BASPCAN CongressApril 2015

RESPONDING DIFFERENTLY:

Engaging families in voluntary services to prevent further intervention from the

formal system.

Presenters:

Christine Secrist, PhD, LMFTLori Mozena, MS, LMFT

Julie Allison, MPA, Iowa Department of Human Services, Bureau Chief

Mid-Iowa Family Therapy Clinic, Inc.

& The Iowa Department of Human Services

WHO ARE WE?

Mid-Iowa Family Therapy Clinic, Inc.

Provides:• Family Centered Services to children and families

referred through the Iowa Department of Human Services.

• Psychiatric and outpatient therapy services to children and their families.

• Community Care services to children and families following a CPS assessment.

Department of Human Services

• Intervene when child safety is at-risk

• Provision of services to children who are at risk

• Seek court intervention when needed

• Case management

Guiding Principals

• Children are safe

• Services must be available equally to all children statewide

• Children grow up best in their families

• Families can gain the skills necessary to effectively support their children

• Families need and deserve community support

In 2013, the Iowa legislature passed House File 590. This called for the implementation of a Differential Response approach to allegations of child abuse to be initiated statewide in Iowa beginning January 1, 2014.

In Iowa, there are two possible pathways a case can follow:

The Child Abuse Assessment path or

the Family Assessment path.

The decision about designation of a path for an accepted case is made at the time the referral is accepted at Intake by DHS.

Only cases for which denial of critical care is alleged and for which there is no indication that the child is in imminent danger will be placed on the family assessment path.

Additional specific screening criteria has been developed in Iowa Administrative Code, the criteria is used by DHS Intake staff and supervisors to determine the correct path for a case.

DHS child protective assessment workers conduct all assessments.

Pathway Assignment Tool

A central piece to the implementation of a Differential Response approach was to utilize a statewide program called Community Care as the only formal service that could be offered to families completing a family assessment.

Community Care began in Iowa in 2005 as a way to reduce risk and ensure safety without Department intervention; it allowed the provider the freedom to

intervene with families without the

restrictions of Department of Human

Services limitations on service

provision.

COMMUNITYCARE

PROGRAM

COMMUNITY CARE

• Statewide voluntary service provided through a contract with the Department of Human Services. The purpose is to strengthen families by building on the family’s resources and developing supports for the family in their community.

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WHO IS ELIGIBLE FOR COMMUNITY CARE?

THE GOALS OF COMMUNITY CARE ARE:

•Reduce concerns for families that create stress and negatively impact relationships between family members.

•Partner with families to improve relationships within the family and build connections in their community.

•Provide contacts and services that meet the family’s needs.

03/21/08

Goals continued:

•Meet the cultural needs of families by providing better matching of service providers.

•Develop support systems for families to increase the resources they have

available, in order to reduce stressors

the family may be experiencing.

03/21/08

COMMUNITY CARE

MODEL

Central point of referral•Electronic

Engagement, assessment, and service planning

Discharge Summary & After-Care Plan

Community Care Manager

Community Care Manager

Community Care Manager

Community Care Manager

Community Care Manager

Meet with the family

Implementation of tailored interventions

Outcomes:•Prevent the reoccurrence of child maltreatment.•Reduce the risk of child adjudicated CINA.•Engage with families to increase the effectiveness of interventions and achieve successful completion of services. •Participate in local DECAT and CPPC meetings in helping build upon community level prevention services.•Provide contacts and services that satisfactorily meet the families identified needs.•Effectively meet the cultural, economic, and environmental needs of families through better matching of service providers.•Increase family support systems to improve the protective capacities of parents and caretakers to help reduce the risk of child abuse.•Provide well trained service staff to deliver the service while having licensed clinical staff available for regular consultation.

Traditional & Family Assessment

Engagement Specialist contacts family, sets up

appointment.If no contact:

Regional Supervisor notified of case

assignment

COMMUNITY CARE MODEL Referral from DHS

CENTRAL POINT OF INTAKE• All referrals to Community Care are

electronically sent to a Department of Human Services (DHS) data base site.

• Mid Iowa staff retrieves the referrals from this site.

INTAKE• Engagement Specialist will review the assessment

completed by the Department to determine what are the most critical issues, prioritizing those issues and immediately attempting to engage the family in services.

• Engagement Specialist will have demonstrated the ability to effectively engage families on the telephone to participate in services.

• Engagement Specialist schedules an appointment with the family to meet with the appropriate care manager.

Engagement specialist begin the engagement of families through the initial phone contact attempt.

Here is an example of that initial dialogue:

"Hello, this is Melissa with the Community Care Program. We have received a referral from (CPW name) and I understand that you are interested in support and assistance with parenting skills with your toddler (DCC – supervision of child). (After some discussion about the needs within their home and the services they may already have in their home) When would be a good time for our Case Manager to come out and meet with you to see how we can help you?”

SO WHAT DOES COMMUNITY CARE DO?

The Care Manager will complete a family functioning assessment that builds upon the CPS assessment.

•Base on the assessment a family care plan is developed. The Family Care Plan is designed to address areas of risk as identified through the assessment.

•Safety/Risk Management

Plan

•Crisis Plan

Based on the assessment, the care

manager may deliver the following

types of services:

1. Family Team Decision Making meeting

2. Safety planning

3. Crisis intervention

4. Providing assistance such as rental deposit, food, etc., that relates directly to risk factors associated with child abuse and neglect.

5. Information and referral

6. Education on a variety of issues (for example, substance abuse, mental illness, impact of trauma, domestic violence)

7. Parenting skill development

8. Parent/child relationship building

9. Support services

10. Rewards Program

The Rewards Program is designed to encourage participation in the Community Care program for at least 5 meetings. The Rewards Program is utilized in order to develop a care plan and begin working on meeting the goals of the family, while reducing overall risk within the household. The reward of $25 is earned after 5 meetings and used to meet a small need within the household of the family’s choice. Household needs have been most commonly identified as:

•Gas card/public transportation fees

•Baby supplies

•Assistance with utilities

•Assistance with rent

•Groceries

•Cleaning supplies

•Pest control

•Seasonal apparel

•Prescribed medication/co-pay

OUTCOMES OF THE COMMUNITY CARE

PROGRAM

*2010 Population Census

Community Care Performance Measure Outcomes

Results from 1/1/14 – 12/31/14

•No higher level of services such as CINA for supervision or placement for 6 months from date of referral to CC.

•No confirmed or founded child abuse within 6 months from date of referral.

•Contact will be made within 14 days on 80% of all referred families.

•85% of referred families report positive satisfaction with services.

OUTCOME #1:

No higher level of services such as CINA for supervision or placement for 6 months from

the date of referral: 5% or less

As of 12-31-14, MIFTC has met this performance

measure 6 out of 6 months.

OUTCOME #2:

No Confirmed or Founded child abuse within 6 months from the date of referral: 5% or less

OrMore than 5% but less than 10%

As of 12-31-14, MIFTC has achieved an average of 5.44%.

OUTCOME #3:

A response will be received within 14 days of the referral date on all referred families: 80%

MIFTC has met this outcome 12 out of 12 months with an average of 85.71%.

OUTCOME #4:

85% of families will be satisfied with Community Care services

This measure is reported on a bi-annual basis. For January – December 2014, our client satisfaction was at 100%.

Since the implementation of Differential Response in Iowa:

•Community Care has seen a statewide increase in the number of referrals to the program:

•1,413 referrals for the entire 2013 year

to

•4,338 referrals for 2014 calendar year.

SUCCESS ACROSS IOWA

Success Stories

Every other month, we gather stories from case managers of families being successful through participation in the Community Care program. Each bi-monthly edition is shared with DHS staff to give Child Protective Workers some examples of services and support provided by Community Care. These stories are helpful to the CPW when presenting the program to clients at the close of an assessment.

“I worked with a mother with two children who were open to meeting weekly. The daughter was having many behavioral issues at home and at school. She would get into many psychical fights with her older brother and would also run away from school. With the support, mom was able to locate local resources and a psychiatrist for her daughter. I provided transportation to the family to and from physical & mental health appointments. Mom and the school had developed a volatile pattern of communication. I was able to support mom and assist her in engaging and collaborating with the school. The school continues to make modifications to meet the daughter’s needs while she is at school. The daughter continues to see a local therapist and was prescribed the correct medication and has been doing well since. Her grades have improved greatly. The mother was open to information on effective parenting to help intervene with her daughter and son. New positive interactions and behaviors were observed each week. The school reported a major improvement in the daughter’s behaviors as well. Family interactions improved greatly with the support of Community Care and other resources.”

“I worked with a family who spoke Kunama. After many attempts to find a translator to help make contact, I discovered that the family had a worker from the school district that spoke Kunama. He was working with them periodically due to the behaviors of the first grade daughter. She was not following directions at home or at school and had gotten suspended from school from time to time due to her behaviors. The school liaison worker who spoke Kunama was my translator. We met together with mom five (5) times. Each time we discussed expectations for supervision of her children and better ways for her to discipline her daughter. The translator and I helped her to understand cultural differences and the need for her to keep her child safe. The school teacher was kept informed on things being done in the home. The school teacher was glad to know the family had our services. A referral was made to behavioral health services and the in-home worker went with me to meet the family. Behavioral health services began for the daughter as the Community Care case closed. The in-home provider continues to use the translator from the school when she does her family sessions with mom and the children. Mom was very happy to have someone work with her daughter on her behaviors and was thankful to have Community Care assist her family. She earned her $25 Rewards after participating in five (5) appointments and was very appreciative of getting that as well.”

“When I began working with this family, they just experienced a violent domestic occurrence of which Mom was the victim. As a result of this domestic violence, Dad was placed in jail and a No Contact Order was put into effect. Mom requested assistance in finding alternative affordable housing and we were able to locate a new residence through local income based housing. She was able to take leave from work to manage her crisis and family transition. Mom connected with a domestic advocate and a therapist. Mom was agreeable to the children attending counseling to help them deal with the break up and domestic violence within their family so we worked together to connect the children with a therapist as well. By the time the case closed, Mom was back to work full-time, the family had moved into a safe alternative home, and Mom and her children were attending therapy on a regular basis.”

“I worked with a mom who has a history of substance abuse, mental health issues,

and lacks transportation. She cancelled her substance abuse evaluation three times

before we had our first Community Care appointment. During our initial meeting, I

suggested that Mom call to schedule her evaluation during a time I could go with

her and she agreed. We went to her substance abuse evaluation together. She was

relieved that she didn't have to go alone and also had the support as well as

someone to talk to before and after the actual evaluation. I went with her to the

follow up appointment and during that time she signed up for on-going supportive

services. Mom is currently utilizing the supportive services to improve the

consistency of her mental health and substance abuse group appointments as they

also assist with transportation. Mom reports that it has been easier to stay clean

with her growing support system. She was appreciative of the push to complete her

substance abuse evaluation because she knows she would have continued to cancel

and not gone on her own without that additional support.”

Families who are living in rural areas have fewer resources directly available to meet their basic needs. Community Care has to be creative in connecting these families to resources.

•Utilizing mobile internet connection and laptops to assist in filling out medical & financial assistance applications on site. Also, to be able to research specific resources in the local region and provide contact information for these services.

• Providing transportation to initial appointments when families don’t have a vehicle or aren’t able to afford the cost of gas. Assist them in connecting with rural transportation services where available.

•Assist families in joining local recreational centers/pools to provide opportunity for positive activity outside the home and to get the family more visible in the community to make positive connections.

Rural areas don’t often have a local grocery store available and need help planning for purchasing groceries more cost-effectively once a month to avoid paying higher prices at convenience stores.

Utilizing local churches and Community Action Agencies to assist with financial assistance for basic needs and utility assistance or fill propane tanks.

Providing more parenting skills and education due to the lack of parenting service providers in rural areas.

Apply for free cell phone for them thru Wireless Assurance or apply for a 911 phone for DV victims that are isolated and have no cell phone.

DISCUSSION

• Continue to achieve the performance measure of contacting families and getting a response back within 14 days, 85% of the referred families each month.

• Increase our use of family team meetings.

• Collect and analyze outcome data, in order to measure effectiveness of services.

• Continue collaborative efforts with the Iowa Department of Human Services in reducing the re-abuse rates of child abuse and neglect.

• Engage with more families. We are currently at 86%, but want to be at 95% or higher!

• Reduce the percent of families coming back through as a confirmed or founded child abuse case. Currently, we are at 5.44% but we want to be, on average, at 5% or less.

• Increase the percent of families we serve successfully without withdrawing from the program. Currently, at 58%. We want to be at 70% or higher.

• Keep families engaged in the Community Care Program for a longer period of time. The average number of face to face contacts is 5, over a 3 month period. We would like to increase our involvement with families to at least 4 months with 7-10 face to face contacts.

• Continue to maintain a high level of client satisfaction.

• Continue to keep children and their families out of the DHS system. Achieve 5% or less of families being a Child In Need of Assistance (CINA) for all the months of service of the contract.