PRESENTATION OF CCAI CHILD WELFARE REFORM STRATEGY CCAI ADVOCACY AGENDA UPDATE MEMBERSHIP WEBINAR MARCH 30 AND 31, 2015

PRESENTATION OF CCAI CHILD WELFARE REFORM STRATEGY

CCAI ADVOCACY AGENDA UPDATE

MEMBERSHIP WEBINARMARCH 30 AND 31, 2015

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Illinois Child Welfare Reform StrategyMarch 2015

The Child Care Association of Illinois proposes necessary reforms to the Illinois child welfare system.

These changes will:• Improve the safety of all youth in care,• Identify problems in programs early, for immediate correction,• Enhance treatment capacity of residential programs, • Develop the community support system needed to provide strong family connections and services for youth in DCFS

care. • CCAI calls for immediate action to improve the overall care and treatment of youth in residential treatment. We must create a child

welfare system that responds to the needs of traumatized children earlier and with fewer disruptions in caregivers. We recognize our proposals call for increased investments. However, if we truly believe that safety and quality of treatment are paramount for our Illinois wards, we must mandate such investments. The proposals also call for more careful study and development---albeit quickly---to improve the overall child welfare system.

• CCAI previously called for changes and investments in order to strengthen our child welfare system. During Senate inquiries into DCFS in the fall of 2013 and in January of 2014 our association highlighted significant challenges:

• Work force shortage of skilled staff able to provide, support and improve quality care.

• Obsolete rates that do not reflect the acuity of the children in care or the developmental needs of our work force.

• Duplicate and burdensome DCFS regulations that expend precious resources that could be better used to provide and improve care.

• This CCAI proposal builds on these concerns, which continue to plague the child welfare system, but also calls for more immediate actions.

Child Care Association of Illinois

Child Care Association of Illinois 3


Workforce Development

The most critical element to improving residential treatment is a well-trained and stable workforce. We must be able to recruit and retain the most committed and skilled staff to work with the most challenging youth in our residential treatment programs. Staff must be given the skills and support necessary and providers must be confident that a sufficient number of staff can be in place at all times to assure safety and quality treatment.

Immediate Actions:

Increase baseline salary for front-line residential workers.We propose a minimum salary of $15/hour for entry level residential workers.

Front line residential youth workers must be able to respond to the treatment needs of youth, discourage youth from questionable behavior choices, create a feeling of safety and security and document their work according to national accountability standards. We want to encourage residential staff to make a long term commitment to the challenging work of providing quality care for youth. We must encourage ongoing professional development and skills improvement. We must establish a higher entry level salary for front-line workers to attract and keep qualified and committed staff. Currently, most youth care staff entering the residential workforce are woefully underpaid-in the range of $9-11 per hour. The result is turnover rates of 25-30%. Additionally, desirable employees who hold bachelors’ degrees are often not willing to fill these jobs due to the low rate of pay. Organizations such as the Council on Accreditation that establish best practice standards require direct service youth care workers “have a bachelor’s degree or are actively pursuing a degree”.

Cost: We estimate the immediate cost of adjusting current salaries for front line staff is $14.2 million annually.

– DCFS reimbursement rates must reflect the acuity of children and youth who need residential treatment and must reflect the skills needed to achieve expected treatment and performance outcomes. DCFS must establish rates that reflect appropriate staffing levels.

– DCFS reimbursement rates must be reviewed and adjusted annually to assure they reflect the acuity of children in a program’s care and adequately resource treatment and performance outcomes.

The protection of youth is paramount. Assuring that all staff possess the assessment and intervention skills necessary to respond to the needs of youth in residential treatment is key to that protection. Staff must have access to consistent, high-quality training & skill development and given opportunities for clinical supervision to continually build skills and improve understanding of the youth and the treatment process. DCFS reimbursement rates must:

– Assure youth safety by allowing sufficient staff supervision to remediate conflict and youth elopement;– Assure that staff can be regularly trained and supervised without compromising youth care and safety;– Assure that youth care staff are able to take required breaks, vacations and can appropriately document service delivery without compromising youth care and safety

DCFS currently convenes a rate review group as part of the Child Welfare Advisory Committee, in response to CCAI’s previous legislative recommendations. We recommend the review of ratios and reimbursements must immediately be convened in tandem with that committee.

– Support professional development of all staff in the child welfare field through loan forgiveness. The Child Welfare Loan Forgiveness program, already in statute, needs to be funded to allow professionals who commit to working in child welfare the opportunity for partial forgiveness on student loans.

Additionally, we will seek to modify the language of the program so that residential youth workers who choose to advance their education will also qualify.

Cost: We estimate the initial annual cost to fund Child Welfare Loan Forgiveness is $500,000. This amount should be increased as demand increases with wider use of the program over time. We urge the General Assembly to appropriate $500,000 for FY’16 to the Child Welfare Loan Forgiveness Program and to annually review necessary amounts to respond to the demand over time.



Quality Assurance, Monitoring and Timely Analysis of Reliable Provider Performance Data

Essential to any system of monitoring and quality improvement is timely and reliable data. We must reform the DCFS licensing and monitoring system and redirect the costs so we focus on the most critical and important matters related to youth safety and quality of service delivery in residential treatment.

Immediate Actions:

DCFS should outsource its data management and analysis for residential program outcomes and the Unusual Incident Reporting system to allow timely processing and informed analysis.

DCFS must revise the Unusual Incident Reporting system to differentiate between immediate safety issues and other reportable concerns.

DCFS must work with its providers to develop specific standardized definitions for reportable incidents such as Runaways.

DCFS must provide Residential treatment programs with real-time individual, outcome and system data on Unusual Incident Report numbers by type of program.

DCFS must work with its providers through the Child Welfare Advisory Committee to develop benchmarks on all outcome metrics to use in contracting decisions.

All residential programs must develop and utilize a robust Quality Assurance plan according to minimum recognized standards.

Every plan must include a provision for youth in care to express concerns and to express ideas for improving the quality of care and treatment.

All agencies are required to train and refresh all staff on the elements of DCFS Rule 384—Behavior Management. The agency’s treatment model and applicability to Rule 384 should be part of the annual QA plan and part of regular DCFS review of the agency’s quality of care.

DCFS should mandate that each residential provider use its QA plan to regularly review its performance and use the QA results in partnership with each agency.

DCFS should develop a technical assistance team, using external experts and provider peers as available, to immediately deploy when performance records show residential programs have failed to self-correct.

Cost: Shifting of existing licensing and monitoring costs in DCFS.



DEVELOP A STRONG TREATMENT FOSTER CARE AND COMMUNITY SERVICE SYSTEM

Residential treatment should be part of healthy continuum of services available for youth in care and available to support families. Development of those connected services on the continuum is essential to assuring the residential treatment is available at the right time for youth in care but also essential to assuring youth in care achieve permanency in a timely way and are in stable placements and connected to families while in care. Children and youth with high need behaviors pose special challenges for our system. We must develop a system that intervenes and addresses behavior challenges more quickly. Earlier intervention with the behaviors frequently yields less need for residential and psychiatric placements for shorter lengths of time as the child develops.

Immediate Actions:

• The Illinois child welfare system must recognize that to provide proper care for youth with high need behaviors we must cultivate full time foster parents. We propose DCFS work with our provider agencies to develop foster care models that recognize the need for and appropriately compensate full time foster parents for youth with high need behaviors.

Cost: A full time professional foster parent per youth: $32,000 per year.

• Approximately 160 youth with high need behaviors placed in residential/shelters wait at any given time for foster care placements that can respond to their special needs or behaviors. We propose DCFS immediately work with our provider agencies to develop pilot projects that will bring new models of developing foster parent capacity to serve these youth within or near their home communities.

Cost: Implementation of pilots: $600,000

• DCFS must work with its providers to collect data, analyze and develop additional Treatment-focused foster care capacity. This must include the cost of using trauma-informed and promising practices, foster parent development models, and involvement of biological families.

Illinois must reconcile its thinking and policy decisions that imply that DCFS alone can make the reforms and improvements necessary to the community services system. Available mental health, substance abuse and youth support services have been diminished by many years of budget cuts and impact the child welfare system’s ability to obtain good outcomes for the children and family it serves. DCFS children and their families are often a second thought as Illinois plans system-of-care improvements or seeks to implement Medicaid changes.



Reclaim Foster Parent Capacity to Provide Community and Family Connections for Youth in Care and To Be Part of a Treatment Team

Illinois needs to recognize the work and commitment provided by foster parent throughout our system. A healthy pool of available and competent foster parents can help find the best placement match for children and minimize the number of disruptions for youth in care that frequently lead to the need for high end care later on. Such a pool is also needed to expedite transitions for youth from residential treatment to stable community placements.

Immediate Actions:

• Foster parent reimbursement rates must be increased each year until Illinois’ rate matches national averages. A study by the University of Maryland and National Foster Parent Association (Reaching the MARC) in 2007 showed that Illinois underfunded reimbursement levels for foster parents by 81%. Modest increases have been provided from time to time since 2007 but these fail to close the gap—even at 2006 cost of living levels. Illinois fails to fund our foster parents even at the minimum USDA levels. In 2015, the current cost of foster parent reimbursement falls 5.5% short of minimum USDA levels and 63% below the MARC study level.

DCFS has no institutionalized plan for adjusting foster parent cost of care rates each year, even though the federal government requires it.

Cost: We estimate annual cost for FY’16 to adjust foster parent rates according to recommended “Reaching the MARC” study rates to be $32 million. The FY ’16 cost to adjust to minimum USDA levels will be $2.6 million.



CHILD WELFARE SERVICE MODERNIZATION: USE DATA TO MATCH CHILD WITH PROGRAM SERVICE

Vital to assuring good care and treatment in residential treatment programs is matching the right child to the right program. Illinois should have good options for purchasing the care truly needed by its youth in care. We need to develop an Illinois system that fits the needs of youth in foster care, invests in provider agency programs willing to take risks to develop new program responses to serve high need children and builds flexible, performance-based funding models. At the same time, DCFS must take leadership in collecting the data necessary to inform providers of the current needs of its population of youth in care. We must demand that DCFS gather and use good data about the needs of its youth in care.

Immediate Actions:

• DCFS must provide regular data for its provider partners about the treatment and placement needs of high need youth and emerging trends in intake and behavioral screening. Regular data sharing will create responsive program development. At a minimum, DCFS should provide this summary data each January 1 for providers to consider as they submit their annual program plans for the next fiscal year.

• All providers must submit an annual updated description of their practice model and name the trauma-informed and promising practices they use. They must identify the type of youth that program is intended to serve. They must identify how their program responds to the needs identified by DCFS for its youth in care in its January 1 annual report.

• DCFS must develop and use a matching system that identifies the profile of youth and anticipated treatment needs and desired outcomes. Those needs should then be matched to a program designed to meet those needs. Agencies must be able to decline acceptance of youth who do not match their program.

• Youth must be able to obtain access to treatment when they need it---not after many disruptions or failed placements. DCFS must develop an Immediate Review System when any child in the system enters his third placement. The immediate review system must involve a joint quality and clinical review with DCFS and the provider agency and must clearly identify whether residential treatment is needed.



USE OF SECURE /LOCKED CARE

Illinois needs to establish sound policy about the use of secured/locked care for abused and neglected children. The policy should develop as a result of solid public debate and contributions by behavior management experts, justice advocates, child welfare agencies and youth in care. Any policy should be informed by information from other public jurisdictions and review of federal regulations and federal reimbursement rules.

Immediate Action:• We recommend a Task Force to review and make recommendations to the

General Assembly and the Governor about whether secure care should be implemented as part of the residential treatment options available to respond to certain behaviors of youth.


CCAI Advocacy AgendaSpring 2015

• Illinois’ Fiscal Condition• New Governor Mandate• FY’15 Recent Deficit “Fix” Includes 10% Across the Board Reduction• FY’16 Overall Cuts Across ALL Human Services (DHS CUTS)• DCFS Planned Cuts of $147 Translate to Elimination of All Services for 18-21

Year Olds• CCAI FACT SHEET and Appropriations Testimony• Next Phase of Messaging on DCFS Cuts• Preparing Concept of Core Services to Protect in the Event of Additional %

Cuts• Proposed Legislation in Response to Tribune Residential Series and Other

Pressures• Working with Legislators• CCAI Advocacy Day


FY’16 Cuts/Reductions• DHS CUTS/REDUCTIONS

• Discontinue day (child) care provided by relatives in the child’s or relative’s home• Increase parental co-pays for day (child) care• Freeze day (child) care intake to ages less than six• Early Intervention reduction• Discontinue Teen Parent Services

• 20% Reduction in Drug/Alcohol Services for DCFS Clients• 10% Reduction in Heroin Addiction Treatment • 20% Reduction in Global Treatment Services• Discontinue Addiction Prevention

• Discontinue Afterschool Youth Programs• Reduce Homeless Youth Services• Discontinue Homeless Prevention Services• Discontinue Community Services

• Reduce Mental Health Care Coordination• Other Adult MH Reductions• Hospital Medicaid rates are being cut.

• Discontinue Funeral/Burial

• DCFS Planned Cuts of $147 Translate to Elimination of All Services for 18-21 Year Olds


Budget Reduction Impacts• This budget prioritizes services for the youngest, most vulnerable

children in the state and protects core child protection services. • This budget continues to provide necessary support services for

infants, children and their families.• This budget maintains funding to meet the post-adoption and

subsidized guardianship obligations for over 23,400 subsidies.• The elimination of funding for young adults aged 18 and over would

effect more than 2,400 young adults on July 1st, and an estimated 3,300 over the course of the fiscal year.

• $34 million or 23% of the reduction occurs in DCFS personal services and operational expenses. Authorized headcount reduced to 2,332.

• Office consolidations are expected, caseload ratios will increase but every effort to minimize the impact will be taken.


FY16 Service Area Walk

FY16 Introduced v FY15 Appropriations

FY 2015 Appropriations (All Funds) 1,181,621,700$

Young Adult Service Reductions (98,484,200)$

Adoption Caseload Change (8,910,400)$

Grant Reductions (6,884,100)$

Grants Subtotal (114,278,700)$

DCFS Personal Services & Related (27,794,500)$

DCFS Operations (5,767,700)$

DCFS Personal Services / Ops Subtotal (33,562,200)$

Total Change (147,840,900)$

FY 2016 Introduced (All Funds) 1,033,780,800$


FY14 Young Adult Spending

FY14 Spending on Young Adults Age 18-Plus

Line Item18+ Services

FY14Age 18 Age 19 Age 20 Age 21

Age 22 and Over

IGH 73,694,997$ 25,522,502$ 23,413,520$ 23,317,109$ 1,164,206$ 277,660$ FC 20,639,735$ 9,750,318$ 6,524,175$ 4,231,474$ 99,103$ 34,666$ ILO INITIATIVE 1,527,575$ 325,629$ 530,039$ 456,882$ 130,496$ 84,530$ SCHOLARSHIP 925,303$ 138,387$ 200,576$ 236,213$ 219,061$ 131,065$ CPPM 353,280$ 101,062$ 104,812$ 82,745$ 43,827$ 20,834$ YIT 836,863$ 87,767$ 131,570$ 157,068$ 292,487$ 167,971$ COUNSELING 219,694$ 88,565$ 62,626$ 68,180$ 154$ 169$ OTHER LINES 286,788$ 138,749$ 66,579$ 70,611$ 6,630$ 4,219$ TOTAL 98,484,234$ 36,152,979$ 31,033,898$ 28,620,282$ 1,955,963$ 721,113$

Cumulative(Descending)

98,484,234$ 62,331,256$ 31,297,358$ 2,677,076$ 721,113$


Current Older Youth/Young Adult Cases

CASE COUNT AGE

PLACEMENT 17 18 19 20 21 22+Grand Total

July Impact (18+)

College/ILO/Other 150 206 246 231 169 84 1,086 936Ind / Trans Living 13 125 254 316 19 727 714Foster: Spec / Oth 231 165 107 69 4 576 345Foster: HMR 170 125 61 39 1 396 226Institution / Grp Home 179 120 41 16 4 360 181Foster: Regular 78 54 13 9 154 76Shelter 18 10 2 3 33 15Grand Total 839 805 724 683 197 84 3,332 2,493

Cumulative (descending) 3,332 2,493 1,688 964 281 84

Excludes Subsidy cases. CYCIS data as of 3/9/15.


Illinois: 18 and Out!DCFS FY’16 Budget Ejects Foster Youth from Care, College, Housing

• The 2010 U.S. Census survey reports that approximately 50% of men and 44% of women from 19 to 24 live at their family home with their parents.

• DCFS wards 18-21 don’t have that option---the State of Illinois is their parent.

• That’s why Illinois developed a program that cares for youth age 18-21 that has served as a national model.

• Illinois serves as the parent of DCFS 2,400 wards, 18-21, but the FY’16 budget expects something different for its wards than is expected from other children: complete self-reliance at 18.

• DCFS’ FY’16 budget cuts $147 million primarily by eliminating care, services and housing support for 2,400 Illinois wards, age 18-21.


Illinois: 18 and Out!

• Under Governor Rauner’s proposed budget, DCFS wards who will lose their home and support services are:– Teenagers in foster care– Teenager in high school– Teenagers in residential treatment– DCFS wards attending college– Young people needing placement and support services who have

with severe mental health needs– 500 DCFS wards who are parents of their own young children

• Seventeen year olds who are still in high school can expect to be cut from care when they turn 18 – even if they are still enrolled in school.


Illinois: 18 and Out!• Assuring foster children remain under the protection of the State until

21, when needed, generates benefits for both the children and the state: – Increased likelihood of obtaining post-secondary education– Increased lifetime earnings– Delayed pregnancy– Increased father involvement with their children– Delayed homelessness

• Governor Rauner’s proposed budget walks away from our responsibility as a state for DCFS wards

• Since FY’10, the DCFS budget has been cut $168 million by the legislature.

• The DCFS FY’16 budget should be held harmless and exempt from further budget cuts.


Preparing Concept of Core Services to Protect in the Event of

Additional % Cuts


Child Welfare/Residential Treatment/Shelter Bills Introduced in 99th General Assembly

• SB 13 DCFS shall revoke/refuse renewal of agency licensed if agency fails to report suspected child abuse/neglect within the facility.

• SB 1385 DCFS to create a 5 year pilot for multi-dimensional treatment foster care.

• SB 1749 Child Welfare Loan Forgiveness—CCAI Initiative—SEE FACT SHEET• SB 1750 Creates a Workgroup to make recommendations of DCFS’ monitoring

of children in facilities. • SB 1751 Creates a multi-disciplinary Workgroup to review treatment programs

for DCFS youth involved in Sex trafficking. Review Secure Care laws and regulations.

• SB 1762 Convene a multi-disciplinary workgroup to improve investigations of child abuse/neglect in Facilities.

• SB 1763 Expands legal definition of abused/neglected child to include those abused in facilities or neglected through facility environments injurious

to the child. DCFS must develop rules regarding investigations of abuse/neglect in facilities.



• SB 1867 Increases legal penalties for soliciting sexual act from a resident of a facility. Increases legal penalties for patronizing/promoting juvenile prostitutes within 1000 feet of a facility.

• SB 1950 Requires extra court reviews when a child is in a shelter for longer than 30 days, in a psych hospital post medical necessity, in detention because of lack of placement, in any type of living arrangement more than 30 days if in need of a different type of placement or in a facility with a corrective action plan.

• SR 140 Mandates the Auditor General to conduct a performance audit of DCFS regarding child is in a shelter for longer than 30 days, in a psych hospital past medical necessity or in detention because of lack of placement, in any type of living arrangement more than 30 days.

• HB 1530 No shelter program shall permit children under 18 to leave unless accompanied by a responsible adult or authorized to leave for a particular purpose. Amended to exclude use of secure care. Amended to include best practices for shelter placement and reporting of kids who leave.



• HB 3172 DCFS must place in each residential treatment center that accepts wards of the Department a locked suggestion box that only DCFS employees shall open weekly.

• HB 3684 Foster Children's Bill of Rights Act.• HB 3950 DCFS to purchase foreclosed homes to create housing to

attract new foster care placements• HB 4037 DCFS will order immediate closure of a facility when

continued operation jeopardizes the health, safety, morals, or welfare of children, or upon the death of a minor unless the death was medically anticipated or DCFS determines the facility did not violate any rule related to the death.

• SB 1775 Safeguard our Children Act. Specifies reporting requirements when child is missing from a from a residential facility. Requires DCFS to develop a standard alert to enter missing child information on the LEADS system.


Working with Legislators


CHILD CARE ASSOCIATION OF ILLINOIS

2015 CHILD WELFARE ADVOCACY DAY

WEDNESDAY APRIL 29, 2015

SPRINGFIELD ILLINOIS

8:30 a.m. -3:00 p.m.

Detailed morning agenda will soon follow. Meeting with your individual legislators is a key part of the day. Try to book an appointment in advance or let them know you are coming with a group and will call them off the floor if they are in session when you arrive.

Join your CCAI colleagues in Springfield to:· Learn the Latest on the FY’16 Budget Negotiations· Discuss Legislative Proposals for Child Welfare Reform—status of bills· Call Upon Your Elected Officials While They Are At Work in the Capitol

Who Should Come?

Executive Directors, Agency Leadership Team Members, Older Youth in Care, Board Members, Foster Parents

Organize Your Team and Sign Up TodayOne Flat Registration Fee Per Agency $75

AGENCY NAME ________________________________________

Number of People Planning to Participate_______________________

Contact Information (Team Leader, Cell Phone and E-Mail_____________________________________________________________________

We urge you to make any hotel reservations for the nights of April 28 or 29 as soon as possible if you plan to stay in Springfield. This is a popular week for groups and events so hotels are becoming limited.

Documents

PRESENTATION OF CCAI CHILD WELFARE REFORM STRATEGY CCAI ADVOCACY AGENDA UPDATE MEMBERSHIP WEBINAR MARCH 30 AND 31, 2015