1. California’s Child Welfare Continuum of Care Reform (CCR) Overview March 18, 2016

2. Background
Legislative mandate - Senate Bill 1013 (Chapter 35, Statutes of 2012)
Builds on previous reform efforts: Reexamination of Group Care (SB 933), Residentially Based Services Reform (AB 1453)
Legislative report with recommendations
Reform Group Homes and Foster Family Agencies with robust and diverse stakeholder input
Continuum of Care Reform:
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

3. 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

4. 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

5. The Goal Children in Resource Families Children in Congregate Care
Permanent
Family

6. Foster Families  Resource Families
The “Paradigm Shift”
Foster Families  Resource Families
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
Resource Family
Relative Caregiver
Foster Family
Adoptive
Family
AB 403 revises the existing licensure, rate structure, and eligibility criteria for FFAs, which recruit, certify, and provide services to foster family homes (FFHs). The new structure envisions a model of FFAs that are prepared and funded to provide intensive treatment level services (currently often unavailable outside of a GH) in a foster home setting, enabling children with emotional or behavioral health challenges to remain with a family. Effective January 1, 2017, AB 403 sunsets the existing rate-setting system for FFAs while providing for an extension of the current rate for FFAs that have been granted an exception.
AB 403 continues implementation of the RFA program, which was established as a permanent statewide program through SB Under the RFA program, CDSS is required to implement a unified, family friendly, and child-centered caregiver approval process to replace the existing multiple processes for licensing FFHs, certifying homes by licensed foster family agencies, and approving relatives and nonrelative extended family members (R/NREFMs) as foster care providers. A resource family will be considered approved for adoption or guardianship and will not have to undergo any additional approval or licensure. Resource families will be approved by counties and FFAs. CDSS is required to provide available funding to counties for the purpose of recruiting, approving, retaining, and supporting foster parents, relative caregivers, and resource families based on CDSS approval of plans submitted by each county.

7. The “Paradigm Shift” (cont’d)
Group Home
Therapeutic Residential Services Settings
(aka STRTP)
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.
AB 403 repeals the existing RCL payment system and eligibility criteria for GHs and it introduces STRTCs, which must meet increased standards of care, shortened duration of stay, and stricter criteria for initial and continued placement. Effective January 1, 2017, AB 403 introduces the following requirements and provisions for facility-based providers:
Existing laws pertaining to GHs and the existing RCL structure will be repealed.
In order to facilitate the transition to STRTC operation, AB 403 provides for conditional extensions of the RCL rate to individual GHs. Under specific conditions, an extension may be renewed, not to exceed two years total.
Certified Out of State Group Homes (OOS GHs) will be required to meet licensing standards required of STRTCs or be granted a waiver to a specific licensing standard upon a finding that there exists no adverse impact to health and safety in accord with Family Code section
In order to receive AFDC-FC reimbursement, an OOS GH will be required to have national accreditation and mental health certification equivalent to what is required of STRTCs in California. AB 403 provides for conditional extensions to individual OOS GHs for accreditation only. Under specific conditions, an extension may be renewed, not to exceed two years total.
Community Treatment Facilities will be required to obtain national accreditation commencing January 1, 2017, and they may request a rate exception that includes time to meet this new requirement.
Effective January 1, 2016, AB 403 authorizes CDSS to license a temporary shelter care facility operated by a county or agency on behalf of a county, and requires CDSS to consult with counties operating shelters to develop a transition plan according to specific requirements and provisions.

8. The “Paradigm Shift” (cont’d)
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

9. 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
Core services refers to: arranging access to specialized mental health treatment, providing transitional support from foster placement to permanent home placement, supporting connections with siblings and extended family members, providing transportation to school and other educational activities, and teaching independent living skills to older youth and non-minor dependents.
(A) Specialty mental health services refers to “for children who meet medical necessity criteria for specialty mental health services under the Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment program, as the criteria are described in Section of Title 9, of the California Code of Regulations.”
(B) Transition Services refers to “support services for children, youth, and families upon initial entry and placement changes and for families who assume permanency through reunification, adoption, or guardianship.”
(C) Education, Physical, Behavioral, Mental Health, Extracurricular Supports refers to “educational and physical, behavioral, and mental health supports, including extracurricular activities and social supports.”
(D) Transition to Adulthood Services refers to “activities designed to support transition-age youth and nonminor dependents in achieving a successful adulthood.”
(E) Permanency Support Services refers to “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.”
(F) Indian Child Services refers to “When serving Indian children, as defined in subdivisions (a) and (b) of Section 224.1, the core services specified in subparagraphs (A) to (E), inclusive, shall be provided to eligible children consistent with active efforts pursuant to Section ”

10. Therapeutic Foster Care
Approved in the State Plan Amendment (SPA)
Workgroup is underway to define service components/model
Big question is whether the service can be made available to relatives and NREFMs
Crucial to providing service where the child is rather than moving the child
Forster parents would need to be trained to deliver speciality mental heatth servcies

11. Increased Engagement and Collaboration
Child & Family Team (CFT)
The child or youth
The child’s family
Other people important to the family or to the child or youth
Representatives who provide formal supports i.e. caregiver, placing agency caseworker, (FFA) or (STRTP)
A county mental health representative
Regional center when the child is eligible for regional center service.
A representative of the child’s or youth’s tribe or Indian custodian, as applicable.
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)
Existing use of the CFT model has shown to be an important tool for building a flexible and individualized network of child welfare, mental health, and educational services to best support the needs of the child and his or her family.  In order to more fully integrate CFTs into the case planning process, AB 403 introduces the following:
County placing agencies are required to engage the child, his or her family, caregivers, providers, natural supports and others in the assessment, placement, and service planning processes.
CFT guides the development of a child's case plan, in order to prevent uniformed and unilateral decisions about the care of a child

12. Placement Options Effective January 1, 2017
In order to be eligible for AFDC-FC funding, a child or nonminor dependent must be placed in one of the following:
The approved home of a resource family.
A housing model certified by a licensed transitional housing placement provider.
An approved supervised independent living setting for NMDs.
A licensed FFA for placement into a certified family or resource family home.
An STRTP licensed as a community care facility (CCF).
An OOS GH that meets STRTP standards, provided that the placement worker, in addition to complying with all other statutory requirements for placing a child or youth in an OOS GH, documents that statutory requirements have been met.

13. Probation Youth Requires county probation departments to work with:
GHs to develop STRTPs that meet the needs of probation-supervised youth in foster care
FFAs to develop strategies to recruit, approve, retain, and support specialized foster homes for probation youth. 
CDSS on strategies to identify, engage, and support relative caregivers
CDSS to define probation youth outcome measures
On January 1, 2018, CDSS is required to consult the Chief Probation Officers of California (CPOC) in order to assess the capacity and quality of placement options for probation youth in foster care.
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.
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.

14. Protecting Tribal Relations
The State of California is committed to protecting the essential tribal relations and best interests of an Indian child by promoting practices in accordance with ICWA
The State is committed to placing the child, in placements reflecting the unique values of the child’s tribal culture and is best able to assist the child in establishing, developing, and maintaining a political, cultural, and social relationship with the child’s tribe and tribal community.
CCR is not intended to displace or preclude current options available to Indian children, such as placement in tribally approved homes or tribal customary adoptions. CCR supports previous State initiatives such as ICWA training, Active effort, etc

15. 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.

16. Mental Health Certification
Effective January 1, 2017, an STRTC or an FFA must be able to ensure the provision of necessary mental health services for its placements.
Mental health certification as a component of the AFDC-Foster Care rate for both STRTPs and FFAs, including EPSDT specialty mental health assessment
The program may be certified as a mental health provider by DHCS or a county mental health plan, may have a formal agreement with a certified mental health provider
For a current GH or FFA applying for a new rate as an STRTP or FFA a conditional extension may be granted if additional time is necessary to obtain mental health certification.
as one criteria for placement reinforces the States ongoing efforts for expanded integration between mental health and child welfare.  AB 403 intends to encourage greater interdepartmental collaboration at the local level and increase each provider's ability to deliver a more complete range of child welfare and mental health services to a child.
or must otherwise arrange for mental health services through the county mental health plan.  
If the program does not have a certification, it may serve children who are assessed as seriously emotionally disturbed and as meeting EPSDT medical necessity criteria if it arranges for a Medi-Cal eligible child to receive EPSDT specialty mental health services, or other mental health services in all other cases.
See Attachment F and Attachment I for AB 403 statutes regarding accreditation, licensure, and rate requirements specific to STRTCs and FFAs, respectively.

17. Provider Licensing Process
CDSS Community Care Licensing (CCL) will review applications for group homes transitioning to “STRTPs”.
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.

18. Other Accountability Components
Cross Departmental Oversight Framework
Evaluate provider performance along common domains
Youth, caregiver and stakeholder satisfaction surveys
Public transparency of provider performance

19. Strengthens training and qualifications requirements
Applies to resource families, foster family homes, certified family homes and facility staff, effective January 1, 2017,
Training requirements have been updated to include such topics as
trauma-informed care;
child and adolescent development including sexual orientation, gender identity, and gender expression;
accessing services, as specified; and,
serving commercially sexually-exploited children, as specified.
Modernizes foster parent training programs, making the curriculum more flexible according to the specialized training needs of individual children and families.

20. New Provider Rate Structure What we know so far…
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.

21. 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

22. 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

24. Inter Organizational Relationships Bai, Y. , Wells, R
Inter Organizational Relationships Bai, Y., Wells, R., & Hillemeier, M. M. (2009). Coordination between child welfare agencies and mental health service providers, children's service use, and outcomes. Child abuse & neglect, 33(6),
Joint budgeting or resource allocation
Cross training of staff
Working with the agency on child welfare case
Development of interagency agreement and memoranda of understanding
Joint planning/policy formulations for service delivery
Discussion and information sharing mechanisms--ongoing

25. What does this mean for….
Child Welfare
Mental Health
Probation
Resource Family Providers
Group Care Providers

26. Roundtable Discussion: The Process
Continuum of Care Reform “Core Services”
This process will facilitate the groups in identifying:
Hopes and dreams for the child welfare system
Key elements that are needed to achieve those hopes and dreams
What is already in place that is working well
Gaps – what else is missing?
Think BIG – no reality testing!

27. What is the best child welfare system you can imagine?
Dreaming BIG!
What is the best child welfare system you can imagine?
How would you know it’s the best?
What would be happening?
What would you see?
What would be the experience of children, youth and families?
Process: On your own, use post-it notes to write down your ideas. Use one post-it per idea.

28. Vision Statement (10 minutes)
At your tables:
Your Scribe will chart your ideas
Share Ideas
Each person quickly reports out what they’ve written on their post-it notes.
Create a Vision Statement
Work with your table partners to create a Vision Statement that reflects your ideas of the Best Child Welfare System.
Chart Your Vision Statement

29. Building Blocks
Key Elements Needed to Build the Best Child Welfare System
What elements need to be in place to for this system to be the best?
Best Practices in: Systems of Care? Recruiting Foster Parents? Therapeutic Foster Care?
Think REALLY big and don’t reality test your great ideas!
Process: On your own, use post-it notes to write down your ideas.
Use one post-it per idea.

30. Building Blocks (10 minutes)
At your tables:
Your scribe will chart your ideas
Share Ideas
Each person quickly reports out what they’ve written on their post-it notes.
Prioritize
Choose 2 to 5 ideas that you want the larger group to see.
Chart
On a different piece of chart paper, chart your 2-5 ideas.

31. Current System Strengths
What’s working now?
What is already in place?
What strengths do you want to expand and/or build upon?
Process: On your own, use post-it notes to write down your ideas.
Use one post-it per idea.

32. Current System Strengths (10 minutes)
At your tables:
Your scribe will chart your ideas
Share Ideas
Each person quickly reports out what they’ve written on their post-it notes.
Prioritize
Choose 2 to 5 ideas that you want the larger group to see.
Chart
On a different piece of chart paper, chart your 2-5 ideas.

33. Gaps What are the current gaps in the system?
Where do children, youth and families fall through the cracks?
What isn’t happening that is negatively impacting children, youth and families?
Process: On your own, use post-it notes to write down your ideas.
Use one post-it per idea.

34. Gaps (10 minutes) At your tables: Your Scribe will chart your ideas
Share Ideas
Each person quickly reports out what they’ve written on their post-it notes.
Prioritize
Choose 2 to 5 of the ideas that you want the larger group to see.
Chart
On a different piece of chart paper, chart your 2-5 ideas.

35. Our direction
What areas do we want to pursue? Use your 10 dots to choose top choices for… Vision (1) Building Blocks (3) Strengths (3) Gaps (3)

36. Next Steps Who else needs to be at the table?
Commitments
How often do we want to meet?
Frequency, Duration, Length of meetings?

37. Wrap up & Close Confirm date for next meeting Final comments
Plus/Delta