California’s Child Welfare Continuum of Care Reform (CCR) Overview California Department of Social Services January 2016

* Senate Bill 1013 (Chapter 35, Statutes of 2012) Background Legislative mandate*: Reform Group Homes and Foster Family Agencies with robust and diverse stakeholder input Legislative report with recommendations Builds on previous reform efforts: SB 933, RBS Reform Continuum of Care Reform: A comprehensive framework that supports children, youth and families across placement settings (from relatives to congregate care) in achieving permanency. Includes: Increased engagement with children, youth and families Increased capacity for home-based family care Limited use of congregate care Systemic and infrastructure changes: rates, training, accreditation, accountability & performance, mental health services * Senate Bill 1013 (Chapter 35, Statutes of 2012)

Vision All children live with a committed, permanent and nurturing family Individualized and coordinated services and supports Focus on permanent family and preparation for successful adulthood When needed, congregate care is a short-term, high quality, intensive intervention that is just one part of a continuum of care available for children, youth and young adults

Guiding Principles The child, youth and family’s experience is valued in: Assessment Service planning Placement decisions Children shouldn’t change placements to get services Cross system and cross-agency collaboration to improve access to services and outcomes Recognizing the differences in the probation system and among other groups of youth

State/County Implementation Team Proposed CCR Implementation Framework DRAFT State/County Implementation Team CDSS, DHCS, CWDA, CPOC, CBHDA, CSAC County Representatives Stakeholder Implementation Advisory Committee Providers, Youth, Caregivers, Tribes, Advocates, Counties, Legislative Staff and others CCR Implementation Workgroups Therapeutic Residential Services Settings/FFA Program & Licensing Rate Structures Accountability Framework RFA Implementation Training Deliverables Program Instructions Regulations ACLs/CFLs Forms Capacity Building Activities Outreach Activities Communication Materials Training Curricula Mental Health Certification Accountability & Oversight Framework Accreditation Process Application review process Provider Performance measures Consumer Survey Rate Structure New Therapeutic Residential Services Settings & FFA rates and rate structures

Therapeutic Residential Services Settings The “Paradigm Shift” Group Home Therapeutic Residential Services Settings (aka STRTC) Children who cannot be safely placed in a family can receive short-term, residential care with specific care plans and intensive therapeutic interventions and services to support transition to a family.

Foster Families Resource Families Resource Family Relative Caregiver Foster Family Adoptive Family Resource Family Approval: Related and non-related families Training for all families Resource Families still choose the role they play in the system: temporary or permanent Prepared for permanency-no additional approvals necessary RFA Process: Single, unified RFA process will be used for all caregiver families: kin, NREFM, county foster families, FFA foster families Avoids need for adoption home study and second, more in-depth background check; once approved, families can adopt or become kin- guardians

The Goal: Children in Resource Families Children in Congregate Care Permanent Family

Increased Engagement Child & Family Team(CFT) Up-front and continuing assessment along common domains Aligns with the California Child Welfare Core Practice Model (Statewide Practice Model) & Pathways to Wellness (Katie A. settlement)

Building Family Care Capacity Existing efforts to improve and increase the capacity of home-based family care: Quality Parenting Initiative Resource Family Approval Process Approved Relative Caregiver (ARC) Funding Option Program (2014: $30 million investment) Tribally-approved homes/Tribal access to background information

Increasing Capacity for Home-Based Family Care Resource family approval by counties, Foster Family Agencies (FFAs) and Therapeutic Residential Services Settings Funding for support, retention, recruitment and training of resource families & relatives Foster Family Agencies provide Core Services: Trauma Informed Culturally relevant Accreditation through COA, CARF & JCAHO May provide core services to children in county approved families and relatives Updated and expanded training requirements across provider and caregiver categories

Limited Use of Congregate Care Transition County Shelter  Temporary Shelter Care Facility Group Home  Therapeutic Residential Services Settings that provide Core Services: Trauma Informed Culturally relevant Capacity to transition to children to family care by approving resource families

Meeting the needs of Probation Youth: Collaboration and coordination will be necessary in order for CCR to be successful for Probation Youth. Identify the training and supports families need to parent probation youth in FFAs and for Therapeutic Residential Services Settings to develop programs targeted at probation youth. Programs developed and/or maintained for probation youth who are in need of substance use disorder treatment, sex offender treatment and behavior modification programming. After-care services as a central component to ensuring a youth’s successful and sustaining transition back into his/her family home.

Meeting the needs of Probation Youth: Extensions for Probation Youth are linked to the progress tied to specific benchmarks. In the year ahead the CDSS will be: Engaging FFAs and other community based organizations to develop strategies to recruit and support specialized foster homes. Defining outcome measures to be collected and analyzed to assess implementation of CCR and the impact on Probation. Working with Providers, Courts and County Probation Departments to develop capacity for home-based family care. Working with Therapeutic Residential Services Settings to address treatment needs of specific Probation populations.

Core Services FFAs and Therapeutic Residential Services Settings make available core services either directly or through formal agreements: Access to specialty mental health services Transitional support services for placement changes, permanency; aftercare Education, physical, behavioral and mental health supports Activities to support youth achieving a successful adulthood Services to achieve permanency & maintain/establish family connections Active efforts for ICWA-Eligible children

Oversight, Accountability & Provider Performance Measures National Accreditation Cross Departmental Oversight Framework Evaluate provider performance along common domains Youth, caregiver and stakeholder satisfaction surveys Public transparency of provider performance

Accreditation: FFAs and Therapeutic Residential Services Settings Accreditation will be accepted from: Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Commission on Accreditation of Rehabilitation Facilities (CARF) Accreditation through Council on Accreditation (COA) CDSS is engaging with agencies and will continue to address specific needs of the State, Counties, and Providers regarding accreditation and CCR requirements.

New Provider Rate Structure Sunset RCL system (1-14) *A single Therapeutic Residential Services Settings rate (IV-E) *A tiered resource family care rate structure based on level of need for the resource family and resource family agency *Therapeutic Residential Services Settings rate will not be blended with Title XIX (rates for mental health services is status quo) *Therapeutic Foster Care Rate (Katie A) Multi-year implementation: New requirements take effect 1/1/2017 Provisions for extensions up to two years Additional extensions for providers and longer for those serving probation youth Therapeutic Residential Services Settings and FFA may be public or private. Design a new program audit that aligns with required program and treatment competencies and accreditation standards; coordinates program, fiscal, and health & safety reviews (DHCS, CCLD, CDSS).

The Work Ahead… 1-1-17 Will take “a village”! CCR Report AB 403 Preparation Policies Rates Outreach Orientations Tools Training Accountability Recruitment Performance measures Pre-Implementation Applications Reviews Licenses Mental Health Certification Data testing Training & TA Will take “a village”! CDSS will be collaborating with a wide array of stakeholders in the implementation work Implementation: Children & families served differently! Extensions Data collection Monitoring Technical Assistance Policy Revision

Provider Licensing CDSS Community Care Licensing (CCL) will review applications for group homes transitioning to “STRTCs”. Applications for licensing will include the Plan Of Operation/Program Statements and licensing forms that need to be updated. Provisional licensure may be issued in order to secure accreditation. Providers will submit an application with revisions of the updated Plan Of Operation/Program Statement to their local CCL Regional Office.

Questions and Contact Info Questions can be sent to: ccr@dss.ca.gov Additional information on the CDSS website at: http://www.cdss.ca.gov/cdssweb/default.htm