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Continuum of Care Reform Overview
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 ofchildren (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 of 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:
o CLETS, CACI & walk-through
o 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 of children in foster care
• Allows seamless transition to permanency
Overview of RFA Process
Receive a RFA orientationUndergo 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, or 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 of 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”
o 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
o RFA must be updated within 30 days
o 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)
o 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)
o Current caregivers with an approved adoptive home study competed before 1/1/18 are automatically deemed RFA approved.
Due Processo 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
o 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 or mental abuse, abandonment, or any other substantial threat to his or her health or safety
o Hearings are to be confidential and not open to the public, with a case by case exception
o 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 RFAo RFA approval is taking far longer than intended causing long delays in
approvals and has led to a statewide crisis:
o Delays in placements with caregiver relatives
o Delays in transitioning children to family settings
o Discouraging families from signing up as foster families or remaining families within our system.
o 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:
o Placement disruptions due to lack of funding
o 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 on 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 of 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 helpthe caregiver complete (1) the RFA application and (2) the EA or ARC application at the moment of placement
• Placing worker should submitthe applications immediately on 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 sameAB 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 once 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 CompositionRequired 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, & LogisticsMeetings 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)
o Any team member may request a meeting
o Offered as necessary
• Certified Facilitator Responsibilities
o Explain CFT and purpose to the family
o 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 placement2. 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:
o Specialized Care Increments
o Dual Agency Rate
o Infant Supplement
o Clothing allowance
o 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 offered 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?
o Rates no longer dependent on age
o No distinction between community placement types
o 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 theamount of care and supervision the child needs from the family.A Level of Care (LOC) Protocol tool is being developed to guidethe county LOC determination.
Home-Based Family Care RateImplementation 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
o Independent researchers will study the implementation of Levels 2 – 4 in the FFA placements
o Summer 2018 – all placements statewide will begin receiving the Home Based Family Care Rate as a triggering event occurs
• 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 others 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
• 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 SvidlerPolicy Attorney Policy AssociateAlliance for Children’s Rights Children’s Law Center of California(213) 368-6010 (323) [email protected] [email protected]
