June 1, 2017 Volume 14, Issue 10 Volume 14, Issue 10

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

Page 1 of 24Inside This Issue (click to go directly to the article): 1. DMH All Providers’ Meeting Includes Packed Agenda 2. ACHSA FFA Committee Hosts DCFS and Probation at May Meeting 3. No Place Like Home Guidelines Webinar and ACHSA Feedback Provided 4. ACHSA Discusses Wraparound Transition with DCFS and DMH at May

DCFS/FBS Committee Meeting 5. L.A. County Integration Advisory Board Hosts County Department of Public

Health Director Barbara Ferrer6. Probation Department Provides Updates at Quarterly Provider Meeting 7. Mental Health Odds & Ends 8. Child Welfare Nuts & Bolts 9. Conferences, Events & Resources 10. In the News 11. Upcoming ACHSA Meetings

KEY ISSUES

DMH All Providers’ Meeting Includes Packed Agenda

On May 22nd, the Los Angeles County Department of Mental Health (LACDMH) facilitated its quarterly All Providers’ Meeting, facilitated by LACDMH Chief Deputy Dr. Robin Kay. The meeting’s agenda covered a wide array of topics, but mostly encompassed the major initiatives that providers could expect in the coming Fiscal Year.

Major Changes for FY 2017-18 – Dr. Robin KayIn her introduction, Dr. Kay announced that the most significant changes affecting providers would include: 1) the implementation of No Place Like Home and Measure HHH, both of which would generate funding for the construction of Permanent Supportive Housing units targeting chronically homeless individuals; 2) the control of Wraparound, which would be transferred from DCFS to DMH; 3) the expansion of FSP slots by 3,000 for forensic and homeless clients; 4) the Department’s sharpened focus on trauma-based services; 5) services for the 0 to 5 population, which would be increased; and 6) the implementation of the new Recovery, Resilience and Reintegration (RRR) service continuum.

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Dr. Kay stated that Governor Brown’s May Revise would affect DMH in some small measure. Notably, control over In Home Supportive Services (IHSS) would be sent back to the counties, and some Vehicle License Fee (VLF) dollars would be reverted back to the State to offset the cost of the transition. To partially offset those lost County dollars, the State had agreed to eliminate its mandated IMD COLA for several years. Also on a positive note, Dr. Kay reassured the attendees that contracted providers should not be adversely affected, as the Department would look internally to figure out a way to mitigate the loss of those dollars.

Dr. Kay addressed rumors of an upcoming reorganization of the Department, stating that the details had yet to be finalized and that as soon as the Department was at liberty to share it, LACDMH Director Dr. Sherin would provide clarification at a future DMH All Provider meeting. She commented that the upcoming changes should only benefit providers, and would help centralize and consolidate services.

Dr. Kay continued with a review of the letter Dr. Sherin had recently sent out regarding “FY 2017-18 Contract Change,” highlighting the change from a 3-year contract to a 1-year contract with two annual extensions. She noted that DMH intended to start using outcomes to drive decision-making which regard to which programs to grown, which to modify, and which to question. Robin commented that the Department needed greater flexibility in contracts in order to re-solicit programs where it makes sense to do so, as it had been more than a decade since the first solicitations under MHSA.

At the same time, she acknowledged that re-soliciting all agency contracts would be impossible, since legal entities now have multiple programs within their contracts. So that would not work, since every agency has a different variation of programs within their legal entity contracts. However, Robin did note that some of those programs embedded within legal entity contracts could be re-solicited in the future, but it was not certain which ones at this time. Measure H Update – Maria FunkDMH Clinical Program Manager of Countywide Housing, Dr. Maria Funk, then addressed the meeting to provide an update on Measure H since its passage, and to state which services would be bolstered by the funding generated. While the Los Angeles Homeless Service Association (LAHSA) calculated that $450 million would be needed to end homelessness in L.A. County, Measure H would only bring in $350 million through tax revenues.

In order to most effectively utilize this money, Maria explained that the County formulated its homeless initiative after crafting forty-seven strategies to end homelessness through an inclusive and collaborative stakeholder-driven process. She stated that these strategies covered six

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different areas including homelessness prevention, case management, and increasing affordable housing stock. On June 1st, this budget would be presented to the Board of Supervisors’ homelessness policy deputies, and if all goes according to plan, the funding should begin to roll out by July 1st.

Maria directed providers to the PowerPoint slides within their packet, detailing twenty-one of the strategies, to give providers a preview of what type of money would begin flowing into their communities that clients could access. Among other topics, the strategies focused on outreach to landlords and developer and investment in shelter beds and rapid rehousing, all of which are interconnected. Furthermore, Maria stressed the need to strengthen the Coordinated Entry System (CES), as it served as the foundation for all of the efforts under the homelessness elimination initiative.

Maria commented that the bulk of the funding would come through LAHSA and the Department of Health Services, and urged providers to get onto the DHS Master Service Agreement. She concluded that under the eligibility and interest solicitation (SEI) process, a new level of FSP would be created to focus on homeless clients, at a rate of $21,000 per year, intended for agencies that have the most expertise in serving the homeless population. Although the work is extremely intensive, none of the work combating homelessness would be successful without this type of outreach. For more information, Maria encouraged providers to visit http://www.homeless.lacounty.gov.

Pharmacy Benefits Management – Russell KimLACDMH Pharmacy Supervisor Russell Kim provided an update on the transition from the Prescription Authorization and Tracking System (PATS) to the Pharmacy Benefits Manager (PBM). He explained that although the PATS system had served providers well in the past, it took a great deal of upkeep to maintain it, and that it limited access to care relative to the current network of pharmacies. Russell stated, as per Medical Director Shaner’s letter to Legal Entity providers, the PBM is expected to go-live at the beginning of June.

Under PBM, uninsured clients will have access to Magellan Pharmacy Solutions’ network of over 1,800 pharmacies across Los Angeles County, including DMH’s existing network of eighty-one pharmacies with agreements set to expire at the beginning of the Fiscal Year. Also, under PBM, clients can access features such as “find a participating pharmacy” through a webpage available 24/7, with DMH-contracted staff available to query medication history and access clinical utilization reports. Dr. Kay reiterated that although the transition from PATS to PBM was incredibly complicated to formulate, the new system would give clients access to a much broader, and richer array of pharmacies across the County.

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Child Welfare & Wraparound Update – Kalene GilbertKalene Gilbert of the Children’s System of Care provided updates on various issues pertaining to CSOC, including the transition of Wraparound from DCFS to DMH. She stated that Wraparound-FSP providers would have Wraparound consolidated within their other FSP programs beginning July 1st, and that IFCCS would also be incorporated into FSP. She stated that County Counsel had completed their portion of the Wraparound transition, and that the Contract Division was in the process of preparing the relevant amendments. Kalene continued that although there would be no programmatic changes at the moment, she encouraged providers to coordinate with their Service Area District Chief to identify new focal populations. She encouraged FCCS providers transitioning to RRR to attend the roundtable corresponding to their respective Service Area on May 30th at the California Endowment building.

Katie A. Indicators – Zena JacobiZena Jacobi of the Central Business Office then addressed the meeting to provide updates regarding Katie A. indicators on claims, and directed providers to the corresponding PowerPoint. Zena stated that in response to the California Department of Health Care Services’ demands to know about all services Katie A. subclass clients receive, the CBO published a Dispatch reminding providers to include the Katie A. indicator to IBHIS claims for all services provided to the subclass. She stressed that the subclass indicator should include whether the client fits the following categories: 1) open DCFS case; 2) EPSDT eligibility; 3) recent hospitalization; 4) more than three placements within a two-year period; and 5) receipt of ICC or IHBS services.

Zena instructed providers to review the Katie A. claims verification data in their Legal Entity extracts, and to work with their clinical and billing staff as well as their software vendors to ensure that the Katie A. indicator is placed on the corresponding subclass member claims. She stated that the Department would provide updated data in approximately six months. Dr. Kay followed by commending Zena and CSOC on their work regarding this issue, and pledged to improve relative to the State’s requirements.

Technology Needs Funding Agreement and Legal Entity Onboarding Schedule – Racheal BurgessRacheal Burgess of the Project Management Division then addressed the meeting to remind providers that all money for the IBHIS onboarding process needed to be invoiced by the end of the 2017 calendar year. She did commend providers on their efficiency regarding IBHIS onboarding, as eighty-five contract providers out of 120 existing Legal Entities had joined. She concluded that all Legal Entities were mandated to be off of IS by

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December 13th, and encouraged providers to contact her at rburgess@dmh.lacounty.gov with any questions.

Contract Changes – Sara Lee DatoSara Lee Dato and Juan Fermin, both of the Contracts Division, gave providers a brief update regarding changes to their contracts, including the amendments within geared towards claiming. The major change that Sara reiterated was the change in terms from 3 years to one year with the possibility of two extensions. Juan discussed changes to accommodate technology changes in both timeline and process which should not be significant. Finally, there was a discussion of the incorporation of the county IT security protocols which have also been added to the contract. More detail can be found in Dr. Sherin’s letter regarding FY 2017-18 Contract Changes, as well as the Department’s included Financial Exhibit

ACHSA’s Executive Director asked Robin to clarify new contract language regarding performance outcome measures, and in particular: 1) the process that would be used for the development of contract performance measures; 2) how legal entities would be involved in the development process; and 3) the timeline for completion. Dr. Kay responded that the County would be looking at both client outcomes and system outcomes. The client outcomes being considered are not that different from what we have already been collecting for some time now. The system outcomes would be new, however, because DMH has never really looked at system outcomes and given feedback to providers to allow for some benchmarking in this area.

Dr. Kay also explained that while the County has used STATS internally, they plan to shift that process to now evaluate contract providers. She went on to say that contract providers will be a part of a collaborative process to develop and evaluate how STATS gets implemented at the systems level, because ultimately the comparison will not be just between contract agencies but also directly operated sites. Finally, Dr. Kay expects that while the client outcome measures would be finalized within the next few months, the system performance outcomes would evolve over the course of the coming year.

Bucket Consolidation – Debbie Innes-Gomberg For the meeting’s last presentation, Debbie Innes-Gomberg, formerly of the MHSA Clinical Implementation Program Division, gave the providers an overview of the bucket consolidation under the MHSA 3 Year Program and Expenditure Plan, and directed providers to the corresponding letter in their packet.

As part of the initiative’s background, Debbie explained that over the past eleven years, because every program added required the addition of a corresponding bucket, many programs and funding plans were conflated,

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which created numerous challenges for the Department and for providers. She added that under the consolidation plan, twenty-four different CSS work plans would be merged into just six. As part of the consolidation, Debbie noted the creation of the RRR services, which were designed to be a flexible service array of service tailored to the individual client’s needs. She stressed that RRR could encompass field-based, clinic-based, and wellness services, all in the aim of helping clients thrive within the community. She urged providers to think about the continuum of services that would help a client maximize his or her recovery.

Debbie stated that the newly developed instrument to evaluate RRR would take into account a client’s housing situation, social connectedness, and purpose. She emphasized meaningful use of time and social connections as key indicators of recovery and resilience, and added that the MHSA Implementation workgroup was in the process of identifying an instrument to measure such indicators.

In contrast with FCCS outcome measures currently being collected, which did not account for the full picture, she stressed the Department’s commitment to measuring the full scale of clients’ recovery processes within RRR and reiterated Robin’s assertion that these are not new domains for data collection, but rather new instruments being identified. She said that the goal was to finalize these client outcomes as soon as possible because they would need to be in place before any system evaluation is even discussed.

Please contact TJ or Abby with questions.  

ACHSA FFA Committee Hosts DCFS and Probation at May Meeting

On May 25th, the ACHSA FFA Committee hosted DCFS Administrative Support Bureau Deputy Director Kym Renner, DCFS Juvenile Court Services and Adoptions Bureau Deputy Director Karen Richardson, DCFS Out-of-Home Care Management Division Chief Naftali Sampson, DCFS Contracts Division Manager Leticia Torres-Ibarra, DCFS Contract Compliance Section Manager Diana Flaggs, and Probation Placement Permanency & Quality Assurance Supervisor Pamela Pease. Following is a summary of the meeting discussion.

Departmental UpdatesKym reported that DCFS plans to initiate a stakeholder process for the DCFS Foster Care Placement Services Request for Statement of Qualifications which will include the following five programs: 1) FFA; 2) Short Term Residential Therapeutic Program (STRTP); 3) FFA Emergency

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Shelter Care; 4) Intensive Services Foster Care for Children with Serious Emotional Behavioral Needs; and 5) Intensive Services Foster Care for Children with Special Health Care Needs. Kym noted that the draft contracts would be posted on the DCFS Contracts website for public comment on June 15th with the first series of stakeholder meetings taking place on June 29th.

Los Angeles County Participation in Level of Care Protocol PilotKym shared that Los Angeles County is in the early stages of the Level of Care (LOC) protocol pilot. Madeline Roachell, Assistant Deputy Director of the DCFS Bureau of Operational Support Services, will be coordinating the pilot which will include 20 to 25 cases in a few different Regional Offices. Kym clarified that the pilot will be to test the tool, but not the rate.

Post Approval Oversight of/Visits to County Approved Resource Family Homes Karen reported that the DCFS protocol for post approval oversight of/visits to County approved resource family homes should be ready to be shared with ACHSA in mid-June. The protocol will dictate the minimum number of visits that must take place, which can be increased based on the individual needs of the family. She also mentioned that the visits will be intensive following initial placement of the child and will become more liberalized as time goes on.

Child Welfare History Checks for Prospective Resource Parents Jodi reiterated that the ACHSA FFA Committee has recommended that DCFS continue to complete CWS/CMS checks for all non-relative resource parents approved by DCFS and by FFAs in order to inform the Department’s placement decisions. At the same time, FFAs recommended that DCFS not complete CWS/CMS checks at RFA annual update as the recertification checks today do not uncover any new or meaningful information, and have added delays to the recertification process. Naftali shared that DCFS is still awaiting formal guidance from the state as to the permissibility of completing CWS/CMS checks, and in the meantime, DCFS will continue completing these checks for FFA resource parents prior to approval and at annual update.

CDSS Resource Family Home Environment Checklist Jodi questioned what tool DCFS plans to utilize when completing its monitoring visits of FFA resource family homes – whether it be the CDSS resource family home environment checklist or something else. She noted that ideally the same tool should be used for approval, annual update, and monitoring of all County and FFA resource family homes. Diana agreed to present ACHSA’s recommendation to the County workgroup responding to the recent Board of Supervisors motion on redesign of the out-of-home care monitoring processes (described in more detail below).

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Further, Jodi shared that ACHSA FFAs have agreed to utilize a Resource Family Home Environment Supplemental Checklist that includes the questions that were included in the original ACHSA recommended checklist but were not ultimately integrated into the CDSS checklist. She emphasized that ACHSA FFAs believe that checking these additional areas is critical to enhance the health and safety of children placed with FFA resource families.

County Required Documentation for RFA Conversion of Certified Foster ParentsJodi inquired as to what documentation should be provided to DCFS for RFA conversion of certified foster parents, and how should this documentation be provided. Committee members asked for confirmation that the approval certificates of converted families should simply be uploaded into the Foster Care Search System, which Naftali agreed to follow up on.

Board of Supervisors Motion on Redesign of Monitoring and Reporting ProcessesKym reported that the Chief Executive Office is coordinating the County Departments’ response to the May 16th Board motion on redesign of the monitoring and reporting processes for FFAs and Group Homes. As of the date of the meeting, the CEO had convened an initial workgroup meeting with DCFS, Probation, DMH, and the Auditor-Controller, with a plan to convene ongoing meetings on a weekly basis.

Kym explained that the workgroup’s goal will be to evaluate the existing monitoring processes such that monitoring can be completed in an effective, yet efficient manner. She noted that the workgroup will likely come up with a loose monitoring framework which will be presented to the Board of Supervisors before being vetted with stakeholders. The Board originally requested a report back in sixty days, but given the broad scope of the motion, the CEO will be requesting an extension so that the report back can be submitted in August.

Jodi shared that ACHSA will be convening ad hoc workgroups to develop recommendations to make to the County Departments and Board offices related to desired modifications to the current monitoring processes. Kym welcomed feedback from ACHSA, and encouraged providers to “think outside of the box” in its recommendations to improve the current monitoring processes.

Guidelines for DCFS Reviews of FFAs Related to Initial Medical/Dental ExaminationsJodi noted that ACHSA collaboratively developed the Guidelines for DCFS Reviews of FFAs Related to Initial Medical/Dental Examinations with DCFS

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and the Auditor-Controller several years ago in order to ensure a common understanding of the steps that should be taken by the FFA in order to obtain initial medical/dental examinations for newly placed children. The guidelines were then released by DCFS in June 2011.

Since several years have passed – during which many changes have been made to the monitoring processes, she asked DCFS to confirm that the guidelines can still be considered in effect. After Diana responded affirmatively, Jodi noted that ACHSA would like to revise the guidelines to include the scenario when a child does not have Medi-Cal to pay for the initial medical exam (which would look similar to the scenario in which the child does not have Medi-Cal to pay for the initial dental exam). Diana agreed to review the recommended revisions relative to the original guidelines and respond to ACHSA regarding the Department’s willingness to integrate the revisions.

Respite Care Services for FFA Resource FamiliesIn April, DCFS shared with ACHSA that in order to pay for respite care services through the FFA, DCFS would need to go through a separate competitive solicitation for respite care services.  Jodi, however, questioned whether respite care services could be provided by FFA resource parents through the County vendor process, similar to what was made available by/for ITFC resource parents many years ago.

Leticia explained that DCFS is now also looking into special payments processing through which payments for respite care services can be made through FFAs to FFA resource parents, outside of a competitive solicitation process. Diana pointed out that a competitive solicitation would actually be a more straightforward process given that the County is highly scrutinized for its special payments for which there are limitations prior to necessitating a competitive solicitation.

As well, Karen admitted that since the DCFS ITFC program manager recently retired, there is lack of institutional memory within DCFS regarding how funding was made available for ITFC parents in the past. ACHSA agreed to consult with its ITFC agencies to see if information could be collected regarding the protocol and payment mechanism that was previously utilized. It was also discussed that respite care services could be integrated into the new FFA contract; however, Karen cautioned that the availability of state funding for respite care services through the Foster Parent Recruitment, Retention, and Support awards in future years is not guaranteed.

Obtaining CSW Signatures on Needs & Services Plans Jodi noted that if DCFS expects providers to escalate requests for Needs & Services Plan (NSP) signatures, providers need an updated DCFS roster for

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CSW, SCSW, ARA, and RA contact information, similar to the DPO/SDPO roster distributed by Probation on a regular basis. Diana admitted that acquiring an updated CSW roster has been challenging given that there are thousands of CSWs who are constantly shifting throughout the Department. At the same time, Diana explained that DCFS has requested that the DCFS placement form be revised to include the ARA and RA contact information, in addition to the CSW and SCSW contact information that is already included. In the meantime, DCFS has provided the contact information for each Regional Office where an on-duty worker should be able to provide the contact information for the appropriate ARA and RA. Karen further suggested that the expectation for out-of-home care providers should be brought up at a future DCFS RA meeting.

FFAs also shared that CSWs are reluctant to open encrypted emails from agencies that contain the NSPs in need of review and signature. Naftali pointed out that CSWs, especially while in the field, may be unable to open encrypted emails due to the security firewalls that DCFS has in place. Again, DCFS representatives noted that this issue should be brought up at a future DCFS RA meeting, making it clear that the use of encrypted emails is a requirement for providers in order to comply with HIPAA. Naftali further suggested that providers should consult with each other to better understand the “end user friendliness” of the various encrypted systems that are available.

FFA Runaway Reporting Requirements Versus Reasonable and Prudent Parent Standard Jodi pointed out that the current runaway reporting requirements in the FFA contract conflict, at times, with the reasonable and prudent parent standard. As an example, if a youth being cared for by a babysitter leaves the home and the babysitter has a reasonably good idea of where the youth is, shouldn’t the babysitter first look for the child and contact the resource parent before immediately calling DCFS and law enforcement?

Jodi stressed that immediately contacting law enforcement when a child leaves without supervision and permission is particularly tricky when thinking about maintaining relationships in the community and relying on law enforcement when truly serious incidents do occur. DCFS representatives recognized the conflict between the current expectations and the reasonable and prudent parent standard, and agreed that further joint discussion, including Community Care Licensing as well, should take place.

Please contact Jodi or Alex with any questions.

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No Place Like Home Guidelines Webinar and ACHSA Feedback Provided

On May 19th, the California Department of Housing and Community Development convened a webinar to inform stakeholders of the No Place Like Home (NPLH) initiative of the various articles within the program. The articles included the definitions of key terms and requirements for tenant selection and retention, as well as supportive services that counties are required to make available for prospective NPLH tenants.

Introduction & GoalsThe webinar’s facilitators began by articulating the goals of the NPLH initiative. They stated that the program is intended to target persons with serious mental illness who are chronically homeless or at risk of chronic homelessness, and to provide Permanent Supportive Housing (PSH) for these individuals using the Coordinated Entry System (CES) of referral and delivery. They further noted that the program would rely upon integration as its major principle, and utilize County infrastructure to both provide supportive services and link clients to behavioral health services among others.

The facilitators emphasized that the goals of the program encompass the Housing First principle and its stipulation of low barrier tenant selection, meaning that an individual should not be excluded from housing eligibility due to substance use or criminal history. They stated that although the Housing First modality dictates that services need to be made available, and that tenants should be actively engaged to participate, the tenants’ receipt of continued living status should not be contingent on participation in services, as the overall goal is to keep clients housed.

Definition of Key TermsThe facilitators defined the target NPLH population as individuals who are homeless, chronically homeless, or at risk of homelessness. These populations include adults with Serious Mental Illness or youth with Serious Emotional Disturbance, as well as individuals with co-occurring mental and physical disabilities, or disabilities related to substance use. The facilitators outlined the categories for individuals at risk of chronic homelessness as individuals with SPMI or SED who meet one or more of the following criteria: 1) individuals exiting institutional settings who were homeless prior to admission; or 2) Transition Age Youth experiencing homelessness with significant barriers to housing stability (e.g. juvenile justice involvement).

The facilitators defined the Housing First principle, under Section 8255 of the California Welfare and Institutions Code, as accepting and retaining tenants regardless of sobriety or criminal convictions, and including tenant-

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driven supportive service plans that emphasize engagement and problem-solving over therapeutic goals. They further explained that although the State is restricted to use of the federal Department of Housing and Urban Development’s definition of chronic homelessness, California can modify the guidelines of the at risk category.

Supportive ServicesAfter defining the program’s key terms, the webinar’s facilitators reiterated that participation in supportive services is voluntary, and access to or continued occupancy in housing cannot be conditioned on participation in services or on sobriety. They stated that each County’s application must include a project-specific supportive services plan developed by the County in partnership with the project developer, supportive services providers, and the property manager.

Each plan must describe the services to be offered and made available to NPLH tenants in a manner that is voluntary, flexible, and individualized. They added that recreational and social activities as well as educational services are included among the services encouraged to be made available. The services that Counties are mandated to make available include case management and peer support services, both provided at an off-site location easily accessible to tenants. Each County’s Service Plan must also include descriptions of the following: 1) target populations to be served, including any additional subpopulations; 2) tenant outreach and engagement; 3) services offered, as well as their anticipated frequency; 4) means for addressing communication barriers, including cultural competency; and 5) coordination with property manager regarding eviction prevention and harm reduction practices.

Tenant Selection RequirementsThe facilitators stated that NPLH tenants must be selected through the use of a Coordinated Entry System or other similar system for those at risk of chronic homeless in accordance with the provisions of Uniform Multifamily Regulations (UMR) Section 8305 and in compliance with Housing First requirements. The requirements of 8305 related to the tenant selection process and maintenance of waiting lists must be implemented as approved by the Department of Housing and Community Development in a manner consistent with the requirements of the CES. In terms of accessibility, multifamily projects of five or more units must meet Tax Credit Allocation Committee (TCAC) accessibility requirements, and any other applicable federal, state, or local accessibility requirements.

Conclusion The facilitators concluded by reminding the participants to carefully examine their methods of distribution in accordance with the above requirements, so their projects can remain financially feasible for the length

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of the twenty-year service mandate. They reminded the participants of the May 30th, 2017 due date to submit public comments on the NPLH Guidelines, and encouraged them to reach out with any further comments or concerns to NPLH@hcd.ca.gov.

ACHSA Submitted CommentsACHSA submitted its comments on the NPLH Initiative to the California Department of Housing and Community Development on May 25th. The comments, attached here, emphasized the need to expand the At-Risk of Chronic Homelessness criteria and to modify the competitive allocation rating points system. ACHSA suggested creating broader criteria to define a person as At-Risk of Chronic Homelessness in order to minimize the need for vulnerable individuals with SPMI to wait to have to become chronically homeless, when Legal Entity providers could shelter them in the interim while they transition to permanent housing. As well, eligible TAY should not need to have a history of involvement in the child welfare or juvenile justice system in order to qualify under NPLH. ACHSA hopes that HCD will incorporate the above comments into NPLH’s final Program Guidelines, which will be released later in the summer.

Please contact TJ or Abby with questions.

ISSUE BRIEFS & UPDATES

ACHSA Discusses Wraparound Transition with DCFS and DMH at May DCFS/FBS Committee Meeting

On May 16th, ACHSA hosted the DMH and DCFS Wraparound program administration at the ACHSA DCFS/FBS Committee meeting. DMH representatives included Mental Health Clinical Program Managers Kalene Gilbert and Michael Tredinnick; DCFS representatives included Division Chief Deborah Silver, Assistant Division Chief Jennifer Hottenroth, and Program Manager Luz Moran. Key discussion items from the meeting are highlighted below.

Department/Program UpdatesKalene reported that DMH is continuing to develop the DMH Wraparound teams in each Service Area and will be expanding the Immersion coaching and training teams by July. Deborah shared that the Department is planning to hire 2,100 new CSWs in the next several years and that there are 400 CSWs who are in the process of being hired. The goal is for CSW caseloads to be 27 cases, ER worker caseloads to be 17 cases and Dependency Investigator caseloads to be 10 cases. She explained that these caseloads may differ as there are lower caseloads in the Immersion offices and higher caseloads for Spanish-speaking workers. Deborah also

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shared that the Department is continuing the hiring process for a new DCFS Director and hopes to select a new Director within three months.

Wraparound Program/Contract Transition and DMH Wraparound Service ExhibitJodi inquired as to the status of the program/contract transition and whether the final DMH Wraparound Service Exhibit been distributed to providers. Kalene explained that the DMH Wraparound Service Exhibit is complete and outstanding issues related to the MOU with DCFS are the reason for transition delays. Once finalized, DMH will be sending out a contract amendment notification to agencies with a final copy of the Wraparound Service Exhibit.

In response to inquiries, Kalene reported that the Department will not require agencies to complete the Plan of Care (POC), though she noted that the POC is best practice. Michael noted that Probation has expressed openness to the idea a modified POC for Probation clients which would integrate the elements of the CFT matrix, but noted that the modified POC would have to be uniform across agencies. Kalene then clarified that the Departments will require agencies to complete the OMA and will not require completion of the CAFAS, with the exception of Probation cases.

Wraparound Referrals/CensusLuz reported that there has been an increase in Wraparound referrals from February to April with the Wraparound census at 1,957 active cases. During the month of April, 244 cases were referred to Wraparound and 187 of those cases were enrolled in the program. Jennifer noted that the Wraparound referral process now utilizes the CSAT process and is the same as other intensive mental health services (IMHS), as the previous Wraparound referral process was burdensome and a barrier to referrals. Kalene noted that the Interagency Placement Committee (IPC) process for all youth considered for Short Term Residential Therapeutic Programs (STRTPs) or stepping down from STRTPs could serve as a connection to IMHS, including Wraparound.

In response to inquiries regarding the ability for youth placed in STRTPs to remain in Wraparound for continuity of care, Kalene noted that DMH has a rapid re-enrollment system for youth placed in residential care for less than 30 days. She agreed to further discuss the feasibility of providing Wraparound services to youth in residential care.

Wraparound Case Rate Utilization Tracking/DocumentationJodi reported that the ACHSA Wraparound CEO/EDs have been discussing a couple of different options for the case rate tracking/documentation and that the ACHSA Board of Directors will be taking a final position at the Board meeting in early June. Jodi then inquired as to the timeline for DMH

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to finalize the case rate tracking/documentation system and whether DMH has released the survey to gather information regarding case rate utilization. Kalene responded that the fiscal transition, including a case rate tracking/documentation system, is projected for September 1st.

Kalene then explained that the DMH case rate survey would be released in the next couple of days as DMH is considering ACHSA’s feedback on the draft survey. She noted that the Department is open to feedback from providers and anticipates changes such as automated reporting for use of flex funds. In response to inquiries, Jennifer clarified that the Multi-agency County Pool (MCP) will remain under DCFS and further information will be provided in the Wraparound Policy and Procedures Manual.

Facilitation of CFT Process by Intensive Mental Health Service ProvidersJodi explained that although Wraparound providers have been informed that they are to facilitate the Child and Family Team (CFT) process for children and families, there have been challenges with individual CSWs.  For example, the Wraparound provider is informed that the provider is not to be included in the CFT meeting unless invited by the family.  Jennifer pointed out that Departmental policy states that the IMHS provider facilitates the CFT meeting and requested that agencies contact her or Luz should CSWs exclude providers from the CFT meeting. Deborah noted that many CSWs are being trained in CFT meeting facilitation, thus CSWs may be requesting to facilitate numerous CFT meetings in order to receive training/facilitation hours.

Survey for Wraparound Providers Regarding Serving Children 0 to 5Jodi reported that at the April ACHSA DCFS/FBS Committee meeting, DMH had discussed Wraparound for children 0 to 5 and reported that the Department plans to utilize a small number of Wraparound providers in each Service Area to pilot Wraparound services for this population.  Jodi inquired as to the status of the DMH survey to all Wraparound providers in order to inform a process to determine which Wraparound providers could participate in the pilot.  Kalene responded that the Department plans release the survey regarding Wraparound for children age 0 to 5 following the analysis of the DMH Wraparound case rate.

Training Expectations for Coaches and Coach DevelopersJodi inquired as to the training expectations for Wraparound coaches and coach developers. It was pointed out that the draft Wraparound Service Exhibit requires that every agency have a coach developer. Kalene reported that there is a 2-day abbreviated training for coaches, but the Department has not yet developed an abbreviated training for coach developers.

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Wraparound Provider Utilization of CFT Planning MatrixMichael noted that all agencies can utilize the CFT Planning Matrix including agencies not yet trained in the Immersion offices. He reported that this policy change will be reflected in the LWA meeting minutes.

Revised Special Incident Report TemplateJodi inquired as to when the revised SIR template will be ready for distribution and implementation. She reminded DCFS that the only revisions that are required are: 1) deletion of “Change of placement” and “Detainment”; and 2) revision of “threats” to “Tarasoff threats” and “Fighting” to “Physical fighting.”  As well, Wraparound providers have asked that the reporting timeframes be aligned with the reporting timeframes for FFAs and group homes. Luz noted that she is continuing to make revisions and agreed to consider the reporting timeframes for FFAs and group homes. It was noted that Wraparound agencies should continue to use the existing Wraparound template until a finalized version is released.

Stated Expectations for Certified Agency Facilitators to Provide Trainings to Other AgenciesJodi explained that it has been reported by Wraparound providers that the certified facilitators at their agencies have been informed that it is an expectation that they will make themselves available to provide trainings to staff at other agencies.  Michael emphasized that this request was inappropriate and should not have been made. He requested that agencies contact him directly should agencies receive similar requests in the future.

Please contact Jodi or Alex with any questions.

L.A. County Integration Advisory Board Hosts County Department of Public Health Director Dr. Barbara Ferrer

On May 24th, the newly-appointed Director of the Los Angeles County Department of Public Health, Dr. Barbara Ferrer, addressed the Integration Advisory Board, whose members are tasked with overseeing and evaluating the progress of the Health Agency within its mission of facilitating an integrative care model. Dr. Ferrer’s presentation outlined her vision for the partnership between the three Departments, and primarily focused on disparities in well-being between white communities and communities of color.

Department of Public Health Director – Dr. Barbara FerrerDr. Ferrer introduced herself and her vision for the Los Angeles County Health Agency through her PowerPoint presentation titled Narrowing the Gaps: Addressing Equity Across the Health Agency. She began by

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differentiating between the concepts of equality and equity, the latter of which symbolized her vision – that each individual should receive what he or she needs for optimal health and well-being.

Dr. Ferrer articulated her belief that acknowledging that resources and opportunities are unequally distributed is the first crucial step to achieving justice for all within the healthcare arena. She continued that gaps in life expectancy are largely dependent on race, with black men and women facing the lowest life expectancies. When issues are examined related to access to care and morbidity, a very devastating picture for African Americans in Los Angeles County can be seen. She stressed that more than facilitating clinical interventions, the three Departments should fulfill their obligation to attend to the socioeconomic factors that detrimentally affect the health and well-being of so many.

Dr. Ferrer stated that the framework for achieving these objectives focuses on three central components. The first is to develop the institutional competency to engage in sustained efforts to eliminate inequities. The second is to support and build the communities’ capacity to lead and engage in efforts to eliminate inequities. The third is to identify partnership opportunities to enhance and promote efforts that result in equitable health outcomes. Dr. Ferrer then elaborated on each component of the framework in providing concrete examples.

In order to build institutional capacity, both employee education and training opportunities focusing on core competencies and leadership development must be provided. The concept of inequity elimination must be integrated into every program in the form of logic models, goals, objectives, activities, and evaluation. A system of continuous quality improvement and accountability must be ensured. Finally, internal policies that may perpetuate inequities must be identified and changed.

Dr. Ferrer provided a framework that would guide the Departments’ efforts in three initial areas of action: 1) narrowing the infant mortality gap; 2) eliminating and reducing disproportionate STI rates; and 3) addressing environmental injustices. As part of this environmental justice initiative, she announced that a huge outreach effort would be launched on June 10th

to the 21,000 L.A. County households affected by the Exide battery plant’s hazardous chemical release in 2016.

Within the environmental justice initiative moving forward, she outlined three main objectives. The first was to support community members and provide them with information needed to advocate for system, policy, regulatory and practice changes. The second was to increase capacity to effectively prevent, prepare for, respond to, and recover from environmental threats. Lastly, the third was to leverage the combined

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authorities and resources of the Federal, State, and local agencies that disproportionately burden in communities of color and communities with limited economic resources.

In order to strategically realize her vision, Dr. Ferrer announced that a Center for Health Equity would be administered out of the Public Health Department that would serve as the center for the entire Health Agency. She continued that a large component of this center would include creating a learning collaborative in order to move toward facilitating a safe and just culture around population health. She emphasized that the most crucial step toward creating greater health equity is to learn from individuals with firsthand experience. Dr. Ferrer stressed the need to reallocate scarce resources and provide services in an accessible, culturally appropriate format in order for individuals to better advocate for their own interests, and reiterated the importance of community infrastructure within beneficial changes in policy and practice.

Questions & Scope of the IABDr. Ferrer’s presentation was very well-received by the IAB members, many of whom expressed their appreciation for her understanding of the unique issues facing the African American community. IAB member Caroline Kelly, also of the Mental Health Commission, indicated that if members begin to explore items of personal interest, much of which is outside the scope of what their organization is tasked with doing, their main objective could be undermined. She urged the members to keep focus on the core mission of the group, to evaluate the integrative efforts of the three Departments. Another member of the IAB, however, countered that issues of racial equity pertaining to well-being were indeed central to the mission of the group, and that it was their responsibility to press the Departments’ officials on like issues.

Please contact TJ or Abby with questions.  

Probation Department Provides Updates at Quarterly Provider Meeting

On May 23rd, 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 Departmental UpdateProbation Placement Permanency & Quality Assurance (PPQA) Director Lisa Campbell-Motton reported that the Probation Placement Services Bureau has a new Bureau Chief, Luis Dominguez. Lisa shared that the County has

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approved four STRTP Program Statements/Plans of Operations. Lisa reminded everyone that the L.A. County CCR Group Home Convening will take place on May 26th at Liberty Park Plaza.

Probation Placement Administrative Services (PAS) Director Adam Bettino reported that PAS Headquarters is moving to 8300 South Vermont, 3 rd

Floor, Los Angeles 90044. Due to this move, Psychotropic Medication Authorizations (PMAs) should not be faxed until further notice and all PMAs should be emailed to placement.PMA@probation.lacounty.gov. He noted that all staff phone numbers will remain the same.

Placement Administrative Services Updates Adam explained that Probation is currently piloting a Probation Interagency Placement Committee (IPC) process with one agency, which includes utilizing the Placement Assessment Center (PAC). Lisa reported that CDSS has released a draft ACL regarding Interagency Placement Committees which she will be sending to all providers for feedback. Lisa then discussed the issue of lengthy wait times for group homes receiving youth from juvenile halls and noted that providers should not wait more than one hour. She advised providers to contact the juvenile hall superintendent and then her or Adam directly if this occurs.

Adam noted that Probation is addressing the number of youth waiting to be placed in the juvenile halls, following several high-profile incidents and a recent increase in the number of youth in juvenile halls. He noted that the issue has been exacerbated by the courts making specific recommendations as to where a youth should be placed. He requested that agencies respond to receipt of placement referrals within six hours or the referral will be sent to a different residential facility. He also requested that agencies visit the youth and make a decision regarding the referral within 24 business hours. Adam noted that there will no longer be placement waitlists and should the provider decide not to accept a referred youth, the provider must include detailed reasoning. Agencies should contact the ZIPP officer should there be any issues with responding within these timeframes

Placement Permanency and Quality Assurance UpdateLisa reported that the new PPQA Program Analyst recently revised the Group Home monitoring tool. However, the Departments will need to take into consideration the recent Board motion regarding changes to the monitoring process before finalizing the monitoring tool. Lisa explained that there continues to be issues with Needs & Services Plans (NSPs) related to documentation of permanency planning, concurrent planning, and case plan goals. She noted that the Department will be reviewing NSPs more diligently and expressed the need for improved residential staff training related to permanency and concurrent planning.

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Lisa then explained that the Department has made several preliminary changes to the Home Pass Policy which includes a Home Pass planning and debrief process. The revised policy will be emailed to all providers for feedback prior to finalization. Lisa reported that the Provider Subcommittee meeting will resume in June. The Provider Subcommittee is currently developing the Clothing policy and Transgender Placement policy. Lisa reminded providers that the Annual System Improvement Plan (SIP) Stakeholder Conference will take place on June 22nd. The conference will focus on the SIP priorities: 1) reduce recurrence of maltreatment; 2) increase permanency in 12 months; 3) enhance the county case review system; and 4) enhance the county child welfare quality assurance system.

Lastly, Lisa noted that starting next fiscal year the Department will focus on ensuring that group home youth are placed in public schools, as appropriate. She noted that Probation is currently discussing this issue with DCFS and L.A. County Office of Education (LACOE). One agency explained challenges in engaging with school counselors and liaisons, noting that schools will often communicate with the Deputy Probation Officer rather than the group home regarding minor conduct issues. LACOE representatives in attendance agreed to share this issue with the LACOE foster youth liaisons.

Sexual Health Presentation for Group HomesPublic Health Nurses (PHNs) Alonzo Machoca and Esther Feng provided a presentation on sexual health, including sexual health resources. The presentation focused on: 1) defining adolescence and puberty; 2) exploring beliefs about discussing sexual health with trusted adults; 3) California minor consent laws and recent teen health policies; and 4) technology-based websites, apps, and text-based resources to learn more about sexual health and teen-friendly healthcare services.

PHNs have been approved to present these materials to youth placed at group homes. Interested agencies can send presentation requests to Dr. Edna Willis at 323-290-9076 or EWillis@ph.lacounty.gov. Presentations range from one to two hours depending on the number of youth.

Final UpdatesProbation Child Trafficking Unit SDPO Joan Pera shared the dates and times of the upcoming CSEC trainings which are available on Eventbrite.

Youth Development Services (YDS) Director David Wong provided success stories from the Success is Our Future event. He shared the new YDS Outreach poster and noted that agencies could request copies of the poster from him. David reminded agencies that there is a YDS Deputy for out-of-state or out-of-county youth interested in the Independent Living Program.

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The next Probation Quarterly Provider will take place on August 22nd at Community Care Licensing (1000 Corporate Center Drive, Monterey Park, CA).

Please contact Alex with any questions.

Mental Health Odds & Ends

Homelessness in Los Angeles County Increases 23% as Need Far Outpaces HousingAccording to a May 31st Los Angeles Times article, the homeless population in Los Angeles County has increased 23% over the past year despite increasing success in placing clients into housing. Supervisor Janis Hahn stated, “It is clear that if we are going to end the homeless crisis, we need to stem the overwhelming tide of people falling into homelessness.” The Homeless Services Authority linked the worsening situation to the economic stress on renters in the Los Angeles area, as more than two million households in Los Angeles and Orange counties have housing costs that exceed thirty percent of their income. Furthermore, only one out of every four homeless persons across the County were classified as “sheltered,” meaning that they were residing in an emergency shelter or longer-term transitional housing. Therefore, three out of every four across the county, or 43,000, were living on the streets.

Child Welfare Nuts & Bolts

County Update on STRTP Program Statement/Plan of Operation ReviewsAt the May 26th Los Angeles County Group Home Convening, DCFS announced that the County has received 27 STRTP Program Statements/Plans of Operation. As of the date of the meeting, six of these STRTP Program Statements/Plans of Operation had been approved by the County.

CCL Investigation Finding Changes: Inconclusive is now UnsubstantiatedThe California Alliance has shared that as of February 17th, 2017, CCL is no longer using the term “inconclusive” for investigative findings for allegations that do not have a “preponderance of the evidence to prove that the alleged abuse occurred” and CCL will now use the term “unsubstantiated.”  This change applies across all licensed community care facilities. No other changes were made to the investigation findings. Since this was a prospective change, all prior CCLD documents that used the term “inconclusive” remain unchanged and the terms “inconclusive” and “unsubstantiated” will co-exist on the CCL Transparency Website for the next 60 months or until March 1, 2022 in the following manner:

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The term “inconclusive” will continue to exist on the CCL Website for investigative findings where the existence of physical documents containing the word “inconclusive” pre-dates February 17th, 2017 and will not be removed for five years.

After February 17th, 2017, CCL will use the term “unsubstantiated” for those cases that warrant that finding.

SB 484 Group Home Site VisitsThe National Center for Youth Law recently highlighted SB 484 program site visits in its newsletter. Senate Bill 484 requires the annual identification and investigation of California group homes that are found to prescribe beyond safety thresholds for youth.  Of the 161 group homes investigated, 30% have been issued advisory notices to create corrective action plans. Common reasons for issuing an advisory note include: 1) staff received insufficient training regarding psychotropic medication; 2) children’s Needs and Services plans were not signed or not being completed within 30 days of the child’s placement; and 3) medication logs were missing initials and/or lacked proper documentation regarding medication refusals, side effects experienced, medication destruction, etc. CDSS plans to release an ACIN regarding the findings of the first round of facility site visits.

State Provides Best Practices for   Youth Running from or Missing from Care CDSS has released All County Information Notice (ACIN) I-13-17, providing promising practices to locate and respond to youth who run away or go missing from foster care. The ACIN provides optional forms for counties to utilize, along with practice suggestions in the areas of runaway prevention and return to care, understanding and responding to reasons children leave care, refusal to return, out-of-county/state, and personal property. This ACIN builds on a previous All County Letter which provided instructions regarding the policies and procedures counties are required to develop to locate and respond to these youth, as required by the Preventing Sex Trafficking and Strengthening Families Act of 2014. This legislation required counties to develop and implement protocols to locate any child or non-minor dependent who has gone missing from foster care.

CONFERENCES, EVENTS & RESOURCES

CII 10th Annual Fatherhood Solution ConferenceJune 16th, 2017

On June 16th from 8:30 a.m. to 5:00 p.m., Children’s Institute will host the 10th Annual Fatherhood Solution Conference at the Westin Los Angeles Airport Hotel (5400 Century Blvd., Los Angeles, CA 90045). This year’s theme is “Fatherhood Roadblocks: Race, Culture, Masculinity and Systems.”

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For more information or to register, please click here.

Workshop: Groundbreaking Interventions for Traumatized Children, Teens & Families in Foster Care and AdoptionJune 21st, 2017

On June 21st from 8:00 a.m. to 1:00 p.m., Penny Lane will host the Groundbreaking Interventions for Traumatized Children, Teens & Families in Foster Care and Adoption Workshop at Antelope Valley City of Hope (44151 15th St. West, Lancaster 93534). The workshop will include new tools and attachment interventions, information on developing a safe holding environment within a therapeutic frame, and engagement and trust-building with resistant children impacted by abuse and neglect. The workshop is CEU approved and will provide 4 hours of continuing education credits. For more information and to RSVP, please click here.

System Improvement Plan (SIP) Stakeholder Engagement Conference June 22nd, 2017

On June 22nd from 8:00 a.m. to 4:00 p.m., L.A. County will host the 2017 System Improvement Plan (SIP) Stakeholder Engagement Conference at Quiet Cannon (901 Via San Clemente). Providers and foster youth are encouraged to attend. For more information and to register, please click here.

NAMI Pathways to Recovery ConferenceJune 25th, 2017

On June 25th from 8:30 a.m. to 5:30 p.m., NAMI will host a conference focusing on personal and professional perspectives on recovery for families and individuals at the Pickwick Gardens Conference Center (1001 W. Riverside Dr., Burbank, CA 91506). Some of the issues discussed include LPS Conservatorship, suicide prevention, self-care and advocacy. Los Angeles County Supervisor Kathryn Barger will be the keynote speaker. To RSVP, please click here.

IN THE NEWS

L.A. Moves to Fill Educational Stability Gap for Foster Youth like Alex and Shirley, The Chronicle of Social Change, 5/2/17

#HackFosterCareLA Brings Tech Lens to Country’s Largest Foster Care System, The Chronicle of Social Change, 5/2/17

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Blood Lines: Relatives Not Always the Best Caregivers for Foster Youth , The Chronicle of Social Change, 5/3/17

Set to Graduate High School, Carlos Faces Deportation Order , The Chronicle of Social Change, 5/3/17

Risky Business: A Child’s Death in L.A. Elicits More Questions than Answers, The Chronicle of Social Change, 5/9/17

County Considers Disbanding Child Welfare Donation Unit After Audit Finds Toys, Funds Unused And Mismanaged, Los Angeles Times, 5/14/17

Updated: Amid Cuts to Youth Services, Trump Includes Big Increase to Child Welfare Entitlement, The Chronicle of Social Change, 5/26/17

UPCOMING MEETINGS & EVENTS

JUNE

12 Adult Mental Health Policy Committee Meeting ACHSA 1:30 PM to 3:00

PM14 Children’s Mental Health

Policy Committee Meeting ACHSA 1:30 PM to 3:30 PM

21 DCFS/FBS Committee Meeting ACHSA 10:00 AM to Noon

22 FFA Strategic Planning & Policy Committee Meeting ACHSA 10:00 AM to Noon

22 Mental Health Contract-Admin Committee Meeting ACHSA 1:30 PM to 3:00

PM

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