family first prevention services act (ffpsa): maine’s
TRANSCRIPT
Family First Prevention Services Act (FFPSA):
Maine’s Proposed Prevention State Plan
December 3, 2020
Christine Theriault, LMSW
Office of Child and Family Services
FFPSA Program Manager
Maine Department of Health and Human Services 2
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Maine Department of Health and Human Services 3
Objectives
To recap the Family First Prevention Services Act.
To provide information on Maine’s proposed approach for implementation of FFPSA.
To gather thoughts and suggestions on initial program ideas.
Prevention Services
for Children and
Families
Increased Quality &
Appropriateness of
Residential Care
IV-E
Maine Department of Health and Human Services 4
Family First Prevention
Services Act Focus Areas
Prevention of foster care placements
through:
• Trauma informed and evidenced
based services including: mental
health & substance abuse prevention
and treatment services, in-home
parent skill-based programs, and
kinship navigator services
Improving the well-being of children
already in foster care by reducing
placement of children in group care
settings and enhancing quality of care for
residential treatment programs.
Establishment of Qualified Residential
Treatment Programs (QRTP)
Maine Department of Health and Human Services
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FFPSA State Plan
Parents, Youth,
Resource Parents
State Agency
Partners
Community Providers
Other States Resources Consultants
OCFS Staff:
CW, CBHS, Operations
FFPSA Stakeholder Workgroups
Prevention Services Eligibility Services Prevention Plan
Services and supports to prevent removal from the home
• In SFY 2019
– 1,322 children entered State custody (a 42% increase over the 928
children that entered in the prior state fiscal year. Nationally, the rate of
children entering care per 1,000 children is 4 (based on 2017 data) and
Maine is slightly higher at 5 entries per 1,000 children.
– Over half of all child welfare removals involved parental substance use
as a contributing factor.
– 1 in 5 infants entered state custody following a drug affected
baby/substance exposed newborn report (may have been from multiple
contributing factors.)
– Over half of the children entering state custody were under the age of 5.
– In the last two federal fiscal years the data on outcomes for youth
exiting custody reflects a significant increase in the number of children
exiting to reunification.
Maine Department of Health and Human Services 9
Prevention Services Planning: The Data
• Qualitative data gathered: parents, youth, providers, school staff, state
partners, community providers, OCFS staff, resource parents
• Themes:
– Need to increase access and availability of services (especially rural
Maine)
– Need to increase knowledge of services (for parents, providers, other
state agencies)
– Workforce needs (recruitment, retention, wages, career ladders)
– Behavioral health and in home support needs.
– Substance Use services for families are needed.
– Cultural and racial sensitivity is necessary in service provision and case
management.
Maine Department of Health and Human Services 10
Prevention Services Planning: The Data
• Federal Guidelines:
– A child who is a “candidate for foster care”
• Imminent risk of entry into foster care, has a child specific plan, but can
remain safely at home with services.
• A candidate for foster care cannot be a child who is already under the
placement and care responsibility of the Office of Child and Family
Services (i.e., in foster care).
• Maine Definition of Candidacy:
– A child who is a victim of maltreatment in which safety and risk factors can
be mitigated by the provision of in-home services and is able to safely
remain at home with a child-specific Prevention Plan.
– Pregnant and parenting youth in foster care.
– Children who have exited foster care through reunification, guardianship, or
adoptions and may be at risk of re-entry.
Maine Department of Health and Human Services 11
Eligibility for Prevention Services
• Post investigation, casework staff will use Structured Decision
Making (SDM) to determine if a child meets the definition of
candidacy for prevention services.
• SDM uses defined and consistent decision-making criteria and tools
for the following areas:
Maine Department of Health and Human Services 13
Determining Candidacy
Prevention Services
• FFPSA IV-E Guidelines:
– 12 month per candidate episode, Evidenced Based Practices (EBP), not already covered by MaineCare.
• FFPSA partnership with CBHS EBP initiatives
• OCFS Proposed Approach:
– Expand existing EBP that are on the Title IV-E Clearinghouse and covered by MaineCare
• Parent Child Interaction Therapy (PCIT), Incredible Years, Triple P
• Training opportunities in the spring/summer 2020
– Expand Parents as Teachers to cover families w/children 0-5
– Develop Homebuilders Family Preservation and Reunification Program
Maine Department of Health and Human Services
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Prevention Services
• OCFS Proposed Approach Continued:
– Increase knowledge and utilization of other services available to families in Maine
• Work across state systems to leverage resources and initiatives to build a system array improving access, availability, knowledge of services.
• Conduct a gap analysis to determine where service needs are to match population needs.
• Utilize State Agency Partnership for Prevention to develop inventory.
• Development and distribution of a Family Services Resource Guide.
• FFPSA Toolkit to assist with candidacy determination and service identification.
Maine Department of Health and Human Services
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Parents As Teachers (PAT)
PAT is a well supported, evidenced based home-visiting parent education program
Aims Components
-increase parent knowledge of early
childhood development & parenting practices,
-promote early detection of developmental
delays and health issues,
-prevent child abuse and neglect,
increase school readiness
-personal home visits,
-supportive group connection events,
-child health and developmental screenings,
-community resource networks
Currently implemented by Maine Families Home Visitors (0-3) Expansion opportunities:
– 0-5 to serve families for longer
– More referrals from OCFS for those cases meeting candidacy
– Increase in staffing to serve more families
– Assess geography of services to ensure more rural areas are covered
• Well-supported, evidenced based, Family Preservation/Family Reunification Program, not covered by Mainecare.
• Serves children 0-17 and their families.
• Work with high-risk families involved with the child protective services system to:
– remove the risk of harm to the child instead of removing the child.
– give families the chance to learn new behaviors, and help them make better choices for their children.
– Child safety is ensured through small caseloads, program intensity, and 24-hour a day service availability.
• Utilizes Motivational Interviewing, Cognitive Behavioral Approaches
• Outcomes: 6 months post-service, 86% of children have remained safely in their homes.
Maine Department of Health and Human Services
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HOMEBUILDERS
Maine Department of Health and Human Services
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Evidence Based Service Target Age Title IV-E Rating Funding Details
Substance Use Treatment Programs
Methadone Maintenance Therapy Age 18+
Under 18
w/consent
Promising -MaineCare funds service delivery.
-Funded by Federal Grant Funds and State
Funds for uninsured.
Multisystemic Therapy (MST) 12-17 years old Well-Supported -MaineCare funds service delivery.
-Future consideration of Title IV-E and SGF
Mental Health Services
Functional Family Therapy
(FFT)
11-18 years old Well-Supported -MaineCare funds service delivery.
-Future consideration of Title IV-E and SGF
Multisystemic Therapy (MST) 12-17 years old Well-Supported -MaineCare funds service delivery.
-Future consideration of Title IV-E and SGF
Trauma Focused Cognitive
Behavioral Therapy (TF-CBT)
5-17 years old Promising -MaineCare funds service delivery.
-State funds supported training.
The Incredible Years 4-8 years old School Aged/Toddler
Basic: Promising
-MaineCare funds service delivery.
-IV-E and State General Funds- to fund training
Parent Child Interaction Therapy
(PCIT)
2-7 years old Well-Supported -MaineCare funds service delivery.
-IV-E and State General Funds- to fund training
Triple P- Positive Parenting
Program
0-16 years old Promising (some
models)
-MaineCare funds service delivery.
-IV-E and State General Funds- to fund training
In Home Skill Based Parenting Supports
Parents as Teachers (PAT) 0-5 years old Well-Supported -Title IV-E and State General Funds
Homebuilders 0-18 years old Well-Supported -Title IV-E and State General Funds
Attachment Biobehavioral
Catchup (ABC)
6-24 mos.
24-48 mos.
Under Review -Maine Care exploration and/or possible Title
IV-E in the future
Kinship Navigator Programs
No programs are proposed N/A None -Use of IV-E and State General Funds in future
Mission: To establish partnerships across state agencies that will result in the
provision of a continuum of primary, secondary, and tertiary prevention services to
families in Maine that will result in safe, healthy, and successful families in Maine.
• State Agency Partnership for Prevention (SAPP) was created and includes:
• Office of Child and Family Services (OCFS)
• Department of Education (DOE)
• Department of Corrections (DOC)
• Maine Center for Disease Control and Prevention (MCDC)
• Department of Labor (DOL)
• Office of MaineCare Services (OMS)
• Office of Family Independence (OFI)
• Office of Behavioral Health (OBH)
• Tasks:
• Inventory of prevention services already being funded or provided
• Identifying gaps in programs and service delivery
• Cross program collaboration to increase access, availability, and knowledge of
services.
Cross Program Collaboration
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State Agency Partnership for Prevention
• FFPSA requires all services (Prevention and QRTP) to be trauma
informed
• QRTP subcommittee on Trauma Informed Care:
– Drafted a preliminary menu of Trauma Informed Care
practices that agencies could select from for implementation.
• A Trauma Informed Care Agency Assessment will be
recommended for implementation for all agencies receiving IV-E
dollars and more.
• Trauma Informed Care Resource Guide will be created that will
encompass resources for all providers.
Cultural and Racial Diversity and Inclusion
20Maine Department of Health and Human Services
Trauma Informed Care
• Training and support (for new EBP models) spring/summer
2021
• Logic Model Development through subcommittee of
Workforce stakeholder workgroup.– Addressing workforce needs in Maine goes beyond OCFS and will
require multiple programs/offices/stakeholders to improve
workforce issues.
– Convening of a Behavioral Health/Supportive Services Workforce
Collaborative
– Data gathering, rate studies, etc. were identified activities as well
• Ongoing work will continue to address Workforce post state
plan submission.
Cultural and Racial Diversity and Inclusion
21Maine Department of Health and Human Services
Behavioral Health Workforce
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• Intake: Current practice using SDM to assign case.
• Investigation: Current practice using SDM tools.
• Decision making:
– Does an investigation become a Prevention Services Case?
– Does the child/children meet the criteria for candidacy?
• If investigation results in a Prevention Services case, a Family Team
Meeting is conducted that will inform the development of a Prevention
Services Family Plan.
• The Prevention Services Family Plan is developed with the family and
signed by the parties.
• Referral to Services: Using Family Services Resource Guide
• Case Monitoring for safety, risk, and progress on goals.
• Prevention Services Family Plan is reviewed every 90 days.
• Monitoring of timeframes: 12 month limit per candidate episode
Prevention Planning with Families
• Training for staff on FFPSA– Candidacy Determination
– What is the right service to select for families?
– Completion of the Prevention Services Family Plan
– Monitoring safety and risk reduction for case closure
– Ongoing SDM trainings
• Monitoring of Caseloads– To be done by supervisors/management utilizing the workload analytic
tool.
• Trauma Informed Care: – Staff are trained using the National Child Traumatic Stress Network
(NCTSN) Child Welfare Trauma Training toolkit. (required after 6
months)
Cultural and Racial Diversity and Inclusion
23Maine Department of Health and Human Services
Child Welfare Workforce
• Evaluation of outcomes of prevention services: ensuring
service array is working to reduce entry into care
• OCFS Quality Assurance Processes will be utilized to
review cases
– Random selection of cases
– At least 50 cases reviewed annually
• New data management system being built, Comprehensive
Child Welfare Information System (CCWIS), to replace the
historical MACWIS (Maine Automated Child Welfare
Information System) system.
• Policy changes will be made after approval of FFPSA
Prevention State Plan.
Cultural and Racial Diversity and Inclusion
24Maine Department of Health and Human Services
Evaluation/Quality Assurance/Reporting
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The FFPSA Transition Grant was released in December 2019 and was automatically awarded to Maine in April 2020 with no application.
FFPSA Transition Grant:
Planning and Implementation
OCFS Plan Grant Funds: 5 year spend ($1,869,714)
QRTP Readiness Support: Accreditation/Fingerprinting/Background
Checks
QRTP Qualified Individual and Assessment Process Support
HOMEBUILDERS
Child Welfare Training
New Evidenced Based Practice Capacity Building
Maine Department of Health and Human Services
Starting October 1, 2021, Children’s residential treatment programs must meet QRTP standards in order for states to receive Title IV-E funds for room and board for child welfare placements
QRTP Requirements Include:
• Placement assessment within 30 days by a “Qualified Individual”
• Heavy family engagement/involvement including siblings.
• Have registered or nursing staff and other licensed clinical staff available 24/7.
• Provide discharge planning and family-based aftercare support for at least 6 months post-discharge.
• Use trauma-informed treatment model.
• Program must be licensed and accredited.
Maine Department of Health and Human Services
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New Standards for Residential Treatment:
Qualified Residential Treatment Programs(QRTP)
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• An assessment will be completed within 30 days of QRTP
placement by KEPRO.
– Utilizing the Child and Adolescent Service Intensity Instrument
(CASII)
• Criminal background/Fingerprint checks for adults working in
QRTPs and other group settings.
• Accreditation preparations (reimbursement/applications/etc.)
• Draft Aftercare recommendations
• Draft Trauma Informed Care recommendations
(assessment/resources)
• Judicial Review requirement (working with AG’s office)
• More information on QRTP planning will come in early Spring
2021.
QRTP Planning To Date
Maine Department of Health and Human Services
• The Department supports racial, ethnic and cultural
diversity and inclusion.
• With global communication, specific outreach has occurred
with the tribes and New Mainer populations.
– Presentations at meetings to provide overview of FFPSA
– Active recruitment for Stakeholder workgroups
– Meetings with New Mainer representatives: feedback from families
– Ongoing communication with tribal representatives
• Needs Identified:
– To ensure child welfare and community service providers are
culturally and racially knowledgeable and sensitive in working with
each family.
– A mechanism for families to provide feedback and input into state
initiatives.
Cultural and Racial Diversity and Inclusion
29Maine Department of Health and Human Services
Cultural and Racial Diversity and Inclusion
• OCFS intends to have Maine’s FFPSA State Prevention plan
completed by December 31, 2020 and plan to be submitted in
early January 2021. Approval expected Spring 2021.
• QRTP planning will continue and QRTP IV-E plan submitted in
Spring 2021
• Prevention implementation is expected in the Fall 2021 with
infrastructure building, pilots, training to begin in Spring and
Summer 2021.
• Continued internal meetings to review polices and practice to
meet FFPSA requirements.
• Stakeholder workgroups (except QRTP) have completed their
work. Smaller implementation stakeholder group convening after
state plan submission.
What is to come….
30Maine Department of Health and Human Services
Family First Prevention Services Act: What’s next…
• Maine OCFS Family First Prevention Services Act Website
• Federal Family First Prevention Services Act Website
• FFPSA Program Fact Sheet
• FFPSA Overview Webinar
• FFPSA Update Webinar
• Child Welfare and Children’s Behavioral Health Annual Reports
What is to come….
31Maine Department of Health and Human Services
FFPSA Resources Available
Questions, Suggestions, or Feedback?
What is to come….
32Maine Department of Health and Human Services
Family First Prevention Services Act Discussion
QUESTIONS??
Christine Theriault
Family First Prevention Services Program Manager
[email protected] or 624-7914
Websites:
• https://www.maine.gov/dhhs/ocfs/family-first-act.shtml
• www.familyfirstact.org
Maine Department of Health and Human Services
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