A Community-Based Approach to Redesigning a Placement Continuum of Care<br />A private, community-based lead agency mode...
Presenters<br />Gregory J. Kurth<br />Chief Executive Officer <br />       Family Services of Metro Orlando<br />Elizabeth...
What Is Community-Based Care (CBC)?<br />	Lead agency oversees a fully array of child protective services within a communi...
19 Community Based Care Lead Agencies<br />
Service Areas<br />FSMO is one of the largest CBC lead agencies in the state of Florida, managing formal child welfare ser...
CMO Partner Agencies<br />
In 2004 FSMO Inherited<br />Over 3,600 kids in protective services (in and out of home)<br />“Cookie cutter” case plans<br...
2004 - A Closer Look<br />Funding of Licensed Care: $48,000 per day/$17.5 million per year<br />Over-utilization of reside...
2004 - A Closer Look<br />Little knowledge of community resources<br />DJJ/DCF/SAMH: agencies operating in silos<br />Nega...
Children Placed Outside of Osceola County<br />
Children Placed Outside of Orange County<br />
In 2004 Over 400 Children in High End Placements<br />
An Example of the # of Admissions and Discharges Compared to Child Movements<br />
Where We Are Today<br />Funding of Out of Home Care Licensed Care: $32,100 per day/$11.7 million per year <br />$5.8 milli...
How FSMO Made a Difference<br />Community Involvement<br />Safety Focus<br />Engagement Based Practice   <br />Prescriptio...
Community Involvement<br /><ul><li>Resource Specialists co-location
DJJ Liaison
DD/CMS Specialist</li></li></ul><li>The Resource Specialist<br />Functions<br /> as a ‘resource’ for placement stabilizati...
DJJ Kids Diverted<br />2004 – 1<br />2005 – 22<br />2006 – 29<br />2007 – 41<br />2008 – 45<br />(January – June)<br />Tot...
83 DJJ Kids Diverted 2007-2008 Savings of $14,424/day<br />
Developmentally Delayed Children<br />  	FSMO hired DD/CMS Specialist in 11/07<br />	9 children diverted from the system. ...
Safety Focus<br />Differentiating Risk from Safety<br />Child Endangerment Risk Assessment Protocol (CESAP)<br />
Why Implement Change?<br />Many Children are Entering Care Unnecessarily;<br />Some child/abuse victims may be remaining h...
Focus on Front-End<br />4.2%<br />25.6%<br />4.2%<br />36.5%<br />4.0<br />5.3<br />8.2%<br />31.6%<br />20.3%<br />8.2%<b...
Safety<br />Risk<br />versus<br />Potential Harm <br />
CESAP Requirements<br />A ‘life of the case’ protocol.<br />Assessing moderate to severe harm immediately or in the near f...
Engagement Based Practices<br />Placement stabilization<br />Families participate in staffings and case development<br />S...
Placement Stabilization<br />Case managers take ownership<br />Know and support foster families (e.g. foster parent liaiso...
<ul><li>Innovative gallery-style photo exhibit that rotates throughout the community
Highlights 80 children in Orange and Osceola counties currently available for adoption
The Heart Gallery is a unique way to engage Central Florida in the child welfare system</li></li></ul><li>Prescription<br ...
May 2004 - A Look at the Permanency Options<br />Biological family rarely considered<br />Children under 12  and siblings ...
Permanency Strength/Need Approach<br />Moving From: <br /><ul><li>Seeing families as the problem
Focus on deficits of parents
Plugging families into existing services
Expert model
Identifying needs and funding sources</li></ul>Moving To:<br /><ul><li>Seeing families as allies
Focus on needs of the children
Crafting, individualizing and tailoring services around specific needs
Collaborative model
Connecting families to services regardless of funding sources</li></li></ul><li>90 Day Reviews<br />All cases reviewed by ...
Placement Matrix<br />
Using CANS Criteria<br />How it was used:<br />Match child’s characteristics to program<br />Profiling provider based on t...
Cost per Client per Day of Residential Services<br />
Number of Residential Clients Served<br />
Beyond Traditional Foster Care  Services Cost per Day<br />
#1 Key to Our Success   Utilization Management<br />Utilization Management Program<br />Expert Review & implement recommen...
System Integration<br />Medicaid managed care - Magellan<br />Utilize all appropriate funding streams<br />Utilize IV-E Wa...
Child Welfare and Mental Health Needs of Children<br />Annually, 600,000 children seen in the U.S. child welfare system do...
Mental Health Issues<br />Children lose funding in RTC and come into care <br />Families need services – children come int...
May 2004 - An Overview of Treatment in High End Facilities & Therapeutic Foster Homes<br />25 Children Reviewed in staffin...
All had psychologicals and assessments
All had multiple psychiatric diagnoses
22 were on psychotropic medications
15 were taking 3 or more medications
Negative view of biological families
Delay in school enrollment</li></li></ul><li>May 2004 - A View of Medication Management<br /><ul><li>Lacking continuity of...
Used medications to control behaviors
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A community based approach to redesigning a placement continuum of care

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Presentated at the Alliance for Children and Families conference in October, 2008. The presentation focused on a comprehensive framework on buiding a child welfare network.

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A community based approach to redesigning a placement continuum of care

  1. 1. A Community-Based Approach to Redesigning a Placement Continuum of Care<br />A private, community-based lead agency model integrating clinical and permanency best practices to dramatically “right size” a child welfare system.<br />
  2. 2. Presenters<br />Gregory J. Kurth<br />Chief Executive Officer <br /> Family Services of Metro Orlando<br />Elizabeth Lewis, RN, B.Ed.<br />Chief Operating Officer<br /> Family Services of Metro Orlando<br />
  3. 3. What Is Community-Based Care (CBC)?<br /> Lead agency oversees a fully array of child protective services within a community network of partners. <br />
  4. 4. 19 Community Based Care Lead Agencies<br />
  5. 5. Service Areas<br />FSMO is one of the largest CBC lead agencies in the state of Florida, managing formal child welfare services for over 2,800 children<br />
  6. 6.
  7. 7. CMO Partner Agencies<br />
  8. 8. In 2004 FSMO Inherited<br />Over 3,600 kids in protective services (in and out of home)<br />“Cookie cutter” case plans<br />High removal rate<br />No Utilization Management<br />No Permanency review process<br />Limited foster home capacity<br />
  9. 9. 2004 - A Closer Look<br />Funding of Licensed Care: $48,000 per day/$17.5 million per year<br />Over-utilization of residential placements; no Mental Health Integration<br />Disrupted placements 3 times that of entries into the system<br />No focus on Older or SED Children for permanency<br />
  10. 10. 2004 - A Closer Look<br />Little knowledge of community resources<br />DJJ/DCF/SAMH: agencies operating in silos<br />Negative perception of biological families <br />Lack of gate keeping/utilization management<br />
  11. 11. Children Placed Outside of Osceola County<br />
  12. 12. Children Placed Outside of Orange County<br />
  13. 13. In 2004 Over 400 Children in High End Placements<br />
  14. 14. An Example of the # of Admissions and Discharges Compared to Child Movements<br />
  15. 15. Where We Are Today<br />Funding of Out of Home Care Licensed Care: $32,100 per day/$11.7 million per year <br />$5.8 million savings annually<br />2700 kids in protective care with 780 kids in paid care <br />Responds to 15,000 calls annually and services to 8,000 children and families <br />
  16. 16. How FSMO Made a Difference<br />Community Involvement<br />Safety Focus<br />Engagement Based Practice <br />Prescription <br />System Integration<br />Relentless Management and Quality Improvement<br />
  17. 17. Community Involvement<br /><ul><li>Resource Specialists co-location
  18. 18. DJJ Liaison
  19. 19. DD/CMS Specialist</li></li></ul><li>The Resource Specialist<br />Functions<br /> as a ‘resource’ for placement stabilization via consultation.<br />Works closely with the CPI on diverting children from coming into care.<br />Consults with the CPI in the development of a safety plan.<br />Assists in generating referrals for CBA services.<br />Assists the CPI in the assessment of safety vs. risk.<br />Conducts and maintains a ‘mapping’ of the community’s ‘traditional’ and ‘non-traditional resources.<br />Assists the CPI in the diligent search for relative placements.<br />
  20. 20. DJJ Kids Diverted<br />2004 – 1<br />2005 – 22<br />2006 – 29<br />2007 – 41<br />2008 – 45<br />(January – June)<br />Total - 139<br />
  21. 21. 83 DJJ Kids Diverted 2007-2008 Savings of $14,424/day<br />
  22. 22. Developmentally Delayed Children<br /> FSMO hired DD/CMS Specialist in 11/07<br /> 9 children diverted from the system. <br /> Saving over $200,000.00 annualized. <br /> These kids are:<br />Difficult to place<br />Have very specialized needs<br />Expensive to treat<br />
  23. 23. Safety Focus<br />Differentiating Risk from Safety<br />Child Endangerment Risk Assessment Protocol (CESAP)<br />
  24. 24. Why Implement Change?<br />Many Children are Entering Care Unnecessarily;<br />Some child/abuse victims may be remaining home who should be placed;<br />In-Home families are not receiving effective child protective services;<br />The System has not clarified the difference b/w Risk and Safety<br />Workers lack prescriptive guidelines<br />
  25. 25. Focus on Front-End<br />4.2%<br />25.6%<br />4.2%<br />36.5%<br />4.0<br />5.3<br />8.2%<br />31.6%<br />20.3%<br />8.2%<br />7.0<br />26.4%<br />8.9%<br />29.4%<br />8.9%<br />Abuse Reports (% of Child Population)<br />Substantiations (% of Reports)<br />Nation<br />State<br />Orange/Osceola<br />Removals (% of Substantiations)<br />Removals (per 1,000 of Child Population)<br />
  26. 26. Safety<br />Risk<br />versus<br />Potential Harm <br />
  27. 27. CESAP Requirements<br />A ‘life of the case’ protocol.<br />Assessing moderate to severe harm immediately or in the near future.<br />Safety Determination Form.<br />Safety Plan.<br />
  28. 28. Engagement Based Practices<br />Placement stabilization<br />Families participate in staffings and case development<br />Specialized Adoption Recruitment: Wendy’s Wonderful Kids / Heart Gallery of Metro Orlando<br />Family Team Conferencing<br />Community providers invited to staffings<br />
  29. 29. Placement Stabilization<br />Case managers take ownership<br />Know and support foster families (e.g. foster parent liaison)<br />1st sign of trouble -- initiate supports<br />“Push down” accountability<br />Work with schools to save placement<br />Explore extra curricular activities<br />
  30. 30. <ul><li>Innovative gallery-style photo exhibit that rotates throughout the community
  31. 31. Highlights 80 children in Orange and Osceola counties currently available for adoption
  32. 32. The Heart Gallery is a unique way to engage Central Florida in the child welfare system</li></li></ul><li>Prescription<br />Case Plan Conferences / Permanency Case Reviews <br />Utilization Management: Level of Care Committee and Authorization of placements<br />Placement matrix <br />CANS (Child Adolescent Needs and Services) survey of group care<br />
  33. 33. May 2004 - A Look at the Permanency Options<br />Biological family rarely considered<br />Children under 12 and siblings growing up in group care<br />Step downs rejected due to increased work on case worker<br />Fear of making the wrong decision lead to inappropriate child labeling<br />
  34. 34. Permanency Strength/Need Approach<br />Moving From: <br /><ul><li>Seeing families as the problem
  35. 35. Focus on deficits of parents
  36. 36. Plugging families into existing services
  37. 37. Expert model
  38. 38. Identifying needs and funding sources</li></ul>Moving To:<br /><ul><li>Seeing families as allies
  39. 39. Focus on needs of the children
  40. 40. Crafting, individualizing and tailoring services around specific needs
  41. 41. Collaborative model
  42. 42. Connecting families to services regardless of funding sources</li></li></ul><li>90 Day Reviews<br />All cases reviewed by “third party” Child Welfare Specialist<br />Families part of the solution<br />Services authorized at time of need<br />Safety issues addressed immediately<br />Immedate Feedback<br />
  43. 43. Placement Matrix<br />
  44. 44. Using CANS Criteria<br />How it was used:<br />Match child’s characteristics to program<br />Profiling provider based on the residential CANS survey<br />Created placement algorithms <br />Number 1 Benefit:<br />Placement stabilization<br />
  45. 45.
  46. 46. Cost per Client per Day of Residential Services<br />
  47. 47. Number of Residential Clients Served<br />
  48. 48. Beyond Traditional Foster Care Services Cost per Day<br />
  49. 49. #1 Key to Our Success Utilization Management<br />Utilization Management Program<br />Expert Review & implement recommendations<br />Focus on early & appropriate treatment<br />Decrease multiple placements <br />Focus on safety, permanency & well being <br />
  50. 50. System Integration<br />Medicaid managed care - Magellan<br />Utilize all appropriate funding streams<br />Utilize IV-E Waiver<br />Embedding UM in permanency <br />
  51. 51. Child Welfare and Mental Health Needs of Children<br />Annually, 600,000 children seen in the U.S. child welfare system do not receive mental health care to meet their needs.<br />48% of these children have clinically significant mental health needs.<br />Journal of American Academy of Child and Adolescent Psychiatry, August 2004<br />
  52. 52. Mental Health Issues<br />Children lose funding in RTC and come into care <br />Families need services – children come into care<br />Adoptive families return children due to lack of services<br />We paid for four kids at $406.00/day until Medicaid funding began<br />$406.00 for 30 days is $12,188.00/child<br />
  53. 53. May 2004 - An Overview of Treatment in High End Facilities & Therapeutic Foster Homes<br />25 Children Reviewed in staffings<br /><ul><li>11 kids were 12 years old or younger
  54. 54. All had psychologicals and assessments
  55. 55. All had multiple psychiatric diagnoses
  56. 56. 22 were on psychotropic medications
  57. 57. 15 were taking 3 or more medications
  58. 58. Negative view of biological families
  59. 59. Delay in school enrollment</li></li></ul><li>May 2004 - A View of Medication Management<br /><ul><li>Lacking continuity of care
  60. 60. Used medications to control behaviors
  61. 61. Courts changed medication dosage
  62. 62. Could take weeks before court approval
  63. 63. Little parental involvement in decision-making </li></li></ul><li>Pre-Paid Medicaid Plan<br /><ul><li>FSMO is Limited Partner
  64. 64. Beginning of purchase of service utilization
  65. 65. Authorizations required for high end services
  66. 66. RTC funding carved out
  67. 67. Full risk for RTC placements
  68. 68. Today a shared risk model</li></li></ul><li>IV-E Waiver<br />Implemented in October 2006<br />All IV-E (except for Adoption Assistance) can be used for child protection-related activities<br />
  69. 69. Relentless Management and Quality Improvement<br /><ul><li>Provider Meetings and Supervisors Forum
  70. 70. Training for all Front-Line Staff
  71. 71. Quality Service Reviews and Team Performance Calls
  72. 72. Balanced Quality Scorecards</li></li></ul><li>FSMO Training Accomplishments<br />FSMO began training the System of Care January 2006<br />298 Case Managers and Protective Investigators trained since inception<br />Deliver 7-week training cycles 6 times a year<br />94% of all trainees have passed the competency based pre-service training program<br />
  73. 73. Scope of Training<br />Pre-service training<br />Field training <br />In-service training<br />Supervisory training<br />Targeted trainings driven by quality improvement initiatives<br />
  74. 74. Transition of Training Program<br />Train protective investigations and case management together to build collaborative relationships<br />Build in mentor and modeling approach to training<br />Moving from global skills development to specialization<br />
  75. 75. Specialization Trainings<br />Goal is to develop subject matter experts within operational centers<br />Competency based trainings<br />Trainings offered in:<br /><ul><li>Impact of Trauma on Early Development
  76. 76. Domestic Violence
  77. 77. Mental Health
  78. 78. Substance Abuse
  79. 79. Sexual and Physical Abuse</li></li></ul><li>Partnership with IT Vendor to Develop an Internal Database<br />Authorize/track placements<br />DJJ diversion<br />Purchase of services<br />Licensing & inquiries<br />UM, Contracts, Fiscal<br />
  80. 80. FSMO Accomplishments 2004-2007<br /><ul><li>COA Accreditation for Network Standards
  81. 81. Increased adoptions
  82. 82. Increased relative care placements
  83. 83. Increase # of foster homes
  84. 84. Increased prevention activities
  85. 85. Fewer children placed in foster homes
  86. 86. Kids moving through the system
  87. 87. Decreased kids in the system
  88. 88. Decreased disruptions
  89. 89. Decreased # of group homes
  90. 90. Decreased high end placements
  91. 91. Decreased # of psychotropic medications</li></li></ul><li>FSMO Awards<br />2006 Congressional Angel in Adoption <br />2006 Computer World Laureate<br />2007 Davis Productivity<br /> Nomination <br />
  92. 92. Interesting Note<br />The state of Florida<br />operates the child<br />welfare system at <br />70% of the national <br />median of per capita<br />funding. <br />
  93. 93. Challenges Moving Forward<br /><ul><li>Augmenting residential programs
  94. 94. Out of Home Care “Bottoming”
  95. 95. Continuity of medical/behavioral care
  96. 96. Adequate services for DJJ & DD kids
  97. 97. Improving well-being outcomes
  98. 98. Transition from foster care</li></li></ul><li>FSMO Child Population 347,741<br />
  99. 99. New Initiatives<br />Program Advisory Committee (Health, Education, Community Resources)<br />Faith Based Initiatives<br />Web-Based Development – Greater Network Interactivity (e.g. Blogging)<br />Educational Liaisons<br />
  100. 100. Contact Presenters<br />Gregory J. Kurth, MA <br /> Chief Executive Officer<br /> gkurth@fsmetroorlando.org<br />Elizabeth Lewis, RN, B.Ed.<br /> Chief Operating Officer <br /> blewis@fsmetroorlando.org<br />Family Services of Metro Orlando<br /> 407-398-7975<br />

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