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7/27/2019 2013 Annual Gathering: Workshop #6C: Residentially-Based Services Collaboration and Innovation in Continuity of Care
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Residentially Based Services Reform ProjectSAN FRANCISCO CONSORTIUM FOR RESIDENTIALLY
BASED SERVICES
FAMILY CONNECTIONS PROGRAM
COLLABORATION AND INNOVATION IN A CONTINUITY OF
CARE MODEL
SEPTEMBER 15, 2013
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Residentially-Based Services
Reform
California's Residentially-Based Services
(RBS) reform initiative seeks to transform
the state's group homes from long-term
congregate care and treatment, to short-
term residential stabilization and treatment
programs with follow along community-
based services to reconnect youth to theirfamilies, schools and communities.
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California Alliance of Child and Family Services
Stakeholders Workgroup
2004
family members
emancipated foster care youth
child and family advocatescounty and state public agency officials
representatives of the legislature
care provider representatives
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Framework for a new system of
residentially-based services
enhance services
expedite permanent family placement for
youth needing time in a residentialtreatment setting
reform the way group homes are utilized in
California, the range of services they offerand how they are reimbursed for these
services
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AB 1453
2007
California Department of Social Services (CDSS)
financial support from Casey Family Programs
creation of the RBS Reform Coalition
Sierra Health Foundation
Child and Family Policy Institute of California
AB 1453 legislation authorized selection of
counties that would, in partnership with privateproviders, implement alternative program and
funding models consistent with the RBS
framework document
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California Alliance of Child and
Family Services
family members
young adults who experienced residential
placements as youth, child and familyadvocates
public agency representatives
provider representatives
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Vision for Transformation
Transitions group homes from a structured often long-term living environment for
children to an intensive short-term intervention tasked with returning children to their
own homes or to another permanent and stable family setting in as short a time
possible.
Offers the range of behavioral and/or therapeutic interventions necessary to overcomemajor obstacles to children living in their own homes or other stable family setting,
including two new and critical categories of services (family support and post-
discharge).
Defines a number of major RBS program features, including comprehensive up-front
assessment of children by county placing agencies, matching of individual children'sneeds with an appropriate RBS program, family finding and engagement, along with
other effective program strategies.
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Demonstration Sites
San Francisco County (March 2011)
Sacramento County (September 2010)
Los Angeles County (December 2010)San Bernardino County (June 2010)
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Strategy - Guiding the Process
California Legislature
California Department of Social Services (CDSS)
County welfare directors
The State Department of Mental Health
Chief probation officers
Casey Family Programs
Child and Family Policy Institute of California
California Alliance
A team of consultants was brought together initially to provide needed
training and technical assistance to demonstration sites
An Executive Team makes overall project decisions, while LocalImplementation Coordinators champion RBS at the county level
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Collaborative PartnersSan Francisco Consortium
Internal
San Francisco County Human Services Agency San Francisco Community Behavioral Health St. Vincents School for Boys Seneca Center
Edgewood Center for Children and Families
External
Casey Family Foundation
California Department of Social Services California Alliance for Child and Family Consultants
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Mission, Goal and VisionMission of the San Francisco Consortium Family Connections Program: Interrupt, at the outset of involvement, the multiple placements and serially disrupted attachments
that characterize the lives of those children and youth in our child welfare, juvenile justice and mentalhealth systems
Goal of theFamily Connections Program: Act as a re-connection engine with a focus on permanency:
5 - 7 months in residential services and 17 - 19 months in community based services
Community based services support youth as they return home to family or kin, or during shortstays in intensive treatment foster care, other FFA or County foster placement
Model is designed to test the feasibility of creating a new, integrated and replicable treatmentoption for children or youth who traditionally have been served through extended group homeplacements, and their families
Three core services together in one continuous, coordinated and strength-based program:
residential treatment
family support
intensive behavioral health services
Vision of the Family Connections Program:
Children and youth with complex needs and situations will no longer have to experience oneplacement failure after another in the search for a match that works
Children and their families will get the help they need, when they need it, and in the places most likelyto help them achieve and sustain positive outcomes
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Guiding PrinciplesTheguiding principlesof the Family Connections Program:
All children and youth deserve a home, a family, a community, and a voice in their care
The function of an FCP is not to be a placement but to be a part of a process to return youth totheir families and communities as soon as possible
Families and kin in the broadest sense are the backbone of every child and youths life, andfamily must be the foundation upon which our interventions are constructed
The FCP is not the family for their enrolled children and youth. The job of the program is to find,engage, and empower positive family relationships
Children, youth and families must have access to the development of, voice in choosing thecomponents included in, and ownership for the accomplishment of their plans of care
Interventions must be strength-based, family-centered, individualized and culturally competent
Continuity and consistency of care, caring relationships and the locations of care are critical tosustaining long-term positive outcomes
Residential interventions must be short-term strategies designed to help children, youth andfamilies make progress on their road to permanency, safety and well-being
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Guiding Principles The FCP acts in partnership with children and youth and their families, as well as
other supportive adults and agencies and organizations in the community;
To support long term success, programs must insure that each young person andfamily establishes a network of supportive individuals and activities in thecommunities where they will be living;
The FCP must be flexible in offering a horizontal continuum of services that can be
accessed at any point or time by enrolled children, youth and families.
Throughout the service delivery process, young people and their families mustexperience themselves as drivers of the service planning process and be treated asexperts on their own strengths and needs;
Accountability for achieving progress and effective outcomes should become a keyelement of further system development; and,
One child one system: The SF Family Connections Program must develop a single,integrated, flexible and transparent system focused on insuring continuity andresolution to cross-system barriers.
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Target PopulationTarget Population
Between the ages of 6 and 16. Gender is not a criterion.
Currently in placement in an RCL level 12 or higher group home, or at risk of or pending placement inan RCL level 12 or high group home
Placement or pending placement in such an RCL due to a combination of family disruption, abuse andor dangerous behaviors that cannot be managed in other settings
Have an available family/kin or anyone else who can provide a permanent home and is willing toparticipate in the program
Although the child or youth has a parent or primary caregiver who is connected with and willing towork towards permanency, a permanency plan is unlikely to be accomplished within 6 months unlessintensive work takes place to resolve difficulties in attachment between the child or youth and his orher parents or other primary caregiver, and/or to address the challenges to reunification caused bythe child or youths persistent dangerous and disruptive actions that at present cannot be managed in
the community.
An average of 5 - 7 months is being used to allow for those clients who will need both more, or lesstime, in the residential component based on their individual needs
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Projected OutcomesChild and Family Outcome Measures:
Reduced lengths of stay in group care
Increased % of youth dis-enrolled to permanency (reunification with immediate family,adoption, legal guardianship with a relative or fictive kin, or living independently within asupportive community
Increase childrens proximity to their home and community
Improved placement stability for youth in group care
Decreased % of youth re-entering after dis-enrollment from group care
Families will have greatly expanded contact with their children while in the group homesetting
Enhanced wellness and health as measured by normed measures agreed upon by theevaluation subcommittee, e.g. Child and Adolescent Need and Services (CANS), YouthSatisfaction Survey (YSS) and YSS-Family
Participating youth are enrolled and actively participating in educational or vocationalprogram and/or employed at six months after dis-enrollment from RBS-including
community based aftercare services
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Key Innovations
To insure that children, youth and families are fully engaged in the effort to build and sustain strong
family connections, programs will have processes that support meaningful involvement, a servicedelivery environment that is supportive to family participation, and specific methods for maintainingconsistent engagement throughout the period of enrollment in the program.
Consistent and Collaborative Treatment
Family search, engagement, preparation and support
Flexible funding to support innovation
One Child and Family Team Across all Environments
Comprehensive Care Planning Unifying Residential and Community Treatment
Building Life Long Connections and Natural Support
Concurrent Community Work While in Residential
Crisis Stabilization Without Replacement (14 days)
Respite in the Community
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Care Components
The FCP consists of three care components:
A Residential Care Center
maximum of 6 RBS youth, anchored by milieu staff, and primarily funded through federal,state and county IV-E case rates.
also serves as a short term Crisis Stabilization for RBS youth and children
A Community Care Component
serving up to 14 children or youth and their families in both the residential center and inthe community,
anchored by youth and family support staff, care coordinators and family partners,
funded in part through state and county IV-E case rates and
in part through EPSDT fee for service billing.
A Clinical Care Component
serving all 14 children or youth
anchored by youth and family clinical care coordinators and mental health rehabilitationspecialists
funded primarily through EPSDT
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Treatment InterventionsEnvironmentally based interventions In the residential component of each FCP, these interventions are designed to provide short-term,
high-impact behavioral stabilization, assessment, and support
Intensive treatment and interventions The therapeutic component of each FCP will provide an array of intensive treatment and interventions
designed to help the child or youth and family understand and address the psychosocial andneurobiological drivers that may be contributing to (or resulting from) the disruptions that the familyhas experienced and is experiencing.
individual therapy
family therapy
psychiatric services
Medication
Day treatment services and Therapeutic Behavioral Services
Parallel services The FCP begins its relationship with the child or youth and family in the residential unit and the
family connections center on campus, but as quickly as possible begins to transition the locus ofsupport and services to the environment where the child or youth will be living upon completion ofenrollment.
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Follow-up and TransitionalSupport
Post-reunification support and services provided during the first few months following the child oryouths return home are a critical element in helping children or youth and their families lock in andadhere to the new ways of interacting
The in-home service team from the FCP will be there to provide ongoing treatment , instruction andsupport as needed
Transitional support - gradual reduction of the level of service involvement always based on theaction plans and modifications developed through the FST
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RBS System Flow Chart
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Residential component - $11,000 per month per child or youth and family. The percentage of therate that is IV-E allowable for IV-E eligible youth is estimated to be 92.62%.
Intensive Treatment Foster Care (ITFC placement) - $5581 per month, per child or youth andfamily. This is the current CDSS-approved rate for ITFC Level 1. The SFC believes that 60% of the
costs are IV-E allowable for federally eligible youth.
Community services - $3,500 per month, per child or youth and family. $3,500 is inclusive of anyfoster care maintenance costs paid by the county to a placement caregiver. Maintenance costs forfederally eligible youth are 100% federally allowable for foster home, relative, and non-extendedfamily member placements, and on average 67.5% allowable for treatment foster family agencyplacements.
Basic Components of the
Funding Model
F il C ti P
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Family Connections ProgramStaffing
Program Director:
Manage the development, implementation and operation of the FCP
Masters level or above., at least 5years experience, at least two as a supervisor or manager
Lead Clinician:
Supervise all behavioral health service plans, assessments and provide liaison with community mental
health services
Masters level or above, 3 years of experience, license required
Residential Supervisor:
Supervise the family specialists across environments. Will also provide oversight of the residential
component and coordinate program management with the program director and lead clinician
Bachelors level or above, at least 5 years experience, at least 2 as a supervisor or manager
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FCP Staffing
Consulting Psychiatrist: (contracted services):
Assistwith assessment and evaluation of children and youths needs as requested, consult with leadclinician and staff on intervention strategies, manage any medication issues that children and youthmay have if they do not have their own community-based prescribing psychiatrists
M.D., board certified child psychiatrist, at least 1 year experience working with children and youthwith severe emotional and behavioral needs
FCP Counselors/ Family Specialists:
Help to implement the behavioral health elements of the Comprehensive Care Plans in the residentialcomponent and in the community, support develop and use of improved family interaction and copingskills, participate in the Family Support Team meetings
Maintain the residential milieu, provide support, nurturance and structure for the residents, help themmanage their challenging behaviors
Bachelors level or equivalent experience at least 1 year experience working with children or youthand families
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FCP Staffing
Clinical Care Coordinators:
Facilitate the engagement process, strengths, needs and goals discovery, and the Family. SupportTeam process. Document the Comprehensive Care Plan developed by the FST, and coordinate itsimplementation. With the FST track service delivery the progress being made by children, youth andfamilies
Masters level, trained in facilitating strength-based, family-centered plan development and
coordination of service activities across multiple domains
Facilitator:
Facilitate child and family team meetings, take notes, and track progress on meeting objectives
Masters level, trained in facilitation, experience working with children and families preferred
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FCP Staffing
Family Partner:
Provide engagement and support for family members and youth, help them understand the nature ofthe program and insure that they have access, voice and ownership in the process of developing andimplementing the Comprehensive Care Plan, and help with facilitating accurate and effective child,youth and family input in the evaluation and continuing improvement of program services andoperations
Prior experience as a parent, family member or primary adult caregiver of a child or youth with
serious emotional and behavioral needs who received services through 1 or more of the countysystems of care, including child welfare, mental health and juvenile justice
Administrative Support Personnel/Scheduler:
Provide assistance with internal record maintenance, scheduling, obtaining needed external records,
provide quality assurance oversight of treatment record
Bachelors level or equivalent experience, at least 1 year of prior administrative supportexperience
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FCP Staffing
Family Finder/Foster Home Recruiter:
Duties include foster home recruitment for the two providers with FFAs, and will do family findingprimarily for the provider who does not run an FFA
Bachelors level, or equivalent experience
Quality Assurance Personnel:
Maintain files, support all QA functions
Bachelors level or above
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Lessons Learned
Obtaining County and State Approvals Be patient
Be specific
Alignment of the VA and funding model is critical.
Not too much information - just answer the question.
Show more patience
Challenge as necessary
Bay Area Consortium to One-County Pilot: Challenges of a Multi-County
Consortium Through a Request for Qualifications process, five counties and six providers were selected to
participate in the BAC demonstration site of the RBS initiative.
Perspectives Counties, providers, consultants
Agreements
Conforming to a structure
Compromise
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Two and Two Can Make Five
There is Opportunity in Every Crisis
Sending children home is not just a matter of doing a lot of therapy; children need
families
Funding usually follows programs; funding for families in residential treatment is
limited
Funding constraints form attitudinal sets: if we cant fund it, we shouldnt think about it
Child Welfare departments have a mandate to get children to permanent families
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Opportunity Contd.
Little ability to help families but high demand to place children in families creates crisis
Crisis creates the opportunity to blend funding and allow a new model
BUT
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Appropriate Clients vs Available Clients
Tremendous surge in the kind of client who needs high end care
New Program presents opportunity to loosen gridlock
High end care clients may not be the most appropriate, but they are the most available
Most available means longest time in care; attempts to find families have failed
Staff want to succeed in pilot; County wants to empty beds
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Clients and Families Need to Match
By the time clients enter the program, attempts to find extended family have been tried
and failed. Clients have often required years to stabilize before provider can safely
recommend to foster care placement.
Extended family members may be available but unable for many reasons.
Mobility Mapping helps to establish whos been important in the clients family. Mobility
Mapping is a tool developed by Kevin Campbell, LCSW, of the Center for Family
Finding and Youth Connectedness.
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Family Finding Pays Off
Families come from the extended family, from our foster care agency and from the
efforts of HHS, through its Family Builders unit.
Finding a family is only the beginning; helping the child to adapt to the family is a huge
part of the work. Long term out of home clients are not used to the intimacy of afamily. Staff members become the bridge between the client and the family.
Staff members develop their own hopes and fears about whether the family and the
child will be able to live with each other; the staff process is just as important at the
child and family process.
Unexpected family issues arise and staff members have to stretch their own roles to
meet the needs.
F il C ti th I l Y W t t
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Family Connections are the Inlaws You Want to
Have
The sheer number of service providers is tough to stomach for the family at first.
There are always adjustments with the hope that providers can be replaced by natural
community supports: friends, teachers, extended family, church members and
neighbors.
Accepting the need for help is critically important; making a new family is hard work
and does take a village.
Striking the balance between rescuing and teaching makes or breaks the case. Family
specialists and case managers join the family knowing that they will have to leaveagain; they become the inlaws who are always hovering.
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