Transcript New Provider Residential Services Orientation State of Georgia

New Provider
Residential Services
Orientation
State of Georgia
AmWay
The Miracle of Pyramid
Marketing
How to sale soap and rule the world.
Introduction
• What We Will Do - Educate
• Presented By
– Georgia Association of Homes and
Services for Children (GAHSC)
– Department of Human Resources (DHR)
• Office of Regulatory Services (ORS)
• Division of Family and Children Services
(DFCS)
• Division on Mental Health, Mental Retardation,
Substance Abuse (MHMRSA)
– Department of Juvenile Justice (DJJ)
Overview
Normer Adams, Executive
Director
Georgia Association of Homes & Services for Children
www.gahsc.org
[email protected]
404 572 6170
Steps to Provision of Services
1. - Organizational Capacity and Needs Assessments
2. - Licensure
3. - Approval Process for Vendors
4. - Referrals and Payments
Steps to Provision of Services
Step one - Organizational
Capacity and Needs
Assessments
FIRST PRIORITY
Develop the “BUSINESS PLAN”
• The Plan vs Good Intentions
– Board
– Mission
– Constituency
Needs Assessment
-Facilities
-Budgets
-Policies & Procedures
FIRST PRIORITY
THE BUSINESS PLAN (continued)
• Research
– The Need
– The Competition
• Interviews
• Field Trips
Needs Assessment
SECOND PRIORITY
Develop “YOUR CONSTITUENCY”
(Who Supports You)
• Your Community
Church, Civic Groups, Interested Parties
• Your Supporters
Give Time, Money, and Resources
• Your Board
Developed from your Constituency
Organizational Capacity Assessment
Board Development
(Those who are accountable to the
organization)
• Truism - An organization is as strong as
its Board.
• Choose people who can help you
• Go beyond friends and family
• Movers and Shakers of community
make good Board Members
Organizational Capacity Assessment
Executive Director
(He/She who manages the organization)
• Choose person of experience, integrity,
responsibility and history
• He/She will represent your organization
• He/She will carry out your policies and
procedures
Organizational Capacity Assessment
Mission
(Drives the activities of the organization)
• Clear concise mission statement
important
“We do good” is concise but not clear.
• Determines the nature of your services
Organizational Capacity Assessment
Budgets and Budgeting
Budget Development
Expenses
Income
62% of cost=State Reimbursement
38% = Your subsidy
Organizational Capacity Assessment
Budgets and Budgeting
Medical Care
Covered by Medicaid - Nearly all
children in residential care qualify for
Medicaid.
Organizational Capacity Assessment
Budgets and Budgeting
(See Handout)
• Staff--Base Pay
• Benefits
• Insurance--Property, Casualty, &
Liability
• Other, including:
Food, office supplies, clothing, travel & recreation, medical expenses, school
supplies & activities, gifts, allowances, conference expenses,vehicle repair, fuel,
maintenance, grounds, promotions, postage, utilities,telephone, moving expenses of staff,
GAHSC membership dues, and legal and professional
Organizational Capacity Assessment
Fundraising
Grants for Startup
List of all the Foundations and Charities
that give to new organizations starting
children homes and group homes:
Organizational Capacity Assessment
Fundraising
Grants for Startup
All Foundations and Charities
1.
2.
3.
4.
Organizational Capacity Assessment
Fundraising
Grants for Startup
• Very Few
• Only to Existing Groups
• Need 501(c)(3) status
• Anticipate 18 months for startup support
• Build constituency
Organizational Capacity Assessment
Not-for-profit Organization
(Nearly all are 501(c)3)
• IRS Regulations for securing tax
deductible contributions
• Takes at least 1 year to secure
• A knowledgeable person can do it
without lawyer
Organizational Capacity Assessment
Your Facilities
• Fire Inspection
– #1 Problem Area
– Most Expensive to Correct
– State Regulations, County Interpretations
and enforcement
• Community
– Build Support Carefully
– If negative, hard to overcome
– Use community leaders to lead
Your Facilities
Zoning
-- Required before Licensing
-- #2 Problem Area
-- Zone for “a licensed childcare
institution for six or more unrelated
children”
-- Movers and Shakers of community
can help with this
Organizational Capacity Assessment
Policies & Procedures
(Provides the why and how of the organization)
• Get a person who has done residential
child care to prepare your policies and
procedures
• These are your rule books for
operations
• You will live and die by them
• They become your Bible for operation
Organizational Capacity Assessment
Technical & Clinical
Assistance
(Gut instinct is not enough.)
Truism - Experience is more valuable
than gut instinct.
• A compliant child may be a depressed child.
• An attentive, indulgent staff may be a
pedophile.
• Money in your pocket may not mean money
in the bank.
• Your High School Joe might like your facility
as coed, but you won’t.
Staff & Personnel Issues
(They make or break your organization)
• Truism - Your program is as good as
your worst staff.
• A thorough background check is
essential.
• “Would you let these folks care for your
child?”
Organizational Capacity Assessment
Reporting Requirements
• Child Abuse Reporting Requirements
• Stuff will happen! Self Report.
• The law requires you to report abuse
and neglect.
• Do not even THINK of not reporting.
Organizational Capacity Assessment
Working with the State
• Some Steer
The State is our partner in
caring for children. Their role is
regulatory and contractual.
Respect it.
• Others Row
Our role is providing services to
children. Together we work to
provide the best care for
children.
Organizational Capacity Assessment
Departments & Divisions
of State Agencies
Department of Family and
Children Services (DFCS)
Budgeting/Rate Setting
Organizational Capacity Assessment
BUDGETING/RATE SETTING
• Family Foster Care
• Institutional Foster Care
Organizational Capacity Assessment
Family Foster Care
• DFCS Family Foster Homes Per Diem
Rate -– $33.30 Per Day – Provider Rate
• Level of Care Family Foster Homes
– Daily Per Diem Calculated
Organizational Capacity Assessment
Institutional Foster Care
PER DIEM RATE
• Currently $44.22 /day for new
providers.
• After first year reimbursement Rate
Calculated-62% Total Allowable Costs
Organizational Capacity Assessment
Allowable Costs
•
•
•
•
•
Salaries
Consultation Fees
Occupancy Costs
Insurance Costs
Maintenance &
Repair
• Depreciated
Equipment
• Consumer Supplies
• Payroll Related
Expenses
• Travel
• Utilities
• Leased Equipment
• Purchased
Equipment
• Lease Purchase
Organizational Capacity Assessment
Unallowable Costs
• Bad Debt
• Contributions &
Donations
• Depreciation
• Investments
• Organizational
Costs
•
•
•
•
Contingencies
Entertainment
Fines & Penalties
Prohibited Activities
Organizational Capacity Assessment
Provider Reports
Institutional Foster Care (IFC)
•
•
•
•
Annual Group Facilities Cost Report
Description of Treatment Program
Independent Audit Report
Typical Weekly Schedule
Organizational Capacity Assessment
Steps to Provision of Services
• Step Two - Licensure
DHR Office of Regulatory
Services
Child Care Licensing
DHR Office of Regulatory
Services
Child Care Licensing
• License Category:
-- CCI-Child Caring Institutions
includes emergency shelters, group
homes, and children's homes. (6 or
more residents in (24 hour care)
• Application Process 
-- How to apply, temporary licensing,
license
Licensure
How to Apply for Licensure
(Handout # 3)
• Purchase licensure application package
• Familiarize yourself with ORS rules and
regulations--develop a working
knowledge of the meaning and intent of
these rules and regulations
• Prepare your agency for compliance
with the regulations
Licensure
Staff Qualifications
(Handout # 5)
• Director: Masters/2 years experience or
Bachelors/4 Years experience
• Human Services Professional (Social
Services): Bachelors/2 Years Experience or
supervised by Masters
• Child Care Worker: 21 Years Old/ High
School or GED
• Satisfactory criminal records check
Licensure
Staff Qualifications
(continued)
• Human Services Professional--Master’s
Degree in social work, psychology,
childhood education, education
counseling and psychology, or related
field ,
• OR a bachelor’s degree in one of these
fields and two years experience, or
under the supervision of another HSP
with a Master’s degree.
Licensure
New Criminal Records Check
Law----July 1, 1999
• Satisfactory state fingerprint result on
Director, with FBI results pending
• Satisfactory preliminary results-employees
• Employee checks can be done by local
law enforcement with results on file
• If employee’s check reveals any crime,
person cannot be hired until resolved.
Licensure
Physical Plant
(Handout #6)
• Water/Sewage
• Bedrooms: 63 Square Feet per resident
Single: 75 Square Feet
• Bathrooms - one sink /toilet per 8 kids, 1
shower per 10 kids
• Proper Storage for Hazardous Items
• SAFETY FIRST--Inside and Outside
Licensure
Behavior Management
(Handout # 7)
• Forms of discipline which are not
allowed
• Excessive or unreasonable work tasks
• Denial of meals and hydration
• Denial of sleep
• Denial of shelter, clothing, or essential
personal needs
• Verbal abuse, ridicule, or humiliation
Licensure
Behavior Management
(continued)
• Chemical restraints or mechanical
restraints
• Denial of communication and visits
unless restricted in treatment planning
process
• Corporal punishment
Licensure
Specifics on Behavior
Management
• Regulations on the use of isolation
rooms
• Regulations on the use of physical
control techniques--ONLY by staff
trained by a certified trainer and
documented in personnel record
• Discipline/behavior management
methods MUST be documented in the
treatment plan
Licensure
Management of Medications
(Handout # 8)
• System for Proper Storage,
Administration and Documentation
• Monitoring for Side
Effects/Complications
• Expired Medications
• Accurate Medication Logs
• Method of Managing Medication Errors
• Documentation in Treatment Plan
Licensure
Regulatory Process
(Handout # 9)
• Submit Application with local approvals
• Self-Assess for Rule Compliance and
Completed Application Materials
• Initial On-Site Inspection: Temporary
License (6 Months)
• Annual Re-Licensing Inspections
• Follow-Up Inspections
• Complaints/Self-Reported Incidents
Licensure
Break
Steps to Provision of Services
Step Three - State
Approval Process of
Vendors
Division of Family
& Children’s Services
DFCS
DFCS (Division of Family & Children Services)
Services Purchased by DFCS
Services purchased by DFCS for children
in it’s custody are:
– Institutional Foster Care (IFC)
– Family Foster Care (FFC)
Services Purchased
Services Purchased by DFCS
• Institutional Foster (IFC) requires license by
the Office of Regulatory Services (ORS)
• IFC includes group homes, emergency
shelters, child care institutions, and
therapeutic camps.
• Family Foster Care (FFC) requires license as
Child Placing Agency or Child Caring
Institution with Foster Care Services.
Services Purchased
Characteristics of Children in
DFCS Custody
• Age
– Birth to 18 years old
• Mental/Emotional/Behavioral Difficulties
• Medical/Physical Difficulties Deprivation
determined by the court
• Abused, neglected, or abandoned
• Committed status
Characteristics of Children
DFCS Approval Process
(Handout # 10)
• Potential Provider requests application
package from the Treatment Services
Unit.
• Completed Application is submitted to
the Treatment Services Unit.
• Application is reviewed by Treatment
Services Unit.
Approval Process of Vendors
Approval
Process Process
(continued)
DFCS Approval
(Handout # 10)
Three Possible Outcomes:
(A) Application accepted--will conduct an on-site
visit and review the program
(B) Application incomplete--will include an
explanation of application items for which more
information is needed
(C) Application denied--will include an
explanation of the basis for denial
Approval Process of Vendors
Approval
Process (continued)
DFCS Approval
Process
(Handout # 10)
• If approved to serve children who are in
the custody of DFCS, a notification
letter will be sent to the provider.
• DFCS Treatment Services Unit notifies
all county DFCS offices of the approval
status.
Approval Process of Vendors
Referral Process
• Program will receive referrals directly
from county DFCS offices.
• County DFCS is responsible for
reimbursement for services.
Referrals and Payments
MHMRSA
Division of
Mental Health
Mental Retardation
Substance Abuse
MHMRSA
•Division of DHR
•Made up of 13 Regional Boards
•Contract with 27 Community Services
Boards (CSBs) and other private
providers
•CSBs also sub contract with providers
Approval Process of Vendors
MHMRSA Regions
Characteristics of Children in
MHMRSA Care
• SED (Severely Emotionally Disturbed)
• Under age of 18
• Major mental illness diagnosis, such as
Major Depression, bi-polar disorder,
anxiety disorder, PTSD, ADHD,
oppositional defiant disorder, and
substance abuse disorders
• Many are multi-agency involved
Characteristics of Children
MHMRSA Approval Process
(Handout # 11)
• Following appropriate licensing from
ORS, contact the Regional Board or
the Community Service Board (CSB) in
your area (see handout material).
• If chosen as an eligible provider, you
must comply with all Division standards
and provider manual requirements
(Regional Boards have this information).
Approval Process of Vendors
SED Residential Treatment
Services of MHMRSA
• Highly structured and supervised home
• Individual, family, group and activity
therapy services
• Psychiatric services, including
medication monitoring by an M.D.
(psychiatrist)
• Community Re-integration Services,
including identification of natural support
systems
Services Purchased
MHMRSA Referral Process
• Contracts are made directly with
Regional Boards or Community Service
Boards.
• The Regional Boards or Community
Service Boards are responsible for
reimbursement for services.
Referrals and Payments
DJJ
Department of Juvenile Justice
DIVISION OF COMMUNITY
CORRECTIONS
Department of Juvenile Justice
Division of Community Programs
Serves to Protect the Citizens of Georgia by
Providing Prevention Services, Court Services
and Supervision, Treatment and Rehabilitation of
Youthful Offenders.
Approval Process of Vendors
DJJ Approval Process
 No Formal, Written Application
 Upon Obtaining Licensure, Contact
the Residential Placement
Specialist (RPS) in the District in
which Your Facility is Located
Approval Process of Vendors
State Outline of DJJ Districts
(Handout # 12)
Residential Placement Specialists
(
Handout # 13)
13 Districts
match DHR
Districts
Approval Process of Vendors
Regional Placement
Specialists
1. Wayne Reynolds
2. Kim Settles
3. Marie Martin
4. Carl Harrison
5. Sue Riner
DJJ Approval Process
• Residential Placement Specialist
(RPS) Conducts Site Visit
• Assesses Willingness and Ability to
Service Delinquent Youth
– School Issues
– Supervision
• Contract
Approval Process of Vendors
DJJ Contracts and Payments
• Contract - referrals and payments are
negotiated through contracts.
Referrals and Payments
Characteristics of Children in
DJJ’s Care
•
•
•
•
•
Average Age - 15 (range is from 8-17)
82% Males - 18% Females
Most Common Offenses - Property & Status
Oppositional - Lack Impulse Control
Common Mental Health Diagnoses - Conduct
Disorder, Depression, PTSD
• Substance Abuse Issues
Characteristics of Children
Services to Children
in DJJ’s Care
• During FY 1998, 789 youth were served
in the Contract Home Program.
• Youth were served in either
– Group Homes
– Private Family Placements
Services Purchased
Private Placements
Normer Adams, GAHSC
Private Placements
Agency determines what services to sell (or
give away) to the private individual. The
nature of these services are determined on
the ability to provide those services within the
Licensing framework
Services Purchased
Characteristics of Children in
Private Placement
• Characteristics of the children -Determined by agency according to their
mission and ability to care for the child.
• And by ability to serve.
Characteristics of Children
Private Placements
• Application Process-- Licensing allows an
agency to provide out of homes services.
Within the rules of Licensing, each agency
develops their own application process.
• Approval Process -- There is no approval
process save Licensure.
Approval Process of Vendors and
Marketing
Private Placements
Referrals and Payments
• Referrals - Referrals are made by private
individuals or agencies. This referral
network is determined by the agency.
• Payments - Payments are negotiated with
each referring party.
Referrals and Payments
MATCH
Multi-Agency Team for
Children
Characteristics of Child
Served by MATCH
• Children have severe mental, emotional
and behavioral disturbances.
Characteristics of Children
MATCH
(Multi-Agency Team for Children)
• Includes DFCS, DJJ, DOE, ORS, and
DMHMRSA
• MATCH is responsible for arranging and
purchasing residential treatment
services for children with mental,
emotional and behavioral disturbances.
Approval Process of Vendors
MATCH Services Purchased
• Intensive Residential Treatment
Programs
• Intermediate Residential Treatment
Programs
• Outdoor Therapeutic Programs
• Therapeutic Foster Care (Levels I and
II)
Services Purchased
MATCH Enrollment Process
(Handout # 14)
• Potential provider requests application
package from the Treatment Services Unit.
• Potential provider must have the appropriate
license from ORS.
• The agency must be in compliance with the
“Certification Standards for Enrollment as a
Provider of Therapeutic Residential Child
Care Services” prior to the submission of the
completed application to the Treatment
Services Unit.
Approval Process of Vendors
MATCH Enrollment Process
(continued)
• Completed application is submitted to
the Treatment Services Unit.
• Application is reviewed by Treatment
Services Unit.
Approval Process of Vendors
MATCH Enrollment Process
(continued)
Three Possible Outcomes:
(A) Application accepted--Treatment Services
Unit and ORS will conduct an on-site visit and review
the program
(B) Application incomplete--will include an
explanation of application items for which more
information is needed
(C) Application denied--will include an
explanation of the basis for denial
Approval Process of Vendors
MATCH Enrollment Process
(continued)
• If enrolled as a MATCH provider,
appropriate paper work, including rate
notification and contract with DHR will
be sent.
• Program is added to the list of approved
MATCH providers.
Referrals and Payments
MATCH Enrollment Process
(continued)
MATCH Outcome Project
• A system designed to measure and
track the effectiveness and results of
residential treatment services provided
to children and adolescents with severe
emotional disturbance.
• All providers are required to participate.
Services Purchased
MATCH Referrals and
Payments
• Provider will receive referrals from County
DFCS or Community Mental Health after the
child has been approved for funding by the
State MATCH Committee.
• Approval letter is sent to the MATCH provider.
• The State Office of DHR is responsible for
reimbursement for service.
Referrals and Payments
Steps to Provision of Services
1. - Organizational Capacity and Needs Assessments
2. - Licensure
3. - State Approval Process for Vendors
4. - Marketing to Referral Sources, DFCS, DJJ, Private
Sector
WRAP-UP
• Questions????????
• Evaluation Forms
• Training Certificate