Screening First Aid and CPR certification- to be completed within 90 days post-approval 1 face to face interview with all other residents in the home including children 2 personal references DMV check on applicant and all adults in the home

Maintaining Resource Family Approval

• RFA must be updated annually or more often if “significant

changes”

• Must begin 60 days prior to approval anniversary and be completed no

later than 30 days after

• If a resource family moves from one county to another
• RFA must be updated within 30 days
• Completed update begins new annual period
• A resource family remains approved until the family

surrenders their approval or their approval is rescinded

Conversion to RFA

• All prospective relative, NREFM & foster families after 1/1/2017

must go through the RFA process

• Current caregivers with a child in placement at some point

during 2017 have until 12/31/2019 to begin the RFA process (WIC § 16519.5(p)(5)

• Applications for a foster family home license or request for

relative/NREFM approval received on or before December 31, 2016 are approved/denied under the prior licensing/approval process (not RFA) (WIC § 16519.5(p)(2)(C)

• Current caregivers with an approved adoptive home study competed

before 1/1/18 are automatically deemed RFA approved.

Due Process

• Applicant for approval or for a criminal record exemption may

file written appeal within 90 days of service of Notice of Action + 30 days additional time for good cause

• Resource family, excluded individual or individual subject to

criminal record exemption rescission must file written appeal within 25 days of notice of action or exclusion order + 30 days additional time for good cause

• The department may issue an exclusion order requiring the

immediate removal of an individual if, in the opinion of the department, the action is necessary to protect a child from physical

• r mental abuse, abandonment, or any other substantial threat to

his or her health or safety

• Hearings are to be confidential and not open to the public, with

a case by case exception

• The testimony of a child witness may be taken outside the

presence of the respondent

Empowering Families through the Approval Process

• Step by step instructions for

families navigating RFA

• Vetted with relative

caregivers

• Available online at

www.stepupforkin.org

• Best Practice: Providing

Guides to families at 1st court hearing

• Version 2 to be released

soon!

Breaking Down the Problems with RFA

• RFA approval is taking far longer than intended causing long delays in

approvals and has led to a statewide crisis:

• Delays in placements with caregiver relatives
• Delays in transitioning children to family settings
• Discouraging families from signing up as foster families or remaining

families within our system.

• Families that take in children prior to approval do not receive foster

care benefits until they are approved and the funding is not retroactive to the date of placement. This is causing:

• Placement disruptions due to lack of funding
• Relatives and extended family members enduring months of

financial stress and hardship while simultaneously attempting to navigate a bureaucratic maze and care for traumatized children

RELIEF FOR FAMILIES

Short-Term Fix - Assembly Bill 110 (2018)

• Governor Brown signed AB

110 into law on March 13, 2018

• Implements Welfare &

Institutions Code § 11461.35

• Provides families

completing resource family approval funding for the period of March 30, 2018 through June 30, 2018

Eligibility for AB 110 funding

The eligibility criteria are as follows:

• 1. A caregiver is caring for a child or nonminor placed

in the home as an emergency placement or based

• n a compelling reason,
• 2. The caregiver has a pending RFA application filed

with the appropriate agency,

• 3. The child or nonminor is not otherwise eligible for a

foster care payment (this criterion is met when the caregiver has not yet been approved as a resource family), and

• 4. The child or nonminor is placed in California

Effective Dates for AB 110 funding

• March 30, 2018 for individuals who took

placement AND submitted an RFA application prior to March 30, 2018

• The date an RFA application is submitted for

those families who submitted an RFA application after March 30, 2018

Required applications for AB 110 funding

• 1. RFA application (RFA-01A)

(Note: the placing agency is required to have a caregiver submit the RFA application within five days

• f an emergency placement OR prior to placement on

a compelling reason)

• 2. Emergency Assistance (EA) application or the

Approved Relative Caregiver (ARC) application (Note: the placing agency should assess a child’s eligibility for EA or ARC and provide the caregiver with appropriate paperwork)

Practice tips to ensure immediate funding

• Placing worker should help

the caregiver complete (1) the RFA application and (2) the EA

• r ARC application at the

moment of placement

• Placing worker should submit

the applications immediately

• n the caregiver’s behalf
• Why? Because AB 110 funding

is contingent on submitting the above applications

Amount of funding

• AB 110 funding to emergency caregivers is equivalent to

the resource family basic level rate of $923 per month

• This funding amount is significantly more than the non-

needy CalWORKs payment, which many relative caregivers relied on while completing RFA

• Relatives and non-relative caregivers receive the same

AB 110 funding amount

• AB 110 funding is not retroactive – it is not available

prior to March 30, 2018 even if placement occurred prior to that date

Post-approval funding

• Caregivers will continue

receiving foster care funding once approved as a resource family

• Caregivers should

contact their county if there is a gap in funding

• nce they are approved

as a resource family

AB 110 sunsets on June 30, 2018, but. . .

The Legislature and stakeholders are working to craft a long- term solution to provide support to families at the time of placement beyond June 30, 2018

POST-PLACEMENT ASSESSMENTS & CHILD AND FAMILY TEAM

The Child & Family Team (CFT)

A group of individuals who are convened by the placing agency and who are engaged through a variety of team- based processes to identify the strengths and needs of the child or youth and his or her family, and to help achieve positive outcomes for safety, permanency, and well-being. Per Welfare & Institutions Code, Section 16501(a)(4)

CFT Composition

Required participants

• child or youth
• current caregiver
• placing agency representative
• family members
• anyone identified as important

Other members

• tribe or Indian custodian
• behavioral health staff
• foster family agency social worker
• school personnel
• Court Appointed Special Advocates
• Regional Center providers

Note: SB 925 would add CASAs to the required participants unless the youth objects

Why Child & Family Teams?

• Families are their own experts and achieve success if given

the supports to do so

• Improved outcomes for children and families
• Promotes collaboration, communication and shared decisions
• Services are most effective when delivered in the context of a

single, integrated plan

CFT Meeting Frequency, Location, & Logistics

Meetings convened

• within 45 to 60 days of entering care
• every 90 days in Los Angeles County

as frequently as necessary

• Initial meeting should not be delayed

to accommodate a pending mental health screening, assessment, or referrals for services Location/time

• convenient for family
• participation by phone/video

permitted Placing agency role

• placing agency convenes CFT
• ensure participant understanding
• should use a neutral facilitator

ACL 16-84; DCFS Child Welfare Policy Manual – 0070-548.01, Child & Family Teams

• CFT should be convened to discuss any placement changes (after

initial placement)

• CFT must be consulted to identify the most appropriate

placement of the child or youth, while always considering the least restrictive placement option

• Placing agency must consider all CFT placement

recommendations

• Placing agency has ultimate responsibility to determine most

appropriate placement

• Must inform the CFT of the recommendation and reasoning

prior to the court hearing and after the judge has made the placement order

Child and Family Team & Placement

DCFS Policy on CFTs (#0070-548.01) Important provisions

• CFT Meetings (or CFTMs)
• Any team member may request a meeting
• Offered as necessary
• Certified Facilitator Responsibilities
• Explain CFT and purpose to the family
• Provide family with the agenda

(should allow family to set the agenda)

DCFS Policy on CFTs (#0070-548.01) Important provisions continued

• Team Member Roles
• Family sets agenda/goals
• Family leads meeting
• Other members provide

support/resources

• Inter-Agency

Collaboration

• CSWs must collaborate with

agencies

• Department of Mental Health

(DMH)

CFTs: BEST PRACTICES

• Prepare the family and/or the child or NMD
• Ensure that recommendations developed by the CFT are being considered

by DCFS and the court.

• Lessons learned from TDMs…make sure facilitator will lead a productive
• meeting. If facilitator will be CSW but family/child is expressing

dissatisfaction with CSW, consider requesting an alternative facilitator.

• CFTs should be child-centered, not an opportunity to criticize

youth/family or create further harm.

• Include those who need to be included! Such as ed rights holder if ed

issues are going to be discussed, etc.

CFT Resources

• ACL No. 16-84,

Requirements and Guidelines for Creating and Providing a Child and Family Team

• ACIN No. I-14-18, CFT

Brochures

• ACL No. 18-23, Child and

Family Team Process Frequently Asked Questions

SHORT TERM RESIDENTIAL TREATMENT PROGRAMS

STRTP: Reducing Reliance on Congregate Care

Discontinue Group Homes Short-Term Residential Therapeutic Placements (STRTP)

Children who cannot be safely placed with a family can receive short-term residential care with intensive therapeutic interventions that support transition to a family.

STRTPs & REDUCING CONGREGATE CARE

• STRTPs only used when child needs intensive 24-hr

care for therapeutic or safety reasons that cannot be provided in a family setting.

• STRTPs must start planning for transition to a home

setting at time of intake.

• STRTPs must provide “core services” to help

transition including Specialty Mental Health Services

• New safeguards to enforce limitations.

SAFEGUARDS: NEW REQUIREMENTS



For child of any age (current law requires this for children under 12), case plan must document:

1.

Needs necessitating STRTP placement

2.

Plan for transitioning to a less restrictive environment, and

3.

The projected timeline by which the child will be transitioned.

 This section of the case plan shall be reviewed and updated at

least semiannually. WIC § 361.2, 16501.1(d)(2)

• If child stays longer than 6 months, placement must be approved by

DCFS director or deputy director. WIC § 361.2

• Beginning 1/1/2017, case plans must show that DCFS has considered

WIC § 16010.8 (intent of legislature that no child reside in a group home longer than one year). WIC § 16501.1(d)(2)(A)

• DCFS must develop process to handle what to do with placement

when Interagency Placement Committee says child not in need of services provided by STRTP. WIC § 11462.01(o)

WHO CAN BE PLACED IN AN STRTP?

STRTP may accept placement a child who:

1)

Does not require inpatient care at a licensed health facility (ie Metro),

2)

Has been assessed as requiring level of services provided in an STRTP, and

3)

Child meets at least one of the following:

• Assessed as meeting medical necessity criteria for Medi-cal

specialty mental health services,

• Assessed as seriously emotionally disturbed,
• Requires emergency placement, or
• Child has been assessed as requiring level of services provided by

the STRTP NOTE: NMDs can now remain in an STRTP up to age 21 if they meet the criteria for placement

WIC § 11462.01

WHO COMPLETES THE ASSESSMENT?

• Like current Level 14 screenings, an Interagency Placement Committee (IPC) must

establish procedures regarding the assessment to be placed in an STRTP.

• IPC must make a determination within 5 business days of a referral from child

welfare/probation

• Assessment can be made by:

1. Interagency Placement Committee (considering the recommendations of the Child & Family Team), 2. Licensed mental health professional, or 3. If the youth is eligible for an IEP under the emotional disturbance category and the IEP team has recommended a residential placement – additional assessment is not required

• Assessment must ensure that the child has needs in common with other children in the

STRTP

• A child may be placed on an emergency basis but must be screened by the IPC within

30 days WIC § 4096, 11462.01

IMPLEMENTATION UPDATE

• Current group homes: Can receive an extension for up to two

years (12/31/18) to work on conversion into STRTP

• There are currently 12 STRTPs including Hathaways Sycamore,

Rosemary’s, David and Margaret, Hillsides, Five Acres, St. Anne’s

• Closed Group Homes:
• Aviva, Pennylane, and Hillsides

UNDERSTANDING FOSTER CARE BENEFITS AND THE NEW HOME BASED FAMILY CARE RATE SYSTEM

Types of Funding to Support a Child in Foster Care

• Foster Care Maintenance Payment: provides for the cost of (and

the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child’s personal incidentals, liability insurance with respect to a child, reasonable travel to the child’s home for visitation, and reasonable travel for the child to remain in the school in which the child is enrolled at the time of placement.

• Additional types of foster care payments:
• Specialized Care Increments
• Dual Agency Rate
• Infant Supplement
• Clothing allowance
• Intensive Services Foster Care

How Did CCR Change Our Rates?

Relative Placeme nt

Relative Placement Eligible for Federal Foster Care Funding NOT Eligible for Federal Foster Care Funding Foster Care Benefits ARC?, no SCI TANF, no SCI

ALL Resource Families, including Relatives

Foster Care Benefits, including all new rates

• ffered by state

and SCI

Old Rate System Home Based Family Care Rate System “a child placed with a resource family is eligible for the resource family basic rate… at the child’s assessed level of care” (WIC § 16519.5(l))

Home-Based Family Care Rate (ACL 16-79)

• AB 403 (2015) mandates new child-centered rate system
• For children placed in family-like settings (i.e. resource

family home)

• How is HBFC different from previous rate structure?
• Rates no longer dependent on age
• No distinction between community placement types
• Special rates for FFAs that provide supports and

services to children placed with non-FFA families

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Home Based Family Care Rate Structure

Basic Level $923 Basic Level 2 $1,027 Basic Level 3 $1,131 Basic Level 4 $1,235 The HBFC Rate paid to the Resource Family is based on the amount of care and supervision the child needs from the family. A Level of Care (LOC) Protocol tool is being developed to guide the county LOC determination.

Home-Based Family Care Rate Implementation Phases 2 & 3

• Intensive Services Foster Care implemented statewide

effective December 1, 2017

• Levels 2 – 4 of the new Home Based Family Care Rates will

implemented in new FFA entries beginning March 1, 2018

• Independent researchers will study the implementation
• f Levels 2 – 4 in the FFA placements
• Summer 2018 – all placements statewide will begin receiving

the Home Based Family Care Rate as a triggering event

• ccurs

• replaces ITFC
• Resource Family must meet

a level of specified training and competencies based on the child’s needs.

• Additional training required

to provide ISFC

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Intensive Services Foster Care

Paid to the Resource Family $2,410 Administration $3,482 Services & Supports $200 Total $6,092

Level of Care Protocol

• The LOC Protocol is based on 5 Domains:
• Physical, Health, Education, Behavioral/Emotional,

and Permanency/Family Support.

• Static Factors are established that identify an

automatic ISFC designation.

• Designed to interact with child welfare assessment

tools and interpret the various assessment tool scores, including an optional Resource Parent Report to be completed by the caregiver.

Issues with the LOC Protocol

• Protocol not demonstrated to

be reliable among users

• Protocol may not accurately

assign children with higher needs to higher levels

• Counties are waiting further

guidance.

• Counties are struggling with
• thers aspects of CCR

implementation

Equal Funding for Unequal Needs

Equal funding helps support youth with relatives and NREFMs to ensure adequate and appropriate family placements. However, delaying funding to youth in these placements and/or a rate system that makes it difficult for families to receive the appropriate level of funding destabilizes the placement and undermines CCR.

• Relative caregivers are more likely to be on a fixed income or to be

unprepared to take in a youth in need. Delays in approval and funding can be devastating.

CONCLUSION

Additional Resources

• Alliance for Children’s Rights - Monthly Webinars – (email

Martha Dietzel to be added to our policy blast at m.dietzel@kids-alliance.org)

• Alliance for Children’s Rights - CCR Question Series
• California Department of Social Services- CCR information page:

http://www.cdss.ca.gov/inforesources/Continuum-of-Care- Reform

• California Youth Connection CCR Toolkit -

http://www.cdss.ca.gov/cdssweb/entres/pdf/CCR/CYCCCR_Tool kit.pdf

QUESTIONS?

CONTACT US: Elise Weinberg Luciana Svidler Policy Attorney Policy Associate Alliance for Children’s Rights Children’s Law Center of California (213) 368-6010 (323) 318-1032 e.weinberg@kids-alliance.org svidlerl@clcla.org