department for community based services kids are worth it ......welfare transformation jessica...
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Department for Community Based ServicesKids Are Worth It
September 10, 2019
Jennifer Warren
September 10, 2019
CHILD WELFARE
TRANSFORMATION
Child Welfare Belongs to All Of Us
Family and child
Prevention Services
Kinship and Relative
Placements
Foster Care (Public and
Private)
Reunification)
Adoption
Post Adoption Supports
Schools Courts
DJJ
Treatment and
Recovery Programs
Public Health
Mental and
Behavioral Health
Faith Based Community
DCBS DATA TRENDS AND OUTCOMES
A LOOK BACK….
Number of Youth in Out of Home CareSFY2014 – SFY2018
7,778
9,034
7000
7500
8000
8500
9000
9500
10000
Jun'14
Aug'14
Oct'14
Dec'14
Feb'15
Apr'15
Jun'15
Aug'15
Oct'15
Dec'15
Feb'16
Apr'16
Jun'16
Aug'16
Oct'16
Dec'16
Feb'17
Apr'17
Jun'17
Aug'17
Oct'17
Dec'17
Feb'18
Apr'18
Entries and ExitsSFY2014 – SFY2018
5,840
6,632
5,371
5,796
5000
5200
5400
5600
5800
6000
6200
6400
6600
6800
7000
Entries Exits
Total DCBS and PCP Foster HomesSFY2014 – SFY2018
4,401
4,577
4100
4200
4300
4400
4500
4600
4700
4800
DCBS and PCP Foster Homes by TypeSFY2014 – SFY2018
2,062
1,935
2,339
2,642
1500
1700
1900
2100
2300
2500
2700
DCBS Foster Homes PCP Foster Homes
Months to Permanency: ReunificationsSFY2014 – SFY2018
8.48.9
9.69.0 9.2
5.9
6.7 6.9 6.67.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2014 2015 2016 2017 2018
Mean (Avg.) Median
Months to Permanency: AdoptionsSFY2014 – SFY2018
36.9 36.9
37.9
37.0 37.0
33.3
32.5
35.7
33.5
35.2
29.0
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
39.0
2014 2015 2016 2017 2018
Mean (Avg.) Median
Youth Exiting OOHC to AdoptionSFY2014 – SFY2018
855
914
1053
1086
1026
750
800
850
900
950
1000
1050
1100
1150
2014 2015 2016 2017 2018
Youth Aging Out of OOHCSFY2014 – SFY2018
662
624
603
640
601
500
520
540
560
580
600
620
640
660
680
700
2014 2015 2016 2017 2018
Active CasesJune 2016 – June 2018
13,500
13,353
13,859
14,272
14,787
12500
13000
13500
14000
14500
15000
Jun '16 Dec '16 Jun '17 Dec '17 Jun '18
Average CPS CaseloadsCY2017 – CY2018*
18.319.0
23.324.023.3
25.3
29.8
32.1
0
5
10
15
20
25
30
35
2017 2018
CPS Current CPS with Past Dues CPS Not at Full Capacity Current CPS Not at Full Capacity with Past Dues
*CY2018 Jan-Jul .
A Call To Action: Time for Transformation
There is a child on the other side of every decision made, every policy implemented, and every law passed who will either feel the
benefit or the consequence.
A FORMAL PROJECT MANAGEMENT STRUCTURE
Child Welfare TransformationThe Overarching Framework for Reform
Phase I
April 2018: A proactive response to an unprecedented opportunity….
The Project’s Governance Structure
Child Welfare Transformation
Sponsors
Stakeholder Advisory
Group
Internal Project
Leadership Team
Steering Committee
AccountabilityTransparencyCollaborationA systems approachPartnershipsRelational approach
Project Management
OutcomesProcessStructure
9 Workgroups
• Workforce
• Permanency
• Prevention
• Fiscal Mod.
• Trans. Aged
Youth
• Foster Parent
• Relative Pl.
• Service Regions
• It
• Requirements
• Scope of Work
• Key Themes
• Risk Assessment
• Communications
• Project Monitoring
• Stakeholder
Engagement
• Strategy implementation
• Deliverables
• Early evaluation
• Course correction as needed
• Embed into ongoing practice
3 Primary Goals
Reduce case loads
Improve timeliness to appropriate permanency
Safely reduce the number of children
entering OOHC
THE COLLECTIVE CHARGE:
o Identify the system we want and work from there: Family and child driven decision making.
o Be innovative, think and dream big: The entire system is on the table.
o Ask, then ask again:o What will it take?o What is/isn’t working? o What are the priorities?o What can we accomplish?o What is the data telling us?o What are the stakeholders telling us?o If this were my family, how would I want to be treated, approached, and engaged?
Formulate strategies to create a child welfare system in
which families and children are the primary focus
INNOVATIVE STRATEGIES
“Innovation is not about saying yes to
everything. It’s about saying no to
all but the most crucial features”
~Steve Jobs
Build on what’s working.
Change what’s hindering.
Transformative strategies.
Engage stakeholders and
staff.
Shift the culture.
Phase I Highlights
• 77 planning sessions as of May 1, 2019;• 154+ hours to date in planning, implementation and follow up; • 53 Transformational Strategies as of May 1, 2019; • Consistent process for identification of scopes for each group;• Achievable key themes identified and strategies formulated;• Framework for ongoing consistent evaluation and decision making;• Ongoing risk assessment, performance monitoring and deliverable
verification; • An established process for DCBS to address current and future challenges
that is consistent, structured and systematic. • Ongoing Stakeholder engagement to inform the work and provide input; • Voices of the Commonwealth has membership on 3 workgroups; and• A parent mentor has been added to the Prevention Supports workgroup.
CONTINUOUS….
QUALITY….
IMPROVEMENT…
CWT Phase IIData Informed/Outcomes Driven
CWT Phase 2: Sustaining the Gains
From Project to Practice……
• Family First implementation
• A movement towards primary and secondary prevention;
• A family centered focus on recovery and resilience by biological parents
• A redesigned Continuous Quality Improvement (CQI) process:
• Becoming data informed and outcomes driven;
• Responding to agency’s changing needs;
• Addressing additional areas needing improvement;
• Continued stakeholder engagement at all levels of the agency; and
• Feedback loop.
Phase 2 Workgroups Workforce Supports Out of Home Care Supports Permanency Fiscal Modernization Prevention Supports Judicial Engagement
THANK YOU!
#ChildWelfareBelongsToAllOfUs
Follow DCBS on social media:o Twitter: @KyDCBSo Facebook: Kentucky Department for Community Based Services https://www.facebook.com/kydcbs/
Family First Prevention and Services Act: A Key Lever in Kentucky’s Child
Welfare Transformation
Jessica Brown
Family First Prevention Services Act
• Landmark legislation: Most significant child welfare law in 20 years.
Dramatically alters the federal financing structure for child welfare programming (Title IV-E).
Prevent entry into foster care
Keeping children in family-like settings
Restricting funds for out-of-home care that is not a foster home.
Reorientation around prevention
Prevention:Implications and opportunities
Transforming the child welfare focus from
foster care to prevention, increased family
stability and well-being.
Investing in evidence-based interventions.
Applying a trauma-responsive lens
Partnering across systems
Major provisions: Prevention
• FFY2020: States gain the option to use
federal title IV-E funding for prevention
services for children, parents and/or kin
caregivers.
• Prevention services include:
• In-home, skill-based parenting programs
• Substance abuse treatment and prevention
• Mental health treatment
Major provisions: Prevention funding
• No income/AFDC test for child, parent or kin recipients of prevention services.
• Preventive services can be federally funded for up to 12 months at a time.
• At least 50% of state’s funded prevention services/programs must be at the well-supported level.
• States must adhere to maintenance of effort requirements
Major provisions: Prevention
• 3 categories of evidence for the prevention programs:
• HHS will publish eligible services and their level of evidence via an Evidence-Based Clearinghouse.
Promising Supported Well-Supported
Title IV-E Prevention Plan
• Prior to implementation, all states must submit a Title IV-E Prevention Plan
• The plan must outline the Evidence Based Practices (EBPs) to be used by the state over a five year period
• The plan can be amended over time as new EBPs are approved by the Title IV-E Prevention Services Clearinghouse
• Kentucky’s initial submission included the following EBPs:
Prevention services and programs
• Mental Health:
Parent-Child Interaction Therapy –well supported
Trauma Focused-Cognitive Behavioral Therapy --promising
Multisystemic Therapy –well supported
Functional Family Therapy –well supported
• Substance Abuse:
Motivational Interviewing --TBD
Multisystemic Therapy –well supported
Sobriety Treatment and Recovery Team (START)--TBD
Prevention services and programs
• In-Home Parent Skill-Based: Sobriety Treatment and Recovery Team (START) –TBD
1-2-3 Magic: Effective Discipline for children 2-12—TBD
85.2% (52)
45.9% (20)
19.7% (12)16.4% (10)
65.6% (40)
4.9% (3) 4.9% (3) 1.6% (1) 3.3% (2) 0.0% (0) 0.0% (0)0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Trau
ma
Focu
sed
-Co
gnit
ive
Be
hav
iora
l Th
erap
y
Par
ent-
Ch
ild In
tera
ctio
nTh
erap
y
Mu
ltis
yste
mic
Th
erap
y
Fun
ctio
nal
Fam
ily T
her
apy
Mo
tiva
tio
nal
Inte
rvie
win
g
Mu
ltis
yste
mic
Th
erap
y
Fam
ilies
Fac
ing
the
Futu
re
Met
had
on
e M
ain
ten
ance
Ther
apy
Par
ents
Tea
cher
s
Nu
rse-
Fam
ily P
artn
ersh
ip
Hea
lth
y Fa
mili
es A
mer
ica
Mental Health Substance Abuse In-Home Parent Skill-Based
Evidence-Based Practice
Jefferson
The Lakes
Two Rivers
Eastern Mountain
Salt River Trail
Northern Bluegrass
Northeastern
CumberlandSouthern Bluegrass
Jefferson
The Lakes
Two Rivers
Cumberland
Eastern Mountain
Salt River Trail
Northern Bluegrass
Northeastern
Southern Bluegrass
Jefferson
The Lakes
Two Rivers
Cumberland
Eastern Mountain
Salt River Trail
Northern Bluegrass
Northeastern
Southern Bluegrass
Jefferson
The Lakes
Two Rivers
Cumberland
Eastern Mountain
Salt River Trail
Northern Bluegrass
Northeastern
Southern Bluegrass
Children/Youth in Families Served by Contracted in Home Services
(FPP/START/KSTEP)
886 836 783 759 651 556 544410
2500
100200300400500600700800900
1000
# of Youth Served by Contracted In-Home Services (FPP/START/KSTEP)
Right-sizing congregate care
Major provisions: Congregate care• Applies significant restrictions to federal
reimbursement for children and youth placed in congregate care.Facilities that meet the Qualified Residential Treatment Program (QRTP) criteria for any child’s stay beyond 2 weeks.
Children whose assessment completed within 30 days indicates their clinical needs are best met in that setting.
• Additional safeguards for children placed in QRTPs Specific case planning requirements
60 day court approval of placements and status reviews
Major provisions: Congregate care
• A QRTP must be a program that:
is licensed and accredited
has a trauma-informed treatment model
facilitates outreach to and participation of family members in the child’s treatment program;
has nursing staff and other licensed clinical staff, on-site if required by the treatment model, and are available 24 hours a day and 7 days a week
Total Percent
QUALIFIED RESIDENTIAL TREATMENT PROGRAM (QRTP) REQUIREMENTS“My agency currently…”
Completely True
Somewhat True
Not at all True
…has a trauma-informed model that is designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances.
76.7 20.0 3.3
…is able to implement the treatment identified for the child by the required 30-day assessment of the appropriateness of placement.
90.0 3.3 6.7
…to the extent appropriate and in accordance with the child’s best interests, facilitates participation of family members in the child’s treatment program.
80.0 16.7 3.3
…facilitates outreach to the family members of the child, including siblings. 56.7 40.0 3.3
…documents how the outreach to the family member is made (including contact information). 76.7 20.0 3.3
…maintains contact information for any known biological family and fictive kin of the child. 63.3 26.7 10.0
…documents how the family members are integrated into the treatment process for the child, including post-discharge. 56.7 36.7 6.7
…documents how sibling connections are maintained 53.3 36.7 10.0
…provides discharge planning and family based aftercare support for at least 6 months post-discharge.
20.0 50.0 30.0
…is licensed and accredited by at least on of the following independent, not-for-profit organizations: The Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation (COA), or any other independent, non-for-profit accrediting organization approved by HHS.
86.7 3.3 10.0
…has registered or licensed nursing staff and other licensed clinical staff who provide care within the scope of their practice as defined by state/tribal law. They are on-site according to the treatment model and are available 24 hours a day and 7 days a week (A rule of construction in section 472(k) (6) of the Family First Act indicates that this requirement shall not be construed as requiring a QRTP to acquire nursing and behavioral health staff solely through means of a direct employer to employee relationship.)
80.0 6.7 13.3
Major provisions: Congregate care
• Exceptions to QRTP requirements are:
Facility for pregnant and parenting youth
Supervised independent living for youth 18
years and older
Specialized placements for youth who are
victims of or at risk of becoming victims of sex
trafficking
Residential family based substance use
disorder facilities
Children/Youth in Congregate Care Statewide
99910.20%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
0
200
400
600
800
1000
1200
Statewide
% o
f ch
ildre
n/y
ou
th
# o
ch
ildre
n/y
ou
th
# of children/youth in congregate care % of children/youth in congregate care
Source: TWS-W058 07-07-19 (Foster Care Fact Sheet Run)
Children/Youth Placed Outside of Region Statewide(34.9% of children/youth are placed outside of their removal region)
972
2,827
2,095
218 282189 252
1,608
781
54916% 8%
43%
78%
66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
0
500
1000
1500
2000
2500
3000
Relative or FictiveKin
DCBS FH (AllTypes)
PCP TFH PCC Res Other
% o
f ch
ildre
n/y
ou
th
# o
f ch
ildre
n/y
ou
th
# Placed within Region # Placed Outside of Region % Placed Outside of Region
Source: TWS-W058 07-07-19 (Foster Care Fact Sheet Run)
Provider readiness survey sample
• 70 providers participated
• 30 residential providers
Pregnant and Parenting Teens program(s) (n=12; 40.0%)
Independent Youth Age 18 and Older program(s) (n=15; 50.0%)
Sex Trafficking Victims programs (n=11; 36.7%)
Family-Based Substance Abuse Treatment Facility (n=7; 23.9%)
Congregate care:Implications and opportunities
Right-sizing congregate care for kids with a clinical need.
Building an effective and appropriate array of family-based placements and community supports to meet treatment needs and promote placement stability.
Preventing inappropriate increases to the juvenile justice population; inappropriate clinical diagnoses.
Expanding the business model of placement providers beyond congregate care.
Thank You!
We want Kentucky to be the Gold Standard for child welfare within the United States...
- Governor Bevin