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  A Community-Based Approach to Redesigning a Placement Continuum of Care A private, community-based lead agency model integrating clinical and permanency best practices to dramatically “right size” a child welfare system.
Presenters Gregory J. Kurth Chief Executive Officer         Family Services of Metro Orlando Elizabeth Lewis, RN, B.Ed. Chief Operating Officer        Family Services of Metro Orlando
What Is Community-Based Care (CBC)? 	Lead agency oversees a fully array of child protective services within a community network of partners.
19 Community Based Care Lead Agencies
Service Areas FSMO is one of the largest CBC lead agencies in the state of Florida, managing formal child welfare services for over 2,800 children
CMO Partner Agencies
In 2004 FSMO Inherited Over 3,600 kids in protective services (in and out of home) “Cookie cutter” case plans High removal rate No Utilization Management No Permanency review process Limited foster home capacity
2004 - A Closer Look Funding of Licensed Care: $48,000 per day/$17.5 million per year Over-utilization of residential placements; no Mental Health Integration Disrupted placements 3 times that of entries into the system No focus on Older or SED Children for permanency
2004 - A Closer Look Little knowledge of community resources DJJ/DCF/SAMH: agencies operating in silos Negative perception of biological families  Lack of gate keeping/utilization management
Children Placed Outside of Osceola County
Children Placed Outside of Orange County
In 2004 Over 400 Children in High End Placements
An Example of the # of Admissions and Discharges Compared to Child Movements
Where We Are Today Funding of Out of Home Care Licensed Care: $32,100 per day/$11.7 million per year  $5.8 million savings annually 2700 kids in protective care with 780 kids in paid care  Responds to 15,000 calls annually and services to 8,000 children and families
How FSMO Made a Difference Community Involvement Safety Focus Engagement Based Practice    Prescription  System Integration Relentless Management and Quality Improvement
Community Involvement ,[object Object]
DJJ Liaison
DD/CMS Specialist,[object Object]
DJJ Kids Diverted 2004 – 1 2005 – 22 2006 – 29 2007 – 41 2008 – 45 (January – June) Total - 139
83 DJJ Kids Diverted 2007-2008 Savings of $14,424/day
Developmentally Delayed Children   	FSMO hired DD/CMS Specialist in 11/07 	9 children diverted from the system.  	Saving over $200,000.00 annualized.   	These kids are: Difficult to place Have very specialized needs Expensive to treat
Safety Focus Differentiating Risk from Safety Child Endangerment Risk Assessment Protocol (CESAP)
Why Implement Change? Many Children are Entering Care Unnecessarily; Some child/abuse victims may be remaining home who should be placed; In-Home families are not receiving effective child protective services; The System has not clarified the difference b/w Risk and Safety Workers lack prescriptive guidelines
Focus on Front-End 4.2% 25.6% 4.2% 36.5% 4.0 5.3 8.2% 31.6% 20.3% 8.2% 7.0 26.4% 8.9% 29.4% 8.9% Abuse Reports (% of Child Population) Substantiations (% of Reports) Nation State Orange/Osceola Removals (% of Substantiations) Removals (per 1,000 of Child Population)
Safety Risk versus Potential Harm
CESAP Requirements A ‘life of the case’ protocol. Assessing moderate to severe harm immediately or in the near future. Safety Determination Form. Safety Plan.
Engagement Based Practices Placement stabilization Families participate in staffings and case development Specialized Adoption Recruitment: Wendy’s Wonderful Kids / Heart Gallery of Metro Orlando Family Team Conferencing Community providers invited to staffings
Placement Stabilization Case managers take ownership Know and support foster families (e.g. foster parent liaison) 1st sign of trouble -- initiate supports “Push down” accountability Work with schools to save placement Explore extra curricular activities
[object Object]
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,[object Object]
May 2004 - A Look at the Permanency Options Biological family rarely considered Children under 12  and siblings growing up in group care Step downs rejected due to increased work on case worker Fear of making the wrong decision lead to inappropriate child labeling
Permanency Strength/Need Approach Moving From:  ,[object Object]
Focus on deficits of parents
Plugging families into existing services
Expert model
Identifying needs and funding sourcesMoving To: ,[object Object]
Focus on needs of the children
Crafting, individualizing and tailoring services around specific needs
Collaborative model
Connecting families to services regardless of funding sources,[object Object]
Placement Matrix
Using CANS Criteria How it was used: Match child’s characteristics to program Profiling provider based on the residential CANS survey Created placement algorithms  Number 1 Benefit: Placement stabilization
Cost per Client per Day of Residential Services
Number of Residential Clients Served
Beyond Traditional Foster Care  Services Cost per Day
#1 Key to Our Success   Utilization Management Utilization Management Program Expert Review & implement recommendations Focus on early & appropriate treatment Decrease multiple placements  Focus on safety, permanency & well being
System Integration Medicaid managed care - Magellan Utilize all appropriate funding streams Utilize IV-E Waiver Embedding UM in permanency
Child Welfare and Mental Health Needs of Children Annually, 600,000 children seen in the U.S. child welfare system do not receive mental health care to meet their needs. 48% of these children have clinically significant mental health needs. Journal of American Academy of Child and Adolescent Psychiatry, August 2004
Mental Health Issues Children lose funding in RTC and come into care  Families need services – children come into care Adoptive families return children due to lack of services We paid for four kids at $406.00/day until Medicaid funding began $406.00 for 30 days is $12,188.00/child
May 2004 - An Overview of Treatment in High End Facilities & Therapeutic Foster Homes 25 Children Reviewed in staffings ,[object Object]
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,[object Object]
Used medications to control behaviors

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A community based approach to redesigning a placement continuum of care

  • 1. A Community-Based Approach to Redesigning a Placement Continuum of Care A private, community-based lead agency model integrating clinical and permanency best practices to dramatically “right size” a child welfare system.
  • 2. Presenters Gregory J. Kurth Chief Executive Officer Family Services of Metro Orlando Elizabeth Lewis, RN, B.Ed. Chief Operating Officer Family Services of Metro Orlando
  • 3. What Is Community-Based Care (CBC)? Lead agency oversees a fully array of child protective services within a community network of partners.
  • 4. 19 Community Based Care Lead Agencies
  • 5. Service Areas FSMO is one of the largest CBC lead agencies in the state of Florida, managing formal child welfare services for over 2,800 children
  • 6.
  • 8. In 2004 FSMO Inherited Over 3,600 kids in protective services (in and out of home) “Cookie cutter” case plans High removal rate No Utilization Management No Permanency review process Limited foster home capacity
  • 9. 2004 - A Closer Look Funding of Licensed Care: $48,000 per day/$17.5 million per year Over-utilization of residential placements; no Mental Health Integration Disrupted placements 3 times that of entries into the system No focus on Older or SED Children for permanency
  • 10. 2004 - A Closer Look Little knowledge of community resources DJJ/DCF/SAMH: agencies operating in silos Negative perception of biological families Lack of gate keeping/utilization management
  • 11. Children Placed Outside of Osceola County
  • 12. Children Placed Outside of Orange County
  • 13. In 2004 Over 400 Children in High End Placements
  • 14. An Example of the # of Admissions and Discharges Compared to Child Movements
  • 15. Where We Are Today Funding of Out of Home Care Licensed Care: $32,100 per day/$11.7 million per year $5.8 million savings annually 2700 kids in protective care with 780 kids in paid care Responds to 15,000 calls annually and services to 8,000 children and families
  • 16. How FSMO Made a Difference Community Involvement Safety Focus Engagement Based Practice Prescription System Integration Relentless Management and Quality Improvement
  • 17.
  • 19.
  • 20. DJJ Kids Diverted 2004 – 1 2005 – 22 2006 – 29 2007 – 41 2008 – 45 (January – June) Total - 139
  • 21. 83 DJJ Kids Diverted 2007-2008 Savings of $14,424/day
  • 22. Developmentally Delayed Children FSMO hired DD/CMS Specialist in 11/07 9 children diverted from the system. Saving over $200,000.00 annualized. These kids are: Difficult to place Have very specialized needs Expensive to treat
  • 23. Safety Focus Differentiating Risk from Safety Child Endangerment Risk Assessment Protocol (CESAP)
  • 24. Why Implement Change? Many Children are Entering Care Unnecessarily; Some child/abuse victims may be remaining home who should be placed; In-Home families are not receiving effective child protective services; The System has not clarified the difference b/w Risk and Safety Workers lack prescriptive guidelines
  • 25. Focus on Front-End 4.2% 25.6% 4.2% 36.5% 4.0 5.3 8.2% 31.6% 20.3% 8.2% 7.0 26.4% 8.9% 29.4% 8.9% Abuse Reports (% of Child Population) Substantiations (% of Reports) Nation State Orange/Osceola Removals (% of Substantiations) Removals (per 1,000 of Child Population)
  • 26. Safety Risk versus Potential Harm
  • 27. CESAP Requirements A ‘life of the case’ protocol. Assessing moderate to severe harm immediately or in the near future. Safety Determination Form. Safety Plan.
  • 28. Engagement Based Practices Placement stabilization Families participate in staffings and case development Specialized Adoption Recruitment: Wendy’s Wonderful Kids / Heart Gallery of Metro Orlando Family Team Conferencing Community providers invited to staffings
  • 29. Placement Stabilization Case managers take ownership Know and support foster families (e.g. foster parent liaison) 1st sign of trouble -- initiate supports “Push down” accountability Work with schools to save placement Explore extra curricular activities
  • 30.
  • 31. Highlights 80 children in Orange and Osceola counties currently available for adoption
  • 32.
  • 33. May 2004 - A Look at the Permanency Options Biological family rarely considered Children under 12 and siblings growing up in group care Step downs rejected due to increased work on case worker Fear of making the wrong decision lead to inappropriate child labeling
  • 34.
  • 35. Focus on deficits of parents
  • 36. Plugging families into existing services
  • 38.
  • 39. Focus on needs of the children
  • 40. Crafting, individualizing and tailoring services around specific needs
  • 42.
  • 44. Using CANS Criteria How it was used: Match child’s characteristics to program Profiling provider based on the residential CANS survey Created placement algorithms Number 1 Benefit: Placement stabilization
  • 45.
  • 46. Cost per Client per Day of Residential Services
  • 47. Number of Residential Clients Served
  • 48. Beyond Traditional Foster Care Services Cost per Day
  • 49. #1 Key to Our Success Utilization Management Utilization Management Program Expert Review & implement recommendations Focus on early & appropriate treatment Decrease multiple placements Focus on safety, permanency & well being
  • 50. System Integration Medicaid managed care - Magellan Utilize all appropriate funding streams Utilize IV-E Waiver Embedding UM in permanency
  • 51. Child Welfare and Mental Health Needs of Children Annually, 600,000 children seen in the U.S. child welfare system do not receive mental health care to meet their needs. 48% of these children have clinically significant mental health needs. Journal of American Academy of Child and Adolescent Psychiatry, August 2004
  • 52. Mental Health Issues Children lose funding in RTC and come into care Families need services – children come into care Adoptive families return children due to lack of services We paid for four kids at $406.00/day until Medicaid funding began $406.00 for 30 days is $12,188.00/child
  • 53.
  • 54. All had psychologicals and assessments
  • 55. All had multiple psychiatric diagnoses
  • 56. 22 were on psychotropic medications
  • 57. 15 were taking 3 or more medications
  • 58. Negative view of biological families
  • 59.
  • 60. Used medications to control behaviors
  • 62. Could take weeks before court approval
  • 63.
  • 64. Beginning of purchase of service utilization
  • 65. Authorizations required for high end services
  • 67. Full risk for RTC placements
  • 68.
  • 69.
  • 70. Training for all Front-Line Staff
  • 71. Quality Service Reviews and Team Performance Calls
  • 72.
  • 73. Scope of Training Pre-service training Field training In-service training Supervisory training Targeted trainings driven by quality improvement initiatives
  • 74. Transition of Training Program Train protective investigations and case management together to build collaborative relationships Build in mentor and modeling approach to training Moving from global skills development to specialization
  • 75.
  • 79.
  • 80.
  • 83. Increase # of foster homes
  • 85. Fewer children placed in foster homes
  • 86. Kids moving through the system
  • 87. Decreased kids in the system
  • 89. Decreased # of group homes
  • 90. Decreased high end placements
  • 91.
  • 92. Interesting Note The state of Florida operates the child welfare system at 70% of the national median of per capita funding.
  • 93.
  • 94. Out of Home Care “Bottoming”
  • 96. Adequate services for DJJ & DD kids
  • 98.
  • 99. New Initiatives Program Advisory Committee (Health, Education, Community Resources) Faith Based Initiatives Web-Based Development – Greater Network Interactivity (e.g. Blogging) Educational Liaisons
  • 100. Contact Presenters Gregory J. Kurth, MA Chief Executive Officer gkurth@fsmetroorlando.org Elizabeth Lewis, RN, B.Ed. Chief Operating Officer blewis@fsmetroorlando.org Family Services of Metro Orlando 407-398-7975