1. Recent State Changes in Laws and Finances Impacting Children and Youth: What are they all about?
CMHACY
Thursday, May 18, 2017
Workshop A-5
Scripps

2. What we’re going to cover:
Continuum of Care Reform Implementation
“Out-of-County” Mental Health
Children’s Mental Health Crisis Continuum of Care
Full-Scope Medi-Cal for Undocumented Immigrant Children
Minors Who are Trafficked May No Longer be Arrested and Charged with Prostitution

3. Continuum of Care Reform Implementation

4. What is bigger than CCR?
Continuum of Care Reform: “A comprehensive approach to improving the experience and outcomes of children and youth in foster care.” A once in a generation opportunity to get foster care right. Still have plenty of time to screw it up.
Based on experiences and insights gained from multiple current, ongoing initiatives…

5. CCR: What we hope for

6. Continuum of Care Reform
AB 403 (Stone; 2015)
AB 1997 (Stone; 2016)
AB 404 (Stone; introduced, 2017)

7. CCR creates 2 levels of care
Home-based family care
Kin care
NREFM care
County licensed foster family homes
FFA certified foster homes
Pre-adoptive families
Short-Term Residential Therapeutic Programs
Goal: Home-based family care for all children and youth in foster care; permanent
families for children exiting foster care.

8. To accomplish this… Group homes, as placements, go away
Short Term Residential Therapeutic Programs, as interventions, are created

9. How will STRTPs be different from traditional group care?
“Group home” as place to live, gives way to “short-term residential therapeutic program” as an intervention or means to get somewhere else…back to family and community.
It’s the train, not the station.

10. To accomplish this… Group homes, as placements, go away
Short Term Residential Therapeutic Programs, as interventions, are created
Foster families, pre-adoptive and kin care families with separate and duplicative licensing and certification processes, go away
Resource families are created using a single RFA approval process
Needed individualized Social Services & Support and Behavioral Health Treatment and Therapies are available to all foster children and youth independent of where and with whom they live.

11. Core Services
STRTPs and FFAs are required to provide or provide for Core Services:
Specialty mental health services
Transition services
Education, physical, behavioral, mental health, extracurricular supports
Transition to adulthood services
Permanency support services
Indian Child Services
Transition Services: “support services for children, youth, and families upon initial entry and placement changes and for families who assume permanency through reunification, adoption, or guardianship.”
Education, Physical, Behavioral, Mental Health, Extracurricular Supports, include extracurricular activities and social supports.
Permanency Support Services: “services to achieve permanency, including supporting efforts to reunify or achieve adoption or guardianship and efforts to maintain or establish relationships with parents, siblings, extended family members, tribes, or others important to the child or youth, as appropriate.”

12. Core Services
STRTPs and FFAs are required to provide or provide for Core Services:
 Specialty mental health services
 Transition services
Education, physical, behavioral, mental health, extracurricular supports
 Transition to adulthood services
 Permanency support services
 Indian Child Services
Transition Services: “support services for children, youth, and families upon initial entry and placement changes and for families who assume permanency through reunification, adoption, or guardianship.”
Education, Physical, Behavioral, Mental Health, Extracurricular Supports, include extracurricular activities and social supports.
Permanency Support Services: “services to achieve permanency, including supporting efforts to reunify or achieve adoption or guardianship and efforts to maintain or establish relationships with parents, siblings, extended family members, tribes, or others important to the child or youth, as appropriate.”

13. For this change to occur successfully
There have to be enough resource families who are willing and able to care for youth and children with deep and enduring needs, and
STRTPs have to work.

14. Critical budget assumptions in CCR
FY :
Youth in Group Home care
5,590
Number transitioning from group home:
To STRTP 60
To all home-based family care 15
Total transitioning 75
FY :
5,605
345
To ISFC
115
To other home-based family care
515
975

15. Critical budget assumptions in CCR
FY :
Youth in Group Home care
5,717
Number and percent transitioning from group homes to:
Foster family home or relative’s home
30%
1,715
FFA
35%
2,001
ISFC
15%
858
STRTP
20%
1,143
Assumes 2% year-to-year growth in group home care

16. Residential care utilization in California

17. How will we know what youth and families need?
Every youth in foster care will be assessed for level of care
Key people in the life of every youth in foster care will comprise that youth’s Child and Family Team – CFT – to assist caseworkers in making critical decisions

18. How will we measure success?
“…outcome-based evaluations of foster care providers or other methods of measuring quality improvement including measures of youth and families’ satisfaction with services provided and program effectiveness.”

19. Where are we now?
County CWS and Probation are training staff to work with CFTs
FFAs and prospective STRTPs have submitted Plans of Operations and Applications

20. CCR: What we’re afraid we may get

21. “Out-of-County” Mental Health

22. A 25 year old problem
Children placed in foster care outside their counties of jurisdiction experience less access to specialty mental health services than children placed within their counties of jurisdiction.

23. SB 785 (Steinberg; 2007) Addressed administrative hurdles to access.
Changed responsibility for specialty mental health services for adopted children from county in which child was adopted to county of residence
Resulted in appreciable positive effect for adopted children. No effect for children IN foster care.

24. Child Welfare Council
Released comprehensive data mining report in 2011 substantiating problem and making recommendations

25. Fixable problem
Children placed in foster care “out-of-county” are also “out-of-plan” for behavioral health care.
Home county mental health plans must:
Provide services in another county
Arrange and pay for services in another county
Arrange with another county to arrange and pay for services

26. Fixable problem

27. AB 1299 (Ridley-Thomas; 2016)
Establishes presumptive transfer of responsibility for specialty mental health services for foster children placed “out-of-county” from the mental health plan of the county of original jurisdiction to the county of residence.
Provides for waiver of presumptive transfer to ensure continuity of care.
Permits mental health plan of county of residence to include the child in its count of children receiving care for purposes of allocating realignment funding.

28. Children’s Mental Health Crisis Continuum of Care

29. What’s the problem?
Fewer than 70 beds child psychiatric hospital inpatient beds for children under 12, statewide
47 out of 58 counties lack any child/adolescent psychiatric hospital inpatient beds for children and youth

30. What’s the problem?

31. Example
9-year-old child is experiencing increased persistent suicidal and homicidal thoughts.
Outpatient services available within the family’s county are not able to meet the child’s increased needs.
Only immediately available intervention is psychiatric hospitalization.
Child experiences six hospital stays in three weeks, all at facilities at least 3-5 hours away from home.
When the child returns home, the lack of crisis services in the community increases the risk of a yet another hospitalization.

32. What’s missing?
California has no licensing category for children’s mental health crisis residential care and no Medi-Cal rate to pay for it.
No California county has all the components of a continuum of care for children in mental health crisis.

33. Crisis residential AB 741 (Williams; 2015) would have:
Established a licensing category for children’s mental health crisis residential programs and
Authorized DHCS to establish a Medi-Cal rate for payment
Passed unanimously out of every committee and both houses
Vetoed by Governor with directions to departments to implement via regulation

34. However…

35. Crisis residential, redux
AB 501 (Ridley-Thomas; 2017) would:
Establish a licensing category for children’s mental health crisis residential programs under the STRTP category and
Authorize DHCS to establish a Medi-Cal payment rate
Anticipate that Gov. will sign
Passed out of first committee on consent

36. Crisis continuum AB 833 (Committee on Budget; 2016):
Allocated $28 million in one-time start-up funds for children’s mental health crisis continuum of care services
$17 million GF; $11 million MHSA
To be administered by CHFFA
Governor’s Jan. budget proposal would cut the $17 million GF
Budget ask 2017: Reject the Governor’s proposal to cut the $17 million

37. Full-Scope Medi-Cal for Undocumented Immigrant Children

38. Did you know…
Under current federal law, immigrants with satisfactory immigration status are restricted to emergency, limited-scope health services under Medicaid

39. Furthermore…
Under ACA, undocumented immigrants were excluded from purchasing coverage on the Covered California exchange and from receiving federal subsidies.
The ACA however opened up limited-scope services to childless adults who were otherwise eligible for Medi-Cal aside from their immigration status.

40. However…
SB 75 (Budget Committee, 2016) grants full-scope Medi-Cal coverage to children under the age of 19 who do not have satisfactory immigration status in as long as they meet the income standards.
Two populations are impacted by the expansion:
Undocumented children in limited-scope Medi-Cal aid codes due to their immigration status and;
Undocumented children not in a Medi-Cal aid code that must be identified at the local level.

41. Why is that important?
Undocumented children covered by Medi-Cal are now eligible for specialty mental health services.

42. That’s a good thing

43. Minors Who are Trafficked May No Longer be Arrested and Charged with Prostitution

44. To protect children…
A person under 18 years old is a minor and cannot legally consent to sexual intercourse.
Any person who engages in sex with a minor victim, knowingly or not, has committed statutory rape.

45. However…
Under current law a victim of Commercial Sexual Exploitation of Children (CSEC) can be detained in juvenile hall and prosecuted for prostitution.

46. Strange…
How can minors be prosecuted for prostitution if they cannot legally consent to sexual intercourse, and any adult who engages in sex with them has committed statutory rape?
Is there such a thing as a child prostitute?

47. So…
SB 1322 (Mitchell, 2016) stops the criminalization of CSEC victims by:
Making the crimes of solicitation and loitering with intent to commit prostitution misdemeanors inapplicable to children younger than 18. 
Allows law enforcement to take sexually exploited children into temporary custody if leaving them unattended would pose an immediate threat to their health or safety. 

48. But does the change…
Make it too hard for police to take trafficked youth into custody for their safety?
Remove the incentive for trafficked youth to testify against their victimizer?
Take away a tool that requires trafficked youth to participate in treatment?

49. That’s all folks!