Treatment Foster Care:

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Treatment Foster Care:

  1. 1. KDMHMRS FY 2008 Child Objectives CHILDRENS SERVICES OBJECTIVES AND INSTRUCTIONS Note: These guidelines are offered to assist you in completing both the Plan and Budget application and the reporting requirements throughout the year. Please share them with appropriate staff. Centers are required to report all client related services in the client and event data sets. The following information is provided to assist with the data set reporting and also to detail the specific information to be reported manually for those services that cannot be coded in the data set. As indicated on the Notice of Available Regional Funding (NARF), you are allowed to spread restricted mental health funds to a number of projects serving children with severe emotional disabilities (SED) and those without SED. Please complete the Spending Plan (Form 117) and the Child System of Care Application if changed from SFY 2007 (Form 118). Forms 117 and 118 are to be submitted with the Plan and Budget application. The Financial Implementation Report (Form 112) must be submitted on a semi-annual basis for all restricted SED funds allocated. The Implementation Report (Form 113C) must be submitted on a semi-annual basis for those projects that cannot be entered in the Event Data Set. If your Regional Board (2, 3, 4, 14, 15) operates a Therapeutic Foster Care Program, you must complete Form 113C addressing the Objectives for TFC as delineated below. Additionally, if your Board offers Youth Transition to Adulthood services, you also must complete Form 113C addressing the Objectives below. Several services also require additional reports as specified below. These include: Early Childhood MH Specialist; KEYS; and IMPACT. EARLY CHILDHOOD SPECIALIST (All Regions) Please complete and submit with the Plan and Budget application, a Project Budget and Financial Report (Form 101) and a Program Narrative (Form 114). The Program Narrative should describe the growth of the program over the past fiscal year, including the number of unduplicated children served, the number of other Regional Board staff serving the birth to five population, names of trainings attended by the Specialist, etc. The ECMH Specialist also shall complete the required data form to the DPH on a monthly basis. The Financial Implementation Report (Form 112) must be submitted on a semi- annual basis for this project. These funds are allocated on a performance basis for the achievement of the following indicators:  Option A: A full-time Early Childhood Mental Health (ECMH) Specialist whose time is completely devoted to this project shall be employed throughout the contract year. Up to two months vacancy credit can be covered, provided that the Center immediately informs DMHSA of the vacancy and proceeds immediately to fill it.  Option B: regional proposals to support an additional staff position with ECMH funds will be accepted for review. While funds for this program are not being increased, alternative staffing plans will be considered. Each region may propose a new Page 1 of 9
  2. 2. KDMHMRS FY 2008 Child Objectives staffing plan for its ECMH program as part of the plan and budget. No more than two staff positions may be funded with ECMH funds. Applications will be reviewed by the ECMH administrators from the Departments for Public Health (DPH) and Mental Health and Mental Retardation Services (DMHMRS). Regions are free to propose any combination of division of job responsibilities (e.g., one part time position doing direct service and another doing outreach and training; two part positions sharing all responsibilities, etc.). Please include a detailed description of how the staff persons will work together to ensure program continuity and consistency. It is essential to program sustainability that the integrity of the program is not compromised. If a center chooses to apply for Option B, please include the above information in the Program Narrative (Form 114). 1 Each regional ECMH program, under the coordination of the Specialist, shall provide these direct services within its resource limits: •Assess children age birth to five for mental health service needs at the location most suitable for the child and family; •When indicated, provide or arrange for the delivery of direct clinical services (i.e. individual, family, and/or collateral therapy) within scope of practice of the provider to children age birth to five with mental health needs and their families at the location most suitable for the child and family. Specialists are not to devote more than .5 FTE to direct services; •Provide consultation and education at no cost to early care and education program staff who serve children age birth to five; •Assist families with children age birth to five in identifying and accessing needed community resources; and •Provide information and serve as a resource to private physicians and other medical care providers through raising awareness of available services and resources for children age birth to five and their families. c Each regional ECMH program, under the coordination of the Specialist, shall provide these collaborative and program development services within its resource limits: •Collaborate with local Healthy Start in Child Care Consultants, and other agencies or programs that serve children birth to five and their families, to provide mental health consultation, assessment, referral and clinical, services on behalf of children age birth to five identified by those programs as needing mental health services; •Offer early childhood mental health training to fellow Regional Board staff, as well as other community partners who serve young children; •Foster community planning for early childhood mental health through local groups and the Community Early Childhood Councils in the area; and •Attend training related to early childhood development and early childhood mental health needs. h Each regional ECMH program, under the coordination of the Specialist, shall meet these administrative responsibilities for the statewide program: •Attend periodic regional consultation and supervision sessions conducted by the statewide early childhood mental health consultant; •Prepare and submit periodic service reports and evaluation data; and Page 2 of 9
  3. 3. KDMHMRS FY 2008 Child Objectives •Attend quarterly state level meetings of all ECMH Specialists. A Each regional ECMH program, under the coordination of the Specialist shall participate in program evaluation: Each Specialist will be responsible for gathering, maintaining, and tracking data related to the implementation of the ECMH Initiative in their respective region and reporting monthly to the Department for Public Health as well as participating in the evaluation system coordinated through the Center for Alcohol and Drug Research. Boards are to notify Beth Armstrong of any Specialist vacancies within one week of their occurrence for the duration of this project. If vacancies do occur, Boards are to notify Beth immediately when the position is refilled. Information to be sent to Beth includes name, address, phone number, fax, email address, projected start date, degree and years of experience working with children and families. Beth can be reached at 502-564-4456 or Beth.Armstrong@ky.gov. Funds will be distributed in equal monthly payments. Non-Performance: Failure to meet performance indicators as outlined above may result in the suspension of payments. Suspensions may be imposed as a result of: •Failure to submit and obtain approval of a financial plan for the fiscal year; •Failure to conduct program operations in accordance with an approved financial plan; •Persistent failure by a Specialist to adequately perform the job duties and responsibilities as outlined above; •Failure to notify the DMHSA contact person within the specified timeframe when Specialist vacancies occur; and •A Specialist devoting more than .5 FTE of their time to direct clinical services. Decisions regarding the imposition or lifting of a payment suspension will be jointly made by the DPH and the DMHMRS. These same agencies will also determine whether payments subsequently will be made for the period during which the suspension was in effect. IMPACT (All Regions) All regions must submit the Allocation of IMPACT Funds (Form 131) with their Plan and Budget application. The Center and the RIAC must collaborate to determine appropriate allocations for your region. If your region is not set up for electronic signatures, please also forward via U.S. mail a copy of the completed Form 131 signed by the RIAC Chair. Specific instructions related to IMPACT allocations are given below:  Targeted Case Management Allocation: On the Allocation of IMPACT Funds Form (131), provide an estimated amount of IMPACT funds that your RIAC expects to expend for non-Medicaid/uninsured children during the fiscal year. Page 3 of 9
  4. 4. KDMHMRS FY 2008 Child Objectives A sufficient amount of IMPACT funds must be set aside to provide targeted case management to those children who are determined by the RIAC to be most in need of this service, but are not eligible for Medicaid or other insurance coverage. KDMHMRS is no longer negotiating rates for Targeted Case Management (TCM) Services. However, Regional Boards and RIACs may wish to consider assessing a rate for the service as a tool to help determine the amount of funding needed to cover the estimated expense.  IFBSS Allocation: On the Allocation of IMPACT Funds Form (131), provide an estimated amount of IFBSS funds that your RIAC expects to expend for this category during the fiscal year. The Department requires that IFBSS expense reports be submitted detailing expenditures in six specific categories. Expenses should be submitted quarterly on the IFBSS Expense Report (Form 130). The services or items provided should also be coded in the Data Set using codes 21, 22, 23, 24 or 25. For the Outpatient Services category, codes 50, 52 and 54 should be used as appropriate and reported in the Data Set. See the definitions for each code on the IFBSS Quarterly Expense Report (Form 130) and/or in the Data Dictionary. It is expected that regular (at least quarterly) financial information will be provided to the RIAC to aide them in providing oversight of these expenditures. Notation of this should be documented in RIAC meeting summaries. If the RIAC designates this oversight to the LIAC(s), notation should also be documented in RIAC minutes and LIACs should send documentation that the information has been reported to Lori Mefford at DMHMRS, 100 Fair Oaks Lane, 4 E-D, Frankfort, KY 40621, or electronically to Lori.Mefford@ky.gov.  RIAC Parent Representative(s) Support Allocation: On the Allocation of IMPACT Funds Form (131), it is mandated that your RIAC set aside at least $1,500 to support the participation of parent representatives and their alternates on the RIACs. Regions may add additional funds to this allocation category as indicated on Form 131. Be sure to total the amount that your RIAC expects to expend for this category during the fiscal year. Upon the recommendation of the SIAC, the Department is requiring that RIACs set aside a minimum of $1500 per year for the sole purpose of supporting SIAC, RIAC and LIAC parent representatives and their alternates (when the alternate attends a meeting or event in the absence of the representative). These funds are to be used for reimbursement of childcare, lodging, meals, travel, stipends, trainings, attendance at SFAC meetings, etc. SIAC, RIACs and LIACs are also required to provide a $20 stipend for half-day meetings and $40 stipend for full day meetings prior to each meeting that a RIAC/LIAC or SIAC representative attends in their role as a representative. A RIAC may designate more than $1500 for this category. Reimbursements for expenses are to occur in a timely manner. The process for this policy should be in the RIAC’s policy and procedure manual.  RIAC Support Allocation: On the Allocation of IMPACT Funds Form (131), list all personnel, other projects and other program expenses supported by IMPACT restricted funds that your RIAC expects to expend in this category during the fiscal year. Page 4 of 9
  5. 5. KDMHMRS FY 2008 Child Objectives o For personnel, show their job title, the total FTE (full time equivalent; e.g., a full time person equals 1.0 FTE, a half-time person equals .50 FTE, etc.) and the total dollar amount supported by these funds for each FTE. Examples include a Family Liaison or a portion of the Local Resource Coordinator’s (LRC) time. Do not include personnel whose time and costs are properly allocated to the case management cost pool or whose employment (salary and fringe) is otherwise covered by Medicaid/other insurance billings. This includes Service Coordinators and the costs associated with their supervision and support. In most cases, a majority of the cost of the LRC also belongs in the case management cost pool. Typically, the only LRC cost allocated to Program Support is time spent on outreach and on program development that is unrelated to specific IMPACT children. o For other projects, RIACs may allocate IMPACT funds to projects that benefit children with SED. If applicable, list other programs or activities that are supported by IMPACT funds (not all regions make these type of allocations). Details of the expenditures of these funds must be shared with RIACs at least quarterly and notation should be documented in the RIAC meeting summaries. An example of this includes supporting a local children’s camp for children with special needs. o For other expenses, specify items and corresponding allocation amounts. This may include parent support group costs, program supplies, training, travel and facility costs related to RIAC members and personnel of the IMPACT program.  Total IMPACT Allocation: On the Allocation of IMPACT Funds Form (131), please total the amounts from all categories. This is normally the amount allocated for IMPACT in the Notice of Available Regional Funding (sent under separate cover). Please include the total allocated amount for IMPACT on the Spending Plan (Form 117) and complete the Allocation of IMPACT Funds (Form 131). If your region is allocating any additional DMHMRS funds to the core IMPACT services, as outlined above, please include those amounts on the Spending Plan in the appropriate column. Submit these forms with your Plan and Budget application. The Financial Implementation Report (Form 112) must be submitted on a semi-annual basis for this project. Itemized expense categories are listed on Form 112. Additionally, the IFBSS Quarterly Expense Report (Form 130) should be submitted quarterly. Questions about any of the above may be directed to Lori Mefford at 502/564-4456 or by e-mail: Lori.Mefford@ky.gov. THERAPEUTIC FOSTER CARE (Regions 2, 3, 4,14, 15) 1. Number of unduplicated certified foster homes in Center’s program (whether or not they presently have children residing in them). (Submit on Form 113C) Measurement method: Report the unduplicated number of certified foster homes during the reporting period. 2. Number of unduplicated children served by the Center’s treatment foster care program. Page 5 of 9
  6. 6. KDMHMRS FY 2008 Child Objectives Measurement method: Report the unduplicated number of clients served during the reporting period. (Submit using Service Code 27 or manually using Form 113C) YOUTH TRANSITIONING TO ADULTHOOD (Age 16-21) 1. Number of unduplicated clients, ages 16-21, who received Transition assistance services, including case management, vocational/employment services, independent living skills training/psychotherapy. (Submit on Form 113C) Measurement method: Report the unduplicated number of all clients who were served during the reporting period. 2. Number of supported employment services provided to transitioning youth (age 16-21). Please refer to the definition for supported employment as it is stated in the DMHMRS data dictionary and the federal definition below. (Submit on Form 113C) Measurement method: Report separately the unduplicated number of clients who received supported employment services during the reporting period. 3. Number of supported housing services provided to transitioning youth (ages 16-21). Please refer to the definition for supported housing as it is stated in the DMHMRS data dictionary. Measurement method: Report separately the unduplicated number of clients who received supported housing services during the reporting period. Kentuckians Encouraging Youth to Succeed (KEYS – Region 7 only) These funds are allocated on an expense reimbursement basis for the achievement of the following indicators: f Staffing: KEYS staff, as identified in the original application, subsequent reapplications, timeline, and strategic plan shall be hired and employed throughout the length of the cooperative agreement. The KEYS Project Director shall provide current staffing information to the KEYS State Site Director on a monthly basis. KEYS vacancies are to be reported to the KEYS State Site Director immediately in writing. The KEYS Project Director will also report staffing updates in the required Center for Mental Health Services (CMHS) semi-annual reports. Any changes to the staffing plan described in the initial grant application and subsequent reapplications will be determined by the Leadership Team submitted to the CMHS Project Officer and Grants Management Specialist for approval. s Service Expansion and Enrollment: Local KEYS staff will participate in developing a strategic plan for KEYS. This will include identification of needed service expansion and projected enrollment numbers for services identified in the original application, subsequent reapplications, and the strategic plan. Service expansion will begin in July 1, 2005. The KEYS Project Director will report enrollment numbers in the CMHS semi-annual reports. If projected enrollment numbers are not obtained for three consecutive months, an action plan to address enrollment issues and improve outreach efforts will be developed and implemented by local KEYS staff and the KEYS State Site Director. Any changes to service expansion described in the original application, subsequent reapplications, or the strategic plan will be determined by the Leadership Team and submitted to the CMHS Project Officer and Grants Management Specialist for approval. Page 6 of 9
  7. 7. KDMHMRS FY 2008 Child Objectives C Positive Behavior Interventions and Supports (PBIS): The KEYS Project Director, in collaboration with the KyCID and the Leadership Team will oversee the selection of schools for inclusion in the PBIS component of KEYS. The KEYS Project Director will oversee the implementation of PBIS in selected schools, including tasks outlined in the initial grant application, subsequent reapplications, the project timeline, and the strategic plan. a Engaging Youth and Families at Multiple Levels of the System of Care: Youth and family involvement will include the objectives described in the original grant application, subsequent reapplications, the project timeline, and the strategic plan. Youth and family involvement will be monitored by the NorthKey Regional Parent Coordinator, KEYS Key Family Contact, KY Partnership for Families and Children, and KEYS Project Director on a regular basis, including the use of the Family Involvement Tool. Ongoing technical assistance will be available to KEYS staff in this area. The NorthKey Regional Parent Coordinator will report youth and family training, advocacy, leadership, and peer-to-peer opportunities to the KEYS Project Director for inclusion in the CMHS semi-annual reports. Descriptions of developing and strengthening the youth and family networks will also be reported in the CMHS semi-annual reports. Report will include date and location of opportunities, name of trainer(s), number in attendance, and location. Youth and family involvement on local and state governance and policy-making boards will be described in the CMHS semi-annual reports. The KEYS Evaluation staff will describe youth and family involvement in research and evaluation to the KEYS Project Director for inclusion in the CMHS semi-annual reports. C Care Planning: KEYS staff will maintain responsibility for developing appropriate, individualized plans for the youth and families they serve. Plans will be developed with the families via a team process. The KEYS Project Director, in collaboration with the NorthKey Quality Assurance Manager and the KEYS core team will develop a monitoring instrument for reviewing plans for youth and families enrolled in KEYS. Plans will be monitored on a regular basis, with ongoing technical assistance and practice refinement opportunities available to assist with compliance. a Training and Technical Assistance: Training and technical assistance opportunities as outlined in the original grant application, subsequent re-applications, project timeline, and strategic plan will be provided throughout the life of the grant. Training will be offered to the following participants: KEYS staff; other mental health staff; family members; youth; educators; other child-serving agencies and community support agencies. Additional training and technical assistance needs may be identified, approved by the Leadership Team, and arranged by the KEYS Training Coordinator. Training and technical assistance will be overseen and coordinated by the Training Coordinator in conjunction with the KEYS Project Director, the Leadership Team, the KY Center for Instructional Discipline and the NorthKey training cadre. The KEYS training coordinator will report training and technical assistance events (both given and received) to the KEYS Project Director for inclusion in the CMHS semi-annual reports. t Evaluation and Research: Evaluation and research expectations as outlined in the original grant application, subsequent reapplications, the project timeline, and the strategic plan will be completed by KEYS staff. The KEYS evaluation team and NorthKey quality assurance staff will be responsible for ensuring that data is collected and entered in compliance with CMHS, ORC Macro, and KEYS deadlines; data collectors receive relevant training; and local evaluation studies are identified, conducted, and reported back to Page 7 of 9
  8. 8. KDMHMRS FY 2008 Child Objectives relevant stakeholders. The KEYS Evaluation Coordinator and local consultant will provide evaluation and research updates to the KEYS Evaluation Director and KEYS Project Director for inclusion in the CMHS semi-annual reports. The KEYS Project Director will notify the State Site Director, Beth Armstrong (502-564-7610 or Beth.Armstrong@ky.gov) of any NorthKey-employed KEYS staff vacancies within one week of their occurrence for the duration of this project. The KEYS Project Director will also notify the State Site Director immediately when the position is refilled. Information to be sent to the State Site Director includes name, position title, phone number, fax, email address, and projected start date. Funds will be distributed in equal monthly payments. CMHS does not allow for the billing of indirect costs through this cooperative agreement. Non-Performance: Failure to meet performance indicators as outlined above may result in the suspension of payments. Suspensions may be imposed as a result of: •Failure to implement KEYS objectives as described above and in referenced documents; •Failure to submit and obtain approval of a financial plan for the fiscal year; •Failure to conduct program operations in accordance with an approved financial plan; •Failure to submit required financial and programmatic materials in a timely manner to the State Site Director; •Persistent failure by NorthKey-employed KEYS staff to adequately perform the job duties and responsibilities as outlined in documents referenced above; •Failure to notify the DMHMRS contact person within the specified timeframe when NorthKey- employed KEYS vacancies occur. Decisions regarding the imposition or lifting of a payment suspension will be made by the KEYS implementation team, with the state level core team maintaining final decision making. This group will also determine whether payments will subsequently be made for the period during which the suspension was in effect. A Project Budget and Financial Report Form (Form 101) and a match reporting form must be completed with the Plan and Budget application and quarterly thereafter for inclusion in the CMHS Semiannual Report. The Financial Implementation Report (Form 112) must be submitted on a semi-annual basis for this project as well as all other projects. FEDERAL DEFINITIONS: Treatment Foster Care: Long term residential treatment for children with SED in a trained foster family setting under the general supervision of a clinician. Services may include behavior management and social and family living skills training. Includes IMPACT Plus TFC. Generally each foster home takes one child at a time, and caseloads of supervisors in agencies overseeing the program remain small. In addition, therapeutic foster parents are given a higher stipend than to traditional foster parents, and they receive extensive pre-service training and in- service supervision and support. Frequent contact between case managers or care coordinators and Page 8 of 9
  9. 9. KDMHMRS FY 2008 Child Objectives the treatment family is expected, and additional resources and traditional mental health services may be provided as needed. Multisystemic Therapy (MST) MST views the individual as nestled within a complex network of interconnected systems (family, school, peers). The goal is to facilitate change in this natural environment to promote individual change. The caregiver is viewed as the key to long-term outcomes. Functional Family Therapy (FFT) A phasic program where each step builds on one another to enhance protective factors and reduce risk by working with both the youth and their family. The phases are engagement, motivation, assessment, behavior change, and generalization. Integrated Treatment for Co-occurring Disorders: Dual diagnosis treatments combine or integrate mental health and substance abuse interventions at the level of the clinical encounter. Hence, integrated treatment means that the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance abuse interventions in a coordinated fashion. In other words, the caregivers take responsibility for combining the interventions into one coherent package. For the individual with a dual diagnosis, the services appear seamless, with a consistent approach, philosophy, and set of recommendations. The need to negotiate with separate clinical teams, programs, or systems disappears. The goal of dual diagnosis interventions is recovery from two serious illnesses. Supported Employment: Mental Health Supported Employment (SE) is an evidence-based service to promote rehabilitation and return to productive employment for persons with serious mental illness’ rehabilitation and their return to productive employment. SE programs use a team approach for treatment, with employment specialists responsible for carrying out all vocational services from intake through follow-along. Job placements are: community-based (i.e., not sheltered workshops, not onsite at SE or other treatment agency offices), competitive (i.e., jobs are not exclusively reserved for SE clients, but open to public), in normalized settings, and utilize multiple employers. The SE team has a small client to staff ratio. SE contacts occur in the home, at the job site, or in the community. The SE team is assertive in engaging and retaining clients in treatment, especially utilizing face-to-face community visits, rather than phone or mail contacts. The SE team consults/works with family and significant others when appropriate. SE services are frequently coordinated with Vocational Rehabilitation benefits. Page 9 of 9

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