Date post: | 24-Jun-2015 |
Category: |
Self Improvement |
Upload: | gregory-kurth |
View: | 569 times |
Download: | 0 times |
Protecting Children. Strengthening Families.
A Community-Based Approach to Redesigning a Placement
Continuum of Care
A private, community-based lead agency model integrating clinical and permanency best practices to dramatically “right
size” a child welfare system.
Protecting Children. Strengthening Families.
Presenters
• Gregory J. Kurth Chief Executive Officer Family Services of Metro Orlando
• Elizabeth Lewis, RN, B.Ed.
Chief Operating Officer Family Services of Metro Orlando
Protecting Children. Strengthening Families.
What Is Community-Based Care (CBC)?
Lead agency oversees a fully array of child protective services within a community network of partners.
Protecting Children. Strengthening Families.
19 Community Based Care Lead Agencies
Protecting Children. Strengthening Families.
Service Areas
FSMO is one of the largest CBC lead agencies in the state of Florida, managing formal child welfare services for over 2,800 children
Protecting Children. Strengthening Families.
Protecting Children. Strengthening Families.
CMO Partner Agencies
Protecting Children. Strengthening Families.
In 2004 FSMO Inherited
• Over 3,600 kids in protective services (in and out of home)
• “Cookie cutter” case plans
• High removal rate
• No Utilization Management
• No Permanency review process
• Limited foster home capacity
Protecting Children. Strengthening Families.
2004 - A Closer Look
• Funding of Licensed Care: $48,000 per day/$17.5 million per year
• Over-utilization of residential placements; no Mental Health Integration
• Disrupted placements 3 times that of entries into the system
• No focus on Older or SED Children for permanency
Protecting Children. Strengthening Families.
2004 - A Closer Look
• Little knowledge of community resources
• DJJ/DCF/SAMH: agencies operating in silos
• Negative perception of biological families
• Lack of gate keeping/utilization management
Protecting Children. Strengthening Families.
Children Placed Outside of Osceola County
% of Children Placed Outside of County by Type Source: HSn Clients Active as Case Dependents 9-29-05
Type of Placement % Out of County
Traditional Foster Homes 68.3%
Group Homes 71.6%
DD Foster Homes 80.0%
DD Group Homes 80.0%
Medical Foster Homes 100.0%
Mental Health Facilities 33.3%
Residential Treatment Centers 77.8%
Therapeutic Foster Homes 70.0%
Shelters 100.0%
Overall 68.9%
Protecting Children. Strengthening Families.
Children Placed Outside of Orange County
% of Children Placed Outside of County by Type Source: HSn Clients Active as Case Dependents 9-29-05
Type of Placement % Out of County
Traditional Foster Homes 28.2%
Group Homes 48.0%
DD Foster Homes 66.7%
DD Group Homes 60.0%
Medical Foster Homes 41.2%
Mental Health Facilities 30.8%
Residential Treatment Centers 22.2%
Therapeutic Foster Homes 37.9%
Shelters 70.8%
Overall 37.4%
Protecting Children. Strengthening Families.
In 2004 Over 400 Children in High End Placements
PIL5%
RTC20%
TFC & STFC17%
RGC39%
Group Home19%
PIL
Group Home
RGC
TFC & STFC
RTC
Protecting Children. Strengthening Families.
An Example of the # of Admissions and Discharges
Compared to Child Movements
One CMO -- July 2005 - April 2006
Transfers, 109, 18%
Admits, 197, 33%
Disruptions, 118, 20%
Discharges, 176, 29%
Protecting Children. Strengthening Families.
Where We Are Today
• Funding of Out of Home Care Licensed Care: $32,100 per day/$11.7 million per year
• $5.8 million savings annually
• 2700 kids in protective care with 780 kids in paid care
• Responds to 15,000 calls annually and services to 8,000 children and families
Protecting Children. Strengthening Families.
How FSMO Made a Difference
• Community Involvement • Safety Focus
• Engagement Based Practice
• Prescription
• System Integration
• Relentless Management and Quality Improvement
Protecting Children. Strengthening Families.
Community Involvement
Resource Specialists co-location DJJ Liaison DD/CMS Specialist
Protecting Children. Strengthening Families.
The Resource SpecialistFunctions
as a ‘resource’ for placement
stabilization via consultation.
Works closely with the CPI on
diverting children from coming into
care.
Conducts and maintains a ‘mapping’
of the community’s ‘traditional’ and ‘non-traditional resources.
Assists the CPI in the
assessment of
safety vs. risk.
Consults with the
CPI in the development of a safety plan.
Assists in generating
referrals for CBA
services.
Assists the CPI in the diligent search for
relative placements.
Protecting Children. Strengthening Families.
DJJ Kids Diverted
2004 – 1
2005 – 22
2006 – 29
2007 – 41
2008 – 45(January – June)
Total - 139
Protecting Children. Strengthening Families.
83 DJJ Kids Diverted 2007-
2008 Savings of $14,424/day
J uly Augus t S ept Oc t Nov Dec J an F eb Marc h April May J une
10
5 63 7
69 8 10
58
6
Monthly # of Kids DivertedMonthly # Diverted
Protecting Children. Strengthening Families.
Developmentally Delayed Children
FSMO hired DD/CMS Specialist in 11/079 children diverted from the system. Saving over $200,000.00 annualized. These kids are:– Difficult to place– Have very specialized needs– Expensive to treat
Protecting Children. Strengthening Families.
Safety Focus
• Differentiating Risk from Safety
• Child Endangerment Risk Assessment Protocol (CESAP)
Protecting Children. Strengthening Families.
Why Implement Change?
• Many Children are Entering Care Unnecessarily;
• Some child/abuse victims may be remaining home who should be placed;
• In-Home families are not receiving effective child protective services;
• The System has not clarified the difference b/w Risk and Safety
• Workers lack prescriptive guidelines
Protecting Children. Strengthening Families.
Focus on Front-End
Orange/Osceola
State
Nation
7.0
5.3
4.0
Abuse Reports (% of Child Population) Substantiations (%
of Reports)
Removals (% of Substantiations)
Removals (per 1,000 of Child Population)
8.2%
4.2%
8.9%
31.6%
36.5%
29.4%
20.3%
25.6%
26.4%
8.2%
4.2%
8.9%
Protecting Children. Strengthening Families.
Safety versusRisk
Now or Near FutureHigher DegreePrevention (short term)
Longer TermLower to Moderate DegreeMitigation (long term)
Potential Harm
Protecting Children. Strengthening Families.
CESAP Requirements
• A ‘life of the case’ protocol.• Assessing moderate to severe harm
immediately or in the near future.• Safety Determination Form.• Safety Plan.
Protecting Children. Strengthening Families.
• Placement stabilization
• Families participate in staffings and case development
• Specialized Adoption Recruitment: Wendy’s Wonderful Kids / Heart Gallery of Metro Orlando
• Family Team Conferencing
• Community providers invited to staffings
Engagement Based Practices
Protecting Children. Strengthening Families.
Placement Stabilization
• Case managers take ownership• Know and support foster families (e.g.
foster parent liaison)• 1st sign of trouble -- initiate supports• “Push down” accountability• Work with schools to save placement• Explore extra curricular activities
Protecting Children. Strengthening Families.
Innovative gallery-style photo exhibit that rotates throughout the community
Highlights 80 children in Orange and Osceola counties currently available for adoption
The Heart Gallery is a unique way to engage Central Florida in the child welfare system
Protecting Children. Strengthening Families.
Prescription• Case Plan Conferences / Permanency Case
Reviews
• Utilization Management: Level of Care Committee and Authorization of placements
• Placement matrix
• CANS (Child Adolescent Needs and Services) survey of group care
Protecting Children. Strengthening Families.
May 2004 - A Look at the Permanency Options
• Biological family rarely considered
• Children under 12 and siblings growing up in group care
• Step downs rejected due to increased work on case worker
• Fear of making the wrong decision lead to inappropriate child labeling
Protecting Children. Strengthening Families.
Permanency Strength/Need Approach
Moving From:
Seeing families as the problem
Focus on deficits of parents
Plugging families into existing services
Expert model
Identifying needs and funding sources
Moving To:
Seeing families as allies
Focus on needs of the children
Crafting, individualizing and tailoring services around specific needs
Collaborative model
Connecting families to services regardless of funding sources
Protecting Children. Strengthening Families.
90 Day Reviews• All cases reviewed by “third party” Child
Welfare Specialist
• Families part of the solution
• Services authorized at time of need
• Safety issues addressed immediately
• Immedate Feedback
Protecting Children. Strengthening Families.
Placement Matrix
Placement Type Child CharacteristicsTraditional Care Functions well in a family
Residential Care Defiant, 24 hour supervision
Enhanced Care Moderate Psychiatric
Specialized Foster Intense Psychiatric
Specialized Group Serious Disturbance
Residential Treatment Unable to function
Medical Care Medically Compromised
Protecting Children. Strengthening Families.
Using CANS Criteria
How it was used:• Match child’s characteristics to program• Profiling provider based on the
residential CANS survey• Created placement algorithms
Number 1 Benefit:• Placement stabilization
Protecting Children. Strengthening Families.
Children in Paid Placement by Age - Trendlines July 1, 2004 vs. October 1, 2008
25
35
45
55
65
75
85
95
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Age
Ch
ild
ren
Poly. (2004) Poly. (2008)
Protecting Children. Strengthening Families.
Cost per Client per Day of Residential Services
275
325
375
425
475
525
4/19
/2004
6/19
/2004
8/19
/2004
10/19
/200
4
12/19
/200
4
2/19
/2005
4/19
/2005
6/19
/2005
8/19
/2005
10/19
/200
5
12/19
/200
5
2/19
/2006
4/19
/2006
6/19
/2006
8/19
/2006
10/19
/200
6
12/19
/200
6
2/19
/2007
4/19
/2007
Protecting Children. Strengthening Families.
Number of Residential Clients Served
250
300
350
400
450
500
550
Protecting Children. Strengthening Families.
Beyond Traditional Foster Care Services Cost per Day
Protecting Children. Strengthening Families.
#1 Key to Our Success Utilization Management
Utilization Management Program
• Expert Review & implement recommendations
• Focus on early & appropriate treatment
• Decrease multiple placements
• Focus on safety, permanency & well being
Protecting Children. Strengthening Families.
System Integration
• Medicaid managed care - Magellan
• Utilize all appropriate funding streams
• Utilize IV-E Waiver
• Embedding UM in permanency
Protecting Children. Strengthening Families.
Child Welfare and Mental Health Needs of Children
• Annually, 600,000 children seen in the U.S. child welfare system do not receive mental health care to meet their needs.
• 48% of these children have clinically significant mental health needs.
Journal of American Academy of Child and Adolescent Psychiatry, August 2004
Protecting Children. Strengthening Families.
Mental Health Issues
• Children lose funding in RTC and come into care
• Families need services – children come into care
• Adoptive families return children due to lack of services
• We paid for four kids at $406.00/day until Medicaid funding began
• $406.00 for 30 days is $12,188.00/child
Protecting Children. Strengthening Families.
May 2004 - An Overview of Treatment in High End Facilities
& Therapeutic Foster Homes
25 Children Reviewed in staffings
11 kids were 12 years old or younger
All had psychologicals and assessments
All had multiple psychiatric diagnoses
22 were on psychotropic medications
15 were taking 3 or more medications
Negative view of biological families
Delay in school enrollment
Protecting Children. Strengthening Families.
May 2004 - A View of Medication Management
Lacking continuity of care
Used medications to control behaviors
Courts changed medication dosage
Could take weeks before court approval
Little parental involvement in decision-making
Protecting Children. Strengthening Families.
Pre-Paid Medicaid Plan
FSMO is Limited Partner Beginning of purchase of service
utilization Authorizations required for high end
services RTC funding carved out Full risk for RTC placements Today a shared risk model
Protecting Children. Strengthening Families.
IV-E Waiver
• Implemented in October 2006• All IV-E (except for Adoption
Assistance) can be used for child protection-related activities
Protecting Children. Strengthening Families.
Relentless Management and Quality Improvement
Provider Meetings and Supervisors Forum
Training for all Front-Line Staff
Quality Service Reviews and Team Performance Calls
Balanced Quality Scorecards
Protecting Children. Strengthening Families.
FSMO Training Accomplishments
• FSMO began training the System of Care January 2006
• 298 Case Managers and Protective Investigators trained since inception
• Deliver 7-week training cycles 6 times a year
• 94% of all trainees have passed the competency based pre-service training program
Protecting Children. Strengthening Families.
Scope of Training
• Pre-service training• Field training • In-service training• Supervisory training• Targeted trainings driven by quality
improvement initiatives
Protecting Children. Strengthening Families.
Transition of Training Program
• Train protective investigations and case management together to build collaborative relationships
• Build in mentor and modeling approach to training
• Moving from global skills development to specialization
Protecting Children. Strengthening Families.
Specialization Trainings
• Goal is to develop subject matter experts within operational centers
• Competency based trainings• Trainings offered in:
• Impact of Trauma on Early Development• Domestic Violence• Mental Health• Substance Abuse• Sexual and Physical Abuse
Protecting Children. Strengthening Families.
Partnership with IT Vendor to Develop an
Internal Database
• Authorize/track placements
• DJJ diversion
• Purchase of services
• Licensing & inquiries
• UM, Contracts, Fiscal
Protecting Children. Strengthening Families.
FSMO Accomplishments 2004-2007
COA Accreditation for Network Standards Increased adoptions Increased relative care placements Increase # of foster homes Increased prevention activities Fewer children placed in foster homes Kids moving through the system
Decreased kids in the system Decreased disruptions Decreased # of group homes Decreased high end placements Decreased # of psychotropic medications
Protecting Children. Strengthening Families.
FSMO Awards
• 2006 Congressional Angel in Adoption
• 2006 Computer World Laureate
• 2007 Davis Productivity Nomination
Protecting Children. Strengthening Families.
Interesting Note
The state of Florida
operates the child
welfare system at
70% of the national
median of per capita
funding.
Protecting Children. Strengthening Families.
Challenges Moving Forward
Augmenting residential programsOut of Home Care “Bottoming”Continuity of medical/behavioral careAdequate services for DJJ & DD kidsImproving well-being outcomesTransition from foster care
Protecting Children. Strengthening Families.
FSMO Child Population 347,741
Statistic 2007 FSMO
Abuse Rate: 1 out of every 239 children is the subject of an abuse call
Removal Rate: 1 out of every 379 children is removed
Exiting Care within 12 Months:
22% more children were removed from their homes than exited the
child welfare system
Protecting Children. Strengthening Families.
New Initiatives
• Program Advisory Committee (Health, Education, Community Resources)
• Faith Based Initiatives• Web-Based Development – Greater
Network Interactivity (e.g. Blogging)• Educational Liaisons
Protecting Children. Strengthening Families.
Contact Presenters
• Gregory J. Kurth, MA Chief Executive Officer
• Elizabeth Lewis, RN, B.Ed. Chief Operating Officer [email protected]
Family Services of Metro Orlando 407-398-7975