March 15, 2018 Volu Volume 15, Issue 515, Issue 5

ACHSA ACHSA Mid-Month BulletinMid-Month Bulletin

Inside This Issue (click to go directly to the article):1. DCFS Hosts Resource Family Approval Stakeholder Brainstorming Forum

and ACHSA Offers Assistance of Providers to Complete Family Evaluations for County Resource Parent Applicants

2. California State Auditor Issues Mental Health Services Act State Audit Findings

3. Results of ACHSA Survey on Needs and Services Plan CSW Signature Requests and Subsequent Advocacy

4. Maria Funk Visits with ACHSA Adult Mental Health Committee to Discuss Housing Issues in L.A. County

5. L.A. County Education Coordinating Council 2017 Annual Report 6. ACHSA Holds AB 109 Meeting with DMH and Probation to Discuss Provider

Concerns Regarding the Operation of the Program7. Child Welfare Nuts & Bolts 8. Mental Health Odds & Ends 9. Upcoming ACHSA Meetings & Events

ISSUE BRIEFS & UPDATES

DCFS Hosts Resource Family Approval Stakeholder Brainstorming Forum and ACHSA Offers Assistance of Providers to Complete Family Evaluations for County Resource Parent Applicants

On February 26th, DCFS convened a forum of stakeholders in order to strategize and garner support to address the Department’s current challenges related to resource family approval (RFA) in Los Angeles County.

DCFS Director Bobby Cagle began the meeting with opening remarks explaining the new initiatives of the Continuum of Care Reform that DCFS is simultaneously implementing, including RFA, Short Term Residential Therapeutic Programs, Child and Family Teams, and the Levels of Care.

Bobby emphasized how difficult it has been for the Department to meet the ninety-day timeline established by the state to complete the RFA process. DCFS currently has 106 dedicated social workers completing approvals, and the Department estimates that it needs 100 more RFA workers in order to complete the approval process within ninety days,

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which has been incorporated into the DCFS budget for FY 2018-19. Bobby explained that given the lengthy budget process and the

necessary training to be provided to new RFA workers, DCFS estimates that the hiring of the 100 additional workers will not be complete until October and November. The Department’s current priority therefore is to identify immediate steps that can be taken between now and October/November to increase the number of approvals completed within ninety days and to decrease the backlog of pending referrals. Overview of Resource Family Approval

DCFS Deputy Director Karen Richardson then provided an overview of RFA including its history throughout the state. She explained the progress that DCFS has made over the last couple of years through its RFA implementation in January 2017 including the submission of the L.A. County RFA Implementation Plan to CDSS for approval in September 2016 and the execution of Relative Home Assessment Services (RHAS) and Relative Support Services (RSS) contracts in December 2016.

Karen noted that the state has set a deadline of December 2019 for the complete conversion of existing approved relative caregivers/non-related extended family members and licensed foster parents to resource parents.

Karen explained the areas in which the RHAS program assists the RFA CSW including: 1) home environment assessments, Corrective Action Plans, and tangible supports; 2) document retrieval assistance; 3) application completion and applicant orientation; 4) transportation to Live Scan and CalWORKS appointments; 5) pre-approval, post-approval and CPR/first aid training; and 6) RSS assessments and referrals.

Karen shared the status of the 7,650 RFA referrals that DCFS has received between January 1, 2017 and January 31, 2018: 1,005 (13%) have been approved. 43 (less than 1%) have been denied. 1,897 (25%) have withdrawn. 4,705 (62%) are in process.

Of the 4,705 prospective resource families that are in process, 1,366 are currently caring for children and 3,339 are not currently caring for children but may be awaiting the placement of specific children into their care. Approximately 71% of the prospective resource families in process have been in the RFA process for more than ninety days.

Karen explained that delayed dispositions for prospective resource families currently caring for children are especially problematic given that federal foster care funding is not available until a resource family has been approved and retroactive funding for the approval period is not available. DCFS has seen that increased financial difficulties for such caregivers, which has impacted placement stability and child well-being.

Additionally, Karen shared that delayed dispositions have generally resulted in delays in transitioning children from higher levels of care to family settings and have contributed to an already insufficient capacity of

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resource families for effective placement matching. As well, the delays have negatively impacted resource family recruitment.

Karen then described the factors impacting timely completion of RFAs including: 1) the volume of pending written reports; 2) processing and approval of criminal record exemptions; 3) incomplete background checks; 4) applicant delays in scheduling pre-approval training; and 5) Documented Alternative Plans and Corrective Action Plans.

DCFS has also experienced challenges in resource parent applicants’ scheduling interviews, submitting necessary forms/documents, and completing health screenings/questionnaires. Karen noted however that requirements related to these factors have been streamlined in the most recent version of the Written Directives and may therefore become less impactful on the RFA process.

DCFS then provided an overview of the strategies utilized by the Department thus far in addressing challenges in the RFA process including: Convening weekly calls with the DCFS Director, RFA managers and

supervisors to discuss the status of unit approvals Providing refresher RFA trainings for CSWs Requesting tablets for RFA CSWs Establishing a criminal record exemption unit and providing mobile

Live Scans Offering pre-approval training in home or online Allowing overtime to DCFS staff Making budget requests for additional staff Exploring the use of retired and temporary DCFS staff Assessing the amendment of existing RHAS and RSS contracts

Discussion of Strategies to Address Resource Family Approval Backlog The next portion of the meeting was dedicated to an open discussion

focused on pinpointing the gaps in current partnerships and infrastructure and identifying capacity needs. Key points are highlighted below.

Strengthened Partnerships and Information Sharing with Other Agencies – Meeting participants suggested strengthening partnerships with other agencies (e.g., DMV, DPSS, CalWorks) to streamline the sharing of documentation and improve communication. This lead to discussion regarding the need for improved access to law enforcement records as is done in other states.

Enhanced Training for CSWs and Judges – Remarks were made supporting enhanced training for case carrying CSWs and juvenile court judges who are often not familiar with the RFA process. This lack of understanding has resulted in children being placed in caregiver settings that clearly cannot meet the RFA standards.

Establishment of Target Timeframes and Tracking System – One meeting participant suggested that DCFS establish basic designated timeframes

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for each sequential step of the RFA process to measure where delays are greatest and to provide guidance to prospective resource families to navigate through the process. Likewise, it was recommended that DCFS track the status of each RFA case in a centralized ledger from which data could be easily shared and extracted.

Analysis of Delays by Service Area – Meeting participants stressed the need to more specifically analyze the delays in each Service Area, including the reasons for the backlogs, which may be unique to each Service Area. This would allow for targeted resolution at specific steps of the RFA process.

Development of RFA Description for Potential Resource Parents – Meeting participants suggested developing a basic one page introduction to the RFA process for ER CSWs to provide to prospective resource parents, noting that conversations related to RFA should begin to happen as early as possible.

RHAS Assistance in Obtaining Documentation – RHAS providers noted that they generally complete their home environment assessments and pre-approval training prior to the RFA worker’s initiation of the family evaluation. Given this sequence of events, RHAS providers are not able to readily assist resource parent applicants to obtain documentation needed for the family evaluation, although RHAS providers noted that they would be willing to do so. RHAS providers recommended that the RFA worker complete a uniform checklist of possible documentation needs for each applicant at the outset of the RFA process that could be used to inform the RHAS program of areas in which the applicant may benefit from assistance.

Use of “Strike Teams” – Child Welfare Board Deputies suggested mobilizing “strike teams” of specially designated CSWs to address the most challenging areas related to the RFA process.

Resource Parent Navigators – Meeting participants suggested piloting the use of compensated navigators (ideally resource parents themselves) who would support resource parent applicants through the approval process.ACHSA Offers Support of Provider Organizations to Complete Family Evaluations

ACHSA shared an overview of the brainstorming forum with the ACHSA Board of Directors at the ACHSA Board meeting in early March, highlighting the Department’s data related to its backlog of prospective resource parents and the Department’s specific challenging areas related to the resource family approval process. The ACHSA Board asked that we communicate to DCFS that ACHSA would like to support the Department in addressing the RFA backlog, however possible, in response to Bobby’s plea at the ACHSA Child Welfare CEO/ED Forum on February 15th.

Given that the Department’s primary challenge seems to be the sheer volume of family evaluations that need to be completed, ACHSA

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suggested to DCFS that providers could assist the Department in completing family evaluations.

ACHSA agencies are currently assisting surrounding counties in completing family evaluations. In these counties, the provider completes the family evaluation for the county’s prospective resource parent, while the county retains the ability to make the ultimate decision as to whether or not to approve the individual.

Please contact Jodi with any questions.

California State Auditor Issues Mental Health Services Act State Audit Findings

Introduction On February 27th, the Office of the California State Auditor released an

audit of the Mental Health Services Act (MHSA). For this audit, the State Auditor evaluated the effectiveness of two state entities, the Department of Health Care Services (DHCS) and the Mental Health Services Oversight and Accountability Commission (MHSOAC), in providing oversight of MHSA funding.

The audit found that DHCS and the MHSOAC could better ensure that the 59 county and local mental health agencies effectively use the MHSA funds they receive.

This article serves to provide an overview of the findings of the audit that pertain to DHCS. Findings from the audit pertaining to the MHSOAC can be found in the full MHSA State Audit accessible here.

Overall findings of the audit concerning DHCS were that:

DHCS has not developed a process for reversion, that allowed counties to amass $231 million in unspent funds, not including reserves.

DHCS has not provided guidance on interest accrued by MHSA funds, resulting in counties accumulating $81 million in unspent interest.

DHCS has not established a process for oversight of reserve funds, resulting in between $157 million and $274 million in excessive reserves.

DHCS had not addressed a $225 million fund balance in the Mental Health Services Act Fund, which they are now working to address as a result of this audit.

DHCS Ineffective Oversight of Local Mental Health Agencies and the Mental Health Services Fund

The State Auditor found that DHCS has not developed a process—known as reversion—to recover unspent MHSA funds from local mental health agencies after the statutory time frames for spending the funds have elapsed. As a result, the local mental health agencies have had less

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incentive to spend MHSA funds in a timely manner and had amassed unspent funds of $231 million—not including reserves—as of the end of fiscal year 2015–16 that they should have reverted to the State for it to reallocate to other local mental health agencies.

State law requires local mental health agencies to revert unspent MHSA funds within certain time frames as the MHSA intended for local mental health agencies to provide services for the mentally ill, not amass unspent funds.

However, the Legislature enacted a one-time change in state law in 2017 that allowed local mental health agencies to retain all funds that were subject to reversion as of July 1, 2017. However, this one-time allowance does not resolve the larger issue that DHCS has not been proactive in implementing a process to revert unspent MHSA funds. This state law required DHCS to develop a reversion calculation methodology and provide related guidance to the local mental health agencies and the MHSA reversion requirements begin again for the fiscal year 2017–18 funding cycle.

Lacking incentive from DHCS to spend their MHSA funds in a timely manner, local mental health agencies had accumulated $2.5 billion in unspent MHSA funds as of fiscal year 2015–16. Although local mental health agencies are permitted to spend each year’s allocation of MHSA funds over several years and may also maintain MHSA funds as reserves, DHCS estimated that as of September 2017 local mental health agencies should have returned $231 million of this $2.5 billion to the State because they did not spend it within required time frames.

Although DHCS determined that it needed reversion regulations in fiscal year 2015–16, they claimed that other MHSA-related priorities delayed them from developing these regulations. DHCS began development of draft regulations in 2016, but does not plan to submit them for regulatory review until June 2018. Under the Administrative Procedures Act, DHCS is required to implement a public comment period as a part of this process which can take from 4 up to 12 months. As a result, if DHCS does submit the regulations in June 2018, these regulations would not be in place until sometime between October 2018 and June 2019.

Despite the claimed obstacles claimed by DHCS, the State Auditor found that given the funding DHCS has received and the amount of time that has elapsed since DHCS became responsible for developing these regulations, appropriate action to implement a reversion process should have already occurred.

Additionally, in the absence of DHCS’ guidance, local mental health agencies have been inconsistent in how they treat the interest they have earned on MHSA funds. As a result, the local mental health agencies had accumulated a total of $81 million in unspent MHSA interest through fiscal year 2015–16.

State law requires that local mental health agencies use the interest they earn on MHSA funds for their MHSA programs but does not specify the

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MHSA programs on which the local mental health agencies may spend interest or whether the interest is subject to reversion. Without statutory instructions to the contrary, the interest a government entity earns on deposited funds is generally subject to the same requirements as the funds earning the interest. Thus, accrued interest on MHSA funds, if not spent, is subject to the same three- or 10-year reversion time frames as the MHSA funds themselves.

Further, DHCS has not established a process for overseeing the sufficiency of local mental health agencies’ MHSA fund reserves, which totaled $535 million at the end of fiscal year 2015–16. In their August 2013 audit report, the State Auditor indicated that DHCS was to define what constitutes the appropriate reserve level that local mental health agencies should maintain from their MHSA fund allocations. DHCS has failed to address this recommendation.

As a result of the absence of DHCS’ oversight, the State Auditor estimated that local mental health agencies held between $157 million and $274 million in excessive reserves as of the end of fiscal year 2015–16. The State Auditor estimated that if DHCS had required the local mental health agencies to maintain reserve levels of 23% for fiscal year 2015–16, they could have had an additional $274 million available to provide mental health services. Alternately, under a more conservative approach, DHCS could have set the reserve levels at 33%, in which case the State Auditor estimate that the local mental health agencies would have had an additional $157 million to spend on mental health services in fiscal year 2015–16.

Finally, until the inquiry by the State Auditor, DHCS had not investigated the reason for a $225 million fund balance in the Mental Health Services Fund and whether the amount represented funds due to local mental health agencies or was a long-standing accounting error. As a result of the State inquiry, DHCS is working with the State Controller's Office to resolve this issue.

DHCS has Provided Minimal Oversight of the MHSA Funds That Local Mental Health Agencies Received

The State Auditor determined that DHCS has made minimal efforts to ensure that local mental health agencies submit their annual reports on time. As a result, some local mental health agencies have not submitted timely annual reports for years, hindering DHCS’ ability to calculate MHSA reversion amounts and to properly oversee MHSA spending.

State law requires DHCS to administer, collect, and publish the annual reports, which identify each local mental health agency’s MHSA Fund revenues, expenditures, and interest earned. Because state law requires DHCS to use the annual reports to determine any MHSA funds subject to reversion, the audit explained that their effectiveness is essential to their ability to perform its oversight functions.

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State regulation requires the local mental health agencies to submit their annual reports by December 31 following the end of the fiscal year, June 30. Although DHCS developed instructions to facilitate completion of the annual reports, the audit found that their records show most local mental health agencies have failed to submit their annual reports on time over the past few years. For example, only one of the 59 local mental health agencies submitted its fiscal year 2015–16 annual report by the regulatory deadline. Additionally, as of December 2017, nine local mental health agencies had yet to submit their fiscal year 2015–16 annual reports and an additional three had not finalized their annual reports in response to DHCS’ concerns.

One of the nine local mental health agencies that did not submit its fiscal year 2015–16 annual report is Los Angeles County – the largest local mental health agency in the State. LA County indicated that it expects to submit the fiscal year 2015–16 annual report in early 2018, and it asserted that it will be able to meet the submission deadline for future reports after it finalizes an overhaul of its cost reporting process, which it expects to complete by fiscal year 2018–19.

In 2014, DHCS claimed that state law did not clearly support these regulations and that they might be at risk of legal challenges if they pursued following them. Nevertheless, DHCS has made minimal effort to address its perceived lack of enforcement authority. The State Auditor established that DHCS has had the legal authority and funding to establish regulations that would allow it to implement sanctions against local mental health agencies that do not comply with the annual reporting requirements since 2012, when it became responsible for the MHSA. Although DHCS intends to address this issue in regulations it is currently developing, it does not anticipate submitting these regulations for regulatory review until June 2018.

Absent specific legal authority for allowing it to formally change the submission deadline, the audit reported that the State Auditor legal counsel believes DHCS’ deadline extensions are unlawful. DHCS explained that it is not tracking the number of deadline extensions it has granted to the local mental health agencies and will not enforce the established annual report submission deadline until it implements new regulations that give it the right to do so. The audit explained that, unless it ensures that local mental health agencies submit their annual reports on time, DHCS will hamper its own efforts to effectively monitor MHSA spending, reserves, interest earned, and funds subject to reversion.

The audit found that DHCS has been ineffective in implementing oversight of local mental health agencies’ MHSA spending and programs. Although DHCS developed a MHSA fiscal audit process in 2014, it has limited the audits’ usefulness because it focused its reviews on data and processes that were at least seven years old. According to state law, DHCS must enter a performance contract with each local mental health

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agency that establishes how the local mental health agency will implement MHSA requirements. As part of the performance contract, the local mental health agency must agree to comply with all state laws and regulations regarding the allocation and use of MHSA funds, and it also must agree to allow access to its records and programs for state audits and reviews.

Although DHCS has taken some steps toward implementing fiscal audits, it had not completed an audit for any local mental health agency as of December 2017.

DHCS indicated that it will not release audit results for local mental health agencies until it establishes a regulatory appeals process that enables them to challenge any of its findings of unallowed costs. DHCS indicated that the appeals regulations for regulatory review will not be submitted until approximately September 2018. Because this process could take between 4 and 12 months, these regulations would not be in place until sometime between January 2019 and September 2019.

The State Auditor recommended that DHCS conduct comprehensive on-site MHSA program reviews in their August 2013. However, DHCS has failed to efficiently implement a comprehensive MHSA program review process that will enable it to assess how each local mental health agency allocates, spends, and monitors its MHSA funds.

Summary of State Auditor Recommendations to DHCS To effectively monitor MHSA spending and provide guidance to the local

mental health agencies, the State Auditor found that DHCS should publish its proposed regulations in the California Regulatory Notice Register by June 2018 and subsequently take the following actions:

Develop an MHSA fiscal reversion process to ensure that the State can reallocate any MHSA funds that local mental health agencies do not spend within the statutory reversion time frames to other local mental health agencies that are better positioned to use the funds to meet the MHSA’s intent.

Clarify that the interest the local mental health agencies earn on unspent MHSA funds is subject to the same reversion requirements as the MHSA funds they receive.

Establish and enforce an MHSA reserve level that will allow local mental health agencies to maintain sufficient funds to continue providing crucial mental health services in times of economic hardship, but that will not result in them holding reserves that are excessive. DHCS should also establish controls over local mental health agencies’ deposits and withdrawals to their reserves.

Additionally, the audit established that DHCS should complete its analysis of the $225 million fund balance in the MHS Fund by May 1, 2018, to determine why this balance existed, whether there is any impact on funding to the local mental health agencies. If it is determined that there is an impact on funding, DHCS is to distribute those funds accordingly.

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Further, it should establish a process to regularly scrutinize the MHS Fund to identify any excess fund balances and the reasons for such balances.

To effectively monitor the issues relating to DHCS’s oversight of the MHSA funds that local mental health agencies received, the State Auditor proposed the following: To ensure that it provides effective oversight of local mental health

agencies’ reporting of MHSA funds, DHCS should publish its proposed regulations in the California Regulatory Notice Register by June 2018. DHCS should then subsequently implement a process that will enable it to withhold MHSA funds from local mental health agencies that fail to submit their annual reports on time.

To ensure that local mental health agencies appropriately spend MHSA funds, DHCS should publish its proposed regulations in the California Regulatory Notice Register by September 2018. It should then develop and implement an MHSA fiscal audit process, independent of the Medi-Cal reviews, to review revenues and expenditures for the most recent fiscal year.

To ensure that local mental health agencies comply with their performance contracts and MHSA requirements, DHCS should establish a process for conducting comprehensive program reviews and begin conducting those reviews by July 2018.

Please contact TJ or Claire with any questions.

Results of ACHSA Survey on Needs and Services Plan CSW Signature Requests and Subsequent Advocacy

When we last reported to you in the January 15 th ACHSA Bulletin , ACHSA had recently highlighted at the ACHSA-DCFS Executive Management meeting the continued systemic challenges encountered by providers attempting to obtain CSW signatures on Needs & Services Plans (NSPs) and following the protocol requiring up to six documented attempts to obtain CSW signatures.

In order to determine the extent of the problem of lack of CSW responsiveness to NSP signature requests, ACHSA informed DCFS that it was conducting a survey of its FFA and residential providers. DCFS representatives expressed interest in seeing the survey results, and asked ACHSA to proposed suggested revisions to the current guidelines requiring multiple CSW signature attempts, which DCFS would consider.

Results of ACHSA Survey In 2017, ACHSA conducted a survey regarding challenges in obtaining

CSW signatures on NSPs. Sixteen providers reported data from the period between October 1st and December 31st, of which thirteen agencies reported data from their FFA programs and five agencies

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reported data from their residential programs. During the survey period, agencies reported that a total of 955 NSPs

were submitted to CSWs for their signatures, of which 758 (79%) received a CSW signature and 197 (21%) did not receive a CSW signature. For the NSPs that received a CSW signature, over half required more than one request for a CSW signature and nearly 30% required three or more requests for a CSW signature.

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The survey includes an analysis by DCFS Regional Office of challenges in obtaining CSW signatures on NSPs. It was determined that almost all DCFS Regional Offices experience significant challenges in CSWs provided a timely signature on NSPs.

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Identified Administrative Challenges/Burden in Obtaining CSW Signatures

In addition to sharing the above survey results with DCFS, ACHSA expressed serious concerns regarding the current County guidelines requiring the “escalation” of CSW NSP signature requests. Providers

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have reported that CSWs are reluctant or unwilling to open encrypted emails, which are used by providers to send NSPs in order to be HIPAA compliant.

ACHSA noted that the guidelines drain providers not only due to the amount of staff time dedicated to tracking and preparing NSP signature requests, but also the staff time dedicated to simply identifying who the escalated requests should be sent to.

For DCFS youth, the appropriate Assistant Regional Administrator (ARA) is not routinely made known to the provider at placement, thereby necessitating that the provider contact the DCFS Regional Office in order to obtain the ARA contact information. Providers have reported that the Regional Office receptionists often are not willing to disclose any information; that it is difficult to reach the Regional Office duty worker; and that the Regional Office duty workers will never share email addresses and often will not provide the ARA’s contact information.

As demonstrated by ACHSA’s survey, providers are forced to use the NSP signature request escalation protocol for most cases, which consumes an intensive amount of staff time and strains relationships with individual CSWs. The escalation of CSW signature request attempts is a significant administrative burden which does not ultimately enhance child safety and well-being or the quality of care provided by agencies.       

ACHSA Proposed Revisions to Current Guidelines to Obtain CSW Signatures on NSPs

As requested by DCFS, the ACHSA FFA and Residential Committees developed recommended revisions to the instructions for obtaining CSW signatures. The recommendations include allowing five additional business days to obtain the CSW signature on the NSP and decreasing the number of required CSW signature requests to one.

Next Steps As a preliminary response to ACHSA’s survey results, DCFS has

informed ACHSA that an electronic NSP system that would allow providers to upload documents and that would automate notifications to CSW, SCSW and other staff could solve many of the challenges identified related to NSPs. ACHSA expressed its support of the development of the electronic NSP system as a long term solution and asked to participate in the County’s workgroup to develop the system.

ACHSA, however, pointed out that an electronic NSP system will take quite some time to plan, design, and implement, noting that ACHSA is interested in identifying an immediate solution to the CSW signature request issue. DCFS is currently reviewing ACHSA’s data and feedback and developing a response.

Please contact Jodi or Alex with any questions.

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Maria Funk Visits with ACHSA Adult Mental Health Committee to Discuss Housing Issues in L.A. County

Introduction On March 12th, ACHSA’s Adult Mental Health Policy Committee

welcomed Maria Funk from the Department of Mental Health as the monthly meeting’s guest speaker. Maria oversees DMH’s Countywide Housing, Employment and Education Resource Development.

Maria gave a presentation capturing the status and updates on DMH housing initiatives and addressed providers’ questions on housing issues and concerns. A digital copy of Maria’s presentation can be found here.

Background on Initiatives to Combat Homelessness Maria presented on the County initiatives to combat homelessness

including the Homeless Initiative and Measure H, Proposition HHH, and No Place Like Home.

She provided background on this history of Measure H highlighting that it was a ballot initiative and was unique due to its presentation at the March election as the first ballot budget item passed during an interim election since 1902. The quarter cent tax allowed for these funds to be allocated toward initiatives to combat homelessness.

On February 9, 2016, the LA County Board of Supervisors adopted a coordinated set of 47 Homeless Initiative strategies to combat homelessness, including strategies in which cities, businesses and faith leaders can participate. This allowed for new one-time funding to be approved in the amount of $99.7 million.

There were five planning meetings to address Measure H Revenue Planning which included stakeholders representing LA County, the City of LA, Councils of Government, Community Based Organizations, the Business community, Faith Leaders, Local Homeless Policy Experts, and Individuals with lived experience.

On June 13th, 2017 the Board Actions approved the Planning Group’s consensus recommendations, funding for FY 2017-2018 and tentative funding for FY 2018-19 and FY 2019-20, and funding for 21 interconnected strategies, including: outreach, crisis/bridge housing, rapid re-housing/permanent supportive housing, prevention help for families and individuals.

The Homeless Initiatives Strategies allowed for the Continuum of Services which are known by those who work on the housing initiatives as Outreach – E6, Interim/Bridge Housing – B7/E8, Rapid Rehousing – B3, Permanent Supportive Housing – D7, Benefits Advocacy – C4/C5/C6, and Strengthening the Coordinated Entry System – E7.

Strategy D7

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Since providers had many questions pertaining to the inclusion of services with housing initiatives, Maria went in to detail on information pertaining to Strategy D7 as it heavily relates to the provision of services with housing.

Under Measure H, Strategy D7 provides services and subsidies for Permanent Supportive Housing (PSH). Strategy D7 will allow for 100% of all D7 participants to receive Intensive Case Management Services (ICMS) through DHS. Services funding for existing project based sites will begin to roll out to developers. Additionally, Strategy D7 will allow for approximately 30% of participants to receive Housing Full Service Partnership (Housing FSP) services through DMH and approximately 30% will receive Community Engagement & Navigation Services (CENS) under SAPC through DPH.

ICMS services are based on a “whatever it takes” approach which allows services to be comprehensive and tailored for each client. These services assist clients in the following areas:

Obtaining necessary documentation Completing and submitting rental subsidy application Housing search Eviction prevention support and intervention Ongoing client support and home visits Making and keeping appointments for health, mental health and

SUD services Transportation Ensuring access and enrollment in health and income benefits

Housing FSP services are focused on helping clients manage the symptoms of their mental illness and assisting them with their mental health wellness and recovery goals. The development of the Housing FSP was a part of the Department’s FSP expansion of approximately 5,000 slots. Services include:

Individual/Group Therapy/Counseling Medication Support Crisis Intervention Referrals and Linkage

CENS includes outreach and engagement, screening and referral, SUD service navigation, and care coordination to improve access to SUD services. Another component of the Substance Use Disorder Services provided through PSH is Field Based Navigation Services which includes outpatient and intensive outpatient SUD services, including individual and group counseling.

Initiatives under Strategy D7 only provide services to clients in new Permeant Supportive Housing developments. However, to account for existing housing developments that do not yet provide services, $7.5 million has been set aside to address how this need should be met with stakeholders. The Department has a strategy to reach out to developers who already have housing to determine funding gaps and existing

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Permanent Supportive Housing in order to then effectively implement services through Strategy D7 to them.

Additionally, DMH is working to integrate Strategy D7 services into housing that the Department has already invested millions of dollars in. Maria explained that in 2007, DMH created the Housing Trust Fund. As the Housing Trust Fund now phases out, the Department has offered providers who were involved in the program to now become ICMS providers. Although Maria recognized that this is a point of confusion for many providers involved in housing, she explained that DMH is providing MHSA funding through DHS’s contracts to fund ICMS in order to serve DMH clients. This will allow the Housing FSP and ICMS to be integrated into all existing DMH housing that do not currently have services.

Maria reported that contracts for these initiatives were determined based on existing partnerships with providers. If no existing partnerships existed, the Department sought out agencies that were already providing services to clients in DMH buildings.

Maria was proud to report that many DMH mental health providers who were not previously ICMS providers have gained the opportunity to expand by becoming ICMS providers through these DMH initiatives.

Maria explained that because ICMS is being provided by DHS, DMH does not have to worry about providing as much case management as it typically does under DMH.

Maria reported that the ICMS Master Agreement is open continuously and available on the DHS website. She encouraged provides to apply as the Master Agreement is very simple and easy to qualify for.

Additionally, Maria explained that the Department is considering having an umbrella agreement between providers and the Health Agency. Under this kind of agreement, providers could potentially hold an ICMS, Housing FSP, and SAPC contract. This would also minimize paperwork for providers by eliminating the need to apply to multiple agencies for the various service programs. Assuming the Department can move to this new strategy, the goal would be to maximize contracts.

Under the Health Agency, DHS, DMH and DPH are working to identify providers for all three types of services whether it be for the Housing FSP, CENS, or ICMS. The goal of this collaboration is to establish a pipeline which allows for clients to receive the appropriate services more efficiently. Services providers will be identified in each SPA to ensure the accessibility of services to clients. An ongoing expansion of providers will also be occurring in order to meet the need. Integration of all key contracted partners in this process will be facilitated by DHS, DMH, and DPH.

Maria covered how Strategy D7 will work for a person experiencing homelessness. People may be identified by street based engagement teams, shelter operators, hospitals, clinics, jails, city staff, other systems of care, self referrals, walk-ins to a CES lead agency, etc. Once identified, clients will be assigned the appropriate triage/assessment tool

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to be administered. The client profile and triage score is then updated or created in HMIS and clients will be prioritized by highest acuity/need and length of time homeless to agencies contracted for ICMS. Clients prioritized into available ICMS slots will be referred to receive ICMS services and will be connected to a housing resource.

Maria explained that DMH is currently in the process of negotiating contracts with agencies who responses to outreach on the Housing FSP and that the Department is hoping to establish contract amendments by May 1st.

Measure H Updates Maria presented outcomes data that captured outcomes between July –

December 2017 which reported some of the following highlights:o 7,297 individuals entered crisis, bridge, and interim housing

including 811 individuals discharged from institutions. o Approximately 3,350 homeless families and individuals secured

permanent housing through specific HI strategies including: 1,385 rapid re-housing participants 1,064 individuals from emergency shelter 483 disabled adults pursuing SSI were housed

Maria emphasized that there is a huge initiative through Measure H to assist clients with getting connected to benefits. If providers have homeless clients in need of assistance to apply for social security, SSI, or Veteran benefits, Maria reported that providers can work with community organizations that have been contracted through Measure H initiatives to accomplish this.

On Friday, the “Everyone In” Campaign was launched, which Maria explained is another initiative under Measure H. Through this campaigned, the County has hired United Way to make sure the community is informed and participating in the homelessness initiatives occurring as a result of Measure H. Another component of the campaign is working to address issues that occur related to citing.

Maria explained that DMH is in the process of making FY 2018-19 funding recommendations. The County Board of Supervisors is looking at the funding recommendations along with housing demand and service needs in order to evaluate where efforts should be expanded. The funding recommendation can be found on the homeless initiatives website. After the public hearing is held on the funding recommendations, they will go through Board for approval.

Maria explained that the LHSA Gap Analysis is being used as one of the documents to determining how funds should be allocated towards housing. One big change in the funding recommendation is to fill the gap for interim housing. This has been identified as a gap of 3,250 beds. There is a great interest among elected officials to address the gap and, therefore, providing additional interim housing is currently a priority.

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Proposition HHH and No Place Like Home Maria reported on Proposition HHH which provides the City of LA with

the authority to issue up to $1.2 million in General Obligation bonds. All proceeds will be used to fund Permanent Supportive Housing and facilities targeting a homeless and special needs population and the City of LA has committed to developing 1,000 units per year for 10 years. Supportive Services for HHH housing will be provided through D7 and there are also plans to leverage No Place Like Home (NPLH) dollars.

Maria explained that NPLH authorizes $2 Billion in bond proceeds to finance the capital costs and Capitalized Operating Subsidy Resources of Assisted Units in rental housing developments for persons who have a mental illness and are experiencing homelessness, chronic homelessness, or who are at risk of chronic homelessness. The bonds are paid for through MHSA funds.

The target population for the NPLH initiatives are those who are chronically homeless, homeless, and at-risk of chronic homelessness. Additionally, all target populations must be adults living with a diagnosed Serious Mental Disorder or children or adolescents with a Serious Emotional Disturbance as defined under MHSA.

Maria explained that counties that have over 5% of the State’s share of the homeless population have been granted the ability to administer these funds themselves. Since LA County falls into this category, the County has the option and flexibility to administer the funds on its own. Maria reported that DMH has been meeting with the County Board of Supervisors as they have the authority to make these decisions. Maria reported that the Board supports the idea of administering the funds through the Community Development Corporation (CDC).

At this point, DMH is preparing for this decision to be made and for the NPLH dollars to get approved through a court validation hearing. It is predicted that, once the funds are validated, LA County will be obtaining $5-7 billion in funds to implement permeant supportive housing which must be done within two years after they are received.

In lieu of the immediate allocation of NPLH funds, Maria explained that DMH has allocated $50 million of MHSA funds to CDC for PSH to prime the pump for implementation of NPLH. After CDC’s NOFA 23A released in September 2017, 10 developments were eligible for funding requesting $43,750,000 to generate 230 units for those that are homeless and have a mental illness. $43.75 million of MHSA funds have been allocated for the 10 eligible developments and Supervisorial Districts 2 and 3 put forth a motion on January 16, 2017 to dedicated $9.17 million of County’s Affordable Housing Trust funds in order to fund all eligible MHSA proposals. $6.25 million of these funds were set aside for Innovative Housing Developments.

Maria reported that many stakeholder meetings were held on Innovative Housing Developments, which ACHSA was active in, to review models of innovative permanent supportive housing development. The units are

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expensive but would be dedicated to the population for 55 years. Units with cheaper and faster implementation models have been agreed to be prioritized for access to the $6.25 million of funding that was set aside for innovative housing developments.

Additional Updates Maria also provided updates on AB 210, legislation the County put

forward at the State level. One frustration for people working in the field is the inability to communicate with each other because of privacy issue. AB 210 allows for those working on multi-disciplinary teams to communicate without violating privacy issues. The legislation was approved in January and now the LA County CEO must determine and submit implementation protocols to locally implement information sharing among service providers. DMH Legal Entity Partners would be allowed to participate once the protocols are established

If providers are interested in gaining RFP funding from LAHSA, Maria recommended going through the Los Angeles Homeless Services Authority (LAHSA) to get on their Master Agreement list.

Please contact TJ or Claire with any questions.

L.A. County Education Coordinating Council 2017 Annual Report

On January 31st, the Education Coordinating Council (ECC) released its 2017 Annual Report. The ECC was created in 2004 by the Los Angeles County Board of Supervisors to improve educational achievement in system-involved youth and is now housed under the umbrella of the Los Angeles County Office of Child Protection (OCP).

Members include directors from the Department of Children and Family Services (DCFS), Probation Department, Department of Mental Health (DMH), superintendents from various Los Angeles County school districts, the presiding judge of the Juvenile Court, advocates, community-based organizations, and former foster and probation youth.

The 2016-2021 ECC Strategic Plan outlines priority areas, outcomes, and actions to accomplish its mission of educational achievement for system-involved youth. A summary of the five priority areas and outcomes are summarized below.

Priority Area I: Enrollment in Early Childhood Education In partnership with DCFS, the ECC created a workgroup to focus on

connecting Los Angeles County foster youth with early childhood education programs. Many early childhood education programs (ECEs) have difficult and complicated enrollment processes and enrollment windows. The workgroup has created immediate goals, which include

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mapping ECE resources, helping families access and navigate the ECE system, and enhancing DCFS’s ability to make referrals electronically and to track whether services are received.

Long-term, the workgroup plans to develop strategies for utilizing existing ECE resources more efficiently regardless of funding source and to seize opportunities to expand the quantity and quality of ECE services in communities with the largest gaps between supply and demand.

Since the June 2017 release of the Office of Child Protection’s (OCP) prevention plan, this workgroup has been subsumed into the overall prevention work and transferred to the Policy Roundtable for Child Care and Development.

Priority Area II: Achievement for School-Aged Youth School Stability

On February 7, 2017, the Board of Supervisors directed the OCP and the Los Angeles County Office of Education (LACOE) to create an implementation plan and timeline for compliance with the Every Student Succeeds Act (ESSA) school stability provisions. The ESSA requires local child welfare agencies and school districts to jointly establish long-term transportation plans to transport foster youth to their schools of origin to aid in educational stability.

The ECC and LACOE convened an ESSA Transportation Workgroup, which then created an ESSA transportation pilot to collect and analyze data to inform a future long-term transportation plan. The pilot was implemented in September 2017 and is expected to continue through June 2018.

The pilot will be evaluated through the Children’s Data Network and presented to the Board of Supervisors in July 2018. Input from the workgroup and data from the evaluation will be used by the Alliance for Children’s Rights to develop an initial draft of a long-term ESSA transportation plan.

Continuum-of-Care Reform (CCR) In November 2017, the ECC entered into an interagency

Memorandum of Understanding (MOU) regarding CCR with DCFS, Probation, DMH, and LACOE. The ECC’s role is to work with members and stakeholders to gather input and advocate for best practices regarding: (1) addressing the educational/emotional needs of system-involved youth in schools; (2) coordinating school-based mental health services with other mental health supports; (3) utilizing Special Education Local Plan Area (SELPA)/school district special education dollars to address the mental health needs of foster and probation youth; (4) creating transparency as to how schools are providing and funding mental health programs and well as the quality of and access to those programs for system-involved youth.

A local CCR education subgroup was created to focus on the education implications of CCR. This group will create school district

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policies/agreements that allow outside providers on school campuses and contribute to clarifying issues that are barriers to coordination of care, such as health privacy laws, Medi-Cal billing, and explicit standards and expectations for the required coordination of services.

Local Control and Accountability Plans (LCAPs) The ECC regularly attended Coalition for Educational Equity for

Foster Youth (CEEFYY) meetings until their dissolution in September 2017. During those meetings, the ECC provided guidance in integrating key areas for foster youth, encouraged school districts to complete LCAP evaluations, urged the state to develop a rubric to help districts assess their LCAPs, and reviewed completed LCAPs.

Moving forward, the ECC will participate in stakeholder engagement that school districts are now required to employ under the law. The ECC will use this engagement as an opportunity to advocate for district LCAPs to be aligned with goals set forth in the 2016-2021 ECC Strategic Plan.

Trauma-Informed Care The ECC examined trauma-informed care at the classroom, individual,

and systems levels. At the classroom/individual level, ECC members engaged with many partners, including LAUSD, LACOE, Probation, DMH, and Alhambra Unified School District to gather best practices. The ECC is sharing these best practices with other school districts and identifying funding models to adopt trauma-informed care in the classroom.

At the systems level, the ECC joined the Los Angeles County Trauma and Resiliency Informed Systems Change Workgroup run by the Center for Collective Wisdom. The ECC provided feedback on the workgroup’s blueprint, Trauma and Resiliency: A Systems Change Approach.

Access to the Arts The ECC would like to increase evidence-based arts education and

alternative programming that improves outcomes for system-involved youth. The ECC has engaged with many nonprofits, including the Spirit Awakening Foundation and the Arts for Incarcerated Youth Network. Together through ECC’s efforts, DCFS and DMH have pledged to explore expanded partnerships to support arts interventions in detention facilities and public schools.

Foster Youth Bill of Rights and Services On July 18, 2017, the Los Angeles Board of Supervisors directed the

Commission for Children and Families to convene a workgroup of multiple partners, including the OCP, to propose a Foster Youth Bill of Rights and Services. The ECC participated in the Communications Subcommittee, which strategized about how the bill of rights could be disseminated countywide through multiple platforms in order to raise community awareness of foster youths’ rights and ensure all current

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and future foster youth, parents, and resource families have access to their rights and services.

Priority Area III: Job/College Access for Transition-Aged Youth (TAY) The ECC is working to develop and implement a career/college pathway

for transition-aged youth. At a pilot demonstration site, partners plan to work with the Palmdale School District, Lancaster School District, and Antelope Valley Union High School District to place five education liaisons in middle and high schools with high concentrations of system-involved youth to implement educational teaming practices and address college preparation. This pilot should help inform a statewide policy agenda.

The ECC submitted a TAY self-sufficiency report to the Board of Supervisors in 2016. Since that time, the ECC has led a workgroup to identify policy barriers that prevented full implementation of a TAY Integrated Service Delivery Model (ISDM) first introduced in 2013. The workgroup recommended changing DCFS’s training for CFT meeting facilitators to that they can better inform and engage youth and families about the importance of including multiple County departments around the table.

The ECC workgroup also began to develop ideas for a single transition plan across County departments for TAY transitioning out of care, including creating an electronic single transition plan with the National Center for Youth Law and LACOE’s Education Passport System.

Priority Area IV: Electronic Information Sharing The ECC aims to move parties toward increased electronic information-

sharing so that the Health and Education Passport (HEP) mandated for each foster youth can be correctly populated with needed information. A proposal for an electronic connection between the Los Angeles Network for Enhanced Services (LANES) and the Department of Public Health (DPH) was approved by the LANES board in April 2017. In this proposal, child welfare public health nurses employed by DPH would use the LANES portal to view health information and to coordinate care and ensure effective treatment for foster youth.

The ECC has led many planning meetings to consider issues like funding access to LANES, privacy of data being accessed, security of the technology in use, and the development of a link. These ECC meetings bring together representatives from LANES, DCFS, DPH, County Counsel, and the Chief Information Officer, and the Chief Executive Office.

The ECC has facilitated moving toward the development of a single electronic data system to be shared among all school districts within the county, with connections and access to a variety of providers. The ECC will examine the DCFS Student Information Tracking System (SITS) and

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LACOE Electronic Passport System (EPS), both of which collect data from local school districts.

Priority V: Research and Evaluation Detailed information was not provided, but the ECC’s related outcome is

to assess the progress of the educational achievement level for system-involved youth in Los Angeles County.

Please contact Abby with any questions.

ACHSA Holds AB 109 Meeting with DMH and Probation to Discuss Provider Concerns Regarding the Operation of the Program

Background Since June of 2017, ACHSA has been working to resolve issues identified

by our AB 109 providers to the Department of Mental Health. ACHSA AB 109 providers have expressed concerns regarding the program that pertain to staff safety, incomplete sharing of information, lack of support from DMH and Probation, and overall provider expectations.

ACHSA met with the Department first on November 8, 2017 to collectively agree on the key issues and to begin to discuss a set of necessary action steps to address the issues providers have experienced. These ACHSA AB 109 Issues and Necessary Action Steps were further discussed at a meeting on March 1st, when ACHSA and its AB 109 providers hosted DMH and Probation. Representatives from DMH at the meeting included Dr. Robin Kay, Mary Marx, and Tara Yaralian, and Reaver Bingham and others represented Probation.

The meeting allowed for constructive discussion on how ACHSA, DMH, and Probation will be collectively moving forward to address the necessary actions steps.

Staff Safety and Liability In terms of the issue of staff safety, ACHSA identified the need to explore

the potential of AB 109 Probation Officers or law enforcement accompanying the agency clinician(s) into the field in extreme cases. Reaver made it clear that Probation did not have the resources to send P.O.s into the field in most cases.

Instead, he suggested that Probation would be interested in making accommodations for meetings to be held at the Probation Offices in extreme cases, but he asked how these cases would be defined. Bruce said that they would be determined based on a risk assessment, which ACHSA would work on drafting and then sharing with Probation and DMH for further discussion.

Reaver requested receiving information on the particular AB 109 cases that posed a threat to staff safety on field based visits. Bruce committed

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to having ACHSA share the particular cases that have occurred with Probation.

ACHSA had requested that there be a discussion of the possibility of transferring liability to the County in extreme cases. Further analysis, however, determined that is was not reasonable to expect the County to accept liability for cases that are being handled by providers. So the only real option for providers with a case they deemed to be of extreme risk is to not provide services to that particular client.

Robin concurred that what we are really talking about is the possibility of refusing treatment and transferring the case back to DMH for a new referral. How this is handled is important, as it could factor into whether agencies would want to continue with the AB 109 program or not.

Robin mentioned that there is a Client Transfer Protocol to transfer a client to another provider in certain circumstances. She agreed that DMH needs to work with providers to determine when a refusal to treat and referral back to DMH would be appropriate.

Robin suggested revisiting and distributing a white paper the Department has on the subject of clinician/provider responsibility to clearly define what qualifies as a “client under the care of a clinician” under AB 109 and how decisions about transferring care are made. She suggested that the Department should revisit Program expectations on maintaining clients, and explain when DMH involvement and response is warranted.

Information Provided It was previously determined by ACHSA and DMH that a necessary

action step to obtaining client background information for AB 109 providers would be for providers to document all cases where new client information of critical importance comes to light after referral. This information would then be given to DMH, Probation, and ACHSA so we could work together to identify when a case may present safety concerns for the treating clinician.

Bruce reiterated Robin’s suggestion to document adverse incidents and to ensure they are communicated to DMH and Probation.

Robin requested that when an incident report is sent in to DMH, providers should indicate that the client is an AB 109 client. She explained that this will allow DMH data to accurately reflect the incidences occurring with AB 109 clients. Bruce agreed and committed to sending this request out to ACHSA AB 109 providers.

Additionally, ACHSA established that a discussion with DMH was needed regarding the possibility of providers refusing field based engagement unless they are given a full Criminal Offender Record Information (CORI) consent in order to properly assess the risk of meeting with a client. Proposed as an alternative to this action step was the possibility of clinicians being accompanied by an AB 109 Probation Officer.

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Reaver shared that, as of now, Probation does not have the resources to send a Probation Officer on every mental health call. He reiterated that holding clinical meetings with AB 109 Clients at Probation offices would be a viable alternative. Reaver also suggested the possibility of coordinating the home visits conducted by Probation Officers with clinician visits.

ACHSA requested a review of CORI regulations for possible remedies regarding modifying the regulations and how it is applied (e.g., court to mandate client consent to CORI upon approving client for the AB 109 Program) as another necessary action step to the issue of complete client information being shared in advance of client engagement.

Robin reported she has met twice with County Counsel and Probation on the issue of the release form for CORI consent. She explained that given the limitations of CORI being controlled by the State, a solution would be to find how Providers can be best served with the resources available.

Robin suggested focusing on solutions pertaining to how the CORI consent can be presented to AB 109 clients in a way which increases the chance of getting consent.

Bruce inquired as to what a feasible timeline would be for a CORI consent form to be approved. Reaver agreed that May 1st would be a realistic date to be set as a goal for completion.

ACHSA also made the request that DMH provide the list of AB 109 incident reports from the past year. Bruce clarified that this request was made with the acknowledgement of the need to preserve confidentiality and with the intent of only receiving the type of incident that occurred, not the names of clients. Robin agreed to generate a list of adverse incidents under the AB 109 Program and provide it to ACHSA.

Establishment of Meetings and a Workgroup with DMH, Probation, and ACHSA Agencies

To improve the working relationships between AB 109 providers, DMH, and Probation, ACHSA suggested the establishment of regular meetings that would foster better support from Probation Officers and DMH to AB 109 providers.

Robin and Mary shared that a Quarterly AB 109 Meeting currently exists and is attended by representatives from Probation. However, Mary shared that the meeting is not well attended by providers.

Bruce suggested that DMH needs to determine why AB 109 providers are not attending these meetings and suggested that it may be due to the lack of constructiveness of the meeting to address provider concerns and issues as they arise.

If Providers have suggestions on how to improve the Quarterly AB 109 Meetings, Robin requested that they be sent to Tara.

In addition to improving the Quarterly AB 109 Meetings, providers suggested arranging for Probation Officers to be co-located at AB 109

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agencies. Reaver stated that this is a possibility for programs that maintain a decent size AB 109 program.

ACHSA also requested the implementation of ongoing AB 109 Workgroup meetings, starting monthly, with agencies, DMH, and Probation that will taper off as needed to address the necessary action items from this meeting.

Bruce highlighted that ACHSA would want to be involved in attending and in the planning of these meetings. Reaver offered to work on forming a workgroup to address what scenarios are occurring and how they can be addressed.

Creation of an Appropriate Feedback System In order to address issues reported by providers on interaction with

Probation, ACHSA has proposed the need to work with DMH and Probation to create an appropriate feedback system to Probation and DMH to address Probation Officer responsiveness, lack of support, or any other conflicts with Probation. ACHSA would be copied on these communications.

Tara shared that a formalized process for reporting complaints with Probation already exists through DMH for these issues. She committed to sharing the formalized process and key contacts with ACHSA.

Bruce committed to sharing the information on the complaint process with providers and gather feedback to identify any shortcomings with the process that causes issues on the provider’s end.

Core Training ACHSA has requested the provision of ongoing comprehensive, core

training for AB 109 Providers. This has been deemed especially necessary due to high staff turnover which creates a need for a core training curriculum to be available for new clinicians as they are hired.

Robin recalled that at the beginning of the AB 109 Program, there was an AB 109 “Boot Camp” offered to providers through DMH. She committed to sending the original Boot Camp agendas to ACHSA and Bruce committed to sending the information out to the AB 109 Providers.

Additionally, Bruce committed to meeting with ACHSA AB 109 providers to collect information on what providers would like to be included in core trainings.

Overreaching Court Orders, Maximum Staffing Ratios, and Documentation for Billing

To address the issue of overreaching court orders, it was established that providers are to report to DMH when court orders seem overreaching.

In response to this proposed action step, Robin made clear that the court cannot order a contracted provider to admit an AB 109 client.

ACHSA had requested that DMH identify desired maximum staffing ratio from AB 109 providers. Although it was acknowledged that Forensic

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Programs use a maximum staffing ration of 1:12, there is no clear assignment for the AB 109 Program.

Mary and Robin confirmed that it is a DMH policy to not assign staffing ratios for AB 109 providers, in part to give the providers the flexibility to assign staffing as they see appropriate.

Providers had previously expressed that there is no existing mechanism for documenting events or case history that happen prior to intake with AB 109 clients. While this information essential to providers in assessing clients, providers are unable to bill for this time.

Robin committed to taking this documentation issues to Brad Bryant and Jen Hallman with DMH Quality Assurance to allow for billing of this time.

Please contact TJ or Claire with any questions.

Child Welfare Nuts & Bolts

State Releases Brochure for Youth and Parents on Child and Family Teams

CDSS has released ACIN I-14-18 to provide counties and their partners with information about the available Child and Family Team (CFT) brochures designed as a resource for use in providing outreach and support about the CFT process, guidelines, and frequently asked questions for children, youth, nonminor dependents, parents, and professionals. The CFT brochures provide an overview of the CFT process, the composition of CFTs and team roles, team meetings, frequently asked questions, and other helpful information for CFT participants.

Office of Child Protection’s Report on Consolidating DCFS Public Health Nurses within the Department of Public Health

The OCP has released its 2017 report on the efforts to consolidate DCFS Public Health Nurses within the Department of Public Health under its Children’s Medical Services branch, creating the Child Welfare Public Health Nurse Program.

Governor Signs Bill Providing Relief for Families Who Accept Placement Prior to Resource Family Approval

On March 13, Governor Brown signed AB 110, which includes an immediate solution to funding relatives and non-related extended family members who accept placement of a child prior to being approved as a resource family. The bill provides short-term funding through June 30th, 2018, the end of the current fiscal year.

CDSS will issue an All County Letter (ACL) to advise counties on implementation of the funding enacted by AB 110, and funding will be made available to families from the date of the publication of the ACL. Families accepting emergency placement after the ACL is posted will

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receive funding at the time of the placement. The Legislature is considering measures to continue the funding in the next fiscal year.

Report Highlights Discussion from Day-Long Forum of Immigration and Child Welfare

The Center on Immigration and Child Welfare has released a report, based on discussion from a November 2017 meeting in New Mexico, which focused on mitigating the risks of child welfare involvement for children and families affected by the Immigration Enforcement. The opening panel included experts explaining the current status of policy affecting the welfare of child immigrants, including the historical context, shifts in federal policy, legal responses and a case example collaboration in Pina County. The remainder of the document provides concise summaries of presentations on the many different aspects of child welfare and immigration, including the status of research in the area and best practices, which featured a representative from the Los Angeles County Department of Child and Family Services.

April and May CSEC Training The County is hosting a number of CSEC-related trainings in April and

May, including topics such as “Parenting/Caregiving in a Digital World” and “Strategies for Sustaining Hope for CSEC Survivors.” For more information and to register, please click here.

Success Is Our Future On May 23rd, Youth Development Services (YDS) will host an event for all

foster youth who are graduating or will graduate next year. For flyers to share with youth and staff, please click here. The Department has shared a number of forms, as well as the deadlines to submit these forms:o For the Provider Advertisement form, please click here.o For the SIOF application questionnaire, please click here.o For the ticket order form, please click here.o For the table list form, please click here.o For the Early Departure form, please click here.o For the media release decline form, please click here.o For the Media Order signed by Judge Levanas, please click here.o For the Academic Scholarship application, please click here. o For the Athletic Scholarship application, please click here.o For the Spoken Word, Arts and Performing Arts Scholarship

application, please click here.o For the Continuing Education Scholarship application, please click

here.

Please contact Jodi or Alex with any questions.

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Mental Health Odds & Ends

L.A. City Council approves Garcetti's El Pueblo shelter plan for homeless The Los Angeles City Council on Friday approved Mayor Eric Garcetti's

plan to create a makeshift shelter for the homeless on city-owned property downtown, backing a new approach to get people off the streets. Trailers will be installed on a parking lot at Arcadia and Alameda streets, near the historic El Pueblo site, and operate for up to three years, housing about 60 residents at a time. Housing placement and mental health services will also be available. For more information, please find the full article here.

Everyone In Campaign A new coalition urges 'Everyone In' to combat L.A.'s homelessness crisis.

The "Everyone In" coalition will train and organize people to advocate for new housing and services for homeless people in their neighborhoods, track progress toward countywide goals, educate the public and give them other opportunities to get involved, officials said. For more information, please find the full article here.

California’s Tax On Millionaires Yields Big Benefits For People With Mental Illness, Study Finds

The RAND Cooperation research report, focused on Los Angeles County, casts a positive light on a 2004 initiative that expanded mental health services statewide. A recent state audit, however, suggested hundreds of millions of dollars from the initiative were piling up, left unspent by counties. For more information, please find the full article here.

Please contact TJ or Claire with any questions.

UPCOMING MEETINGS & EVENTS

MARCH

22 FFA Strategic Planning & Policy Committee Meeting ACHSA 10:00 AM to Noon

22Mental Health Contractual-Administrative Committee

MeetingACHSA 1:30 PM to 3:30

PM

APRIL

9 Adult Mental Health Policy Committee Meeting ACHSA 1:00 PM to 3:00

PM

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11 Children’s Mental Health Policy Committee Meeting

Amanacer Conference Room

1:30 PM to 3:30 PM

Association of Community Human Service Agencies1200 Wilshire Boulevard, Suite 404, Los Angeles, CA 90017

Tel: 213-250-5030 / Fax: 213-250-5040E-mail: mailbox@achsa.net / Web: www.achsa.net