+new provider residential services orientation

Orientation 1

+New ProviderResidential Services

Orientation

State of Georgia

Introduction• What We Will Do - Educate

• Presented By– Georgia Association of Homes & Services for

Children (GAHSC)– Department of Human Resources (DHS)

• Office of Residential Child Care (ORCC) Licensing• Division of Family and Children Services (DFCS)

– Division of Behavioral Health and Developmental Disabilities (DBHDD)

– Department of Juvenile Justice (DJJ)

Orientation 3

Who Should AttendApplicants for the Licensing of:

•Child Caring Institution – (Group Home, Emergency Shelters, Second Chance Homes)•Outdoor Child Caring Institutions•Child Placing Agency (Foster Care, TFC)

Orientation 4

Who Should NOT Attend•Day Care Center Operators•Foster Parent wantabe’s•Adult Personal Care Home Applicants•Psychiatric Hospital Applicants•Maternity Homes Applicants•Insect Exterminators Applicants•Beauty Shop Operators Applicants•Road Contractors Applicants

OverviewNormer Adams

Executive DirectorGeorgia Association of Homes

& Services for Children

www.gahsc.org

[email protected]

404 572 6170

1. - Organizational Capacity and Needs Assessments

2. - Licensure

3. - Contracting with the State

4. - Referrals and Payments

Steps to Provision of ServicesPresentation Organization

Step one - Organizational Capacity and Needs

Assessments

Steps to Provision of Services

Organizational Capacity Assessement

FIRST PRIORITY

Develop the

“BUSINESS PLAN”

The Plan vs. Good Intentions-Board -Facilities

-Budgets -Legal Issues

-Constituency -Policies & Procedures

FIRST PRIORITY

THE BUSINESS PLAN (continued)

• Research– The Need– The Competition

• Interviews• Field Trips

Needs Assessment

FIRST PRIORITY

What will I be When I grow Up?

Child Placing – An agency that recruits, supports and places children in foster homes

Child Caring Institution – Group home or other congregate care environment where facilities are built for the placement and care of children.

Outdoor Child Caring Institutions – Programs using a wilderness model for care and treatment of children.

Needs Assessment

FIRST PRIORITY


Child Placing – An agency that recruits, supports and places children in foster homes

• First placement priority for state. • 75% of all foster children go into this placement. • Lowest cost per day per child• Regulations require that they be not-for-profit. You

can not own them, profit from them or sell them.

Needs Assessment

FIRST PRIORITY


Child Caring Institution – Group home or other congregate care environment where facilities are built for the placement and care of children.

• This is last placement choice for children with basic needs.

• DFCS is not issuing any new contracts for this service• Only 14% of all foster children are placed in these

facilities.

Needs Assessment

FIRST PRIORITY


Outdoor Child Caring Institutions – Programs using a wilderness model for care and treatment of children.

• These are wilderness programs for children.• Most are considered treatment facilities.• Few of these facilities are being used for placement.• Requires over 500 acres in land.• State very reluctant to contract with new providers.

Needs Assessment

FIRST PRIORITY What License should I get?

Child Placing/ Foster Care

• Private Family centered Child Care

• Few Capital Costs• Labor Cost follow Labor

needs• Higher Reimbursement to

Cost ratio• Higher Percentage of

children entering care

Child Caring Institution / Group Homes

• Campus focused Child Care

• High Capital Costs• Labor cost do not

follow labor needs• Lower Reimbursement

to Cost ratio• Lower percentage of

children entering care

Needs Assessment

Board Development(Not-for-Profit Only)

Should you be a Not-for-Profit (501 c 3)?

Organizational Capacity Assessment

For-Profit•Personal profit and benefit•Personal management•Ownership of assets•Risk of own resources

Not-for-Profit•Community ownership and control•Community support though contributions•Risk of community resources

Georgia’s Priority of Placement

1. Family

2. Relative

3. Adoption

4. Foster Care – public sector

5. Private sector foster care

6. Private sector group homes

Board Development(Those who are accountable for the organization)

Truism - An organization is as strong as its Board.– Choose people who can help you– Go beyond friends and family– Movers and Shakers of community make

good Board Members


Executive Director(He/She who manages the organization)

• Choose person of experience, integrity, responsibility and history

• He/She will represent your organization

• He/She will carry out your policies and procedures


Budgets and Budgeting Budget Development

Expenses• Staff--Base Pay• Benefits• Insurance--Property,

Casualty, & Liability• Food• Clothing• Transportation• Other

Income• State Fees• Contributions-nonprofit

only– Charity gifts– Grants– Endowments


Budgets and Budgeting

Medical Care Covered by Medicaid –

Nearly all children in residential care qualify for Medicaid.


Fundraising

Grants for Startup

List of all the Foundations and Charities that give to new organizations starting children homes and group homes.



FundraisingGrants for Startup

All Foundations and Charities: 1.2.3.

Fundraising

Grants for Startup

• Very Few

• Only to Existing Groups

• Need 501(c)(3) status – Not-for-Profit

• Anticipate 18 months for startup support

• Build constituency


Not-for-profit Organization(Nearly all are 501(c)3)

• Internal Revenue Service (IRS) Regulations for securing tax deductible contributions

• Takes at least 1 year to secure

• A knowledgeable person can do it without lawyer


Your Facilities

• Fire Inspection - # 1 Problem Area– Most Expensive to Correct– State Regulations, County Interpretations and

enforcement


Your Facilities

Truism- If Community Support starts off negative, walk away. It will never turn positive.

• Community Support - # 2 Problem Area– Build Support Carefully– If negative, hard to overcome– Use community leaders to lead


Your Facilities

Zoning – The “Tip Off”

to the Community -- Required before Licensing-- Zone for “a licensed childcare institution for six or more unrelated children”-- Movers and Shakers of community can help with this


Policies & Procedures(Provides the why and how of the organization)

Truism – If your director can not explain them, they should not be your director.

• Get a person who has done residential child care to prepare your policies and procedures

• These are your rule books for operations• You will live and die by them• They become your Bible for operation


Technical & Clinical Assistance(Gut instinct is not enough.)

Truism – Education and Experience is more valuable than gut instinct.

• A compliant child may be a depressed child.• An attentive, indulgent staff may be a

pedophile.• Money in your pocket may not mean money in

the bank.• Your High School Joe might like your facility as

coed, but you won’t.

Staff & Personnel Issues(They make or break your organization)

Truism - Your program is as good as your worst staff.

• A thorough background check is essential.

• “Would you let these folks care for your child?”


Reporting Requirements

Truism – God Forgives but the State never

Forgets

• Child Abuse Reporting Requirements

• Stuff will happen! Self-report.

• The law requires you to report abuse and neglect.

• Do not even THINK of not reporting.


Working with the State

• Some SteerThe State is our partner in caring for children. Their role is regulatory and contractual. Respect it.

• Others RowOur role is providing services to children. Together we work to provide the best care for children.


Budgeting/Rate Setting


Truism – Child Welfare programming makes for a bad business investment.

Truism – If you are in it for the money, you are in it for the money.

Georgia’s regulations prohibit any organization from making money. Your daily per diem will be the lesser of (your costs or the maximum rate.)



Truism – If you in it for the money, you are in a world of trouble. There is no profit in child welfare.

• Funding remains the top priority for any administrator!

• Without money, nothing happens. • The State is your number # 1 customer, and quite

often, your only customer!• In Georgia, there are only a hand full of For-Profit

agencies. (There is a reason for this. There is no profit in child welfare!)



Placement providers are paid a per diem for Room and Board and Watchful Oversight.

Group Homes

Base Additional Maximum Oversight $105.69 $133.82 $187.64.

Child Placing Agency$42.11 $57.71 $93.92

Departments & Divisions of State Agencies

DHS Office of Residential Child Care

Licensing Office of the State

Rhonda James #2 Peachtree St., 32nd Floor

404-657-5589

http://ors.dhr.georgia.gov/portal/site/DHR-ORS

• Step Two - Licensure


DHS Office of Residential Child Care

Residential Child Care Licensing• License Categories:

– CPA – Child Placing Agency - Placement of children in foster and or adoptive homes **Both domestic and international placement**

Home Study Services– CCI – Child Caring Institutions includes emergency shelters,

group homes, and children's homes. 6 or more residents 6-17 years old

*Medically fragile children– OCC – Outdoor Child Caring Institution - Wilderness Camps

– Determine the type of program you want to be

Licensure

How to Apply for Licensure

1. All CCIs must obtain local zoning and fire approval before submitting an application

2. Purchase licensure application package

3. Familiarize yourself with ORS rules and regulations--develop a working knowledge of the meaning and intent of these rules and regulations

4. Develop policies and procedures to address each rule

5. Prepare your agency for compliance with the regulations

Licensure

Staff Qualificationsfor CCI

• Director: Masters/2 years related experience or Bachelors/4 Years experience

• Human Services Professional (Social Services): Bachelors/2 Years Experience or supervised by Masters

• Child Care Worker: 21 Years Old/ High School or GED

• Director and owner must document a satisfactory criminal records check

Licensure

Staff Qualificationsfor CPA

• Director: Bachelors/2 Years related experience unless doing clinical supervision of staff

• Case Work Supervisor (Social Services): Qualified Masters/2 Years CPA experience

• Case Worker: Bachelors degree• Director and Owner must document a

satisfactory criminal records checkLicensure

Criminal Records Check Law

• Must be in compliance with Criminal Records Checks Law.

• If employee’s check reveals any crime, person cannot be hired until resolved.

• Must submit fingerprints to Office of Investigative Services for clearance.

Licensure

Physical Plant for CCI

1. Water/Sewage2. Bedrooms:63 Square Feet per resident (double

occupancy. Single: 75 Square Feet3. Bedrooms – must document space capacity to serve at

least six residents4. Bathrooms – one sink/toilet per 8 kids, 1 shower per

10 kids.5. Separate bathroom for staff.6. Staff may not enter into a resident bedroom to access

the bathroom.7. SAFETY FIRST--Inside and Outside

Licensure

Behavior Management• Develop behavior management policies

and procedures• Policies should address behavior

management techniques for type of children served

• Behavior management plan must be documented in the resident’s service plan.

Licensure

Behavior Management (continued)

• The policies address form of discipline that shall not be used.

• Examples

- Verbal Abuse, Ridicule or Humiliation

- Denial of sleep, shelter or clothing

- Corporal punishment

Licensure

Behavior Management (cont’d)

• Develop policies on emergency safety interventions

• Emergency safety means those behavioral interventions techniques that are authorized under and an approved emergency safety intervention

• Plans are utilized by properly trained staff in an urgent situation to prevent a child from doing immediate harm to self or others- List of approved programs attached

Licensure

Approved Emergency Prevention Providers

1. Crisis Prevention Institute3315-H North 124th StreetBrookfield, WI 53005Web: www.crisisprevention.com

2. Devereux Crisis Intervention (CP/I)444 Devereux DriveVillanova, PA 19085Web: www.devereux.org

Approved Emergency Providers Continued

3. Human Empowerment Leadership Principles (HELP)P O BOX 280366Nashville, TN 37228

Web: www.capscanhelp.com

4. The Mandt System (Mandt)P O BOX 831790Richardson, TX 75083-1790Web: www.mandtsystem.com

5. Professional Crisis Management (PCM)10273 NW 46th StreetCarlisle, pa 17013


5. Professional Crisis Management (PCM)10273 NW 46th StreetSunrise, FL 33351Web: www.pcma.com

6. Safe Crisis Management36 South Pitt StreetCarlisle, PA 17013web: www.jkmtraining.com


7. Therapeutic Aggression ControlP O BOX 336

623 N. Main StreetDanbury, NC 27016web: www.tact2.com

8. Therapeutic Crisis InterventionFamily Life Development CenterIthaca, NY 14850web: www.rccp.cornell.edu

Management of Medications• System for Proper Storage, Administration

and Documentation• Monitoring for Side Effects/Complications• Expired Medications• Accurate Medication Logs (Prescription

and Non-prescription)• Method of Managing Medication Errors• Documentation in Service Plan

Licensure

Regulatory Process

• Self-Assess for Rule Compliance and Completed Application Materials

• Submit Application with all local approvals if required

• Initial On-Site Inspection – Office Conference: Temporary License (12 Months)

• Annual Re-Licensing Inspections• Follow-Up Inspections• Complaints/Self-Reported Incidents

Licensure

B r e a k

Step Three - Contractual Process for Providers


Division of Family

& Children’s Services

DFCS

•Provider Relations Unit •404-657-3572

•http://www.dfcs.dhr.georgia.gov/portal/site/DHR-

DFCS/

Services purchased by DFCS for children in its custody are provided by the following:– Child Caring Institution– Child Placing Agency– Outdoor Camp Program

Services Purchased

Room, Board, and Watchful Oversight (RBWO) Services Purchased by DFCS

• RBWO is a system that purchases placement services for children in out-of-home placement.

RBWO Services Purchased by DFCS

Services Purchased

Characteristics of Children in DFCS Custody

• Age– Birth to18 years old

• Mental/Emotional/Behavioral Difficulties• Medical/Physical Difficulties • Deprivation determined by the court• Abused, neglected, or abandoned

Characteristics of Children

What is Room and Board and Watchful Oversight?

Child Placing Agencies:

•Traditional RBWO•Base RBWO•Maximum RBWO•Specialty Base Watchful Oversight (SBWO)•Specialty Maximum Watchful Oversight (SMWO)•Specialty Medically Fragile Watchful Oversight (SMFWO)

R.B.W.O. is the provision of lodging, food, and attentive and responsible care to children.

Room and Board and Watchful Oversight

Child Caring Institutions:

• Base•Additional Watchful Oversight•Maximum Watchful Oversight

Providers shall be responsible for the provision or acquisition of services to ensure that each child's physical, social, emotional, educational/vocational, nutritional, spiritual/cultural and permanency needs are met.

DFCS Contract Application Process

• Potential Provider requests application package from the Provider Relations Unit .

• Completed Application is submitted to the Provider Relations Unit .

• Application is reviewed by Provider Relations Unit .

Approval Process of Vendors

Contract Approval ProcessThree Possible Outcomes:

(A) Application accepted--will conduct an on-site visit and review the program

(B) Application incomplete--will include an explanation of application items for which more information is needed

(C) Application denied--will include an explanation of the basis for denial


Contract Approval Process (continued)

• If approved to serve children who are in the custody of DFCS, a notification letter will be sent to the provider and contract process initiated.

• DFCS Provider Relations Unit notifies all county DFCS offices of the approval status.


Contract Approval Process (continued)

• Licensure does not guarantee the purchase of RBWO services by the State.


Automatic Denial

The following conditions will merit the denial of Contract Status:

• A person’s private resident located in a licensed facility.• Cut doors in a child room to meet fire codes. Sprinklers

are preferred when required.• Directors who are qualified by regulation/standards but

not accessible to DFCS/DJJ and are not accountable to the Board.


Referral Process

• Program may receive referrals directly from county DFCS offices.

Referrals and Payments

DJJDepartment of Juvenile Justice

DIVISION OF COMMUNITY CORRECTIONS

•Community Corrections (404)-657-2431•Marie Martin (478) 952-5592•www.djj.georgia.gov

Department of Juvenile Justice

Division of Community Programs

Serves to Protect the Citizens of Georgia by Providing Prevention Services, Court Services

and Supervision, Treatment and Rehabilitation of Youthful Offenders.


Upon Obtaining Licensure, Contact the Residential Placement Specialist (RPS) in the District in which Your Facility is Located

Potential Provider requests application package from the Residential Placement Specialist.

Completed Application is submitted to the Residential Placement Specialist.

Application is reviewed by Residential Placement Specialist and supervisor.


DJJ Contract Application Process

DJJ Districts and Regions

Residential Placement Specialists

5 DJJ Regions

match DHR Regions

Regional Placement Specialists

1. Wayne Reynolds

2. Kim Settles

3. Angela Parker

4. Carl Harrison

5. Sue Riner


DJJ Contract Approval Process

• Residential Placement Specialist (RPS) Conducts Site Visit

• Assesses Willingness and Ability to Service Delinquent Youth– School Issues– Supervision

• Contract Process Initiated


• Average Age - 13 (range is from 8-17)

• Mostly Males• Most Common Offenses - Property & Status• Oppositional - Lack Impulse Control• Common Mental Health Diagnoses - Conduct

Disorder, Depression, PTSD• Substance Abuse Issues


Characteristics of Children in DJJ’s Care

• During FY 2004, 59,000 youth were served by the Department of Juvenile Justice.

Services Purchased

Services to Children in DJJ’s Care

Private Placements

Normer Adams, GAHSC

Private Placements

Agency determines what services to sell (or give away) to the private individual or corporation (usually another state.)

The nature of these services is determined on the ability to provide those services within the Licensing framework and Approved Levels of Care.

Services Purchased

• Determined by agency’s mission and ability to care for the child.

• And Agency’s ability to serve


Characteristics of Children in Private Placement

Private Placements

• Client Application Process-- Licensing allows an agency to provide out-of-home services. Within the rules of Licensing, each agency develops their own application process.

• Contract Approval Process -- There is no approval process save Licensure.

Approval Process of Vendors and Marketing

Private PlacementsReferrals and Payments

• Referrals - Referrals are made by private individuals or agencies or another state. This referral network is determined by the agency.

• Payments - Payments are negotiated with each referring party.


Private PlacementsReferrals and Payments

Most Private Placements are done on a charity basis unless the placement is done by another State.


1. - Organizational Capacity and Needs Assessments

2. - Licensure

3. - State Approval Process for Vendors

4. - Marketing to Referral Sources, DFCS, DJJ, Private Sector

In Conclusion:Steps to Provision of Services

+new provider residential services orientation

Documents

care of children

foster children

treatment of children

places children

agency foster care

congregate care environment

treatment facilities

basic needs