2013 Kandiyohi County Health and Human Services Annual Report

Transcription

1 Kandiyohi County Health and Human Services Annual Report Fiscal Year 2013

2 2013 in Review Board Members, Community Partners, Agency Staff and Members of our Community, It is a privilege to present you with the 2013 Annual Report for Kandiyohi County Health and Human Services. Our Management Team has worked hard to revise our format and create a document that is both informative and easy to understand. The report is divided into sections based on the type of services provided and each section describes the county s role, some 2013 highlights, identifies trends and offers some statistical information regarding the services. I would encourage you to explore the Appendix for additional statistical data and to look further at trends in specific areas was a transition year and also a year of new beginnings. January 1, 2013 marked the beginning of a new relationship with Renville County for public health services. The Kandiyohi-Renville Community Health Board was formed after several years of planning. During 2013, we prepared to fully integrate our Environmental Health Program, applied for and received a SHIP (Statewide Health Improvement Program) Planning grant with the Minnesota Department of Health and have been working on a joint Community Health Assessment that is required every 5 years. Our agencies are not fully integrated, but are looking at every opportunity and change that arises in public health to evaluate if it is something that should be explored at the Community Health Board level or something that is unique to one community. Kandiyohi County continued our work related to our Phase II planning, which involved the county departments located in the Health and Human Services Building. Family Services and Public Health currently had shared leadership in the Director position and work was underway to establish higher level working relationships between Community Corrections, Veteran s Services, Family Services and Public Health Departments. October 1, 2013 we began referring to our department as Kandiyohi County Health and Human Services with January 1, 2014 marking the official full implantation of the merger. CHANGE would be the main word I would use to describe our world in We experienced internal and external restructuring as well as major program and process changes throughout the course of the year. The launch of MNSure, changes in rules and payment systems in home and

3 community based services, new performance requirements and changes in our community have resulted in an increased workload in most areas of the department. Sometimes this increase is reflected in our statistical numbers, but sometimes it is invisible on the surface and only understood if you look deeper into the program area. Increased or changed requirements for documentation, plans and reports, new computer systems that don t interact with the old ones requiring staff to work in multiple systems with duplicate data entry all contribute to the stress of working in county government. We had limited ability to impact these changes as most of them were directed through our state agencies and legislation. Our employees are our most valuable resource. As you can see if you review our report, they provide critical services for our Kandiyohi County community and our most vulnerable populations. The knowledge and expertise needed to be able to navigate our complex system sometimes takes years to acquire. I am amazed by their dedication, service, and commitment to quality. I hope you will take some time to review our report and thank a county Health and Human Services employee. Please contact me if you have any questions about this report at ext or ann_s@co.kandiyohi.mn.us. Best wishes for a happy and healthy 2014! Sincerely, Ann Stehn Health and Human Services Director,

4 Kandiyohi County Health and Human Services Annual Report Fiscal Year 2013 Table of Contents Mission Statement and Guiding Principles Role of Government and Our Partners Chemical Dependency Children s Mental Health Adult Mental Health Vulnerable Adult/Adult Protection Home and Community Based Services Child Welfare Child Protection Human Services Intake Child Protection Assessment Licensing Family Child Care Family Child Foster Care Traditional Adult Foster Care / Corporate Foster Care for Adults and Children Child Support Services Income Maintenance Public Health Assure an Adequate Local Public Health Infrastructure Community Health Board Future Public Health Workforce Promote Healthy Communities / Healthy Behaviors Family Health/Health Promotion Family Home Visiting SHIP WIC Follow Along Program Child and Teen Checkups Drug Free Communities Coalition for Healthy Adolescent Sexuality Prevent the Spread of Infectious Disease Immunizations Disease Investigation Refugee Health Protect Against Environmental Health Hazards Food, Beverage and Lodging Program Tobacco Program Public Health Nuisances Environmental Health Programming

5 Appendix Prepare For and Respond to Disasters and Assist Communities in Recovery Assure the Quality and Accessibility of Health Services Birth Defects Information System Care Coordination Personal Care Assistant Correctional Health Fiscal Services Human Services Public Health Kandiyohi County Board of Commissioners Human Services Committee Kandiyohi County Board of Health Kandiyohi-Renville Community Health Board Kandiyohi-Renville Community Health Board Advisory Committee Staff Listing Statistical Information Kandiyohi County Health and Human Services Kandiyohi County Health and Human Services Building rd Street Northeast Willmar, Minnesota

6 Kandiyohi County Health and Human Services Mission Statement Working in partnership with our community to promote the health and safety of the residents of Kandiyohi County in a caring, professional, and fiscally responsible manner Our Guiding Principles Respect & honor individual potential Promote preventative and early intervention services Protect the public through utilization of evidence based practices Provide quality service and education Role of Government Provide critical services in our local community that assist people in need and provide a safety net for our most vulnerable citizens. Kandiyohi Health and Human Services will: Protect vulnerable populations Expend public fund and be accountable to funders (taxpayers) Provide infrastructure and oversight of the private sector expending public funds. Our Partners Individuals and families who are in need, health care providers, schools, community agencies, charitable organizations, federal, state, county and city government and other individuals, businesses and agencies both in and outside of our local community.

7 Chemical Dependency Adults and children who are unable to manage their use of chemicals lose control of their lives. Chemical dependency is an addiction that impacts an individual s ability to be successful in all aspects of his or her life. Families can be devastated by the chemical use of a member. Why is this important? Individuals with untreated chemical dependency may lose their employment, deplete their financial resources, and even engage in criminal behavior to support their habit. Without assistance, many families are not able to intervene in the cycle of self-destruction caused by uncontrolled chemical use. Timely and appropriate intervention can prevent loss of jobs, housing, family support and possible incarceration. What is the county s role? The chemical dependency program manages the consolidated fund to provide treatment for income eligible individuals. Staff provides chemical dependency assessments, referrals to the appropriate treatment resources, and follow-up community integration services. The goal of the program is for individuals to successfully manage their chemical use so that it does not interfere with community living. MN Statue 254B and Rule 24/Rule 25 governs the county s role in completing Chemical Use Assessments and Chemical use treatment for persons who meet income guidelines. The request for the Chemical Use Assessment and treatment may involve a court action in which the assessment and treatment is court ordered or may involve a person voluntarily seeking a Chemical Use Assessment and treatment funding if eligible. Trends In the last few years, we have seen a decrease in the number of chemical assessments being requested. At the same time, we are seeing a steady number of individuals being referred to nonresidential services and an increase in the number of individuals being referred to residential treatment. With the increase in the number of persons going to residential treatment we are seeing an increase in the amount of case management services needed. There has also been a decrease in the last three years in the number of Detoxification admits. Though decreasing Detoxification services continues to place a high demand on the county funding. There are requests from the county level for legislators to address the cost of Detox. Detoxification has been addressed to be an acute medical need and payment for that needs to be considered. The area of Chemical Health, particularly in the area of Chemical Use Assessments and the county s role in completing them, are a topic of discussion at the State level. The State has entered into pilot projects, with a few counties, that is allowing for Chemical Use Assessments to be completed by Chemical Use Treatment providers. The funding of Rule 24/25 remains with the counties. The hope of this project is to assess the efficiency of the provider s ability to move people more quickly into a treatment program as determined by the assessment. One of the components of the projects is to implement a Care Coordinator whom would follow the person through treatment and beyond for an extended period of time. When established, this ongoing relationship will allow for supporting people in maintaining chemical free lifestyles and not be in and out of treatment. We will be keeping a close eye on what is happening with these projects and how they may affect Chemical Health services in Kandiyohi County.

8 We have seen an increase in the number of civil commitments being needed to address chemical use. Frequently these commitments are involving Mental Health as well at a Glance Requests for Rule 25 Chemical Use Assessments Individuals referred to non-residential treatment Individuals referred to residential treatment Detoxification Admits

9 Children s Mental Health When children suffer with severe emotional disturbance, their needs often overwhelm their parents. In these circumstances, families need assistance finding resources and developing support systems so that the children can grow and develop to their full capacity in their own homes. Why is this important? Children s who s mental health needs are not met in a timely manner are more likely to experience social isolation, school failure, and delinquent behavior. Families who do not have adequate resources are not able to provide the parental and emotional support to their children. Timely and appropriate intervention can prevent the need for more intrusive and costly options at a later date. What is the county s role? As the local mental health authority, the county is responsible for developing a network of services for children. The children s mental health program provides supports and services to children with several emotional disturbances and their families. The goal of the program is to assist chidlren with severe mental health issue to thrive in their home communities. Children qualify for Children s Mental Health services according the MN Children s Mental Health Act. The child needs to have a diagnosis that meets the definition of Severe Emotional Disturbance in order to be eligible for Children s Mental Health services. This diagnosis needs to be determined by a Mental Health professional. Trends We have had a significant increase, in 2013, in the number of children whom have received case management services. Though consistent numbers are being maintained in services children and families are being referred to. We believe that these numbers reflect that we have been able to work through challenges with some children and families and been able to successfully close those cases. However also included in those numbers are cases in which the families chose not to follow through. School Link Mental Health did receive funding in the 2013 legislative session and mental health providers and schools within our county are continuing and increasing the services they are able to offer. Earlier in 2013, we began to identify a group of middle school age children on our children s mental health caseloads as well as hearing from our partners (schools, law enforcement and mental health providers) that they were having contacts with these same children. A Task Force was developed with school, law enforcement, mental health providers, county Attorney s office and other service providers. The goal was to identify the similarities of these children and identify relationships that we could build with the parents and children to attempt to address identified needs as early as possible. We have found some success in developing the group as it relates to the children and families as well as it relates to our understanding each other s work and how we can collectively make attempts to improve the challenges of these children and their families. Though our case management services, parents identify their needs and struggles of parenting a child with severe emotional illness as well as working with the youth to build skills in identifying their struggles and moving to areas of recovery and steps to help maintain their health.

10 Transitioning youth into adulthood continues to present challenges but we have had successes in a couple of cases in which the youth has been able to move out on their own following high school and are maintaining within the community at a Glance Children who received Case Management Children s Day Treatment Program Family Community Support Services Program Mental Health Services - Children Children s Partial Hospital Case Closed Current Caseload

11 Adult Mental Health Individuals with severe and persistent mental illness are at high risk of being unemployed and becoming homeless. These added challenges increase the stress level and often contribute to a cycle of increasing symptoms and decreasing coping behaviors. Adults with mental disease may need assistance finding appropriate medical treatment and support services to help manage their illness. Why is this important? Early intervention to assist adults with mental illness will allow them to maintain or regain employment and retain housing with the appropriate level of support. The financial cost of unemployment, homelessness and medical care far exceeds the cost of preventative support services. The emotional cost to individuals and their families is devastating. What is the county s role? As the local mental health authority, the county is responsible for developing a network of services for adults. The adult mental health program provides service to support Kandiyohi County adults who suffer from serious mental illness. The goal of the unit is to assist adults with mental illness manage their diease and be successful living in the community. MN Statue identifies the requirements for eligibility for Rule 79 case management services. The person needs to be diagnosed by a mental health professional with a diagnoses of serious and persistent mental illness. The case managers are required to complete a functional assessment with the consumer so as to identify mental health needs and assist the consumer in developing goals so as to move toward recovery and maintain positive mental health. Trends We have seen a decrease in the number of civil commitments from 2012 to We have however seen an increase in the number of revocations. This has not been something that we have tracked but we have found in 2013 that even though our number of commitments has decreased we are finding more need to revoke a person provisional discharge. We are tending to believe that the reason for the increase in the revocations is due to the clients not been able to establish a consistent level of health and behaviors before needing to be discharged from facilities. We will need to continue to work close with our partners and stakeholders to continue to assure safe and positive outcomes to the services we are able to provide. Kandiyohi County Court Process Stakeholders group met with Department of Human Services personal as well as with State legislators to discuss the successes and challenges of the Adult Mental Health System. Out of these meetings we developed a document that addresses what are changes that have occurred in the Adult Mental Health System since the closure of the Regional Treatment Center. The document lays out the successes and the challenges involved. It identifies what we believe is still work to be done. This document was made available to our partners, commissioners, Department of Human Services as well as state legislators. The state continues to struggle with the need for appropriate and consistent treatment and ongoing services for adult with mental health. We continue to have strong partnership with Community Corrections, Law Enforcement, and County Attorney office through our work with the Mental Health Consultation team, Court process team, and Crisis Response team. Waiver services continue to provide a funding source for services for our mental health consumers. These waiver services add another layer of work for our case managers.

12 2013 at a Glance 187 Case Management Clients Clients who received case management services Pre-petition Screening Reports (Commitments) for mental illness or chemical dependency Partial Hospital Program (all persons served) Community Support Services Assertive Community Treatment Mental Health Services - Adult Rule Day Treatment

13 Vulnerable Adult/ Adult Protection Adults with disabilities or the elderly who are isolated are particularly vulnerable when caretakes or family members take advantage of their limitations. In these circumstances, it is the role of government to assess their vulnerability and develop a pla for their protection. Why is this important? Abuse, neglect or financial exploitation of the elderly or disabled who do not have the resources to protect themselves is not acceptable. Intervention to protect the health and welfare as well as the resources of these citizens will allow them to continue living in the community at the highest level of independence and self-sufficiency. What is the county s role? The adult services program investigaes allegations of abuse, neglect and exploitation of elderly or disabled individuals and provides protective services when needed. In addition, the program assesses care needs for the elderly and disabled in the community and coordinates services to prevent nursing home placements. The goal of the program is that vulnerable adults wil live in safe environments. Adult Protection services are services to identify and prevent maltreatment of vulnerable adults. Maltreatment will follow under the areas of Abuse-physical, emotional and sexual; care giver or self-neglect and financial exploitation. The county is the Common Entry Point for Vulnerable Adult reports in Kandiyohi County. Once the report is received that agency determines what Agency is responsible for screening determination and investigation of the report. The possible agencies are the Minnesota Department of Human Services, the Minnesota Department of Health and Kandiyohi County Health and Human Services. We have completed a variety of organized family meetings with family members of the Vulnerable Adult. We have found these to be an effective way for family to accept that their loved one is in a vulnerable situation and what their role maybe in helping to address the needs. We continue to use the mandated Structured Decision Making tools to assist in our work with investigating Vulnerable Adult reports. This continues to not be in SSIS and is a web based tool which requires our workers to work in two systems. We have found the tool to be helpful in acknowledging our screening decisions. Trends The number of reports that were addressed has decreased; the number of allegations within those reports has increased. The cases are becoming more involved thus leading to more allegations. The number of financial exploitation allegations has risen from 17 in 2012 to 27 in Self-neglect allegations rose from 8 in 2012 to 29 in The number of Common Entry Reports made and those requiring referral to the Office of Health Facility Complaints continue to increase. The rise in these reports and referrals are thought to be due to the increased requirements on a particular provider regarding requirement of reporting.

14 2013 at a Glance Common Entry Point Intakes Total reports sent to Department of Human Services Total reports sent to Office of Health Facility Complaints Total reports addressed by Kandiyohi County Family Services Total reports Allegation Substantiated Inconclusive False Not Adult Maltreatment Not Vulnerable Adult Investigation Not possible Pending Total Abuse emotional Abuse mental Abuse physical Abuse sexual Financial exploitation fiduciary relationship Financial exploitation Not fiduciary relationship Involuntary servitude Neglect Caregiver Neglect Self Totals:

15 Home and Community Based Services To promote voluntary Home and Community Based Services that prevent or shorten institutional stays or improve the quality of life in community based living settings for elder and disabled persons. Why is this important? Elderly and disabled persons in our community want to be full participants in our society. Home and Community Based Services (HCBS) are designed to assist the disabled and elderly, in a personcentered approach, to be as independent as possible in the community. The participation of the elderly and disabled in our community adds diversity, resourcefulness, and creative energy to our society which contributes to the quality of life for all residents of Kandiyohi County. What is the county s role? Developmental Disabilities The Kandiyohi County Board under Minnesota Statute 256B.092, is required to provide Rule 185 case management services to individuals who meet the eligibility criteria in Minnesota Rule to , otherwise known as Rule 185. Rule 185 Case Managers are social workers who provide on-going planning services to persons with Developmental Disabilities or Related Conditions. Approximately 216 recipients are served under these programs annually. Some of the services and supports available are: Semi-Independent Living Services (SILS) Family Support Grant (FSG) Developmental Disabilities Waiver (DD) Intermediate Care Facility for Developmental Disabilities (ICF-DD) Developmental Disabilities Targeted Case Management (DD/VA TCM) Physically disabled under the age of 65 The Kandiyohi County Board delivers state administered home and community based waivers for the physically disabled consumers under Federal 1915(c) waiver, a provision of the Social Security Act that allow States to receive Federal financial participation in the cost of services that are an alternative to institutional. The Department of Human Services (DHS) changed the Pre- Admission Screenings process effective November 1, Historically, medical professionals contacted Kandiyohi County to approve admissions to nursing facilities. Kandiyohi County completed 321 preadmission screenings in 10 months during 2014, a record number. The new process for nursing home admission approval is completed electronically by the Medical Professional and submitted to the Senior Linkage Line staff or Blue Cross Blues Shield for managed care members for approval. The Senior Linkage Line or Blue Cross Blue Shield can request a Long Term Care Consultation to be completed by Kandiyohi County if the referred consumer doesn t meet nursing home level of care or is requesting community based services rather than nursing home placement. DHS discontinued lead county contracts for HCBS as of December 31, Providers interested in becoming an approved waiver service provider must enroll directly with the DHS s Minnesota Health Care Provider Enrollment.

16 Approximately 260 recipients are served under these programs annually. Some of the services and supports available are: Community Alternative for Disabled Adults (CADI) Brain Injury Waiver (BI) Relocation Service Coordination (RSC-TCM) Elder Services for persons over the age of 65 The Kandiyohi County Board also delivers the Elderly Waiver for persons not enrolled in a manage care product and over the age 65, which is State administered home and community based waiver under the Federal 1915(c) waiver. Approximately 37 recipients are served under this program annually. In addition, the Alternative Care Program modeled after the Elderly Waiver Program but funded 100% by the State of Minnesota for person that would be eligible for Medical Assistance within 135 days of entering a nursing facility. Approximately 20 recipients are served under these programs annually. Kandiyohi County entered into a contract with Blue Cross Blue Shield in 2005 to provide care coordination services for Kandiyohi County residents that were enrolled in the Minnesota Senior Care Plus and Minnesota Senior Health Options products. Approximately 300 members are served under this program annually. Long Term Care Consultations: Long Term Care Consultations provides an assessment of the health, psychological, and social needs/strengths of the individual. The consultation determines a person risk of nursing home placement and eligibility of the Elderly Waiver, Alternative Care, and Community Alternative for the Disabled and Brain Injury Wavier.

17 In 2013, a total of 480 consultation were completed; 159 consultation were face to face and 321 telephone consultations were completed for nursing home placement. Trends 600 Long Term Care Consultations over the past six years Number of Constulations The number of seniors on Medical Assistance turning 65 in Kandiyohi County continues to increase annually. Every senior on Medical Assistance is enrolled in MSC+ or MSHO after their 65th birthday and then assigned a care coordinator by their managed care provider. Kandiyohi County: Population by Age Group, Age Group Population Population Change 0 to 4 years 2,572 2, % 5 to 14 years 6,256 5, % 15 to 24 years 6,046 5, % 25 to 34 years 4,677 4, % 35 to 44 years 6,230 4, % 45 to 54 years 5,629 6, % 55 to 64 years 3,640 5, % 65 years & over 6,153 6, % Total Population 41,203 42, % Source: U.S. Census Bureau - most current information available The Department of Human services is assuming more the administrative functions related to the Waiver Programs such as provider enrollment/contracting and service rate setting.

18 Child Welfare Children who become parents before age eighteen and children who develop patterns of truancy from school are at high risk of failing to complete their high school careers. These children need additional support services to encourage them to gain the skills necessary for future self-support. Why is this important? Individuals who do not complete high school have a dramatically reduced future earning capacity and may not be able to be fully selfsupporting. A significant percentage of high school dropouts become involved in criminal behavior. Children of minor parents who do not complete high school are at higher risk of abuse, neglect, and school failure. Providing the support necessary to finish their education can allow these youth to participate more fully in a successful transition to adulthood. What is the county s role? Both the minor parent and truancy programs are designed to assist adolescents to remain successfully in a school setting. The goal of both programs is successful completion of school. Last summer Kandiyohi County Health and Human Services was the recipient of another grant for a Summer Girls Group. The 2013 theme was Service Learning, using the acronym of RAK Group (Random Acts of Kindness). It was probably our most successful, well-attended group in our history. The West Central Tribune wrote a comprehensive article about it and State Representative Mary Swatsky recognized the group members with personal letters. In 2013, Kandiyohi County Health and Human collaborated with various agencies within the community allowing the young pregnant or parenting mothers to do job shadowing and work at local nursing homes and daycares. Trends Truancy An increase in referral numbers are the result of the law changing regarding the school drop-out age. We are now receiving more referrals for truant 16 and 17 year old students. In August, six clients attended to Bridges out of Poverty Workshop and six clients attended the Teen Job Forum (and received school credit for attending). In September, 17 pregnant or parenting mothers toured the Rice Memorial Hospital Emergency Room with education on the differences between emergency room service and urgent care services.

19 Another reason for the increase in referrals is the result of schools revising the attendance policies regarding excessive illness days; with the requirement for doctor s notes after a certain number of days missed due to illness. We are also seeing an increase in the amount of students who are choosing to enroll in online learning. It works well for some but not very well for others. It s difficult to monitor as school attendance is tied to work completion instead of being at a school. It requires some oversight by a parent which sometimes is not available for the student at a Glance Kandiyohi County Continues to offer Child Welfare Services to Families who need assistance in parenting their child. Some of the issues include: on-going truancy, delinquent, runaway, or chemical abuse behaviors. This agency opened 42 of these types of cases which is down 19 from The reason could be due to the recent Parent Support Outreach Program grant and service as explained later in this report. Truancy 226 truancy referrals were received in 2013: 128 were students 12 and older 98 were 11 and younger 9 met the threshold for Child Protection based on Educational Neglect Truancy Referrals 144: 61 were under age were under age were under age were under age were under age were under age 12 Minor parent: 30 referrals were received in 2013 for pregnant or parenting young mothers. This is 13 less than in 2012 due to client s ageing out of the program, moving or completing their education plan Clients Minor parents who received case management services

20 Child Protection One of the most imporant quality measures for a county is how it cares for its children. Especially those whose parents have failed to meet basic safety needs. While there are a number factors that influence the occurance of maltreatment, there is no acceptable rate of child abuse and neglect. Why is this important? The death of a child from abuse or neglect is never acceptable. When maltreatment has been established, the county is charged with the responsibility to rehabilitate families and assure the safety of children. Failure to fulfill this responsibility has long term and permanent consequences for children and impacts the future of all citizens. What is the county s role? All reports of maltreatment are received and screened according to statutory guidelines. If the reports are not accepted for assessment or investigation, the caller is given information on other community resources. Accepted reports are either provided with a family assessment and services if needed, or a child protection investigation and services. Trends Parent's abusing chemicals and dealing with significant mental health issues continue to be predominant themes in the families presenting through the Child Protection System. The issues are persistent and require extensive resources. Many of the adolescents we serve that are habitual truant, runaways, or committing delinquent acts present with similar issues as the adults, requiring intensive interventions. In looking at the appendix (Table: Court Petitions filed in 2013), one can see that this agency has a high volume of court involved cases along with a high number of out of home placements. We continue to research and implement evidenced based models which not only include the above mentioned, but also Intensive Family Based Services. This service utilizes a therapist in providing diagnostic and therapeutic services in the home in order to either avoid an imminent placement or expedite the return of a child that has been placed.. Kandiyohi County has been utilizing Restorative Practices such as Family Group Decision Making, Court Settlement Conferences, Signs of Safety Practice and now the Crossover Youth Program. Each of these practices has a goal of utilizing least restrictive interventions while incorporating family resources into setting goals and case planning. Family Group Decision Making has been utilized in this county since This year, we have partnered with neighboring counties along with PACT for Families Collaborative in obtaining a grant which allows us to increase and broaden the use of these services. Agency staff members continue to utilize their Signs of Safety skills and, more recently, the Crossover Youth Practice Model. A crossover youth is defined as a youth who is currently involved with Kandiyohi County Health and Human Services and then commits a delinquent act which requires further juvenile justice intervention. The Agencies involved collaborate in order to reduce the likelihood of further criminal involvement and the need for out of home placement.

21 Our initial findings would support that continued use of this service will prevent placements and provide for better outcomes for families at a Glance 2013 Child Protective Services Type Initial Opened Closed Remaining Adults in Remaining Children in Remaining Assessment Case Management Child Welfare (General) Type Initial Opened Closed Remaining Adults in Remaining Children in Remaining Assessment Case Management TOTALS Contracted Service Interventions LSS Youth Programs: 26 youth that were eligible and served 10 homeless youth with disabilities and 11 minor children along with them, 4 homeless youth assisted to obtain and maintain housing in our transitional housing program along with 2 infants Street Outreach Program basic needs to 26 Kandiyohi County youth 32 minor parents attending Community Teen Moms Family Based Services: Family Based Services: 120 Families $264, Intensive Family Based: 16 Families $42, Family Group Decision Making Conferences 6 Families $1, Out of Home Placements See charts in appendix Adoption Adoption recruitment and service is provided by KCHHS for our state ward children in this county. This refers to a foster child in the custody of the Commissioner of Human Services as awarded by the court. In 2013, there were 14 children adopted and at the end of the year, there were 17 more waiting to be adopted.

22 Human Services Intake Intake social workers take phone calls and meet with people who walk into the agency seeking help to address struggles in their lives or the lives of family members or want to report a concern about children or vulnerable adults who they believe are being abused or neglected or at risk of harm. There is one primary intake person and one back up intake person scheduled for this service during business hours so when someone calls or come in they will always be able to be connected with someone that can help them within a very short time. Why is this important? For those who are requesting help the intake worker discusses resources that are in the community that might be helpful to them and when appropriate helps make a connection to those resources. Intake social workers help individuals sort out what kind of help it is that they are looking for and what might be the best resource for them. Having someone available to talk to whenever they call the agency leads to positive customer service. It is the public policy of this state is to protect children and vulnerable adults whose health or welfare may be jeopardized through physical abuse, neglect, or sexual abuse. Concerned individuals calling in reports of possible abuse or neglect allow our Agency to intervene and to assess risk and work towards greater safety. What is the county s role? Sometimes services through Kandiyohi County Health and Human Services would be the most appropriate and the intake worker helps them complete an application for services and get it promptly to the appropriate supervisor. For child protection or vulnerable adult reports, the intake worker meets daily with the screening team to process and make screening decisions on whether an assessment is warranted. When there is identifying information all intakes are to be recorded in the Social Services Information System (SSIS). We do receive several calls that involve researching, providing options for resources and listening to concerns where the caller does not provide identifying information. These calls would not be included in the numbers listed in SSIS. Intakes are retained according to the appropriate retention schedule. The 2013 Minnesota Legislature appropriated funds for statewide expansion of the Parent Support Outreach Program (PSOP) beginning July 1, Kandiyohi County had been offering PSOP services since 2012 through a grant. PSOP is an early intervention program designed to provide services to families that are screened out of the child protection system and who had at least one child age under the age of 10. Funding for the program is used for case management, basic needs and/or professional services. Kandiyohi County Health and Human Services partners with Heartland Community Action to provide the case management. This has been a very positive partnership with staff from Heartland able to access many in kind supports for the families as well as provide the case management to address parenting, housing, budgeting and other needs. Participation is voluntary.

23 2013 at a Glance Intake Reports ,432 Year ,991 2,700 2,800 2,900 3,000 3,100 3,200 3,300 3,400 3,500 Number of Reports Taken The total number of reports taken by Intake staff includes reports made regarding adult maltreatment child maltreatment requests for Child Protection case management transfer Information and Referral calls related to licensing requests for voluntary services such as Adult or Children s Mental Health Services or Child Welfare In 2013, there was significant growth in the Parents Support Outreach Program and the outcomes of this program will be followed. At this time, it appears that at least 75% of those served through PSOP have NOT re-entered the system through child protection Number of Families

24 Child Protection Assessment All reports of possible maltreatment of children are cross reported to our agency and the appropriate law enforcement agency. When the reported concerns meet the criteria provided by statute that constitutes maltreatment our agency opens an assessment if the alleged maltreatment is being inflicted by a caregiver and the family lives in Kandiyohi County. In addition to the statute, MN Statute Reporting of Maltreatment of Minors, workers refer to MN Child Maltreatment Screening Guidelines found at Maltreatment can involve physical abuse, sexual abuse, emotional abuse or various types of neglect. Once a report is accepted for assessment it must be responded to by a Family Assessment or a Traditional Investigation. The Family Assessment Response is the preferred response to use whenever possible. Reports of substantial child endangerment, sexual abuse, and maltreatment in facilities are examples of reports that would not be able to be addressed through the Family Assessment process and, in those cases; a Traditional Child Protection Investigation would be opened. The goal of both approaches is to help families to achieve child safety. Trends The complexity of cases continues to be a challenge. The graph on the following page depicts the number of allegations that have been reported to our agency over the past several years. A report about abuse is often accompanied by drug use that impacts the ability to supervise children or to provide for their basic needs/safety. The increase in the number of neglect cases seems to have a direct correlation to the problem of caregivers who are actively using drugs such as marijuana, cocaine and methamphetamines. In 2013 we had several young children that tested positive to drugs in their system due to ingesting the drugs themselves. In 2013, our agency partnered with Woodland Centers to develop a service that provides Intensive Family Based mental health services to a family.. This program provides us with a licensed (or licensed eligible) therapist that offers direct service in the home to families where children have been removed from their care, usually related to a crisis or emergency situation, or where children are at imminent risk of placement. The Intensive Family Based staff is able to start early in a case and meet with the family several times a week. This has been helpful in engaging parents and their supports to address safety concerns right away so we can bring children home sooner or prevent the out of home placement completely. Workers in assessment are using skills of engagement, completing a thorough assessment of the situation, exploration of resources for the family, strength based practice and Signs of Safety practices to assess immediate safety as well as to work with the family for future safety. When appropriate, assessment staff works closely with law enforcement and the county attorney s office. When there is a need for children to be placed out of the home workers explore any family member that might be an appropriate and safe resource for the children.

25 2013 at a Glance Type of Allegations Assessed by Family Assessment Number of allegations assessed is up 67% since 2007 and up 76% since 2009.

26 Licensing At the county level we are responsible for licensing Family Child Care, Family Child Foster Care, Corporate Child and Adult Foster Care as well as Family Adult Foster Care. Family Child Care Why is this important? Minnesota has among the highest percent of families with both parents empoyed and employed single parents. This means that safe, quality child care is critical to maintaining the required workforce. Counties in Minnesota are responsible for implementation of the federal Temporary Assistance to Needy Families (TANF) program that requires all recipients of public assistance to obtain employment. Without sufficient child care, the county cannot meet its mandate for this program. The quality of child care provided to pre-school children has a positive impact on school readiness. A parent s ability to financially support his or her family is heavily influence by their ability to obtain affordable child care. What is the county s role? Family Services is responsible for the licensing and monitoring of family child care home. The child care licensing program completes state licensing recommendations, monitors compliance with state regulations, and provides resources for training to providers to enhance development of children. Child Care providers need to follow through with the state regulations (Minnesota Rules to ) for licensure. These rules set limits on the number and ages of children allowed in care, set safety standards regarding the physical environment, sanitation and health, water, food, and nutrition. There are guidelines and limits regarding behavior guidance and activities and equipment. There are regulations of the care giver qualifications and training needs as well as forms needed for each child. Public information is available on child care homes. This public information consists of whether a person is licensed or not, whether there was any negative action on a license, any variances that the care giver is operating with, the nature and outcomes of any complaints, and correction orders that have been issued on a licensed home.. Kandiyohi County is always looking for people interested in being licensed foster care providers. Foster parents might be needed in an emergency situation, for a short term while families work on struggles or they might end up being a forever home for children. Foster parents often support birth parents when the children are able to transition home or they might provide respite care for short periods of time to support other foster parents or birth parents. If you, or someone you know, is interested in more information about being a foster parent please contact our agency and ask to speak with our Family Foster Care Licensor.

27 In the State of Minnesota, people may do unlicensed care if they care for relatives and one other family in addition to their own children. If people are providing child care for more than this, they are required to be licensed. Trends Our licensor continues to provide orientation, licensing and support to child care providers in our community. She assists in connecting the providers with required training as well as to stay on top of all requirements as they change, recalls of equipment, and new research regarding the safety and wellbeing of children. The licensor is in the homes on a regular basis to provide that support as well as to ensure we have safe and positive child care settings for the children of Kandiyohi County at a Glance Kandiyohi County currently has 110 licensed child care homes that we are responsible for licensing and monitor for quality of care. We opened 4 new homes and 14 were closed in We continue to maintain a consistent level of homes. We continue to support and monitor our providers in meeting the requirements of their licenses to ensure safe and positive child care settings for the children and their families. In 2012 we had no licenses revoked in Kandiyohi County. There were no investigations in 2013 that led to any suspensions or revocations of licenses. Family Child Foster Care Why is this important? Foster parents provide a temporary home for children who cannot remain in their own homes. Children enter foster care because of neglect, abuse, a family crisis or the child s behaviors or special needs. Care is given until their own parents can resume the parent role or until a permanent plan is made with relatives or adoptive parents. Sometimes foster families may be asked to provide a permanent home. While the child is out of the home, a case manager is working to provide services to the child and the family. Foster parents receive a financial reimbursement to care for the needs of the children. Often Foster Parents become mentors and support to the birth parents. Trends In addition to recruiting and licensing community members who are willing to be foster parents to children we are also actively working with family members of children who are

28 in need of foster care. If a child is court ordered into foster care placement we are required to place with an already licensed foster home or with a relative or person of significant relationship who is willing to apply for licensure and follow through with the process of becoming a licensed foster care home. We continue to appreciate the skills and dedication that the foster parents demonstrate. Frequently we are serving large sibling groups, children with extensive emotional needs and families with few natural supports. Often times the foster parents are coordinating several medical/ therapy appointments for children as well as school activities and a frequent visitation schedule so the children can spend time with their biological parents while we work toward reunification. The need for additional foster homes is growing. We hope to continue to recruit foster families so that we have enough homes to always find the best fit for the children who need to be placed. We also have a growing need for respite care for the parents we are serving as well as to support foster families at a Glance Kandiyohi County currently has 23 traditional child foster care homes. In 2013, 9 homes were newly licensed and 9 homes closed. Some of the homes that closed their licenses did so as they became the adoptive family to the children in their care. We are deeply appreciative of all of our foster homes including those that become the lifetime family for children who cannot be reunited with their birth family. Traditional Adult Foster Care/ Corporate Foster Care for Adults and Children Why is this important? Adult Foster care is a licensed sheltered living arrangement for adults who have special needs or impairments that makes it impossible for them to live alone. This might include people who have physical, emotional or developmental impairments. Adult foster care homes provide five basic services: room, board, supervision, protection, and assistance with money management and personal care. Corporate Adult and Child foster care refers to settings in which the license holder is a corporation rather than an individual. The primary care givers are shift-staff rather than one primary care giver who live in the home as in the traditional model. Trends Most of the traditional adult foster homes been licensed for over 10 years and have had long term placements. We have not seen an increase in traditional foster homes as a