Department for Community Based ServicesKids Are Worth It

September 10, 2019

Jennifer Warren

September 10, 2019

CHILD WELFARE

TRANSFORMATION

Child Welfare Belongs to All Of Us

Family and child

Prevention Services

Kinship and Relative

Placements

Foster Care (Public and

Private)

Reunification)

Adoption

Post Adoption Supports

Schools Courts

DJJ

Treatment and

Recovery Programs

Public Health

Mental and

Behavioral Health

Faith Based Community

DCBS DATA TRENDS AND OUTCOMES

A LOOK BACK….

Number of Youth in Out of Home CareSFY2014 – SFY2018

7,778

9,034

7000

7500

8000

8500

9000

9500

10000

Jun'14

Aug'14

Oct'14

Dec'14

Feb'15

Apr'15

Jun'15

Aug'15

Oct'15

Dec'15

Feb'16

Apr'16

Jun'16

Aug'16

Oct'16

Dec'16

Feb'17

Apr'17

Jun'17

Aug'17

Oct'17

Dec'17

Feb'18

Apr'18

Entries and ExitsSFY2014 – SFY2018

5,840

6,632

5,371

5,796

5000

5200

5400

5600

5800

6000

6200

6400

6600

6800

7000

Entries Exits

Total DCBS and PCP Foster HomesSFY2014 – SFY2018

4,401

4,577

4100

4200

4300

4400

4500

4600

4700

4800

DCBS and PCP Foster Homes by TypeSFY2014 – SFY2018

2,062

1,935

2,339

2,642

1500

1700

1900

2100

2300

2500

2700

DCBS Foster Homes PCP Foster Homes

Months to Permanency: ReunificationsSFY2014 – SFY2018

8.48.9

9.69.0 9.2

5.9

6.7 6.9 6.67.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

2014 2015 2016 2017 2018

Mean (Avg.) Median

Months to Permanency: AdoptionsSFY2014 – SFY2018

36.9 36.9

37.9

37.0 37.0

33.3

32.5

35.7

33.5

35.2

29.0

30.0

31.0

32.0

33.0

34.0

35.0

36.0

37.0

38.0

39.0

2014 2015 2016 2017 2018

Mean (Avg.) Median

Youth Exiting OOHC to AdoptionSFY2014 – SFY2018

855

914

1053

1086

1026

750

800

850

900

950

1000

1050

1100

1150

2014 2015 2016 2017 2018

Youth Aging Out of OOHCSFY2014 – SFY2018

662

624

603

640

601

500

520

540

560

580

600

620

640

660

680

700

2014 2015 2016 2017 2018

Active CasesJune 2016 – June 2018

13,500

13,353

13,859

14,272

14,787

12500

13000

13500

14000

14500

15000

Jun '16 Dec '16 Jun '17 Dec '17 Jun '18

Average CPS CaseloadsCY2017 – CY2018*

18.319.0

23.324.023.3

25.3

29.8

32.1

0

5

10

15

20

25

30

35

2017 2018

CPS Current CPS with Past Dues CPS Not at Full Capacity Current CPS Not at Full Capacity with Past Dues

*CY2018 Jan-Jul .

A Call To Action: Time for Transformation

There is a child on the other side of every decision made, every policy implemented, and every law passed who will either feel the

benefit or the consequence.

A FORMAL PROJECT MANAGEMENT STRUCTURE

Child Welfare TransformationThe Overarching Framework for Reform

Phase I

April 2018: A proactive response to an unprecedented opportunity….

The Project’s Governance Structure

Child Welfare Transformation

Sponsors

Stakeholder Advisory

Group

Internal Project

Leadership Team

Steering Committee

AccountabilityTransparencyCollaborationA systems approachPartnershipsRelational approach

Project Management

OutcomesProcessStructure

9 Workgroups

• Workforce

• Permanency

• Prevention

• Fiscal Mod.

• Trans. Aged

Youth

• Foster Parent

• Relative Pl.

• Service Regions

• It

• Requirements

• Scope of Work

• Key Themes

• Risk Assessment

• Communications

• Project Monitoring

• Stakeholder

Engagement

• Strategy implementation

• Deliverables

• Early evaluation

• Course correction as needed

• Embed into ongoing practice

3 Primary Goals

Reduce case loads

Improve timeliness to appropriate permanency

Safely reduce the number of children

entering OOHC

THE COLLECTIVE CHARGE:

o Identify the system we want and work from there: Family and child driven decision making.

o Be innovative, think and dream big: The entire system is on the table.

o Ask, then ask again:o What will it take?o What is/isn’t working? o What are the priorities?o What can we accomplish?o What is the data telling us?o What are the stakeholders telling us?o If this were my family, how would I want to be treated, approached, and engaged?

Formulate strategies to create a child welfare system in

which families and children are the primary focus

INNOVATIVE STRATEGIES

“Innovation is not about saying yes to

everything. It’s about saying no to

all but the most crucial features”

~Steve Jobs

Build on what’s working.

Change what’s hindering.

Transformative strategies.

Engage stakeholders and

staff.

Shift the culture.

Phase I Highlights

• 77 planning sessions as of May 1, 2019;• 154+ hours to date in planning, implementation and follow up; • 53 Transformational Strategies as of May 1, 2019; • Consistent process for identification of scopes for each group;• Achievable key themes identified and strategies formulated;• Framework for ongoing consistent evaluation and decision making;• Ongoing risk assessment, performance monitoring and deliverable

verification; • An established process for DCBS to address current and future challenges

that is consistent, structured and systematic. • Ongoing Stakeholder engagement to inform the work and provide input; • Voices of the Commonwealth has membership on 3 workgroups; and• A parent mentor has been added to the Prevention Supports workgroup.

CONTINUOUS….

QUALITY….

IMPROVEMENT…

CWT Phase IIData Informed/Outcomes Driven

CWT Phase 2: Sustaining the Gains

From Project to Practice……

• Family First implementation

• A movement towards primary and secondary prevention;

• A family centered focus on recovery and resilience by biological parents

• A redesigned Continuous Quality Improvement (CQI) process:

• Becoming data informed and outcomes driven;

• Responding to agency’s changing needs;

• Addressing additional areas needing improvement;

• Continued stakeholder engagement at all levels of the agency; and

• Feedback loop.

Phase 2 Workgroups Workforce Supports Out of Home Care Supports Permanency Fiscal Modernization Prevention Supports Judicial Engagement

THANK YOU!

#ChildWelfareBelongsToAllOfUs

Follow DCBS on social media:o Twitter: @KyDCBSo Facebook: Kentucky Department for Community Based Services https://www.facebook.com/kydcbs/

Family First Prevention and Services Act: A Key Lever in Kentucky’s Child

Welfare Transformation

Jessica Brown

Family First Prevention Services Act

• Landmark legislation: Most significant child welfare law in 20 years.

Dramatically alters the federal financing structure for child welfare programming (Title IV-E).

Prevent entry into foster care

Keeping children in family-like settings

Restricting funds for out-of-home care that is not a foster home.

Reorientation around prevention

Prevention:Implications and opportunities

Transforming the child welfare focus from

foster care to prevention, increased family

stability and well-being.

Investing in evidence-based interventions.

Applying a trauma-responsive lens

Partnering across systems

Major provisions: Prevention

• FFY2020: States gain the option to use

federal title IV-E funding for prevention

services for children, parents and/or kin

caregivers.

• Prevention services include:

• In-home, skill-based parenting programs

• Substance abuse treatment and prevention

• Mental health treatment

Major provisions: Prevention funding

• No income/AFDC test for child, parent or kin recipients of prevention services.

• Preventive services can be federally funded for up to 12 months at a time.

• At least 50% of state’s funded prevention services/programs must be at the well-supported level.

• States must adhere to maintenance of effort requirements

Major provisions: Prevention

• 3 categories of evidence for the prevention programs:

• HHS will publish eligible services and their level of evidence via an Evidence-Based Clearinghouse.

Promising Supported Well-Supported

Title IV-E Prevention Plan

• Prior to implementation, all states must submit a Title IV-E Prevention Plan

• The plan must outline the Evidence Based Practices (EBPs) to be used by the state over a five year period

• The plan can be amended over time as new EBPs are approved by the Title IV-E Prevention Services Clearinghouse

• Kentucky’s initial submission included the following EBPs:

Prevention services and programs

• Mental Health:

Parent-Child Interaction Therapy –well supported

Trauma Focused-Cognitive Behavioral Therapy --promising

Multisystemic Therapy –well supported

Functional Family Therapy –well supported

• Substance Abuse:

Motivational Interviewing --TBD

Multisystemic Therapy –well supported

Sobriety Treatment and Recovery Team (START)--TBD

Prevention services and programs

• In-Home Parent Skill-Based: Sobriety Treatment and Recovery Team (START) –TBD

1-2-3 Magic: Effective Discipline for children 2-12—TBD

85.2% (52)

45.9% (20)

19.7% (12)16.4% (10)

65.6% (40)

4.9% (3) 4.9% (3) 1.6% (1) 3.3% (2) 0.0% (0) 0.0% (0)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Trau

ma

Focu

sed

-Co

gnit

ive

Be

hav

iora

l Th

erap

y

Par

ent-

Ch

ild In

tera

ctio

nTh

erap

y

Mu

ltis

yste

mic

Th

erap

y

Fun

ctio

nal

Fam

ily T

her

apy

Mo

tiva

tio

nal

Inte

rvie

win

g

Mu

ltis

yste

mic

Th

erap

y

Fam

ilies

Fac

ing

the

Futu

re

Met

had

on

e M

ain

ten

ance

Ther

apy

Par

ents

Tea

cher

s

Nu

rse-

Fam

ily P

artn

ersh

ip

Hea

lth

y Fa

mili

es A

mer

ica

Mental Health Substance Abuse In-Home Parent Skill-Based

Evidence-Based Practice

Jefferson

The Lakes

Two Rivers

Eastern Mountain

Salt River Trail

Northern Bluegrass

Northeastern

CumberlandSouthern Bluegrass

Jefferson

The Lakes

Two Rivers

Cumberland

Eastern Mountain

Salt River Trail

Northern Bluegrass

Northeastern

Southern Bluegrass

Jefferson

The Lakes

Two Rivers

Cumberland

Eastern Mountain

Salt River Trail

Northern Bluegrass

Northeastern

Southern Bluegrass

Jefferson

The Lakes

Two Rivers

Cumberland

Eastern Mountain

Salt River Trail

Northern Bluegrass

Northeastern

Southern Bluegrass

Children/Youth in Families Served by Contracted in Home Services

(FPP/START/KSTEP)

886 836 783 759 651 556 544410

2500

100200300400500600700800900

1000

# of Youth Served by Contracted In-Home Services (FPP/START/KSTEP)

Right-sizing congregate care

Major provisions: Congregate care• Applies significant restrictions to federal

reimbursement for children and youth placed in congregate care.Facilities that meet the Qualified Residential Treatment Program (QRTP) criteria for any child’s stay beyond 2 weeks.

Children whose assessment completed within 30 days indicates their clinical needs are best met in that setting.

• Additional safeguards for children placed in QRTPs Specific case planning requirements

60 day court approval of placements and status reviews

Major provisions: Congregate care

• A QRTP must be a program that:

is licensed and accredited

has a trauma-informed treatment model

facilitates outreach to and participation of family members in the child’s treatment program;

has nursing staff and other licensed clinical staff, on-site if required by the treatment model, and are available 24 hours a day and 7 days a week

Total Percent

QUALIFIED RESIDENTIAL TREATMENT PROGRAM (QRTP) REQUIREMENTS“My agency currently…”

Completely True

Somewhat True

Not at all True

…has a trauma-informed model that is designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances.

76.7 20.0 3.3

…is able to implement the treatment identified for the child by the required 30-day assessment of the appropriateness of placement.

90.0 3.3 6.7

…to the extent appropriate and in accordance with the child’s best interests, facilitates participation of family members in the child’s treatment program.

80.0 16.7 3.3

…facilitates outreach to the family members of the child, including siblings. 56.7 40.0 3.3

…documents how the outreach to the family member is made (including contact information). 76.7 20.0 3.3

…maintains contact information for any known biological family and fictive kin of the child. 63.3 26.7 10.0

…documents how the family members are integrated into the treatment process for the child, including post-discharge. 56.7 36.7 6.7

…documents how sibling connections are maintained 53.3 36.7 10.0

…provides discharge planning and family based aftercare support for at least 6 months post-discharge.

20.0 50.0 30.0

…is licensed and accredited by at least on of the following independent, not-for-profit organizations: The Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation (COA), or any other independent, non-for-profit accrediting organization approved by HHS.

86.7 3.3 10.0

…has registered or licensed nursing staff and other licensed clinical staff who provide care within the scope of their practice as defined by state/tribal law. They are on-site according to the treatment model and are available 24 hours a day and 7 days a week (A rule of construction in section 472(k) (6) of the Family First Act indicates that this requirement shall not be construed as requiring a QRTP to acquire nursing and behavioral health staff solely through means of a direct employer to employee relationship.)

80.0 6.7 13.3

Major provisions: Congregate care

• Exceptions to QRTP requirements are:

Facility for pregnant and parenting youth

Supervised independent living for youth 18

years and older

Specialized placements for youth who are

victims of or at risk of becoming victims of sex

trafficking

Residential family based substance use

disorder facilities

Children/Youth in Congregate Care Statewide

99910.20%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

0

200

400

600

800

1000

1200

Statewide

% o

f ch

ildre

n/y

ou

th

# o

ch

ildre

n/y

ou

th

# of children/youth in congregate care % of children/youth in congregate care

Source: TWS-W058 07-07-19 (Foster Care Fact Sheet Run)

Children/Youth Placed Outside of Region Statewide(34.9% of children/youth are placed outside of their removal region)

972

2,827

2,095

218 282189 252

1,608

781

54916% 8%

43%

78%

66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0

500

1000

1500

2000

2500

3000

Relative or FictiveKin

DCBS FH (AllTypes)

PCP TFH PCC Res Other

% o

f ch

ildre

n/y

ou

th

# o

f ch

ildre

n/y

ou

th

# Placed within Region # Placed Outside of Region % Placed Outside of Region

Source: TWS-W058 07-07-19 (Foster Care Fact Sheet Run)

Provider readiness survey sample

• 70 providers participated

• 30 residential providers

Pregnant and Parenting Teens program(s) (n=12; 40.0%)

Independent Youth Age 18 and Older program(s) (n=15; 50.0%)

Sex Trafficking Victims programs (n=11; 36.7%)

Family-Based Substance Abuse Treatment Facility (n=7; 23.9%)

Congregate care:Implications and opportunities

Right-sizing congregate care for kids with a clinical need.

Building an effective and appropriate array of family-based placements and community supports to meet treatment needs and promote placement stability.

Preventing inappropriate increases to the juvenile justice population; inappropriate clinical diagnoses.

Expanding the business model of placement providers beyond congregate care.

Thank You!

We want Kentucky to be the Gold Standard for child welfare within the United States...

- Governor Bevin