Davidson Conference Center

December 1, 20089:00-4:00 PM

3415 South Figueroa Los Angeles CA 90089

MEETING PURPOSE

To bring together DCFS, DMH, CEO and other partners to…

1. understand the Katie A. Strategic Plan’s components;

2. provide focused feedback on the implementation of three components of the Katie A. Strategic Plan;

3. build greater ownership over the implementation of the Katie A. Strategic Plan.

WELCOME

MIGUEL SANTANA, Deputy Chief Executive Officer, Children and Families' Well-Being

SHEILA SHIMA, Deputy Chief Executive Officer, Health and Mental Health Services

AGENDA: MORNING

I. WELCOME & OVERVIEW 9:00-9:15

II. STRATEGIC PLAN OVERVIEW 9:15-10:30

High-Level ContextHigh-Level Plan Components

III. SERVICE ACTIVITIES 10:40-12:00

MH Screening and AssessmentMH Service DeliveryData and Tracking of Indicators

AGENDA: AFTERNOON

IV. AFTERNOON ACTIVITIES 1:00-1:25

V. IMPLEMENTATION PLANNING 1:35-3:05

Break Out Sessions

VI. PRESENTATION AND INTEGRATION 3:20-4:00

VII. ADJOURN 4:00

RECOGNITIONS

1. Executive Leadership

2. Board Deputies

3. Departmental Leadership

4. CHAMPS

5. Operational Planning

6. Caseload Reduction Workgroup

7. Data Workgroup

8. Training Workgroup

RECOGNITIONS

9. Specialized Foster Care Managers’ Meeting

10. Interagency Placement Review Meeting

11. Intensive In-Home Mental Health Services Meetings

12. CFT/Finance Workgroup

13. CSAT/Referral Tracking System Workgroup

14. EPSDT Determination Workgroup

15. MAT Coordinators Meeting

16. MAT Steering Committee

AGREEMENTS

1. A learning opportunity among ‘experts’ of different parts of a complex system; this not a training…

2. Some components of the Plan need your feedback—hence this is an invitation to co-craft elements of the Plan that still need work.

3. Play an active role in understanding concepts and giving feedback.

PRESENCE PRINCIPLES

1. Those who show up are the right ones.

2. When it starts is the right time.

3. Whatever happens is the only thing that could’ve.

4. When it’s over, it’s over…

OVERALL CONTEXT

OVERALL CONTEXT

TRISH PLOEHN, MSW, Director, Department of Children and Family Services

MARVIN J. SOUTHARD, DSW, Director, Department of Mental Health

BRANDON NICHOLS, Senior Deputy County Counsel, Social Services Division

BACKGROUND: 2002CLASS ACTION LAWSUIT FILED AGAINST THE STATE

AND LOS ANGELES COUNTY ALLEGING:

1. Failure to assess mental health needs.

2. Inadequate mental health services.

3. Placement disruptions.

4. Over-reliance on congregate care.

5. Institutionalization—MacLaren Children’s Center.

BACKGROUND: JULY 2003

Los Angeles County entered into a Settlement Agreement resolving the County-portion of the lawsuit.

The Settlement Agreement required the County to make systemic improvements to better serve members of the class.

KATIE A. CLASS MEMBERS

1. Are in the custody of the Los Angeles County DCFS in foster care or who are at imminent risk of foster care placement by DCFS;

2. Are eligible for services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program;

KATIE A. CLASS MEMBERS

3. Have a mental illness or condition that is documented or, had an assessment been completed, could have been documented; and

4. Need individualized mental health services to treat or ameliorate their illness or condition.

SETTLEMENT OBJECTIVES

1. Promptly receive necessary individualized mental health services in their own home, a family setting, or the most homelike setting appropriate to their needs;

2. Receive care and services needed to prevent removal from their families or dependency or, when removal cannot be avoided, to facilitate reunification, and to meet their needs for safety, permanence, and stability;

SETTLEMENT OBJECTIVES

3. Be afforded stability in their placements, whenever possible; and

4. Receive care and services consistent with good child welfare and mental health practice and the requirements of law.

HISTORY: THREE PLANS

1. ENHANCED SPECIALIZED FOSTER CARE (SFC) MENTAL HEALTH SERVICES PLAN [2005]

Pilots in three Service Planning Areas

2. CORRECTIVE ACTION PLAN (CAP) [2007]

Modifications required by the Court

3. KATIE A. STRATEGIC PLAN [2008]

Comprehensive five-year plan

Legal Background and Context

!The “Bottom Line” !!Why Moving Forward and Making

Progress is Critical!&

!Why Partnership and Engagement (DMH, DCFS, CEO, Community

Partners, Providers, Stakeholders etc. is KEY!

What are the Components of the Plan:

Questions, Questions and more Questions…

KATIE A. STRATEGIC PLAN:

CONTENT

A (Brief) Panel Discussion

Katie A. Strategic Plan: High Level Overview

Does any-ONE have a question they’d like to ask?

E X I T(Beginning With End In Mind)

QUALITATIVE SERVICE REVIEW

Katie A. Strategic Plan: High Level Overview

Continued

Does anyone else have a question they’d like TWO ask?

FUNDING OF SERVICES

Katie A. Strategic Plan: High Level Overview Continued

THIRD time is a charm….Who else has a question they’d like to ask?

CASELOAD REDUCTION

Katie A. Strategic Plan: High Level Overview Continued

Does anyone else have a question FOUR leadership?

TRAINING

Katie A. Strategic Plan: High Level Overview Continued

Does anyone else have a question for leadership?

# 5

ACTIVITIES

DATA AND TRACKING OF INDICATORS (Insuring We Know What’s Happening)

and REFERRAL TRACKING SYSTEM

(The System that will be in place to do this)

SCREENING & ASSESSMENT

THREE TRACKS TO SCREENING

C S A T: PURPOSE

1. To coordinate DCFS and DMH non-line staff to rapidly receive screenings and/or referrals to ensure service linkage.

2. To integrate ‘siloed’ services and programs into CSAT through clear policies and procedures for all operational responsibilities.

3. To use a data tracking system to regularly monitor progress on indicators (i.e., timely delivery of screening, assessment, referral linkage, full utilization of resources, etc.).

C S A T: PARTNERSDCFS, DMH, DPH AND DPSS STAFF…

1. CSW

2. Service Linkage Specialist

3. DMH Co-Located Specialized Foster Care Staff

4. MAT Staff

5. Team Decision Making Staff

6. Resource Utilization Management/Resource Utilization Liaisons

7. Youth Development Specialists

8. Permanency Partners Program (P3) Staff

9. Adoption Safe Families Act Staff

10.Linkages Co-Located Staff

11.Educational Liaisons

12.D-Rate Coordinators

13.PHN

MENTAL HEALTH SERVICE DELIVERY

Katie A. Strategic Plan: High Level Overview Continued

We have time for one LAST question.

? # 6

KATIE A. STRATEGIC PLANHigh Level Summary

REFLECTIONS

STRUCTURE

Select a facilitator (who keeps group focused and makes sure everyone gets a chance to speak).

Select a recorder of key points.

QUESTIONS

1. What did you like about what you heard?

2. What questions do you have?

Screening, Assessment and Service Delivery:

“As the Caseload Churns” (An Activity)

Objectives:Better understand key decision points (mental health

screening/assessment and service delivery components looking at 3 “points of entry/service”)

Connect these with existing resourcesIdentify key places where input is neededEngagement, feedback and clarificationSome GuidelinesBasic case information onlyTrack thoughts, questions and ideas for processing laterKeep child, family member and CSW role at the forefrontEngagement, Teaming, Tracking, Improving….

Activity: “The Flow”Prologue: “Decisions/Decisions/Decisions”

Key Concepts: Mental Health Screening Tool (MHST), Referral Tracking System, Coordinated Services Action Team (CSAT),

 3 Families

Family # 1 Jackson-Washington Family (Detention Required)Family # 2 Jefferson Family (Case Opening/No Detention)Family # 3 Evans Family (Triggering Event and/or Case Plan Update

Due)

Act I Scene 1: Background/ Initial Assessment: Safety/Risk Assessment Act I: Scene 2: Team Decision Making and Mental Health ScreeningAct I: Scene 3: Mental Health Assessment Act I: Scene 4: Mental Health Services Linkage  Act II: Mental Health Service Delivery/Tracking of Indicators ( A “Walk-

Through”)  Epilogue: Reinforcing Key Points, Table Discussion and Report Out

Decisions, Decisions, Decisions!Handout

At Your Tables

Review 3 Referrals

(A) Initial Referral ------to-------(B)-Successful Case Closure

Question One:Pick one of these scenarios and list 7-10 major

decision/intervention points that will have to be made during the time from referral to case closure.

Question Two:Pick one decision/intervention point on your list. Brainstorm

below your ideas on the tools, resources and supports that a CSW currently has available to help them make this decision.

Scenario # 1Today’s date: _____________: CPHL Call:

“Hello, I’d like to make a referral regarding Joe Jackson and La Trecee Washington. They are currently running around the neighborhood completely unsupervised since early this morning. Both children have serious behavior problems. Parents are into drugs and are nowhere to be found.”

Date: (12 months from today): _________________ Judge: “Joe Jackson and La Trecee Washington are discharged as dependents of the court and the petition is dismissed.”

Scenario # 2Today’s date: _____________ CPHL call from Law

Enforcement: “Hello, I’d like to request that a Social Worker to respond to the Pacific Shores Motel. We have two children Brianna and Maria Jefferson (ages 15, and 7) in custody. We may have to arrest their mother for child endangerment and resisting arrest.”

Date: (6 months from today) _________________ CSW: “Mrs. Jefferson, you’ve done very well. I’m pleased to see all of these support systems in place and your case is officially closed.”

Scenario # 3Today’s date: ____ CPHL (Level 12 Group Home)

“This follows up on previous referrals/phone calls on Marco Evans. He continues to physically assault both staff and residents when he gets angry and upset and broke a window during his last outburst. Due to his large stature, (5’11’ and 290 lbs), GH staff are unable to protect themselves and the other residents. We are requesting his immediate removal. He has two siblings (Samuel and Josephine) who are also in foster care and their court hearing is coming up”

Date: (12 months from today):__________________ Judge: “Marcos, Samuel and Josephine Evans are discharged as dependents of the court and the petition is dismissed.”

Decisions/Interventions – Resources and Supports

Decision Intervention Point

?

Tools Resources and Supports

?

Decision Points-Tools/Resources(Some Examples)

IN PERSON RESPONSE? ALLEGATION

SUBSTANTIATED? SAFETY DECISION? ASSESSMENT OF FUTURE RISK

(CASE OPENING OR REFERRAL)?

COURT DECISION? ASSESSMENT/CASE PLAN:

WHAT SERVICES ARE REQUIRED?

DISPOSITION OF CASE? (RE)PLACEMENT DECISION? RE-ASSESSMENT/PLAN

MODIFICATION? PERMANENT PLAN, CASE

CLOSURE?Other

KNOWLEDGE, VALUES, SKILLS

SUPERVISORS, COLLEAGUES (Internal/External)

SERVICE PROVIDERS, CARE-PROVIDERS, CONSULTANTS LAWS

TEAMING STRUCTURES AND STRATEGIES

POLICY GUIDELINES DECISION MAKING AND

ASSESSMENT TOOLS CASE PLAN AGREEMENTS RESEARCH Other

TOOLS RESOURCES AND SUPPORTS:

MENTAL HEALTH NEEDSMENTAL HEALTH SERVICES

AND THE MEANS TO TRACK PROGRESS

?

MH SCREENING & ASSESSMENT

Key Concepts: (A Reminder)Mental Health Screening Tool (MHST), Referral Tracking System, Coordinated Services Action Team (CSAT)

 3 FamiliesFamily # 1 Jackson-Washington Family

(Detention Required)

Family # 2 Jefferson Family (Case Opening/No Detention)

Family # 3 Evans Family (Triggering Event and/or Case Plan Update Due)

Family # 1: Washington-Jackson Case

Detention Imminent/Required: All Other

Controlling Interventions Exhausted) Father: Dale Jackson (25)

Mother: Rhonda Washington (25) Child: Joe(Jackson (6),

Child: La Trecee Washington (6)CSW:

• Narration

Family # 1: Washington-Jackson Case

Key Steps/Key PointsAct I Scene 1: Background/ Initial Assessment (SDM,

Other)

Act I: Scene 2: Team Decision Making and Mental Health Screening

Key Points: TDM, HUB and MAT Referral, Consent/Eligibility, Referral Tracking System, CSAT Accessed

Act I: Scene 3: Mental Health Assessment

Key Points: MHST Completed (HUB), MAT Assessment/Summary of Findings, CSAT Accessed

Act I: Scene 4: Mental Health Services Linkage

Key Points: MAT Support for CSW and Service Linkage, CSAT Engaged

Family # 2

The Jefferson Case (Non-Detained: Controlling Interventions

Implemented) Mother: Dorothy Jefferson

Father: Ralph Jefferson (whereabouts unknown)Child: Briana Jefferson (15)Child: Mariah Jefferson (7)

CSW

Narration

Family # 2 : The Jefferson Case Key Steps/Key Points

Act I Scene 1: Background/ Initial Assessment (SDM, Other)

Act I: Scene 2: Team Decision Making and Mental Health Screening

Key Points: TDM, MHST Completed, Service Linkage Specialist and CSAT Engaged, Consent/Eligibility,

Referral Tracking System,

Act I: Scene 3: Mental Health Assessment

Key Points: Co-Located Staff Engaged, Assessment, CSAT Engaged,

Act I: Scene 4: Mental Health Services Linkage

Key Points: Co Located Staff, Service Linkage Specialist and (appropriate) CSAT Support Provided

Family # 3 The Evans Family

(Triggering Event and/or Case Plan Update Due) Mother: Theresa Evans

Father: Sam Dearden - DeceasedChild: Marcos Evans – (13) Child: Samuel Evans – (9)

Child: Josephine Evans – (17) CSW

Narration

Family # 3 : The Evans Case Key Steps/Key Points

Act I Scene 1: Background/ Initial Assessment (SDM, Other)

Act I: Scene 2: Team Decision Making and Mental Health Screening

Key Points: TDM/RMP Process Utilized, Service Linkage Specialist, CSAT Engaged, MHST Completed (if not receiving MH services), Consent/Eligibility, Referral

Tracking SystemAct I: Scene 3: Mental Health Assessment

Key Points: Co-Located Staff, CSAT Engaged

Act I: Scene 4: Mental Health Services Linkage

Key Points: Service Linkage Specialist, CSAT and Co Located Staff Engaged

The “Pause Button”Debriefing the Role Players

Thoughts, Reactions

AND

APPLAUSE!

Epilogue: A Table Activity

Matching Points of Entry --- Key Process

StepsStep One: Match the Point of Entry With Corresponding Process Steps

Step Two: Match Terms With Definitions

It’s easy to feel lost.

Treatment Foster Care

Community Treatment Facilities

EPSDTSystems

Navigators

ISCs

Evidence Based Practices

AB3632

TBS

COD

Crisis Intervention

HUBs

MH Screening Tool

D-R

ate

Prog

ram 730 Evaluations

Psychotropic Authorization

Fortunately, help has arrived.

DMH Specialized Foster Care

Co-Located Staff

Consultation

Information Exchange

Assessment

Brief Treatment

Systems Navigation

Service Linkage

It’s a complicated system out there.

Full Service Partnerships

Intensive In Home MHS Programs

Wraparound

DCFS STUDYThose who graduated from the Wraparound Program were 36 times less likely to have another placement episode than those leaving RCL 12+ facilities that did not receive Wrap services, despite having roughly comparable placement rates before and during their respective treatments.

256

7

264 249

0

100

200

300

Tota

l # o

f Pla

cem

ent E

piso

des

Wraparound Non-Wraparound

Out-of-Home Placements (Wraparound Graduates vs. RCL 12+ Non-Wraparound Youth)

Before Wrap/RCL 12+ After Wrap/RCL 12+

CHILD AND FAMILY TEAM APPROACH

CHILD & FAMILY TEAM

1. Engagement of child, family, formal and informal support systems.

2. Identifies needs and strengths.

3. Develops plan for child and family.

4. Supports plan implementation.

5. Modifies plan, as needed.

6. Transitions to informal supports (i.e., family, church, etc.).

INTENSIVE HOME-BASED SERVICES

INTENSIVE IN-HOME MENTAL HEALTH

SERVICES

It’s not going to be easy

But if we work together

DMH DCFS

Oh, what we will have done!

LUNCH

IMPLEMENTING THE KATIE A. STRATEGIC PLAN

SPA-LEVEL APPRAOCH

LESSONS LEARNED

SPA-LEVEL APPROACH

ART LIERAS: Co-Location

ROBERTA MEDINA: Integration and Referral Population

ANA SUAREZ: Navigation and Linkage

JACQUELYN WILCOXEN: Communication and MAT Platform

CO-LOCATION

REFERS MAINLY TO KEY ‘PHYSICAL’ ASPECTS OF COLLABORATION…

1. Spaces are visible and accessible, versus tucked in the corner; and physical configuration of units;

2. Sensitive about displacing others while moving in co-located staff;

3. Infrastructure: mail, telephone, computers, etc.;

4. Locks on cabinets and chart storage;

5. Physical presence of staff (duty schedules).

INTEGRATION

DIFFERENT PROGRAMS AND SERVICES SUPPORT A COMMON VISION, MISSION, AND VALUES…1. Staff commit to shared mission, goals, and practice

(‘ALL of us help kids walking through the door…’);

2. Align programs with different funding requirements;

3. Clear roles and authority lines;

4. Conditions: need enough time to work out the above areas incrementally; on an informal basis; and top-down and bottom-up processes.

REFERRAL POPULATION

CLEAR CRITERIA AND PROCESSES REGARDING TARGET POPULATION…1. Eligibility criteria: e.g., children in foster care,

detained, open case, placed in/out of SPA, etc.;

2. Policies and procedures from beginning to end;

3. Providers implement shared policies and procedures;

4. Address common ‘structural’ issues, i.e., EPSDT, consent, medical necessity, Court v. Voluntary...

NAVIGATION

OBTAIN KEY INFORMATION AND MAP RESOURCES FOR CHILDREN AND FAMILIES.

1. Gather key documents, such as Medi-Cal, consent, program eligibility, etc.;

2. Utilize co-located staff;

3. DMH: Foster Care Navigators; Service Area Navigators.

LINKAGE

ENSURING APPROPRIATE AND TIMELY SERVICE CONNECTION…

1. Make referral and verify that linkage occurred;

2. Maintain documentation of what happened after linkage;

3. Address overlaps in service;

4. Feedback loop to CSW;

5. Address challenges: initial assessment versus ongoing treatment; following up to linkage beyond initial referrals.

COMMUNICATION

CREATE EFFECTIVE STRUCTURE OF COMMUNICATION AND DECISION-MAKING…1. Central administration and regional administration;

2. Lateral communication/across Departments (i.e., Probation; DMH; DCFS; etc.);

3. Vertical communication within Departments;

4. Communication across SPAs;

5. A structure for decision making, not just communication.

MAT PLATFORM

1. Key component of MH Screening & Assessment;

2. Currently implemented in SPAs 3 and 6; and in all other SPAs by end of fiscal year;

3. Can be a point of focus for DMH, DCFS, and DHS staff to build and expand partnerships to ensure screening and assessment and service linkage for newly detained children;

4. Can help prepare non-pilot offices for easier roll-out of CSAT and other Strategic Plan components.

IMPLEMENTATION: RESOURCES & TOOLS

1. MEETINGS-AT-A-GLANCE

2. ANNOTATED INDEX: STRATEGIC PLAN

3. DMH-DCFS REGIONAL OFFICES ROSTER

IMPLEMENTATION: RESOURCES & TOOLS

1. PROGRAMMATIC OVERVIEW

2. ‘FISH’ CHART

3. KATIE A. WEBSITE

CASEFLOW PROCESS FOR MENTAL HEALTH SCREENING, ASSESSMENT &

SERVICE LINKAGE

BREAK OUT SESSIONS

FOCUSED FEEDBACK ON IMPLEMENTATION OF:

1.MENTAL HEALTH SCREENING & ASSESSMENT

2.MENTAL HEALTH SERVICE DELIVERY

3.OVERALL COORDINATION OF SPA-COUNTY IMPLEMENTATION

BREAK OUT SESSIONS

FOCUSED FEEDBACK…

1.NOT ON WHOLE PLAN

2.NOT CONSENSUS BUILDING

3.NOT ACTION PLANNING

BREAK OUT SESSIONS

STRUCTURE AND SUPPORT…

BREAK OUT SESSIONS BY SPAs & CLUSTER BY OFFICE

ONE FACILITATOR & TWO (OR MORE) PLAN ‘EXPERTS’ AS RESOURCES

RECORDED SESSION

BREAK OUT SESSIONS

1. SPA 1—CLUB A: Second Floor

2. SPA 2—ALUMNI A: Second Floor

3. SPA 3—BOARD ROOM: Second Floor

4. SPA 4—CARDINAL & GOLD ROOM: Second Floor

5. SPA 5—CLUB B: Second Floor

6. SPA 6—FIGUEROA ROOM: Second Floor

7. SPA 7—ALUMNI B: Second Floor

8. SPA 8—CALIFORNIA ROOM: Mezzanine Level

PRESENTATIONS

NON-PILOT SPAs

PILOT SPAs

INTEGRATION

CONVERGENCES?

DIVERGENCES?

CLOSING