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Davidson Conference Center

December 1, 2008 9:00-4:00 PM 3415 South Figueroa Los Angeles CA 90089

MEETING PURPOSE



To bring together DCFS, DMH, CEO and other partners to…

understand the Katie A. Strategic Plan’s components; 2.

provide focused feedback on the implementation of three components of the Katie A. Strategic Plan; 3.

build greater ownership over the implementation of the Katie A. Strategic Plan.

WELCOME



MIGUEL SANTANA

, Deputy Chief Executive Officer, Children and Families' Well-Being 

SHEILA SHIMA

, Deputy Chief Executive Officer, Health and Mental Health Services

AGENDA: MORNING

I. WELCOME & OVERVIEW II. STRATEGIC PLAN OVERVIEW

 High-Level Context  High-Level Plan Components

III. SERVICE ACTIVITIES

 MH Screening and Assessment  MH Service Delivery  Data and Tracking of Indicators 9:00-9:15 9:15-10:30 10:40-12:00

AGENDA: AFTERNOON

IV. AFTERNOON ACTIVITIES V. IMPLEMENTATION PLANNING

 Break Out Sessions 1:00-1:25 1:35-3:05

VI. PRESENTATION AND INTEGRATION

3:20-4:00

VII. ADJOURN

4:00

RECOGNITIONS

Executive Leadership Board Deputies Departmental Leadership CHAMPS Operational Planning Caseload Reduction Workgroup Data Workgroup Training Workgroup

RECOGNITIONS

Specialized Foster Care Managers’ Meeting 10.

Interagency Placement Review Meeting 11.

Intensive In-Home Mental Health Services Meetings 12.

CFT/Finance Workgroup 13.

CSAT/Referral Tracking System Workgroup 14.

EPSDT Determination Workgroup 15.

MAT Coordinators Meeting 16.

MAT Steering Committee

AGREEMENTS

A learning opportunity among ‘experts’ of different parts of a complex system; this not a training… 2.

Some components of the Plan need your feedback —hence this is an invitation to co-craft elements of the Plan that still need work.

Play an active role in understanding concepts and giving feedback.

PRESENCE PRINCIPLES

Those who show up are the right ones.

When it starts is the right time.

Whatever happens is the only thing that could’ve.

When it’s over, it’s over…

OVERALL CONTEXT



TRISH PLOEHN

, MSW, Director, Department of Children and Family Services 

MARVIN J. SOUTHARD

, DSW, Director, Department of Mental Health 

BRANDON NICHOLS

, Senior Deputy County Counsel, Social Services Division

BACKGROUND: 2002



CLASS ACTION LAWSUIT FILED AGAINST THE STATE AND LOS ANGELES COUNTY ALLEGING:

Failure to assess mental health needs.

Inadequate mental health services.

Placement disruptions.

Over-reliance on congregate care.

Institutionalization —MacLaren Children’s Center.

BACKGROUND: JULY 2003

 Los Angeles County entered into a Settlement Agreement resolving the County-portion of the lawsuit.

 The Settlement Agreement required the County to make systemic improvements to better serve members of the class.

KATIE A. CLASS MEMBERS

Are in the custody of the Los Angeles County DCFS in foster care or who are at imminent risk of foster care placement by DCFS; 2.

Are eligible for services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program;

KATIE A. CLASS MEMBERS

Have a mental illness or condition that is documented or, had an assessment been completed, could have been documented; and 4.

Need individualized mental health services to treat or ameliorate their illness or condition.

SETTLEMENT OBJECTIVES

Promptly receive necessary individualized mental health services in their own home, a family setting, or the most homelike setting appropriate to their needs; 2.

Receive care and services needed to prevent removal from their families or dependency or, when removal cannot be avoided, to facilitate reunification, and to meet their needs for safety, permanence, and stability;

SETTLEMENT OBJECTIVES

Be afforded stability in their placements, whenever possible; and 4.

Receive care and services consistent with good child welfare and mental health practice and the requirements of law.

HISTORY: THREE PLANS

ENHANCED SPECIALIZED FOSTER CARE (SFC) MENTAL HEALTH SERVICES PLAN

[2005]  Pilots in three Service Planning Areas

CORRECTIVE ACTION PLAN (CAP)

[2007]  Modifications required by the Court

KATIE A. STRATEGIC PLAN

[2008]  Comprehensive five-year plan

Legal Background and Context

!The “Bottom Line” !

!Why Moving Forward and Making Progress is Critical!

& !Why Partnership and Engagement (DMH, DCFS, CEO, Community Partners, Providers, Stakeholders etc. is KEY!

KATIE A. STRATEGIC PLAN: CONTENT A (Brief) Panel Discussion

What are the Components of the Plan: Questions, Questions and more Questions…

Katie A. Strategic Plan: High Level Overview



Does any-ONE have a question they’d like to ask?

E X I T

(Beginning With End In Mind)

• Successful completion of meaningful Strategic Plan.

1 2 • Acceptable progress on indicators.

3 • Passing score on a Qualitative Service Review.

QUALITATIVE SERVICE REVIEW

CHILD STATUS INDICATORS 1. Safety 2. Stability 3. Physical & Emotional Well Being 4. Learning & Development 5. Prospects for Permanence SYSTEM PERFORMANCE INDICATORS 1. Child & Family Engagement 2. Team Coordination 3. Planning & Assessment 4. Implementation 5. Tracking & Adjustment 6. Cultural Accommodations

Katie A. Strategic Plan: High Level Overview Continued

Does anyone else have a question they’d like

TWO

ask?

FUNDING OF SERVICES

EPSDT

Dollars

TITLE IV-E

Funds $

COUNTY

General Funds

MHSA

Funds

Katie A. Strategic Plan: High Level Overview Continued

THIRD

time is a charm….Who else has a question they’d like to ask?

CASELOAD REDUCTION

OUTCOME:

REDUCED CASELOADS

Improve HR Resource Practice & Rates

Reduce Front-End Referrals & Case Openings

Demonstration Project —Residential Based Services

Increase Permanency Practices & Rates

Katie A. Strategic Plan: High Level Overview Continued



Does anyone else have a question

FOUR

leadership?

KEY OUTCOMES

Safety, Permanence; Child Well Being

FIVE TENETS 1.

Engaging Families

Teams around Families

Teams Gather Info & Develop Assessments

Teams Create Individualized Plans

Tracking & Adapting Plans Based on Results

TRAINING

CORE CONSTRUCTS 1.

Engagement & Team Preparation

Plan Development

Implementation

Transition.

FOCUS 1.

Supports Key Strategic Plan Elements (CSAT/CFT).

Joint Overview and Orientation Training.

Support CSAT and Related Processes and Protocols

Training and Coaching CFT Implementation.

Katie A. Strategic Plan: High Level Overview Continued

 Does anyone else have a question for leadership? # 5

ACTIVITIES

DATA & TRACKING OF INDICATORS MENTAL HEALTH SCREENING & ASSESSMENT MENTAL HEALTH SERVICE DELIVERY

DATA AND TRACKING OF INDICATORS

(Insuring We Know What’s Happening)

and REFERRAL TRACKING SYSTEM

(The System that will be in place to do this)

TIMELINESS OF MENTAL HEALTH SCREENING 6.

OUTCOMES TIED TO SERVICES 2.

ASSESSMENT 5.

DURATION OF SERVICES 3.

REFERRAL TO SERVICE 4.

PROVISION OF SERVICES

SCREENING & ASSESSMENT 1. THREE TRACKS

2. CSAT

3. REFERRAL TRACKING

THREE TRACKS TO SCREENING

1. ALL NEWLY DETAINED CHILDREN

MAT ASSESSMENT WITHIN 45 DAYS

2. ALL NEWLY OPENED NON-DETAINED CASES

MH SCREENING BY CSW

3. ALL EXISTING-OPEN CASES

MH SCREENING BY CSW, WITH EXCEPTIONS KATIE A. CLASS MEMBERS

C S A T: PURPOSE

To coordinate DCFS and DMH non-line staff to rapidly receive screenings and/or referrals to ensure service linkage.

To integrate ‘siloed’ services and programs into CSAT through clear policies and procedures for all operational responsibilities.

To use a data tracking system to regularly monitor progress on indicators (i.e., timely delivery of screening, assessment, referral linkage, full utilization of resources, etc.).

C S A T: PARTNERS

DCFS, DMH, DPH AND DPSS STAFF…

CSW 2.

Service Linkage Specialist 3.

DMH Co-Located Specialized Foster Care Staff 4.

MAT Staff 5.

Team Decision Making Staff 6.

Resource Utilization Management/Resource Utilization Liaisons 7.

Youth Development Specialists 8.

Permanency Partners Program (P3) Staff 9.

Adoption Safe Families Act Staff 10.

Linkages Co-Located Staff 11.

Educational Liaisons 12.

D-Rate Coordinators 13.

PHN

MENTAL HEALTH SERVICE DELIVERY

CHILD AND FAMILY TEAMS (CFTs) EXPANSION OF WRAPAROUND SERVICES INTENSIVE IN HOME MENTAL HEALTH SERVICES

Katie A. Strategic Plan: High Level Overview Continued We have time for one LAST question.

? # 6

KATIE A. STRATEGIC PLAN High Level Summary

•

MENTAL HEALTH SCREENING & ASSESSMENT

•

MENTAL HEALTH SERVICE DELIVERY

•

DATA AND TRACKING OF INDICATORS ACTIVITIES SUPPORTS

•

FUNDING OF SERVICES

•

TRAINING

•

CASELOAD REDUCTION

•

EXIT CRITERIA AND FORMAL MONITORING PLAN EXIT

REFLECTIONS

STRUCTURE

  Select a facilitator (who keeps group focused and makes sure everyone gets a chance to speak).

Select a recorder of key points.

QUESTIONS

What did you like about what you heard?

What questions do you have?

Screening, Assessment and Service Delivery:

“As the Caseload Churns” (An Activity)

  

Objectives:



Better understand key decision points (mental health screening/assessment and service delivery components looking at 3 “points of entry/service”) Connect these with existing resources Identify key places where input is needed Engagement, feedback and clarification

Some Guidelines



Basic case information only

  

Track thoughts, questions and ideas for processing later Keep child, family member and CSW role at the forefront

Engagement, Teaming, Tracking, Improving….

Activity: “The Flow”

Prologue : “Decisions/Decisions/Decisions”



Key Concepts:

Mental Health Screening Tool (MHST), Referral Tracking System, Coordinated Services Action Team (CSAT),

3 Families Family # 1 Jackson-Washington Family

(Detention Required)

Family # 2 Jefferson Family

(Case Opening/No Detention)

Family # 3 Evans Family

(Triggering Event and/or Case Plan Update Due) Act I Scene 1: Act I: Scene 2 : Act I: Scene 3: Background/ Initial Assessment: Safety/Risk Assessment Team Decision Making and Mental Health Screening Mental Health Assessment Act I: Scene 4:  Mental Health Services Linkage 

Act II:

Mental Health Service Delivery/Tracking of Indicators ( A “Walk Through”)

Epilogue:

Reinforcing Key Points, Table Discussion and Report Out

Decisions, Decisions, Decisions!

Handout At Your Tables

Review 3 Referrals (A) Initial Referral ------to-------(B)-Successful Case Closure Question One:

 Pick one of these scenarios and list 7-10 major decision/intervention points that will have to be made during the time from referral to case closure.

Question Two:

 Pick one decision/intervention point on your list. Brainstorm below your ideas on the tools, resources and supports that a CSW currently has available to help them make this decision.

Scenario # 1



Today’s date: _____________: CPHL Call:

“Hello, I’d like to make a referral regarding Joe Jackson and La Trecee Washington. They are currently running around the neighborhood completely unsupervised since early this morning. Both children have serious behavior problems. Parents are into drugs and are nowhere to be found.”



Date: (12 months from today):

_________________ Judge:

“Joe Jackson and La Trecee Washington are discharged as dependents of the court and the petition is dismissed.”

Scenario # 2



Today’s date: _____________ CPHL call from Law Enforcement

“Hello, I’d like to request that a Social Worker to respond to the Pacific Shores Motel. We have two children Brianna and Maria Jefferson (ages 15, and 7) in custody. We may have to arrest their mother for child endangerment and resisting arrest.”



Date: (6 months from today)

_________________

CSW

“Mrs. Jefferson, you’ve done very well. I’m pleased to see all of these support systems in place and your case is officially closed.”

Scenario # 3

Today’s date

____ CPHL (Level 12 Group Home)

“This follows up on previous referrals/phone calls on Marco Evans. He continues to physically assault both staff and residents when he gets angry and upset and broke a window during his last outburst. Due to his large stature, (5’11’ and 290 lbs), GH staff are unable to protect themselves and the other residents. We are requesting his immediate removal. He has two siblings (Samuel and Josephine) who are also in foster care and their court hearing is coming up”

Date: (12 months from today):__________________ Judge:

“Marcos, Samuel and Josephine Evans are discharged as dependents of the court and the petition is dismissed.”

Decisions/Interventions – Resources and Supports

 Decision Intervention Point  Tools Resources and Supports ?

Decision Points-Tools/Resources

(Some Examples)

         

IN PERSON RESPONSE?

ALLEGATION SUBSTANTIATED?

SAFETY DECISION?

ASSESSMENT OF FUTURE RISK (CASE OPENING OR REFERRAL)?

COURT DECISION?

ASSESSMENT/CASE PLAN: WHAT SERVICES ARE REQUIRED?

DISPOSITION OF CASE?

(RE)PLACEMENT DECISION?

RE-ASSESSMENT/PLAN MODIFICATION?

PERMANENT PLAN, CASE CLOSURE?

Other

        

KNOWLEDGE, VALUES, SKILLS SUPERVISORS, COLLEAGUES (Internal/External) SERVICE PROVIDERS, CARE-PROVIDERS, CONSULTANTS LAWS TEAMING STRUCTURES AND STRATEGIES POLICY GUIDELINES DECISION MAKING AND ASSESSMENT TOOLS CASE PLAN AGREEMENTS RESEARCH Other

TOOLS RESOURCES AND SUPPORTS: MENTAL HEALTH NEEDS MENTAL HEALTH SERVICES

AND THE MEANS TO TRACK PROGRESS

MH SCREENING & ASSESSMENT



Key Concepts: (A Reminder)

 Mental Health Screening Tool (MHST),  Referral Tracking System,  Coordinated Services Action Team (CSAT)

3 Families Family # 1 Jackson-Washington Family

(Detention Required)

Family # 2 Jefferson Family

(Case Opening/No Detention)

Family # 3 Evans Family

(Triggering Event and/or Case Plan Update Due)

Family # 1: Washington-Jackson Case Detention Imminent/Required: All Other Controlling Interventions Exhausted)



Father:

Dale Jackson (25) 

Mother

: Rhonda Washington (25) 

Child

: Joe(Jackson (6), 

Child

: La Trecee Washington (6) CSW: • Narration

Family # 1: Washington-Jackson Case Key Steps/Key Points

Act I Scene 1: Act I: Scene 2 : Background/ Initial Assessment (SDM, Other) Team Decision Making and Mental Health Screening

Key Points: TDM, HUB and MAT Referral, Consent/Eligibility, Referral Tracking System, CSAT Accessed

Act I: Scene 3: Mental Health Assessment

Key Points: MHST Completed (HUB), MAT Assessment/Summary of Findings, CSAT Accessed

Act I: Scene 4: Mental Health Services Linkage

Key Points: MAT Support for CSW and Service Linkage, CSAT Engaged

Family # 2

The Jefferson Case (Non-Detained: Controlling Interventions Implemented )



Mother:

Dorothy Jefferson 

Father:

Ralph Jefferson (whereabouts unknown) 

Child:



Child:

Briana Jefferson (15) Mariah Jefferson (7)  CSW  Narration

Family # 2

: The Jefferson Case Key Steps/Key Points

Act I Scene 1: Background/ Initial Assessment (SDM, Other) Act I: Scene 2 : Team Decision Making and Mental Health Screening

Key Points: TDM, MHST Completed, Service Linkage Specialist and CSAT Engaged, Consent/Eligibility, Referral Tracking System,

Act I: Scene 3: Mental Health Assessment

Key Points: Co-Located Staff Engaged, Assessment, CSAT Engaged,

Act I: Scene 4: Mental Health Services Linkage

Key Points: Co Located Staff, Service Linkage Specialist and (appropriate) CSAT Support Provided

Family # 3

The Evans Family (Triggering Event and/or Case Plan Update Due)



Mother:

Theresa Evans 

Father:

Sam Dearden - Deceased  

Child:



Child: Child:

Marcos Evans – (13) Samuel Evans – (9) Josephine Evans – (17)  CSW  Narration

Family # 3

: The Evans Case Key Steps/Key Points

Act I Scene 1: Act I: Scene 2 : Background/ Initial Assessment (SDM, Other) Team Decision Making and Mental Health Screening

Key Points: TDM/RMP Process Utilized, Service Linkage Specialist, CSAT Engaged, MHST Completed (if not receiving MH services), Consent/Eligibility, Referral Tracking System

Act I: Scene 3: Mental Health Assessment

Key Points: Co-Located Staff, CSAT Engaged

Act I: Scene 4: Mental Health Services Linkage

Key Points: Service Linkage Specialist, CSAT and Co Located Staff Engaged

The “Pause Button”

Debriefing the Role Players Thoughts, Reactions AND APPLAUSE!

Epilogue: A Table Activity Matching

Points of Entry

--- Key

Process Steps Step One

: Match the Point of Entry With Corresponding Process Steps

Step Two

: Match Terms With Definitions

It’s easy to feel lost.

HUBs TBS AB3632 730 Evaluations

Psychotropic Authorization

Fortunately, help has arrived.

DMH Specialized Foster Care Co-Located Staff

Consultation

Information Exchange

Assessment

Brief Treatment

Systems Navigation

Service Linkage

It’s a complicated system out there.

Full Service Partnerships

Intensive In Home MHS Programs

Wraparound

DCFS STUDY

Those who graduated from the Wraparound Program were 36 times less likely to have another placement episode than those leaving RCL 12+ facilities that did not receive Wrap services, despite having roughly comparable placement rates before and during their respective treatments.

Out-of-Home Placements (Wraparound Graduates vs. RCL 12+ Non-Wraparound Youth) 256 264 249

300 200 100

0 Wraparound Before Wrap/RCL 12+ Non-Wraparound After Wrap/RCL 12+

CHILD AND FAMILY TEAM APPROACH

CHILD & FAMILY TEAM

Engagement of child, family, formal and informal support systems.

Identifies needs and strengths.

Develops plan for child and family.

Supports plan implementation.

Modifies plan, as needed.

Transitions to informal supports (i.e., family, church, etc.).

INTENSIVE HOME-BASED SERVICES

INTENSIVE IN-HOME MENTAL HEALTH SERVICES

-Guided by CFT -Services based on needs and strengths.

-Evidence-based and best practice.

-Mental health and rehabilitation services.

-Whatever it takes approach.

-Home/field-based services.

-24/7 availability.

-Flexible funding.

It’s not going to be easy

But if we work together

DMH DCFS

Oh, what we will have done!

LUNCH

IMPLEMENTING THE KATIE A. STRATEGIC PLAN

SPA-LEVEL APPRAOCH

LESSONS LEARNED

CO-LOCATION MAT PLATFORM INTEGRATION REFERRAL POPULATION COMMUNICATION LINKAGE NAVIGATION

SPA-LEVEL APPROACH



ART LIERAS

Co-Location



ROBERTA MEDINA

Integration

and

Referral Population



ANA SUAREZ

Navigation

and

Linkage



JACQUELYN WILCOXEN

Communication

and

MAT Platform

CO-LOCATION



REFERS MAINLY TO KEY ‘PHYSICAL’ ASPECTS OF COLLABORATION…

Spaces are visible and accessible, versus tucked in the corner; and physical configuration of units; 2.

Sensitive about displacing others while moving in co-located staff; Infrastructure: mail, telephone, computers, etc.; Locks on cabinets and chart storage; Physical presence of staff (duty schedules).

INTEGRATION



DIFFERENT PROGRAMS AND SERVICES SUPPORT A COMMON VISION, MISSION, AND VALUES…

Staff commit to shared mission, goals, and practice (‘ALL of us help kids walking through the door…’); Align programs with different funding requirements; 3.

Clear roles and authority lines; Conditions: need enough time to work out the above areas incrementally; on an informal basis; and top down and bottom-up processes.

REFERRAL POPULATION



CLEAR CRITERIA AND PROCESSES REGARDING TARGET POPULATION…

Eligibility criteria: e.g., children in foster care, detained, open case, placed in/out of SPA, etc.; 2.

Policies and procedures from beginning to end; Providers implement shared policies and procedures; Address common ‘structural’ issues, i.e., EPSDT, consent, medical necessity, Court v. Voluntary...

NAVIGATION



OBTAIN KEY INFORMATION AND MAP RESOURCES FOR CHILDREN AND FAMILIES.

Gather key documents, such as Medi-Cal, consent, program eligibility, etc.; 2.

Utilize co-located staff; 3.

DMH: Foster Care Navigators; Service Area Navigators.

LINKAGE



ENSURING APPROPRIATE AND TIMELY SERVICE CONNECTION…

Make referral and verify that linkage occurred; 2.

Maintain documentation of what happened after linkage; Address overlaps in service; Feedback loop to CSW; Address challenges: initial assessment versus ongoing treatment; following up to linkage beyond initial referrals.

COMMUNICATION



CREATE EFFECTIVE STRUCTURE OF COMMUNICATION AND DECISION MAKING…

Central administration and regional administration; 2.

Lateral communication/across Departments (i.e., Probation; DMH; DCFS; etc.); Vertical communication within Departments; Communication across SPAs; A structure for decision making, not just communication.

MAT PLATFORM

Key component of MH Screening & Assessment; 2.

Currently implemented in SPAs 3 and 6; and in all other SPAs by end of fiscal year; 3.

Can be a point of focus for DMH, DCFS, and DHS staff to build and expand partnerships to ensure screening and assessment and service linkage for newly detained children; 4.

Can help prepare non-pilot offices for easier roll-out of CSAT and other Strategic Plan components.

IMPLEMENTATION: RESOURCES & TOOLS 1.

MEETINGS-AT-A-GLANCE 2.

ANNOTATED INDEX: STRATEGIC PLAN 3.

DMH-DCFS REGIONAL OFFICES ROSTER

IMPLEMENTATION: RESOURCES & TOOLS 1.

PROGRAMMATIC OVERVIEW 2.

‘FISH’ CHART 3.

KATIE A. WEBSITE

CASEFLOW PROCESS FOR MENTAL HEALTH SCREENING, ASSESSMENT & SERVICE LINKAGE

BREAK OUT SESSIONS

FOCUSED FEEDBACK ON IMPLEMENTATION OF:

MENTAL HEALTH SCREENING & ASSESSMENT 2.

MENTAL HEALTH SERVICE DELIVERY 3.

OVERALL COORDINATION OF SPA-COUNTY IMPLEMENTATION

BREAK OUT SESSIONS

FOCUSED FEEDBACK… 1.

NOT

ON WHOLE PLAN

NOT

CONSENSUS BUILDING

NOT

ACTION PLANNING

BREAK OUT SESSIONS

STRUCTURE AND SUPPORT…

 BREAK OUT SESSIONS BY SPAs & CLUSTER BY OFFICE  ONE FACILITATOR & TWO (OR MORE) PLAN ‘EXPERTS’ AS RESOURCES  RECORDED SESSION

BREAK OUT SESSIONS

SPA 1 —CLUB A

: Second Floor

SPA 2 —ALUMNI A:

Second Floor

SPA 3 —BOARD ROOM

: Second Floor

SPA 4 —CARDINAL & GOLD ROOM

: Second Floor

SPA 5 —CLUB B

: Second Floor

SPA 6 —FIGUEROA ROOM

: Second Floor

SPA 7 —ALUMNI B

: Second Floor

SPA 8 —CALIFORNIA ROOM

: Mezzanine Level

PRESENTATIONS

 NON-PILOT SPAs  PILOT SPAs

INTEGRATION

 CONVERGENCES?

 DIVERGENCES?