March 1, 2017 Volume 14, Issue 4 Volume 14, Issue 4

ACHSA UPDATEACHSA UPDATEA bi-weekly briefing of the Association of Community Human Service Agencies

Page 1 of 23Inside This Issue (click to go directly to the article): 1. ACHSA/DMH Executive Management Team Meeting Highlighted by

Discussion of MHSA 3-Year Plan Implementation Issues 2. Continuum of Care Reform Focus of ACHSA Child Welfare CEO/ED Forum

with Acting DCFS Director Brandon Nichols3. Report on February 14 th DMH Adult Provider Meeting 4. Not Surprisingly Probation Wants to Talk About Continuum of Care Reform

Implementation at Probation Provider Meeting5. DMH Children’s CSS Workgroup Meeting Begins Process of Considering

Implementation of Programs Under Bucket Consolidation6. Going to the Mat for MAT: ACHSA Advocates for Multidisciplinary

Assessment Team Program 7. Mental Health Odds & Ends 8. Child Welfare Nuts & Bolts 9. Conferences, Events & Resources 10. In the News 11. Upcoming ACHSA Meetings

KEY ISSUES

ACHSA/DMH Executive Management Team Meeting Highlighted by Discussion of MHSA 3-Year Plan Implementation Issues

On February 24th, LACDMH Chief Deputy Dr. Robin Kay facilitated the quarterly ACHSA/DMH Executive Management Team meeting. The session covered a variety of topics, ranging from the MHSA 3-Year Plan and service provision under the new Recovery, Resiliency, and Reintegration (RRR) bucket to ACHSA’s advocacy regarding homelessness issues, to the intense fear within the County’s client population following the federal government’s recent crackdown on immigration.

DMH Departmental Status Update Robin began the meeting by expressing optimism regarding the Department’s recent budget meeting with the office of the County CEO. She reported that at the meeting, DMH Director Dr. Jonathan Sherin’s presentation focused on different treatment approaches corresponding with where clients are in the recovery process. Robin next talked about all of the

Page 2 of 23

new developments in the Children’s System of Care, including the Wraparound transition scheduled for the spring, the implementation of Immersion and the Core Practice Model, and the $300 million investment for Continuum of Care Reform implementation.

Robin mentioned that the Department was in the process of expanding the FSP program in order to have enough slots for clients served under the new State and County housing programs – Measure HHH and No Place Like Home. She informed the meeting attendees that the Department is also beginning an internal reorganization process, including choosing a new CIO, but that the process would be long and cumbersome. Robin concluded by stating that the public hearing for the MHSA 3 Year Program & Expenditure Plan was met with almost no controversy. Next, the Plan would go to the Commission to be ratified, and then to the Board of Supervisors for its adoption.

Health Agency Update Robin reported that Dr. Sherin is making an effort to work with the Health Agency, and is trying to find ways that he, Dr. Katz, and Dr. Barbara Ferrer, the new director of the Department of Public Health, can collaborate and build the Agency together. Bruce asked if since the new Health Agency had been instituted there had been any greater oversight of the Department of Mental Health by Dr. Katz. Robin responded in the negative, saying that overall the implementation of the Health Agency had been non-disruptive to DMH operations, and that Dr. Sherin had wanted the Agency to be more of a partnership, with DMH taking the lead on issues of cultural competency.

MHSA Implementation Issues

1. Transition of FCCS to FSP/RRR MHSA Program Head Debbie Innes-Gomberg stated that most providers who were interested in shifting current FCCS dollars to FSP have already done so, and that as ACHSA had requested DMH had provided clear instructions to agencies as to how this process should work.

2. Establishing New FSP Programs TJ noted that with the phase-out of FCCS, there are quite a few children’s programs that have only provided FCCS that have clients with needs too severe to be adequately served under the RRR program. Therefore, these agencies would need to add FSP programs to their contracts. Robin pledged to discuss this issue with County Counsel, and would have an answer for ACHSA by March 3rd.

3. Implementation of FSP Integration Pilot Model for Non-Pilot Agencies Bruce asked what steps providers would have to take before the beginning of the next Fiscal Year, as all agencies are now expected to use the model of

Page 3 of 23

the Integrated FSP Pilot Program, regardless of whether or not they were pilot participants. Debbie stated that within the next month a document would be put together for providers of all age groups, with a memo attached containing the at-risk criteria, guidelines for authorization versus notification, and other pertinent information. She agreed to work with ACHSA pilot agencies to help in facilitating the implementation.

4. Use of What FSP Model for Children? Bruce asked that DMH confirm that the current children’s FSP model would stay in place beginning with the new fiscal year, since the model ACHSA has been working on is not close to being completed. Robin agreed, although she noted that there has been a recommendation that the Department start using the CASII to determine levels of care. TJ stated that the goal of the Integrated FSP Pilot Program for Children, currently in development by ACHSA, is to create an integration model that showcases resiliency and clients’ movement to lower levels of care. He expressed support for the Department’s use of the CASII, emphasizing that the assessment tool is very well-suited to the CSOC, developmentally appropriate, and descriptive of external family and environmental factors, as well as the child’s functioning.

5. How is the $5.5 Million of RRR Going to be Allocated to Providers? Both Robin and Debbie expressed uncertainty with how the $5.5 million dedicated to the RRR program would be allocated to providers. Robin stated that the County had several big-ticket priorities, but that the Department needed to be judicious with how the money is spent. Robin said the Age Group Leads needed to weigh in on this question as well.

6. Funding Bucket Implementation Dennis stated that the funding bucket consolidation solely concerned services covered under MHSA. Population target expectations would remain, despite the lack of bucket division by age groups, with the understanding that this would be an issue that would need to be addressed by the Schedule 8 Revision Workgroup.

Timeline for COLA/Cost of Care Discussions Bruce expressed concern that discussions with DMH regarding possible “COLA-like” options for contract agencies not drag on too long to the point that there will be no available dollars to fund them. Robin acknowledged that she was continually getting requests for funding of potentially competing projects. She did agree, however, to put these proposals on the SLT Budget Workgroup agenda as a placeholder until the Department has a better idea of what it needs to pay for them, since every significant expenditure has to go through that workgroup.

Page 4 of 23

Timeline for Schedule 8 Repeal/Replace Discussion – Service Planning Expectations Document

ACHSA Mental Health Policy Director TJ Hill stated that because the current Schedule 8 document is not feasible to use with the funding bucket consolidation, it needs to be replaced. Although DMH Finance Director Kim Nall could not conclusively state by when Schedule 8 would need to be resolved, she stated that the replacement would be discussed at upcoming program deputy meetings, with Margo Morales in charge. Ultimately, Dr. Kay stated that by the end of the following week, a workgroup would be convened with leads assigned on the issue. Dennis Murata gave assurances that replacing Schedule 8 would not require any changes to providers’ electronic health records, as all existing data would be pulled from IBHIS. ACHSA will be convening a Schedule 8 internal workgroup meeting before meeting with DMH to

Status of 1915(b) Waiver Special Terms and Conditions ComplianceRobin reported that at the last triennial evaluation administered by the State Department of Health Care Services (DHCS), Los Angeles County’s behavioral health care system was given its best ever review. Unfortunately, the County’s hospital evaluation had not gone well, just as it had never been well-reviewed in the past. The Department was held responsible for inpatient psych audits, as well as long waiting lists for IMDs. Robin stated that it would be helpful for the team to examine the dashboard in order to review the Department’s performance.

Katie A. PanelBruce opined that the Katie A. panel should be discontinued. Robin stated that a judge needed to be convinced that the Los Angeles County behavioral health community had achieved the mandated criteria. Robin stressed that the Court needed to be informed that the Department is working intensively with County Counsel to formulate clinically focused-intervention to the highest-end youth. Unfortunately, Robin added that the qualitative criteria are very difficult to prove, as the measures used have little scientific credibility. Nevertheless, LA County Counsel is seriously considering tactics on how to end Katie A. monitoring.

Update on ACHSA Homelessness AdvocacyBruce presented two documents that had been prepared by the ACHSA housing and homelessness ad hoc workgroup, which focused on the unintended consequences of both the Housing First policy and the federal definition of chronic homelessness. Regarding the Housing First policy, while he acknowledged its well-intentioned nature of removing barriers to individuals in need of housing, there is a sub-group of clients who, if they are placed immediately into housing without any preparation, will be set up for failure. Bruce stressed that this policy should not be applied rigidly, and needed to be considered on a case-by-case basis. He also discussed

Page 5 of 23

ACHSA’s concerns regarding the push to try to limit housing services for the chronically homeless. ACHSA will be approaching the Board offices to discuss its concerns regarding both of these issues. Robin stated her agreement with the points articulated, and stated that she was working with Maria Funk on producing a white paper for the Board of Supervisors aimed to begin a discussion about whether or not the County should select the State or local option for administration of NPLH funds.

Other Issues: ImmigrationRobin stated that she was in the process of sending a questionnaire out to directly-operated programs, asking if they had more than their usual number of no-shows or cancellations due to clients fearing that their immigration status will be discovered. Bruce asked what the Department’s intended response to this survey would be, since while it would be useful to show the impact of current federal activities, it was more important to focus on helpful actions. Robin mentioned both a proposed training by legal experts and a letter DMH is working on for clients regarding their fears and anxieties, which she said she would share with ACHSA. TJ expressed interest in the effort, and also stated that Los Angeles Unified School District has reported a sharp increase in absences for the same reason.

Please contact TJ or Abby with questions.  

Continuum of Care Reform Focus of ACHSA Child Welfare CEO/ED Forum with Acting DCFS Director Brandon Nichols

On February 16th, ACHSA hosted DCFS Acting Director Brandon Nichols at the Child Welfare CEO/ED Forum.  Key discussion items from the forum are highlighted below.

DCFS STRTP and FFA Contract Requirements In response to ACHSA inquiries, Brandon reported that the Department does not plan to consider additional contract requirements for the new STRTP and FFA contracts that go beyond the current STRTP and FFA Program Statement elements. Additionally, Brandon reported that DCFS is reviewing its monitoring processes in order to make such reviews less burdensome for providers.

Approval of STRTP Program Statements and Plans of Operation Jodi inquired as to whether the Department has noticed any common areas of concern in the submitted STRTP Program Statements and Plans of Operation, to which Brandon shared that DCFS staff have not reported any concerning trends. In response to requests from providers, Brandon committed to share with ACHSA the total number of STRTP Program

Page 6 of 23

Statements and Plans of Operations submitted to the County, the number of STRTP Program Statements and Plans of Operations that have been approved, and the average length of time taken to complete the review of the approved STRTP Program Statements and Plans of Operations.Bruce discussed concerns regarding reported delays in the STRTP Program Statement and Plan of Operations review process and recommended that a single DCFS point person should be identified to respond to group homes’ questions regarding the status of their submitted STRTP materials, which Brandon agreed to consider. In response to provider concerns, Brandon agreed to look into whether agencies that have submitted their STRTP Program Statements and Plan of Operation can be provided with more specific timeframes related to when their materials will be approved. Additionally, ACHSA recommended that the County’s review of revised STRTP Program Statement and Plan of Operation sections resubmitted by group homes should be prioritized over the review of new STRTP materials that have been subsequently submitted by other agencies, which Brandon agreed to consider.

Interagency Placement Committee Screenings for STRTPsBruce inquired as to the County’s readiness for Interagency Placement Committee (IPC) screenings for STRTPs. He noted that ACHSA had met with DCFS and DMH and shared the Association’s recommendations to implement a regional Interagency Placement Committee (IPC) model with the capability for telephonic meetings. Brandon reported that the Departments are meeting twice monthly to plan and map the IPC process and agreed to share with ACHSA an updated draft IPC process. He confirmed that the Departments plan to implement a regional model and are interested in utilizing telephone conferences rather than in-person meetings.

Providers discussed concerns that while group homes and STRTPs are receiving placements, CSWs may be more likely to refer to group homes as the current referral process to group homes is less burdensome. Brandon agreed to look into how DCFS plans to ensure adequate and appropriate referrals to STRTPs while both group homes and STRTPs are receiving placements. Providers in attendance also expressed concerns regarding the County’s lack of a fully developed and thoughtful process to make residential placement decisions, which has led many agencies to question the future viability of their residential programs.

Recent Significant Decline in DCFS Placements of Children into Group HomesIn response to Jodi’s statement that agencies have reported a decline in new referrals to group homes, Brandon noted that the Department has not made any policy or practice changes regarding group home referrals. He agreed to share with ACHSA the Department’s data regarding the number of group

Page 7 of 23

home referrals made in the last couple of months. Bruce discussed concerns regarding the State’s unrealistic projections that there will be an 80 percent decrease in youth in congregate care. He pointed out that Los Angeles County has already significantly decreased its residential care population over the last ten years, and emphasized the concept of first placement, best placement.

Post Approval DCFS/FFA Number of Required Visits to Resource Family Homes Jodi reviewed ACHSA’s recommendation that DCFS align its required visits to children placed with County approved resource parents with the current requirements in the FFA contract. She noted that the Department was considering utilizing a model similar to the Ventura County RFA visitation model and shared a crosswalk develop by ACHSA comparing the Ventura County model and the FFA contract requirements. Brandon agreed to follow up on ACHSA’s recommendation that DCFS visit its approved resource family homes at the same frequency as the requirements in the DCFS FFA contract.

DCFS Child Welfare History Checks for Resource Parents Jodi reported that starting on January 1st, 2017 the County no longer completes CWS/CMS checks for the County RFA process, although FFAs are currently required to complete a CWS/CMS check through the DCFS Out-of-Home Care Management Division prior to certifying foster families. Brandon reported that the State’s decision to not complete the CWS/CMS checks for its RFA process was driven by a lawsuit in which the court found that the CWS/CMS check did not provide potential resource families due process. He agreed to look into whether DCFS plans to complete child welfare history checks for FFA resource parents prior to approval and at annual updates.

Conversion of Youth Placed in Group Homes Transitioning to STRTPsWendy Carpenter from Penny Lane inquired as to the Department’s conversion plan for youth placed in group homes transition to STRTPs. Bruce recommended that the County grandfather in youth currently placed in group homes. Brandon agreed to look into how DCFS plans to handle the conversion of youth placed in group homes transitioning to STRTPs.

Future of Emergency Shelter Care ProgramsIn response to ACHSA inquiries, Brandon reported that the County has not received a clear response from the State regarding the permissibility of Emergency Shelter Care (ESC) programs. He noted that DCFS is continuing to advocate for the Department’s continued operation of 30-day ESC programs within the STRTP model and agreed to share with ACHSA any updates regarding the status of DCFS’ discussions with the State.

Page 8 of 23

ACHSA committed to further advocate at the state level regarding the continued need for 30-day emergency shelter care programs in L.A. County, if necessary.

CCR Performance Outcome MeasuresIn response to inquiries, Brandon reported that the Department does not plan to make any changes to the performance outcome measures in the current FFA and Group Home contracts until further guidance is received from the State.

Please contact Alex or Jodi with any questions.  

ISSUE BRIEFS & UPDATES

Report on February 14th DMH Adult Provider Meeting

On February 14th, the Los Angeles County Department of Mental Health held its quarterly Adult Provider Meeting, facilitated by Adult System of Care Deputy Director Dr. Debbie Innes-Gomberg. The meeting focused on a variety of topics, ranging from the importance of peer support systems to consumers’ access to community resources throughout their treatment process. The meeting also featured a presentation by ASOC Program Head Scott Hanada on the importance of providing supportive yet competitive employment positions for clients.

Departmental Update – Debbie Innes-GombergDebbie began her Departmental update by discussing the importance of the role of peer support systems throughout each client’s treatment process. Citing DMH Director Jonathan Sherin’s advocacy regarding peer support, she stressed the importance of having peers become part of the outreach and engagement process, as well as utilizing them in institutional settings, such as jails and hospitals. She also suggested ways that peers can become less tied to a particular program, but more tied to a client as he or she moves through the system of care. As Dr. Sherin stated, peers have the potential to provide a surrogate family function, as they have lived experience that most clinicians do not. Debbie stated that this idea remains consistent with the continuity and fluidity of a treatment team that clients require as their needs change.

The other component of Debbie’s Departmental update encouraged the providers in attendance to brainstorm reintegration strategies, and to clarify the role of the community throughout the course of clients’ recovery processes. Debbie stressed that stigma reduction campaigns serve as a crucial component of the reintegration process, and pledged to increase them, especially within underserved cultural communities. Part of this

Page 9 of 23

campaign, she stated, is to educate community members and prepare them for consumers living among them, especially in light of the new State and County housing measures serving chronically homeless individuals with serious mental illness.

Furthermore, Debbie stressed that capacity and access need to be pragmatically stimulated, meaning that more opportunities for consumers to access community resources must be created. She suggested that consumer support groups could serve as one form of access. Debbie also emphasized the Department’s goal of involving the community in innovative ways, including identifying trauma early on or preventing trauma exposure altogether. She cited the faith and health neighborhood initiatives as examples of community strategies making headway in reintegration and stigma reduction.

MHSA 3 Year Program & Expenditure Plan – Debbie Innes-GombergIn her discussion of the MHSA 3 Year Program & Expenditure Plan, Debbie stated that as the Department moves toward a more flexible and fluid system of care, especially in ASOC, the topic of determinant use had been revisited. These determinants, especially within the Milestones of Recovery Scale (MORS), should help providers decide when a client is ready to move from FSP to a lower level of care, specifically the RRR program. Debbie stated that with the one-time allocation of $121.6 for clinical investments within FSP programs, this could be an opportunity for clients to expand their FSP programs in unique ways.

Debbie also mentioned that there is currently an adult priorities workgroup with several provider representatives that is working to clarify what FSP and RRR services would look like in terms of implementing levels of care. In order to clarify services for different levels of care, the principles developed in the Adult Integrated FSP Pilot are being incorporated, as the pilot model will be expanded to virtually every agency. Furthermore, there will be trainings on using the MORS held before July 1st. Also, because the current Schedule 8 document is infeasible with the consolidation of the funding buckets, a joint DMH-provider workgroup is in the works to formulate a new service expectation document. Debbie stated that the new document will likely transform the relationships that providers had with their Service Area District Chiefs, and that those positions will become much more managerial with regard to service planning.

Supported Employment – Scott HanadaASOC Program Head Scott Hanada then made a presentation on supported employment to educate providers in attendance about Individual Placement and Support (IPS) Model Training. IPS, he explained, is an evidence-based supported employment program for people with mental illness. He asserted that the goal of the IPS program is to have clients employed in competitive

Page 10 of 23

positions, with at least minimum wage payment. The positions themselves do not have to be designated for those with disabilities, and the clients would, ideally, be working alongside their non-disabled peers. This employment program should be integrated with the client’s treatment, with an employment specialist incorporated into the treatment team.

Within the program, Scott envisioned as little exclusion as possible, and job placement primarily based on the interests of the individual client. The Department’s goal is for clients to make educated decisions, including knowing exactly how their benefits will be affected. The job search will, ideally, help clients find a position within thirty days. The IPS program also involves intensive support for employers. Although implementing this project would be a challenge, Scott stated that providers could bid for new slots as part of Whole Person Care, and could tap into their flex funds, just as the behavioral health community did as the FSP program was launched.

Please contact TJ or Abby with questions.

Not Surprisingly Probation Wants to Talk About Continuum of Care Reform Implementation at Probation Provider Meeting

On February 14th, the Los Angeles County Probation Department convened the Quarterly Provider Meeting for Los Angeles group home agencies serving Probation youth. Providers from throughout the county were present for a briefing on Department updates.

Probation Placement Permanency & Quality Assurance Director Lisa Campbell-Motton opened the meeting by thanking agencies for their collaboration with the Department to serve youth in their care. She then asked those in attendance to share success stories from the previous quarter to which a number of providers shared positive stories.

Probation Departmental UpdateLisa reported that the new Chief Probation Officer Terri McDonald started earlier in the week. Terri has already made known several priority areas of focus, including use of force in institutions and juvenile camps, field enhancement training, and employee wellness. Lisa reported that Probation is not considering the bifurcation of Probation into children and adult as the Department has hired two new assistant chiefs, Sheila Mitchell and Reaver Bingham, who are residing over juvenile and adult services, respectively.

Department of Child and Family Services UpdateDCFS Contract Compliance Section Manager Diana Flaggs provided an overview of the STRTP Program Statements and Plans of Operation review

Page 11 of 23

process. She noted that many agencies that had submitted their STRTP Program Statements and Plans of Operation were receiving edits related to changes made in version two of the STRTP Interim Licensing Standards. Diana then shared the ACL 16-84 regarding Child and Family Team (CFT) guidelines.

Placement Administrative Services Updates Probation Placement Administrative Services (PAS) Director Adam Bettino reported that Probation providers should not be receiving or accepting placement referrals directly from the courts or from children’s advocates, and he noted that placement referrals should only be made by the ZIPP officers. Adam acknowledged the significant provider payment issues occurring with DCFS since October, when DCFS transitioned to a new payment system. He noted that Probation has requested that DCFS issue a notice in writing regarding this and any progress made thus far to address payment issues.

Adam reported that the Department is aware of the increase in vacancies in group home beds. He reported that the Probation population is down over 50 percent; there are now approximately 600 Probation youth in residential care.  He noted that the issue has been exacerbated by the courts making specific recommendations as to where a youth should be placed. Adam then discussed challenges with providers not giving a timely response to referrals and requested that providers respond to referrals within two days. Should the provider decide not to accept a referred youth, the provider must include detailed reasoning. Several providers pointed out the trend of an increased number of youth from juvenile hall refusing placements to which Adam requested that those agencies follow up with the ZIPP officers.

Deputy Probation Officer (DPO) Tim Valadez reported ongoing challenges with Probation providers not communicating runaway incidents in a timely or appropriate manner. He shared the Probation PAS AWOL reporting guidelines, noting that providers must include the police report number. Additionally, providers should separately request a bed hold, which is available for up to three days should the youth return.

Residential Based Services UpdateResidential Based Services (RBS) Director Felicia Davis reported that the Department plans to have one model for the Probation CFT, which will be the MDT model with minor changes. Felicia reported that Probation is working with DCFS and DMH to develop the Interagency Placement Committee (IPC) process in order to place youth into STRTPs. Probation will be developing its own IPC protocol which will include utilization of Placement Assessment Centers (PACs).

Placement Permanency and Quality Assurance Update

Page 12 of 23

Lisa reported that during the review of STRTP Program Statements and Plans of Operation, the Departments have noticed a number of issues in the Program Statement sections related to the Quality Parenting Initiative (QPI) and Quality Improvement Project (QIP). She noted that this is most likely because these are entirely new Program Statement sections and she shared further information regarding the QIP.  Representatives from Rancho San Antonio pointed out that they have received conflicting feedback from multiple Program Statement reviewers regarding the formatting of sections of the STRTP materials.  They requested that the Departments communicate to its reviewers to only provide feedback on content, not formatting.  Lisa requested that agencies share this feedback with their reviewers and should there continue to be issues to move up the chain of command.

Lisa shared information regarding the Nonprofit Sustainability Initiative, noting that the organization provides technical assistance and funding to assist with mergers and acquisitions for agencies struggling to transition to an STRTP. Lisa then reported that Supervising Deputy Probation Officer (SDPO) Pamela Pease is now overseeing Resource Family Approval (RFA). Lisa reported that DCFS and Probation have received feedback on the recently updated Needs and Services Plan guidelines. The Departments will be meeting on Thursday to discuss provider feedback and revise the document. Lisa reported that the Probation Electronic policy has been finalized and thanked those involved in the Probation Provider Subcommittee for their efforts. She noted that the subcommittee will be discussed the Clothing Allowance policy and then the Transgender Group Home Placement policy as its next meetings.

Final UpdatesProbation Child Trafficking Unit SDPO Joan Pera reported that State guidance regarding required CSEC training is pending and she encouraged providers to continue sending staff to CSEC trainings. In response to inquiries regarding training requirements, Probation committed to draft a document of all current staff training requirements to be shared with providers. She reported that Probation is in the process of developing curriculum for CSEC boys, parent intervention, parent prevention and parent support.

Youth Development Services (YDS) Director David Wong shared information regarding the upcoming Success is Our Future events. More information regarding this event is in the Child Welfare Nuts & Bolts section.

The next Probation Quarterly Provider will take place on May 23rd at Community Care Licensing (1000 Corporate Center Drive, Monterey Park, CA).

Please contact Jodi or Alex with any questions.

Page 13 of 23

DMH Children’s CSS Workgroup Meeting Begins Process of Considering Implementation of Programs Under Bucket Consolidation

On February 27th, Kanchi Tate, DMH Program Manager of Administration of the Children’s System of Care (CSOC), facilitated the sixth meeting of the Children’s CSS Work Plan Consolidation Workgroup. The aim of the meeting, she stated, would be to summarize what happened during the previous five workgroup meetings, while examining the current continuum of service programs, outcomes, and benchmarks within the FSP and non-FSP buckets.

Summary of Children’s ProposalKanchi began the meeting by sharing a draft of the Children’s Countywide Intensive and Non-Intensive Comparison Chart. This document contained distinction criteria pertaining to focal populations and risk factors, service provision, range of services, caseload, treatment team, and referrals that distinguished the Intensive (FSP) versus the non-Intensive (RRR) service continuum. CSOC Deputy Director Kalene Gilbert, who was present for the beginning of the meeting, sensed the uncertainty in the room and assured the attendees that no programmatic changes would be made within FSP. IFCCS would remain a specialized FSP program, but would have its own Service Exhibits and special reporting requirements. In other words, the funding streams would remain blended, but the programs themselves would remain separate.

One of the meeting participants from a contract agency remained skeptical about the introduction of RRR in place of FCCS. She also expressed concern that while the Katie A. panel has told her agency that the services they provide are lacking in intensity, DMH has criticized them for spending too much money. Therefore, a less rigid caseload than presented in the document, and greater flexibility overall, would be appreciated. Kalene agreed with her point of view, and stated that the Department was largely moving in the direction of greater flexibility, not in terms of expanding eligibility criteria, but in terms of establishing different levels within the FSP program. ACHSA Mental Health Policy Director TJ Hill stated that the creation of different levels of care within FSP is especially pertinent due to the fluctuation in children’s levels of stability, due to the rapidly changing circumstances in many of their lives.

Review of Resiliency, Recovery, Reintegration (Non-Intensive)The workgroup then moved on to describing the non-intensive service continuum, currently known as RRR, and formerly known as CIRRS. Kanchi stated that unlike the intensive service continuum, which only serves up to age fifteen, RRR would serve up to age twenty-one. As Kanchi stated that

Page 14 of 23

thirty-five percent of services within RRR would be field-based, TJ expressed certain misgivings. TJ worried that with such a wide range of services falling under RRR, thirty-five percent may be too rigid. Furthermore, the non-intensive continuum overall seemed to be the most undefined area of service. TJ also stated that with heightened fears and concerns within the undocumented community, it might be in both providers’ and clients’ best interests to increase the percentage of clinic-based services, where clients feel they may be able to safely receive services without risk of deportation by indicating where they live.

Furthermore, with regard to the outcome collection requirements, TJ mentioned that it would be wise for providers to use a reportable metric, such as the Youth Outcome Questionnaire (YOQ), that would allow the State to give the County credit for engaging in successful treatment. Kanchi hesitated, and stated that the Department wanted to avoid overwhelming providers by mandating them to use multiple outcome measurement tools. TJ agreed that any new outcome measure would replace existing measures. TJ replied that during the first year of both continuums’ implementation, many conversations would be had over whether the service array is too flexible or too inflexible. The overall process, he asserted, would have an experimental nature during the first year of implementation.

Levels of CareTJ mentioned that ACHSA was in the process of developing an integrated FSP pilot for children similar to the adult model, and that the workgroup at the center of the process had formulated a list of determinants of care that clarify the staff time and budget amount exerted for each client. TJ announced that the Child and Adolescent Service Intensity Instrument (CASII) had been chosen as the assessment tool, as it pinpoints internal, familial and environmental factors in a child’s life in developmentally appropriate ways. The goal of the ACHSA workgroup, he stated, was to introduce the pilot program beginning in FY 2017-18 with a group of about six children’s providers. TJ noted that within the adult pilot, although there was initial pushback from clinicians due to the perception of cumbersome outcome measurements, in the end, both clients and providers found the new system to be highly beneficial; he predicted the same end result for the children’s pilot.

TJ expressed concern over the possibility that there would be an FSP program with no levels of care assigned. He stated that although a very purposeful system had been put in place for adults, no such system had been created for children. With such lack of clarity between and within the two service continuums, there was little incentive for clients to move to a lower level of care. A provider commented, however, that if an excessive amount of structure was incorporated into the system, services were less likely to be individualized; individualization of services is especially

Page 15 of 23

important due to how rapidly children can transition between levels of need, for better or for worse. TJ understood her concerns, but indicated that the behavioral healthcare system was always working against a limited array of resources, and that we needed to create systems that allow providers to manage cases more efficiently. Creating different levels of care could help identify why some clients are utilizing the highest percentage of mental health funds, and move toward serving them in the most cost effective way with the clinically appropriate services.

Conclusion & Next StepsAt the meeting’s conclusion, Kanchi encouraged the workgroup to reconvene within a couple of months, after more work on the children’s integrated FSP pilot program had been completed. With this progress, Kanchi believed that levels of care within both service continuums could be more clearly defined.

Please contact TJ or Abby with questions.  

Going to the Mat for MAT: ACHSA Advocates for Multidisciplinary Assessment Team Program

Since we last reported to you regarding ACHSA’s advocacy related to the Multidisciplinary Assessment Team (MAT) program in the January 15 th

ACHSA Bulletin, a couple of key MAT-related meetings have taken place. Highlights from these meetings are described below.

ACHSA MAT MeetingOn February 7th, ACHSA convened an internal meeting of its MAT providers in order to provide an update on the Association’s continued discussions with DCFS and DMH over the past several months regarding possible changes to the MAT process and Summary of Findings (SOF) and to talk about ACHSA’s position in regards to the proposed changes moving forward.

Bruce began the meeting by reminding MAT providers of the August meeting between ACHSA and DCFS Deputy Director Helen Berberian, Division Chief Deborah Silver, and MAT program manager Laura Andrade where the following agreement was reached: If a child/family requires a CFT meeting(s) during Stage 1 of the MAT

process (or any time prior to the completion of the SOF), the MAT assessor will facilitate the meeting(s).

The MAT assessor will facilitate the CFT meeting to review and discuss the SOF, as is done today with the MAT program.

After the SOF CFT meeting, there will be a “warm handoff” of the MAT case from the MAT assessor to the CSW. The CSW will then facilitate

Page 16 of 23

subsequent CFT meetings to follow up on implementation of the SOF recommendations. The MAT agency will be invited to participate in subsequent CFT meetings, particularly if the agency is continuing to provide mental health services to the child.

 Jodi explained that since August, DCFS has shifted away from this original agreement, particularly because the agreed upon model would conflict with the DCFS CFT process through which the CSW facilitates all CFT meetings. MAT providers commented that the current model for the SOF meeting – which is co-facilitated by the MAT assessor and DCFS MAT coordinator – works well. It was noted that the MAT assessor is often more knowledgeable regarding the child than the assigned CSW since the SOF meeting takes place right around the time of the case transition from the Emergency Response (ER) CSW to the back end CSW. It was further pointed out that CSWs are always invited to SOF meetings but, in some Service Areas rarely show up for these meetings.

At the same time, MAT providers operating in Regional Offices that have implemented the CFT model (a.k.a. the DCFS immersion offices), complimented the CFT process which has significantly improved how CSWs engage families and service providers. Bruce questioned whether MAT assessors would be interested/willing to become certified as CFT facilitators. In response, providers working in the immersion offices noted that the intensive training to become certified as a CFT facilitator could take up to nine months. Given the extensive nature of the required CFT facilitator training, the following revised MAT CFT model was agreed to: If a child/family requires a CFT meeting(s) during Stage 1 of the MAT

process (or any time prior to the completion of the SOF), the CSW should facilitate the meeting(s), with the MAT assessor being invited to attend the meeting.

The CSW and MAT assessor should co-facilitate the CFT meeting to review and discuss the SOF. While the CSW would be certified as a CFT facilitator, the MAT assessor would not have to be similarly certified.

The CSW should then facilitate subsequent CFT meetings to follow up on implementation of the SOF recommendations.

During the meeting discussion, MAT providers reported significant upfront delays in receiving referrals, noting that it is common for them to receive referrals two to three weeks following detention, after children have experienced multiple placements. MAT providers pointed out some known reasons for the upfront delays, including capacity issues (systemically resulting from the inadequate DCFS MAT allocation) and Medi-Cal issues. It was agreed that the systemic upfront delays in getting referrals to MAT agencies should be more closely examined.

Additionally, it was discussed that DCFS continues to question the

Page 17 of 23

usefulness of MAT, largely because there is no follow up on the SOF recommendations. Bruce stressed that the lack of accountability following the MAT assessment is a DCFS issue that should not reflect on the quality and utility of the program.

MAT Best Practices Workgroup MeetingAt the February 14th MAT best practices workgroup meeting convened by DCFS and DMH, Jodi reported on the MAT meeting that ACHSA had convened the previous week. She highlighted the key operational issues impacting the MAT program, namely: 1) inadequacy of the DCFS MAT allocation and the resulting impact on MAT provider capacity; 2) upfront delays in referrals to MAT providers; and 3) lack of CSW follow up on SOF recommendations.

In regards to the inadequacy of the MAT allocation, DMH Mental Health Clinical Program Head Christy Maeder and DMH MAT Program Manager Mike Sherman stated that every Service Area currently has capacity to accept new MAT cases and it is projected that there will be capacity through the end of this fiscal year. Christy further pointed out that there was unused DCFS MAT funding in some Service Areas last fiscal year.

DCFS and DMH acknowledged the upfront delays in getting MAT referrals to agencies. The most common Medi-Cal issues resulting in delays, explained Mike, include initiating a child’s Medi-Cal (particularly for infants) and shifting a child’s Medi-Cal from parent to DCFS. Some MAT providers also ask for the Benefits Identification Card (BIC) issue date, which could take up to one week to obtain, prior to initiating services for a child in order ensure that the child has full scope Medi-Cal. Additionally, the workgroup discussed back end delays in the MAT process related to scheduling SOF meetings. It was pointed out that each DCFS MAT coordinator is expected to attend every SOF meeting in his/her Regional Office and therefore may not be able to schedule the SOF meeting within the 30 to 45 day timeline that is expected. According to ACHSA’s proposed new model, the CSW, rather than the DCFS MAT coordinator, would co-facilitate the SOF meeting with the MAT assessor, potentially addressing this challenge. ACHSA and the County Departments agreed to further investigate the specific reasons for the upfront and back end delays.

The Departments agreed on the need for greater accountability to ensure that SOF recommendations are followed up on. DCFS representatives pointed out their hope that the CFT process could serve as the formal mechanism to ensure follow up and accountability.

After reminding the workgroup about the MAT process that was previously agreed upon by DCFS and ACHSA in August, Jodi presented ACHSA’s new modified proposal for the MAT process. She emphasized that the modified

Page 18 of 23

proposal aligns with what the process that the MAT best practices workgroup had discussed during an earlier meeting in October of last year.

In response, DCFS Division Chief Deborah Silver explained a new development in DCFS’ position in regards to the initial CFT meeting for newly detained children. Based on the experience of CSWs in the immersion offices, Deborah explained, DCFS has found that convening an initial CFT meeting during the first few weeks following detention is not realistic. DCFS has discovered that asking the ER CSW to facilitate the four-step CFT process has made it much more difficult for such workers to comply with the Department’s thirty-day investigation mandates. As well, Deborah reported that DCFS has found that it has been difficult for the ER CSW, who is completing the investigation, to effectively engage the family. Deborah further pointed out that the state Continuum of Care Reform guidelines allow the initial CFT meeting to take place within sixty days of detention. Given these considerations, DCFS has taken the position there will not be a Stage 1 CFT meeting; the Stage 2 CFT meeting will be the initial CFT meeting for the family.

Overall, both Departments reiterated that MAT is an integral process. The Departments did, however, stress that a key challenge is determining how to consistently involve the MAT assessor in the first two steps of the CFT process – staff engagement and family engagement – which may involve non-billable activities that would have to be covered by the minimal DCFS MAT allocation.

Next Jodi reviewed a streamlined version of the SOF which included ACHSA’s recommendations to delete, revise and reorder a number of sections. Additionally, ACHSA recommended replacing the Child Needs and Child Referrals sections with an alternate simplified format entitled Child Needs and Services Recommended, which would be especially important since these sections are of most relevance to the court.

Jodi reviewed the dependency proceedings timelines, noting ACHSA’s understanding that the formal timelines for the jurisdiction hearing and disposition hearing are waived in almost all cases. As well, the jurisdiction hearing and disposition hearing almost always take place on the same date – generally 45 to 60 days following detention. It is ACHSA’s understanding that timeframes among courtrooms vary greatly, based on the experience of the judges and dynamics between attorneys; however, most jurisdiction hearings take place within 45 to 60 days from removal. Deborah reminded the workgroup that SOFs are getting to the court in time for the jurisdiction hearing in only 38% of cases, to which Bruce pointed out that the SOF should be able to get to the court during prior to the jurisdiction hearing if the current upfront delays in referrals could be addressed.

Page 19 of 23

Shano Palovich, DCFS CSAT Program Manager, then reviewed the CFT meeting notes currently utilized to document the discussion and action plan from each CFT meeting. Workgroup members acknowledged possible overlap in some areas in the CFT meeting notes and SOF, as well as information unique to each document.

Next StepsWorkgroup members agreed that the next MAT best practices workgroup meeting on March 14th would include further discussion regarding the upfront and back end delays in the MAT process. ACHSA also committed to review the CFT meeting notes and ACHSA’s recommended streamlined SOF to determine whether these two templates could be integrated into a single document.

Please contact Jodi with any questions.

Mental Health Odds & Ends

Los Angeles Times Endorses Measure H on the March 7 Ballot A recent Los Angeles Times article encouraged its readers to vote YES on Measure H: the quarter-cent sales tax increase that would raise $355 million annually for ten years to fund mental health, substance use, and other services to help homeless individuals find and maintain their housing. The article explains that the initiative does not duplicate Proposition HHH, the bond measure to supply more housing for the homeless that overwhelming passed on November 8. Instead, it supplements HHH by paying for the services to be provided in the city’s newly-constructed supportive housing units. The author analogizes Measure H as the software to the “hardware” of the housing units funded by Proposition HHH.

Child Welfare Nuts & BoltsRidley-Thomas Introduces   Bill to Fill   Gap Between Children’s Outpatient Mental Health & HospitalizationAssemblymember Sebastian Ridley-Thomas (D-Los Angeles) has introduced Assembly Bill 501, which would expand the definition of Short-Term Residential Therapeutic Program (STRTP) in order to create a state licensing category for children’s mental health crisis residential programs, a critically-needed service that is missing from the current continuum of care. With 47 out of 58 counties lacking any child/adolescent psychiatric hospital inpatient beds for children under 12, and fewer than 70 beds statewide, children’s mental health crisis residential services are pressing for children whose treatment needs are not met by outpatient services.

According to the bill’s sponsor, the California Alliance of Child and Family

Page 20 of 23

Services, the creation of the licensing category is consistent with EPSDT Specialty Mental Health Services (SMHS) program requirements, and this bill would fill a gap in regulations which prevent California from fully complying with the EPSDT SMHS entitlement for children and youth. To learn more about AB 501, download the fact sheet. To submit a letter of support for AB 501, download the sample letter and send to Assemblymember Ridley-Thomas’ office at ryan.pessah@asm.ca.gov, with lthull@cacfs.org cc:ed.

New Website Helps Empower Foster Youth to Make Fully-Informed Decisions About Their College Options   A new website called FosteringQualityEducation.org was recently launched by the Children’s Advocacy Institute to guide foster youth through evaluating and choosing a college, with an emphasis on how to avoid predatory practices such as for-profit institutions. Tips about evaluating the quality of a college and its suitability, and making the most of financial aid are conveyed through informative and relatable videos.

A Review of the Process of Trying Youth as Adults Makes a Case for Stopping the PracticeThe Human Impact Partners has released the report “Juvenile InJustice: Charging Youth as Adults is Ineffective, Biased, and Harmful” which provides a comprehensive look at the process of trying youth as adults. With the passage of Proposition 57 in California, prosecutors may no longer directly file juveniles in adult court; however, minors can still be tried as adults through juvenile transfer. The report makes a number of recommendations; first and foremost, eliminating the practice of charging youth as adults under any circumstance.

In all 50 states, youth under age 18 can be tried in adult criminal court through various types of juvenile transfer laws, such as a judicial waiver in California, which allows youth as young as 14 to be tried as adults at the discretion of a juvenile court judge. Key findings indicate that the justice system is biased against youth of color, with inequities persisting even after controlling for variables like offense severity and prior criminal record. Additionally, “tough on crime” laws are ineffective, with studies finding higher recidivism rates among juveniles tried and sentenced in adult court than among youth charged with similar offenses in juvenile court. The report also found that the adult court system ignores the environmental factors that affect adolescent behavior, whereas the juvenile court system is meant to focus on reasons for the youth’s behavior rather than just their guilt or innocence, with a juvenile court judge responsible for reviewing that youth’s case with their family, community, and future development in mind.

Page 21 of 23

CONFERENCES, EVENTS & RESOURCES

CSEC 101: CSEC Awareness TrainingMarch 7th, 2017

On March 7th from 8:00 a.m. to 5:00 p.m., Nola Brantley will host a CSEC awareness training at the Double Tree Inn in Norwalk (13111 Sycamore Drive). For more information, and to reserve a spot, please click here.

CSEC 102: Engaging and Empowering CSEC and TAYMarch 16th – 17th, 2017

On March 16th and 17th from 8:00 a.m. to 5:00 p.m., Nola Brantley and Dr. Nicole Klasey will host an “Engagement Strategies for CSEC” training at the Embassy Suites in Downey (8425 Firestone Boulevard). Participants must have taken CSEC 101 prior to enrolling in order to be eligible. For more information, and to reserve a spot, please click here.

Training: Key Legal and Ethical Issues for Mental Health ProfessionalsMarch 24th, 2017

On March 24th from 9:00 a.m. to 4:00 p.m., Penny Lane (15314 Rayen StreetNorth Hills, CA 91343) will host an a training led by Michael Griffin, J.D., LCSW, that will focus on legal and ethical issues that have fundamental importance to psychotherapists. Topics typically included are: standards of care, scope of practice, scope of competence, consent/informed consent for treatment, consent for the treatment of minors, avoiding conflicts of interest, and much more. This event will provide 6 hours of continuing education credits. For more information, and to reserve a spot, please click here.

CSEC 102: Engaging and Empowering CSEC and TAYMarch 27th – 28th, 2017

On March 27th and 28th from 8:00 a.m. to 5:00 p.m., Nola Brantley and Dr. Nicole Klasey will host an “Engagement Strategies for CSEC” training at the Ramada Inn in South El Monte (1089 Santa Anita Avenue). Participants must have taken CSEC 101 prior to enrolling in order to be eligible. For more information, and to reserve a spot, please click here.

Page 22 of 23

Save the Date: Success is Our FutureMay 18th, 2017

On May 18th, Youth Development Services (YDS) will host an event for all foster youth who are graduating or will graduate next year. For the flyer to share with youth and staff, please click here.  The Departments have shared a number of forms, including their upcoming deadlines:

o For the SIOF Application form, please click here.o For the ticket order form, please click here.o For the High School Graduates Early Departure form, please click

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

here. o For the Athletic Scholarship form, please click here.o For the Spoken Word, Art and Performing Arts Award form, please

click here.

IN THE NEWS

This Foster Father Takes In Only Terminally Ill Children , Los Angeles Times, 2/8/17

Child Protection Agency Misses Hundreds of Payments Due to Computer Glitches, Los Angeles Times, 2/10/17

An 8-Year-Old Boy’s Death Has Social Workers Wondering, “Could I Face Criminal Charges?”, Los Angeles Times, 2/13/17

Why Do More L.A. County Black Children End Up In Foster Care? Experts Clash Over The Reason, Los Angeles Times, 2/16/17

Inside A Mom’s Months-Long Fight To Get Back Her Children , Los Angeles Times, 2/16/17

Study Examines Racial Disparities in the Juvenile Justice System , The Chronicle for Social Change, 2/21/17

L.A. County to Implement State Plan to Prevent Unintended Pregnancies Among Youth, The Chronicle for Social Change, 2/23/17

Missing the Bus: California Fails Students in Foster Care , The Chronicle for Social Change, 2/23/17

UPCOMING MEETINGS & EVENTS

MARCH

8 Children’s Mental Health Policy Committee Meeting ACHSA 1:30 PM to 3:30

PM

Page 23 of 23

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

PM23 FFA Strategic Planning &

Policy Committee Meeting ACHSA 10:00 AM to Noon

23 Mental Health Contract-Admin Committee Meeting ACHSA 1:00 PM to 3:00

PM28 DCFS/FBS Committee

Meeting ACHSA 10:00 AM to Noon

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