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SCC Department of Family & Children Services New Service Model for Receiving & Intake Center
Operational Plan
Service Partner Focus Group #2A
October 31, 2014
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Context, Purpose & Intended Results
CONTEXT:
The Plan of Service Has Been Reviewed & Approved by Leadership, & Efforts Will Now Turn to the Operational Planning Phase. This Is the First Service Partners Focus Group in this Phase & Is Planned as an Open & Collaborative Discussion & Working Session. Outcomes from the Operational Planning May Impact the Plan of Service.
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Context, Purpose & Intended Results
PURPOSE:
The Purpose of this Meeting Is to:
Review The Plan of Service & Service Model
Review Key Informant Interview Feedback
Review Staff Workshop Feedback
Engage in a Discussion about the Future Operational Plan
INTENDED RESULTS:
The Intended Results of this Meeting Are to:
Have a Shared Understanding of the Plan of Service
Gather Input into the Operational Plan by Defining the How, Who & Where of Service Delivery
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Agenda
Agenda Review
Summary of Plan of Service & Service Model
Summary of Outreach
Key Informant Interviews
Staff Workshop
Operational Phase Exercise
Next Steps / Conclusion
Agenda Review
Review Process Plan & Progress
Process Overview
Insert Process Map Here
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Participation & Context
Participants Core Team Advisory
o RAIC Stakeholder Group o Child Abuse Council o Social Services Advisory Commission o Juvenile Justice Commission o Court Systems o Labor Organizations o Caregiver Community
Service Partners o Health & Hospital o Public Health o First 5 o County Office of Education o Contracted Placement Support o Law Enforcement o SARC o Mental Health o Drug & Alcohol o Probation
Staff
o Operations
o Management
o Placement
o Users
o Experts
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Process Overview – Key Milestones
Vision & Needs
Validate Process
Who?
When?
Selected Site
Criteria & Scenarios
Program
Quantity & Quality
Define Space Needs
Site
Scenarios
Plan
Costs
Funding
Service Support
Service & Operational
Model
Define Service Needs
What? How?
Feasibility Study
Approval
2
End
3 4
2
5
6
Summary of Service Model Phase
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Service Model Phase Systems Model Diagram
24/7 Child Centric System Develop Child Typologies Align Caregivers to the
Specific Needs of the Children/Youth Recruit robust numbers of
foster & professional parents Provide adequate training for all
caregivers
Activate Process Initiation at Protective Custody Provide ‘first response’ medical
& mental health care
Implement System-Wide Technology Strategy
Maintain a Continuum of Trauma Informed Care
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Service Model Phase Service Model Diagram
Vision Statement
A successful diversion or placement of children & youth with the objective of best placement the first time, focusing on minimum impact to the family & supporting the child(ren)/youth’s emotional & physical wellbeing while providing appropriate, supportive, & continued care
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Service Model PhaseService Model Diagram
Goals/Objectives� Reduce Number of Placements Per Child
� Prompt and Proficient Placement
� Follow Placement Best Practices
� Divert
� Place Directly with a Relative or NREFM
� Best Placement with Appropriate Caregiver
� Temporary Emergency Housing
� Limit Further Trauma
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Service Model Phase Service Model Diagram
Core Principles
To Operate a Child Centric System (child\youth & family centric)
To Efficiently & Sustainably Provide Core Services With a Flexible & Adaptable Service Model
To Function as a Collaborative, 24/7 System With Clear Alignment, Coordination, & Communication between All Service Providers
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Core Services Mental & Medical Health
First Response
Minimally Invasive Examination for Initial Identification of Critical Physical & Mental Health Needs
Identification of Contagious Conditions & Wounds
Follow-Up Care
Thorough Mental & Physical Health Assessment
Continued Coordinated Care
Appropriate Medical & Mental Health Care on an Ongoing Basis
Medical Access
Access to Medicare/Medi-Cal Cards
Access to Providers
Central Resource for Reliable & Accurate Information
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Core Services Assessment / Placement
Find & Facilitate Best Placement Re-initiate a Post Protective Custody Diversion Program
Develop Streamlined Process Initiation Protocol to Facilitate Rapid Assessment & Placement
Develop Child Typology Database to Facilitate More Appropriate Matches
Care & Provision for Child(ren)/Youth Develop a Program to Supply All Children/Youth with Basic Personal Belongings Prior to
Placement (Clothes, Toiletries, Etc.)
Conduct Interviews with Children/Youth
Provide Appropriate Home-like Opportunities/Locations for Family Visitation
Support Services Interviews
Team Decision Making Meetings
Assessment & Placement Team Coordination
Support for Social Workers (food & workspace)
24/7 Fingerprinting & Background Checks
Family Location Using Lexis Nexis & Other Sources
Central Resource for Reliable & Accurate Information
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Core Services Caregiver Support
Expedient & Equitable Access to Funding, Equipment & Resources Equalize Funding for All Caregivers
Provide Initial Caregiver Support & Someone to Shepherd Caregivers Through Early Stages
24/7 Access To Equipment & Supplies
Develop a Program to Supply All Caregivers With Basic Needs (Crib, Car Seat, Bedding, Etc.)
Transportation
On-Going Training, Evaluations & Support Training Courses (small to large groups)
Informational Meetings
Non-crisis Interaction for Training & Support
Expanded Training Programs for New & Experienced Caregivers
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Core Services Caregiver Support, Continued
Marketing & Recruitment
Qualified Caregiver Recruitment & Management
o Create & Maintain a Robust Number of Qualified Caregivers, Trained & Aligned to Children/Youth Needs
o Institute & Fund a Professional Marketing & Recruitment Plan for Caregivers that Align With Children/Youth Needs
Administer Marketing & Recruitment Events
Service Partner Collaboration
Opportunity for Co-location of Partner Services
o KAFPA
o Relative Support Team
o Unity Care
o Other
Central Resource for Reliable & Accurate Information
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Core Services Emergency Housing
It Has Been Identified that an Appropriate & Adequate Spectrum of Emergency Housing Options Needs to Be Offered for Child(ren)/Youth Who Are Unable to Be Placed within a 24 Hour Period
The Detailed Criteria of Emergency Housing Will Be Developed in the Operational Phase
The Plan of Service Defines Emergency Housing as an Appropriate Facility to Serve the Specific Needs of the Child(ren)/Youth that Will Accept Placement 24/7 with No Exceptions, & Will Provide Housing While Appropriate Placements Are Being Made
It Has Already Been Clearly Identified that the County Will not Be Operating a Licensed Residential Shelter Facility
Summary of Outreach
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Key Informant Interviews
A Continuum of Trauma Informed Care with First Response Protocol
Some Method of First Response Protocol Must Be Initiated
Responses Varied when Asked if First Response Protocol Should Be Offered Out of a Single or Multiple Locations
‘First Response’ Care Should Be Performed by Trauma Informed Medical Staff
Responses Varied, but General Consensus Identifies a Benefit to Co-Locating Assessment & Medical Staff in the Same Location
Respondents Did not Give High Priority to Co-Locating ‘First Response’ Care with Trauma Informed Care for Children not in Protective Custody
A Definition of a ‘Spectrum of Emergency Housing’ Is Needed to Move Forward
When Asked which Operational Model Would Be the Most Effective Responses Varied
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Key Informant Interviews
Participants Agreed there must Be Some Form of Emergency Housing, however Opinions on the Definition of Emergency Housing Varied
Responses on How Much Time Children/Youth Should Reside in Emergency Housing Varied from as Little Time as Possible, up to a Maximum of 14 Days When Especially Difficult to Place
General Consensus Was that a Combination of Solutions Is Needed Depending on the Circumstances of each Child/Youth & Group Homes Should Be Limited & Used Only as a Last Resort
Consensus Across the Board Was in Favor of Providing Appropriate Space for Family Visitation during & after the Placement Process
Responses Varied Regarding Co-Location, Centralized vs. Community Based, & Being County or 3rd Party Run
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop
The Staff Workshop Discussion Resulted in Developing a List of Questions that Must Be Answered in Order for the Plan of Service to Be Successful. Some of the answers were developed in the Workshop, others through internal staff meetings.
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Medical & Mental Health
Who will determine the criteria for a First Response clearance for placement?
DFCS & VMC trauma care physicians
Protocol for clearance would need to be established
Who will provide First Response services?
VMC
Third party provider
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Medical & Mental Health
Who should provide First Response exam?
Specially trained trauma care practitioners with pediatric medical/psychiatric training in neglect & abuse conditions & treatment
Nurse Practitioner
o In the past a Psych. NP provided these services but was underutilized
o Ability to write needed prescriptions is very important
o A pediatrics NP with psych qualifications is ideal for this position
Doctor
o Doctor is needed if more severe conditions are determined but in most cases the emergency department would be used
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Medical & Mental Health
Who will decide next steps for the child/youth with a discovered condition/injury?
Team Decision: ER worker, assessment staff, social worker, on-call doctor/nurse practitioner/physician assistant
Who is taking the children/youth to these services 24/7?
Emergency response (ER) social worker
When should a First Response exam take place, if a child/youth is taken into Protective Custody in the middle of the night?
As soon as possible by an on-call nurse practitioner/doctor
Let the child/youth sleep, exam during standard hours 8:00am-5:00pm 7 days a week
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Medical & Mental Health
How will the County deal with the increased number of child(ren)/youth having First Response exams (all children in protective custody prior to placement)?
Need to develop a growth strategy/succession plan be to increase the number of trauma informed care Physicians, Nurse Practitioners & Physician Assistants to manage the increase in First Response & 24/7 services
Could telemedicine be used?
o Concerned with the appropriate treatment
o Would need to be done by medical practitioners & not social workers
How is a First Response exam accomplished with a later follow up exam when insurance will only cover one exam in 30 days?
How can medical staff at Juvenile Hall have seamless services with DFCS?
Use the First Response protocol & criteria for clearance to placement
Develop a coordinated care plan with First Response practitioners
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Medical & Mental Health
As success grows with Protective Custody Diversion, there is an increased % in the severity of medical/mental conditions of child(ren)/youth. How will the trauma care practitioners evolve their services to meet the increased complexity of needs?
Where is First Response offered - Single Central Location or South, North & Central County?
Centralized services would allow for better coordinated care & is preferred as a short-term solution until more providers are available
Could be in other County clinics if there are enough trauma care specialists that can travel to a designated site
What are the exceptions to having a required First Response exam?
Having come from the hospital & already receiving medical clearance
o If a child/youth is in the hospital for a broken bone, have they had an assessment for mental health issues? Other medical health issues?
Having been seen by doctors at Juvenile Hall, with same protocol for clearance
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Assessment & Placement
Who will define new or returning programs & protocols? Who will implement them?
o Program Director
Who will run a post protective custody program? o Social work staff
What elements of the program used in the past should be part of the new program?
How will workers accomplish their existing & additional tasks? How many people are needed for this Plan of Service? Will additional staff be added?
What role will additional staff be responsible for?
How will child typologies be developed? Who will decide what the child typologies are?
o Assessment staff, medical professionals, social workers
Who decides which typology a child is in? o Assessment staff, medical professionals, social workers
• Is there a standard form with checkboxes to determine typology?
Who has access to the child typology database?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Assessment & Placement
How can basic needs (clothing, shoes, toiletries, school supplies, toys) be provided to all children/youth?
How can we partner with organizations (such as KAPFA & Unity Care), private companies (such as Yahoo, Facebook, etc.) & non-profits to help provide these items?
o How do we recruit them? Who does it?
Who will manage this service?
o Can there be a new coordinator position for partner services for these needs?
Where will these items be stored?
o By the non-profit providing them, or by DFCS?
Can a child/caregiver be provided with a gift card to be able to purchase the basic items up front?
o The issue with gift cards is being able to verify that it was used for the child, not currently.
How can assessment & receiving take place in different locations?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Caregiver Support
How can training be made easier & more attainable for caregivers?
Can we set up an in-home training program with a parent mentor based on the specific needs of the child?
o Expand the Resource Support Team
• Increase training for the Resource Support Team
• Can it be expanded to the relative home?
Caregivers can’t be forced into doing additional training, how can we motivate them to do it?
o Recruit new caregivers who want it
o Provide additional compensation/certification for existing care givers that acquire training
Who will run the expanded training programs?
o Could it be a third party?
How can we better align caregiver training to child typologies?
Can caregivers get additional compensation for training for additional special needs / more difficult typologies? Special care increment?
o How will it be funded? Federally? By a grant?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Caregiver Support
How many homes would be ESH vs. Foster Homes vs. Professional Parent Homes?
How can funding to each of these caregiver types be improved to align with the economy & cost of living?
How can funding to relatives be improved or be provided faster?
Relatives are often asked to take a child/youth with little to no warning & are not prepared for the associated costs
How can we provide better solutions for caregivers to quickly get the supplies they need to support a child/youth?
Can we give gift cards to caregivers to take care of the child’s basic needs?
o The difficulty is in auditing & proving that the money was spent on the children
Can we work with non-profits, & outside organizations to provide these items?
How can we better align social workers with the cultural & language needs of caregivers?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Emergency Housing
Who will establish the criteria for the Emergency Housing Facilities in the Plan?
How does DFCS find an appropriate spectrum of housing for each of the child(ren)/youth typologies?
Where should these facilities be located?
What is the function of the emergency housing facility?
Option 1 – acts as the 23:59 hour home while First Response, Assessment & Placement are complete – can expand up to 30 days
Option 2 – used after 23:59 hours to extend the time allowed to find best placement- can expand up to 30 days
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Emergency Housing
How many different types of emergency housing facilities need to be in the spectrum?
Options should be based on typology, not age, based on demographics & tracked over time
There must be an option with the resources to deal with dangerous youth
o An ICPC can take up to 60 days, where do they go in the meantime?
How long does it take to assess & prep a relative to take a child?
Emergency housing limits should provide enough time to assess & prep a relative
Average time for a Relative assessment & preparation is 14 days
Difficult & complex cases can take more time
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Family Visitation
Who will run the visitation center?
DFCS
3rd party provider
How can a visitation center coordinate seamlessly with staff & social workers?
Where should a visitation center be?
Should there be a central location?
Should there be multiple community based locations?
Should there be a combination of both?
Should visitation be joined with the assessment function of the service model?
There should be some level of visitation with assessment but not a full service visitation center
There should be a separate visitation center with its own service model
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Recruitment & Marketing
What changes can be made to create a paradigm shift in recruiting?
Hire a professional marketing firm
o It should be a partner relationship with a professional marketing firm, not a position within the County with central coordination back to DFCS
o Can it be funded by a grant?
Create a marketing & recruitment coordinator position
o With extensive knowledge of needs
o To work with outside marketing firm & guide marketing & recruitment message
o Properly assign & train staff in recruitment techniques
Further develop community relationships
Design a new recruitment methodology to align to contemporary ‘sales’ strategies
Partner with co-counties for marketing effort
How can this be an ongoing & sustainable effort?
What is the long term plan? How will program continue after consultant work?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Summary of Staff Workshop Recruitment & Marketing
How can the effort to recruit new Caregivers start now in a parallel process?
How can staff be trained & better utilized to recruit Caregivers?
How do we bring equity between recruiters & case carrying social workers?
What are the keys to successfully recruiting new Caregivers?
Consider targeting a demographic that can serve this population (wealthier Silicon Valley residents with the space & funds to support foster children)
Recruitment at large corporations (Facebook, Yahoo, etc.) – look for families through corporate sponsors?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Discussion
Exercise #1– How, Who, Where?
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
How? Who? Where?
Break into Groups
Using the Sheets Provided & Post-It Notes, Address the How, Who & Where of the Core Services
Present Your Key Points to the Group
S E R V I C E + E N V I R O N M E N T = E X P E R I E N C E
Next Steps / Conclusion
Next Steps
Feedback
Always Focus on their Success!
