With the State Department of Social Services and Department of Health Care Services

KATIE A. SETTLEMENT AGREEMENT

DECEMBER 2, 2011

July 18, 2002. Complaint filed in Los Angeles against Los Angeles County and the State Departments of Health Care Services (DHCS) and Social Services (DSS)

June 18, 2003. Certified as a “Class Action” suit

July 2003. Los Angeles County settled the claim on behalf of the County-wide class

December 11, 2011. Settlement agreement with DHCS and DSS

December 11, 2014. End of court jurisdiction

BACKGROUND

The Katie A. Class is identified as children in California who:

1. Are in foster care or at imminent risk of foster care placement; and

2. Have a mental illness or condition that has been documented or, had an assessment already been conducted, would have been documented, and

3. Who need individualized mental health services, including but not limited to professionally acceptable assessments, behavioral support and case management services, family support, crisis support, therapeutic foster care, and other medically necessary services in the home or in a home-like setting, to treat or ameliorate their illness or condition

KATIE A. “CLASS MEMBERS”

Means that within the last 180 days a child has been participating in voluntary family maintenance services or voluntary family reunification placements and/or has been the subject of either a telephone call to the Child Protective Services hotline or some other documented communication made to a local Child Protective Services agency regarding suspicions of abuse, neglect or abandonment

Members of this class include children living with their parents or relatives or in any of a variety of placements, such as group homes or foster homes

DEFINITION OF “IMMINENT RISK”

Are children and youth who are full-scope Medi-Cal eligible meet medical necessity, have an open child welfare services case, and meet either of the following criteria:1. Child is currently in or being considered for:

A. WraparoundB. Therapeutic foster care or other intensive servicesC. Therapeutic behavioral servicesD. Specialized care rate due to behavioral health needs or crisis

stabilization/intervention; or2. Child is currently being considered for:

A. Group home (Rate Classification Level 10 or above)B. Psychiatric hospital or 24-hour mental health treatment facilityC. Has had three or more placements within 24 months due to

behavioral health needs

KATIE A. “SUB-CLASS MEMBERS”

Vision Statement: Adopting the Core Practice Model will improve the safety, stability, well-being, and permanency of our children, youth, and families

Mission Statement: Application of the Core Practice Model will create a process by which communication is strength based, culturally competent, collaborative, empowering, and goal focused. This model will result in the use of timely, effective services in the most natural setting possible in order to achieve each child, youth, and family’s individualized goals

CORE PRACTICE MODEL: VISION AND MISSION STATEMENTS

CORE PRACTICE MODELCHILD AND FAMILY TEAM INTENSIVE HOME-BASED MENTAL HEALTH SERVICES INTENSIVE CARE COORDINATION

Medi-Cal Documentation and Claiming Manual – Intensive Care Coordination (ICC) and Intensive Home-Based Mental Health Services (IHBS) draft is released on October 17, 2012 for a 30-day public comment

Core Practice Model Guide draft is released on December 14, 2012 for a 30-day public comment

COMPONENTS OF THE SETTLEMENT AGREEMENT

Core Practice Model services will be:Needs driven, strength based, and family focused

from the first conversation with or about the family Individualized and tailored to the strengths and needs

of each child and familyDelivered through a multi-agency collaborative

approach that is grounded in a strong community base

Family voice, choice, and preference are assured throughout the process

A blend of formal and informal resources designed to assist families with successful transitions that ensure long-term success

VALUES AND PRINCIPLES

Culturally competent and respectful of the culture of the children and their families

Services and supports are provided in the child and family’s community

Children are first and foremost protected from abuse and neglect, and maintained safely in their own homes

Children have permanency and stability in their living situations

The Department of Social Services is developing the crosswalk that aligns Katie A. Core Practice Components with the California Partners in Permanency Core Practice Elements and Behaviors (refer to handout).

VALUES AND PRINCIPLES (CONTINUED)

1. Collaboration2. Teaming3. Trauma-Informed Practice (Focuses on what has

happened to a child and his/her family rather than what is wrong with that child or family). Essential elements are defined by the National Child Traumatic Stress Network Child Welfare Committee include:A. Maximize physical and psychological safety for children and

familiesB. Enhance child well-being and resilienceC. Enhance family well-being and resilienceD. Partner with youth and familiesE. Enhance the well-being and resilience of those working in the

systemF. Partner with child-serving agencies and systemsG. Cultural Competence and Cultural Humility

FOUNDATIONAL CONCEPTS

Engagement

Assessment

Service planning and implementation

Monitoring and adapting

Transition

PRACTICE COMPONENTS, STANDARDS AND ACTIVITIES

An array of services that includes evidence-based practices, promising practices, innovative practices and culturally specific healing practices and traditions

Services may be provided by mental health providers, by child welfare workers, by community providers and/or by other community/tribal partners.

Services matched to the needs identified in the assessment process and should be individualized and dynamic, changing in response to the changing needs of the child and family

GENERAL ARRAY OF SERVICES

1. Intensive Care Coordination (ICC)

2. Intensive Home-Based Mental Health Services (IHBS)

3. Treatment Foster Care

SPECIFIC SERVICES FOR KATIE A. SUBCLASS MEMBERS

1. Outcomes and Accountability. It is expected that implementation of the CPM will improve services for children, youth and families involved with child welfare services overalls, demonstrated in such areas as:

A. Parent, child, youth and caregiver involvement in case and treatment planning

B. Degree to which parents, children, youth and caregivers feel fully engaged and involved as partners in all of their experiences with child welfare and mental health

C. Assessing and addressing service needsD. Child safety at home or in foster careE. The number and percentage of children in long-term foster careF. The number and timelines of permanent exitsG. Decrease in re-entry into foster careH. Decrease in non-permanent exitsI. Improved lifelong connections for children and youthJ. Increase in well-being of families and children

CONTINUOUS QUALITY IMPROVEMENT

1. CDSS and DHCS are charged with determining what will be measured that reflects intended outcomes to evaluate progress on implementing the CPM and access to IHBS and ICC for mental health services. Relevant data may include:

A. Clinical status data, including assessments of symptoms, risks, functioning, strengths, and other information on how the class members is doing in his or her life

B. Utilization data, including disposition such as aftercare from hospitals and group homes, etc.

C. Treatment facility data that reflect what is happening within the episode of treatment, monitoring the degree to which Child and Family Team, IHBS and ICC are provided and the extent to which they are provided within the CPM

CONTINUOUS QUALITY IMPROVEMENT (CONTINUED)

Monitoring and Review:CDSS and DHCS will establish a Data and Quality Task Force and produce a report with recommended actions and timelines to:1. Establish a method to track the use of ICC, IHBS and

TFC for subclass members2. Utilize the External Quality Review and California

Child and Family Services Review requirements to develop a plan for the collection of data and information about children in the class who receive mental health services

3. Collect data elements in DHCS, CDSS data systems specific to the class (and subclass) in order to evaluate utilization

CONTINUOUS QUALITY IMPROVEMENT (CONTINUED)

1. CDHS, CDSS and DMH to develop an Implementation Plan to include specific steps, deliverables, timeline for implementation

2. Establish a shared management structure that builds upon existing State agencies that serve foster youth (i.e., Department of Education, Department of Alcohol and Drug Programs, Department of Corrections and Rehabilitation)

3. Develop a Core Practice Model Guide4. Develop a Medi-Cal Specialty Mental Health

Documentation Manual for Intensive Care Coordination and Intensive Home-Based Mental Health Services

5. Establish a Joint Management Task Force to include youth, parent partners, county and provider groups

REQUIREMENTS OF THE STATE

1. Joint Management Structure to develop a shared vision and mission statement, policy and program direction, clear and consistent guidance, and outcomes and accountability measures. This will also include joint development of policies and procedures that support the model and provide ways to avoid duplication and resolve conflicts between the involved agencies and services providers.

2. Staff selection to include Child Welfare and Mental Health practitioners, trainers, coach/consultants, evaluators and administrators

3. Pre-service and In-service Training

4. Ongoing consultation and coaching

IMPLEMENTING KATIE A. AT THE LOCAL LEVEL

5. Staff and Program Evaluation

6. Facilitative Administration Support

7. Systems Intervention

IMPLEMENTING KATIE A. AT THE LOCAL LEVEL (CONTINUED)

Build upon community partnerships to guide ongoing local practice and system changes that may be required by Katie A. settlement requirements

Shared community commitment to the Practice Model

Capacity-building and installation through education, training, involvement and advocacy

Effective, sustained implementation support

ACTIVE, INVOLVED COMMUNITY PARTNERSHIP

Contact Irene Takahashi, Division Manager, Department of Behavioral Health-Children’s Mental Health, at 559-600-6886 or E-mail to itakahashi@co.fresno.ca.us. She will direct questions to the identified Katie A. liaisons for the Department of Behavioral Health or the Department of Social Services.

FOR ADDITIONAL INFORMATION OR QUESTIONS