1. San Bernardino County Children’s START: Screening, Triage, Assessment, Referral, & Treatment Amy Cousineau, Children’s Network Jenae Tucker, Desert Mountain SELPA Children’s Center

2. January 2005: Children’s START Planning Retreat n Facilitated by Drs. Chasnoff and McGourty from the Children’s Research Triangle, the following partners attended: n Children’s Network IEHP n CSUSB First 5 n Head Start Public Health n Desert/Mtn SELPA DCS n Children’s Fund DBH n LLU Children’s Hospital IRC

3. Children’s START Vision Statement n Children and their families, especially young children ages 0-6, will be screened, assessed and referred for treatment through a universal collaborative and standardized process that strengthens and builds on existing programs in the community. Our goal is to improve the mental and social functioning of children as measured by school readiness and the achievement of appropriate developmental milestones.

4. 4 Initial Goals n The group decided that San Bernardino would need 3 START Centers due to the geographic size of the County. n The 1st Center opened in October, 2005 at the Desert Mountain SELPA. n The 2nd Center opened in December, 2006 at CSUSB. n The 3rd Center opened in October, 2007 at West End Family Counseling. 4

5. Children’s START Lessons Learned n EPSDT funding will not allow intensive assessment up front. All psychological assessments funded by EPSDT must be linked to the DSM IV diagnosis and treatment plans.

6. 6 CAPTA n New requirement that “child protective services refer children under the age of 3 who are involved in a substantiated case of child abuse or neglect to early intervention service funded under Part C of the Individuals with Disabilities Education Act...” n The amendment does not change eligibility, as children referred must still meet the eligibility criteria. 6

7. 7 CAPTA & START n Suggested Strategies from ACL No: 06- 54 n Develop MOU between child serving agencies outlining procedures, roles, and responsibilities for screening, evaluation, and referral for early intervention services for children under the age of 3. 7

8. 8 CAPTA & START n Identify multiple pathways, in addition to Early Start, for child serving agencies and providers to collaborate and assure that children receiving child welfare services and under the age of 3 are: n Screened for developmental status, n Referred for developmental evaluation and assessment if screening indicates the need for referral. 8

9. 9 CAPTA & START n Identify developmental screening tools that are practical and effective for use by caregivers and social workers. n Provide cross-training opportunities and educational materials that will increase the caregivers and social worker knowledge about the developmental needs of young children receiving child welfare services. 9

10. 10 Screening DCS Children n DCS developed policy that all children with open cases ages 0-5 will be referred to their regional START provider. Screening then occurs as part of the initial intake assessment. n Results of the ASQ/SE are sent to DCS and input into CMS for tracking and follow-up. 10

11. Children’s START Braided Funding/ Desert 1st START Center Desert/MTN SELPA Counseling Center Public Health Nurse Funded with matching $$ from First 5 Pediatrician funded through CHDP & IEHP & Education Mental Health Treatment EPSDT funding & match from First 5 Speech/Language & O/T funded by Education $$$ Mental Health Treatment CAPIT funding Training & Capacity Building First 5 IRC

12. Children’s START Braided Funding/Central Valley 2nd Center CSUSB Public Health Nurse funded with match from First 5 Pediatrician- In development Funding from IEHP Mental Health Treatment EPSDT & match from First 5 Speech/Language & O/T funded by First 5 Training & Capacity Building First 5 No Education Dollars (Yet) IRC

13. Children’s START Braided Funding/ West Valley West End Family Counseling Mental Health Treatment EPSDT & match from First 5 Public Health Nurse Funded with match from First 5 West End SELPA Speech/Language & O/T Training and Capacity Building First 5 IRC

14. Children’s START MOU Between County Agencies n A Memorandum of Understanding for Children’s START was approved by the San Bernardino County Board of Supervisors on June 27, 2006. Participating departments include: n Children and Families Commission for San Bernardino County n Children’s Fund n Children’s Network n Department of Behavioral Health (DBH) n Department of Children’s Services (DCS) n Department of Public Health (DPH) n Preschool Services Department (PSD)

15. Children’s START Collaborative Process Lessons Learned n Identify key stakeholders who have program expertise and/or resources. n Create a common vision in which everyone can invest. n Identify or create a neutral convener/infrastructure for leadership. n Use First 5 dollars to leverage State and Federal funds. n Partner with County Mental Health for EPSDT utilization.

16. Children’s START: SUSTAINABILITY n This effort will not succeed with First 5 investments alone. It is imperative that a County develop partnerships with the following entities: n Local Mental Health Agency n Public Health Agency n Child Welfare Agency n Grant-making organizations n Regional Centers

17. Children’s START: SUSTAINABILITY EPSDT n First 5 San Bernardino invests critical matching dollars in order to draw down the federal EPSDT dollars. For every nickel invested, there is approximately a 95% return from the State and Federal government for children who meet the “medical necessity” criteria and are full- scope medi-cal beneficiaries.

18. 18 CAPTA & START n While our initial goals for the START program did not set out to meet the CAPTA requirements, we have created a system that will do so. n Future plans include partnering with MHSA/PEI to assist in meeting the screening goals for our child welfare population. 18

19. 19 In Closing... n Thank you for the opportunity to share our experience with the development of the San Bernardino County START program. n Contact information: n acousineau@hss.sbcounty.gov acousineau@hss.sbcounty.gov 19