Big Bend Community Based Care. Network Management Manual

Transcription

1 Big Bend Community Based Care Network Management Manual A comprehensive continuum of child welfare and related services provision that incorporates local community s priorities for child safety, well being and permanency. April 2011 Revised June 2011

2 TABLE OF CONTENTS Introduction... 4 Network Management Organization... 4 Mission, Vision, Guiding Principles, Values and Objectives... 5 Mission... 5 Vision... 5 Guiding Principles... 5 Values... 5 Objectives... 7 Governance BBCBC Organizational Structure...8 A. Core programmatic areas... 8 Quality management and Data Analysis...8 Training Fiscal management Utilization management Intake and Placement Diligent Search..17 Foster Home Re-licensing Attestations. 17 Contract Administration B. Supervision, Support, Employee Recognition and Grievance Procedures Supervision and Support Employee Recognition Grievance Procedures C. Cultural Competence Collaboration and Partnerships Programs and Services A. Case Management Case Management as it Relates to Family Preservation Cases Case Management as it Relates to Parent Needs Assistance referrals 26 B. Adoption and Post-Adoption Services Adoption Services /15/2011 2

3 Post-Adoption Services C. Independent Living Independence Village...34 Independent Living Pilot.. 34 D. Foster Home Management E. Prevention and Intervention Prevention Family Intervention F. Other Well Being Initial Assessment & Care Medical, Dental & Vision Assessments Behavioral Health Assessments and Services Point of Contact Education Documentation in FSFN Proposed Child, Adolescent and Family Assessment Center..42 System Components for Medical Homes for Children in the Child Welfare System..42 6/15/2011 3

4 INTRODUCTION Big Bend Community Based Care, Inc. collaborates with multiple and diverse community organizations, including DCF and our provider network, to develop and manage a System of Care that demonstrates quality programmatic and financial outcomes through collaboration, transparency, and efficiency. The Big Bend Community Based Care System of Care is a service delivery approach based on partnerships designed to create a broad, integrated process for meeting families multiple needs. Each partner brings diversity, advocacy, program expertise, experience and community standing to the System of Care. As former Secretary George Sheldon said, this is the essence of what makes community based care a laboratory of success and not merely a patchwork of contracted services. This Network Management Manual describes BBCBC s current System of Care. This System of Care document describes the primary elements of the child welfare system in which BBCBC is the Lead Agency and contains a level of detail believed to provide an overview of the System of Care. BBCBC has formal policies containing a higher degree of detail accessible on our website at NETWORK MANAGEMENT ORGANIZATION BBCBC, an accredited network management organization, was initially formed in 2002 to develop community based services and supports for children and families for the counties of Circuit 2. BBCBC later assumed services for Circuit 14 in As a network managing entity, our primary role is to establish and maintain an integrated network of providers with the goal of ensuring optimal access, quality of care, and consumer satisfaction. Our approach as a network management organization is a collaborative one which includes DCF, informal and formal network service providers, and key community stakeholders, such as DCF, Guardian Ad Litem, Children s Legal Services, Community Alliances, local Judicial systems and, most importantly, the communities and families we serve. Our contractual partners are non-profit, have a long history of serving families, and reside here in our community. They include Children s Home Society, Camelot Community Care, Inc., DISC Village, Inc., Anchorage Children s Home, Boys Town of North Florida, Florida Baptist Children s Home, Habilitative Services, Life Management Center, Capital City Youth Services, as well as numerous individual professionals. We have also engaged community advocates, faith based and grassroots organizations and local service providers such as the Brehon Institute, Florida State University, Florida A & M University, Tallahassee Community College, Chipola College, Tri-County Community Council, One Church One Child, and Ounce of Prevention. Managing two Judicial Circuits across 12 primarily rural counties creates some unique challenges for our agency. These challenges range from multiple working agreements with multiple providers within each of those counties to understanding the differences between the two Circuits despite the similarities one might first assume. Although Circuits 2 and 14 have a similar number of children served, a greater proportion of those in Circuit 14 are in Out of Home Care. The two largest population centers are Tallahassee in Leon County and Panama City in Bay County. Approximately 150,000 6/15/2011 4

5 children reside in the 12 counties and children represent about 20% of the total population in each county. The % of persons living in poverty ranges from a low of 13.0 in Bay County to a high of 20.0 in Calhoun. For comparison purposes, the statewide % for Florida is The population in Circuits 2 and 14 are significantly different from a racial/ethnic perspective. In Circuit 2, 53% of the children are white; 42% are black; 5% are Hispanic. In Circuit 14, 80% of the children are white; 17% are black; 3% are of other races. In addition, Tallahassee is a government town and Panama City one of tourism impacting both the clients we serve and the resources available to families. MISSION, VISION, GUIDING PRINCIPLES, VALUES AND OBJECTIVES The System of Care is based upon the belief that child welfare services should be focused on children and families and embedded in the communities in which they live. To this end, BBCBC has developed a mission, vision, guiding principles and core values that direct us in the development of our network and service provision system. MISSION To provide the highest quality child welfare prevention and intervention services to children and their families in their home communities. VISION To create local ownership of the child protection system in each of our 12 communities. By doing so, we believe the quality of life for the children and families we serve will dramatically improve and the incidences of child maltreatment will dramatically decrease. GUIDING PRINCIPLES Community engagement, quality services, fiscal responsibility and professional development. VALUES The belief that all children have the right to grow up safe, healthy and fulfilled in families that love and nurture them. We rely on the following values to guide our work: Big Bend Community Based Care will: Respect the caregivers of children, Be innovative and dedicated to excellence, Be ethically, socially, and culturally responsive, Promote family and personal responsibility, 6/15/2011 5

6 Partner with community and faith-based organizations to foster open and collaborative relationships, Earn the trust and respect of our partners, customers and the public by providing exceptional customer service while practicing sound fiscal stewardship, Employ an analytic and systematic approach to planning and performance management, and; Facilitate a work environment that encourages professional development and growth. Family Centered Practice - The System of Care emphasizes the core practice functions of Family Centered Practice which include: engaging families and assembling families individual teams; assessing children and families strengths and needs; collaboratively developing and implementing case plans; involving and supporting parents and caregivers in decision making; and monitoring and modifying services. Ultimately, these core practice functions, and the many initiatives, strategies, steps, interventions, approaches and activities within them, are intended to drive the service delivery process emphasizing: Child Safety is first concern Intensive services early Focus on family system Building on family strengths Collaboration with the family Strong use of informal support systems BBCBC uses the family s strengths and support system to plan and make decisions that are in the best interest of the child while simultaneously recognizing family protective factors and identifying and reducing areas of risk in order to maintain safe home environments. By engaging families and natural support systems, families are empowered to ensure that the needs of the child are being met, thereby reducing the need for formal involvement of the Child Welfare and Judicial systems. The work place setting must be conducive to the implementation and use of Family Centered Practices. First and foremost, in accordance with Trauma Informed Care systems, it is important that a traumasensitive environment be established and maintained to limit potential triggers and prevent revictimization. Furthermore, the provision of administrative and management support to workers allows them to become proficient in Family Centered Practice. To accomplish this, BBCBC has worked to ensure that network partners are able to access training surrounding nationally recognized Family Centered Practices. Similarly, once trained, BBCBC carefully structures and provides ongoing support and training to ensure that workers are able to effectively integrate these practices into daily casework. To support ease of access to services, supports and resources, BBCBC has co-located multiple agencies in our service centers. Finally, we have worked to ensure that our facilities are sufficiently 6/15/2011 6

7 able to address comfort and privacy needs of large family groups when conducting case conferences, interviews, discussions, and meetings. Trauma-Informed Care - BBCBC is committed to integrating the concepts of Trauma Informed Care into our System of Care. Trauma Informed Care recognizes how trauma affects the lives of individuals seeking services. Trauma Informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that services and programs can be more supportive and avoid retraumatization. Our approach to ensuring that network providers develop services and supports in accordance with the concepts of Trauma Informed Care includes: Participation in related training, Active engagement in local workgroups with the intent of implementing Trauma Informed Care principles not only within the child welfare system but across the entire community, Integration of language in subcontracts that requires evidence that the subcontractor is trauma informed (or has a plan to become trauma informed) and has practices in place that prevent revictimization, Development of a Trauma Informed Care training curriculum for network providers and integration into both pre-service and foster parent training, and; Identification of specific therapists and mental health providers who are trauma informed. BBCBC offers Trauma Informed Care training to staff, network partners, and foster parents (through the revised MAPP Curriculum as well as through specialized training). Our Trauma Informed Care training is designed to help network partners recognize the presence of trauma symptoms and acknowledge the role that trauma has played in families lives. Our involvement in the local Trauma Informed Care workgroups facilitates the adoption of trauma informed approaches into the delivery of a broad range of services including mental health, substance use, housing, vocational or employment support, domestic violence, victim assistance, and peer support. OBJECTIVES BBCBC has established the following Strategic Objectives to guide our organization and System of Care: 1. To increase community awareness and ownership of the needs of children and their families. 2. To serve children and their families in their home community. 3. To prevent and reduce the incidences of child abuse and neglect. 4. To increase the quality of care for children and their families. 5. To facilitate timely permanency for every child in foster care. 6/15/2011 7

8 6. To prepare foster children and young adults for continuing education, employment, and selfsufficiency. 7. To promote coordination and local delivery of services community by community. 8. To develop community resources that will increase the quality of life for children and their families. GOVERNANCE As the lead agency, we have developed a governance plan that ensures that the Board of Directors is reflective of our community s racial, ethnic, and cultural diversity and representative of each geographic area within our Circuits. This local connection facilitates and supports community engagement and involvement with the System of Care. Our Board is fully vested in organizational policymaking, management and operational oversight of BBCBC. Board members are held to a strict code of ethics that ensures they do not have business or financial ties with the organization that result in personal financial gain. The Board s primary functions are governance, evaluation of the company performance, selection of the CEO, risk management, strategic planning and community representation. BBCBC ORGANIZATIONAL STRUCTURE Our approach to developing a network of care is grounded in collaboration. However, it is understood that, as the Lead Agency, BBCBC is the single point of organizational accountability for developing and managing the System of Care. A. CORE PROGRAMMATIC AREAS There are six core programmatic areas in which BBCBC assumes direct management responsibility: 1) Quality Management and Data Analysis, 2) Training, 3) Fiscal Management, 4) Utilization Management, 5) Intake and Placement, and 6) Contract Administration. QUALITY MANAGEMENT AND DATA ANALYSIS BBCBC has a multi-faceted, continuous Quality Management (QM) system designed to utilize both quality assurance and quality improvement (QA/QI) data and integrate them into daily management functions and the service delivery system. Our system is focused on performance relative to child safety, permanency, and well-being and on identifying system improvements that yield results for every child and family served. Overall, our QM system involves collecting, reviewing, analyzing, reporting and using output, outcome, and satisfaction data from key areas of operations for the purpose of ensuring that services are consistent with performance expectations, standards, and best practice. Big Bend Community Based Care s Mission, Vision and Values underlie both the agency s Strategic and QM Plans. The Quality Management Plan describes processes and activities including: stakeholder 6/15/2011 8

9 participation, long-term planning, short-term planning, internal quality monitoring, case record review, outcomes measurement, customer satisfaction, feedback mechanisms, information management, and improvement/corrective action plans that are in accordance with Council on Accreditation (COA) standards. The Plan incorporates input from DCF, the agency s Board of Directors, partner agencies, services providers, and staff. The QM Plan is updated annually and the QM structure and processes on an ongoing basis to address changing needs and requirements. BBCBC s approach to meeting performance targets: Involves all network partners Integrates CFSR and ASFA outcome expectations Continuously measures and evaluates all partners and performance within our System of Care Is open and transparent. Our approach is focused on a quality delivery system that is efficient and continuous, coordinated with State level quality assurance processes and instruments, and promotes the accurate collection and reporting of data. Through the application of a quality management model integrating these components, our System of Care utilizes the continuous analysis of information to improve the quality of services to the child, their family, and substitute caregivers. This approach permits BBCBC to work collaboratively with sub-contractors to apply the correct amount of oversight while ensuring performance expectations are maintained. BBCBC s quality management activities assess the organizational performance of our Lead Agency and the service delivery and client outcomes of our System of Care. Appropriate data collection and measurement tools have been, and continue to be, developed to analyze and communicate the strengths and weaknesses within a service, program or administrative department. Data is used to assess required outcomes, outputs and consumer satisfaction/feedback. Examples of collected data in each of these categories include: Outcome Related Data: Outcome related/performance data (including Child and Family Services Review, Adoptions and Safe Families Act and contract deliverable data) are aggregated at the unit, subcontractor and Circuit level. Each level of data is used to identify areas for improvement, policy revision or replication in other units. Data are provided monthly and quarterly as applicable for the specific measure. Additionally, BBCBC sponsors Quarterly Performance Meetings to review partner agencies performance on contract and other management measures. These meetings are hosted by the CEO, COO and Management Team and includes partner agency CEOs, Program Managers and additional staff at their discretion. Quarterly Performance Meetings are held jointly with our DCF Region staff twice each year. Performance meetings focus on quarterly and trend data for selected measures in service provider contracts with BBCBC. The meetings focus on analysis of the data, identified barriers to performance and planning action states to address deficiencies. Systemic and recurring issues are identified for root cause analysis and countermeasure development. Countermeasures can include activities such as providing Network-wide training or implementing a specific clean-up activity (such as for data integrity issues). These actions are recorded in meeting 6/15/2011 9

10 minutes and addressed at subsequent meetings, as well as correspondence and follow-up that occur in the interim. Quality Related Data: Data collected quarterly based upon The Quality Practice Standards for Case Management and quality assurance reviews of quarterly Supervisory Case Reviews. BBCBC uses Florida s Quality Practice Standards for Case Management review tool for case file reviews. The tool addresses federal CFSR and State requirements, but focuses specifically on core standards of high quality case practice. BBCBC analyzes aggregate Quality Practice Standard data arrayed by five Windows into Practice focus areas: Assessment, Family Engagement, Service Planning and Provision, Promoting Case Progress and Supervision. Data are shared with partner agencies, the CEO, COO, the Contract Coordinator and the Management Team. Partner agencies are responsible for addressing deficiencies and items that warrant Quality Improvement activities and respond to Requests for Action within set time limits. These responses are reviewed by quality management staff in consultation with the QM Director and COO and are approved or returned for further attention. Subsequent data are used to determine the success of the actions implemented by the partner agency. System-wide areas identified for improvement are addressed in quarterly Quality Improvement Workshops designed to determine the root causes of deficiencies and allow for partner agencies to develop quality improvement plans to address them. BBCBC operating policy also requires quarterly quality assurance assessments of a sample of Supervisor Reviews completed for active cases. This review is designed to assure that: The components of the Mentoring and Modeling Quality Guide are included in supervisor reviews of cases, and Requirements related to services for children prescribed psychotropic medications are properly implemented. The sample for these quality assurance reviews are drawn from the most recent list of children prescribed psychotropic medications. Applicable items from the Quality of Case Practice Standards for Case Management are used as the tool. Output Related Data: BBCBC has a centralized yet program specific data collection process used to support the quality management system. Management/output data is analyzed at least monthly to support organization-wide planning and correction of problem areas. Client Counts Reduction in Out of Home Care Utilization Data Staff Turnover Incidents/Grievances 6/15/

11 Satisfaction Data: Community input is collected from stakeholders annually and includes information from partner agencies, the court system, guardians ad litem, medical providers, counselors, and foster parents. Stakeholder surveys are completed annually. Aggregate data is used to establish quality improvement initiatives to meet outcomes expectations including: Collection and Analysis of Case-Specific Outcome and Output Data: Through several mechanisms (including case reviews, analysis of supervisory reviews, System of Care monitoring, incident reporting, and permanency tracking), our Quality Management Team collaborates with network partners to review and assess a variety of compliance and qualityrelated elements. Quality assurance processes not only review compliance related activities, but are designed to assess quality of service provided to children and families. Review of Data and Reports: Our QM Team utilizes multiple data sources in order to continuously assess service provision and outcomes. Case specific FSFN data and DCF Web Portal reports are reviewed, analyzed and reported regularly to assess progress toward contractual outcomes and performance expectations. Program Evaluation Data and External Monitoring: Our System of Care integrates findings from evaluation and external monitoring processes (including quality assurance reviews, fiscal monitoring, eligibility monitoring, and contract monitoring) into our assessment and reporting procedures. These reports are used to create performance improvement initiatives and objectives. Client Feedback and Satisfaction Data: BBCBC uses exit interviews, client satisfaction data, and stakeholder satisfaction data to ensure program quality. Information collected through these sources is reported to network partners and is used to enhance the effectiveness of the service delivery system. Complaints and Grievances: Complaints and grievances are assessed on an individual basis by BBCBC Operations Managers. Trends are assessed and reported to the leadership team. Incident Reports: Information from incident reports is monitored, compiled, reviewed and reported to the leadership team on a monthly basis. Data Analysis and Monitoring of Outcomes and Quality Performance Indicators: BBCBC s QM Director tracks and reports outcomes and performance measures consistent with the State Quality Improvement Plan (QIP) and the Circuit 2 and 14 Quality Improvement Plan (QIP) and incorporates performance indicators in its review of delivered service. Quality Management Responsibilities The QM Team is responsible for conducting QA/QI activities including: development and implementation of management tools to standardize performance measurement; collection and analysis of qualitative and quantitative performance data; development of system-wide and provider-specific reports; identification of trends and patterns; and integration of findings into a continuous quality improvement process. 6/15/

12 BBCBC has identified and defined the quality and compliance data elements to be collected and used to drive improvement efforts. Based on the data elements reported above, BBCBC generates reports that are used to manage and track performance across the System of Care, assessing quality, required outcomes, outputs, and consumer satisfaction. The QM staff analyzes these data to identify topics in need of system-wide training. Identified needs are addressed in collaboration with the Chief Operations Officer, Operations Managers, the Training Coordinator and Training Specialists to assure broad-level, systemic quality improvement activities. Additional Support for Quality Service Delivery To provide support to case managers, BBCBC has employed and co-located a Data Systems Training Coordinator in our largest service centers. The Coordinators use a variety of tools and weekly reports to validate the timeliness and accuracy of data entry and also use the reports to identify specific training needs. These tools include: 1. Case Status Summary The Case Status Summary report provides critical data related to the completion of specific case processes and whether information related to the processes have been entered into the system. Through the report, BBCBC is not only able to ensure case progress, but is able to validate that related data has been entered in a timely manner. 2. Status Report The Status Report allows BBCBC to monitor and manage the accuracy and timeliness of critical AFCARS-related foster care and adoption data. TRAINING Quality personnel translate into quality programs and systems, which in turn, create positive outcomes for those individuals served by the System of Care. Being innovative, dedicated to excellence and facilitating a work environment that encourages professional development and growth, is the cornerstone upon which BBCBC s commitment to staff development are built. Staff development is the key to cultivating our employees growth and maximizing their potential. BBCBC s training programs provide employees, both within our administrative organization and within our core network partners, the opportunity to gain the skills and behaviors necessary to be successful. BBCBC, in collaboration with network partners, develops an annual training plan based on information gathered through employee surveys, evaluations and professional development plans. Through these sources, we are able to assess training needs within the System of Care and develop or coordinate training sessions that address necessary competencies. As our service area is culturally influenced by informal networks that respond best to a personal touch, our training team, supervisors and managers all communicate frequently and trainers are often called upon to lead one-on-one coaching and skill building sessions with staff. BBCBC s Service Centers in Circuits 2 and 14 house state-of-the-art training facilities. Each training classroom is equipped with the technology, furnishings, equipment and privacy needed to ensure an environment conducive to learning. 6/15/

13 The State of Florida s pre-service training curricula is competency based and designed to assist new staff in understanding service delivery that is compliant with existing laws, policies, and procedures. The training provides a comprehensive foundation for child protection work including types of maltreatments, legal requirements, removal and placement decision making, interviewing families, assessment and case planning processes, and adoptions. The curriculum is approved by the State and provided to new staff by BBCBC trainers. Training techniques support the learner using a variety of methodologies, including alternative instruction delivery methods such as web-based instruction, participation in activities related to support and modeling, self-evaluation, and feedback. In order to reinforce the fidelity of services and continuing professional development of staff, on-going training is supported by an extensive catalog of in-service training opportunities. BBCBC offers inservice trainings each month to meet the needs of staff and also implement emerging policies and practices. Many of these trainings are sponsored jointly with DCF and attended by both CMO and DCF staff thus offering the opportunity for collaboration between Big Bend Community Based Care, case management, CPI and other community providers. Policy and practice changes that have a significant impact on our System of Care are incorporated into mandatory training sessions. All inservice trainings are posted on a website calendar and announcements are sent to supervisors and program managers throughout our network. To enhance our internal training and professional development curriculum and stay on the cutting edge of best practices, BBCBC draws upon the expertise of nationally recognized experts. Assessment of training needs across the System of Care and the development of new training topics are informed and guided by our Quality Management process. Results of QA/QI activities are shared with the training team during regular bi-monthly meetings and action plans are jointly developed and implemented. Significant deficits are shared immediately by QM staff to training staff. In addition, the training team regularly reviews performance data. FISCAL MANAGEMENT BBCBC maintains a financial management system that helps safeguard funds and tangible assets, promotes stewardship, ensures the integrity of financial reporting, and provides timely cost and utilization data. Designed to ensure appropriate utilization of funding, the integrity of reporting and claiming procedures, and appropriate billing and collections, the system efficiently processes a large volume of financial transactions and produces timely reports that meet the varied needs of different users, such as the Board of Directors, executive management, program management, DCF, stakeholders and other grantors. A combination of prevention controls and detection controls are utilized to reduce the occurrences of errors in the system and also quickly call attention to any errors that are not prevented so that corrective steps can be made as soon as possible. To maximize internal controls and accuracy of information, BBCBC has implemented functionality that permits client service information to be imported from ICWSIS and FSFN into the MIP accounting system. The financial management system is managed by experienced professionals and staffed with well trained team members, each with specifically assigned responsibilities. Specifically assigned duties ensure that the functions of 6/15/

14 authorizing, processing, recording, and reconciling transactions are performed by separate individuals. This segregation helps reduce errors and makes it impossible for an individual working alone to commit serious fraud without rapid detection. Internal accounting controls, including the segregation of duties are described in BBCBC Policy BBCBC s financial management system receives frequent oversight from multiple sources including: Board of Directors Finance Committee, DCF, and an independent certified public accounting firm. On an annual basis, BBCBC develops a detailed budget by department and program. Historical spending data, current client counts, trends, and future projections are all considered while developing the budget. Actual spending is monitored throughout the year to determine how it differs from the budget. The Cost Allocation Plan serves as a primary control to ensure expenditures are charged and reported to the correct program and funding source. DCF has provided a Cost Allocation Plan template that requires expenditures to be assigned to specific cost pools. BBCBC uses its coding structure to directly link the cost pools in the Chart of Accounts. This link helps ensure expenditures are charged and reported as required by the Cost Allocation Plan. The plan is updated at least annually and sent to DCF for review and approval. BBBCB utilizes the COBRIS database to process direct client assistance for Purchase of Service (POS) requests from subcontracted providers, CPI s and CLS staff. These requests are directly linked to the child through FSFN to ensure coding is accurate per BBCBC s cost allocation plan. Monthly reports are provided to the subcontractors who have budget authority for these expenditures. In addition, these reports are monitored for any trends and changes to services and funding strategies are developed as necessary. BBCBC recognizes the importance of developing diverse financial resources and has demonstrated the ability to secure funding apart from our DCF Community Based Care contract. Every organization needs to develop a reserve of assets to help fund expansion, acquire financing, or reduce the impact of an unexpected loss. The Board of Directors views the task of developing diverse financial resources not only as a means to fund enhanced or expanded services that are aligned with the agency s mission, but also as a critical responsibility that ensures the ongoing viability of BBCBC as an effective organization. As the Lead Agency in Circuits 2 and 14, we will continue our track record of diversifying services and funding to build stability and better serve children. As the tools for communicating with the community have expanded and improved, so too has the response from the community. BBCBC works diligently to explore opportunities to develop new program and financial resources. BBCBC maintains a 501(c) (3) status and has implemented financial policies and procedures to ensure compliance with donor restrictions and all IRS regulations and reporting requirements. The BBCBC Revenue Maximization/Federal Funding (Rev Max Unit) is responsible for maximizing funding allocations. The Rev Max Unit is dedicated to ensuring that children in care have appropriately determined eligibility, accurate data entry, and appropriate funding sources are utilized to maximize federal earnings. Rev Max staff collect the necessary information to document eligibility and apply for Title IV-E and Medicaid, monitor TANF and verify eligibility for Adoption Subsidies. 6/15/

15 UTILIZATION MANAGEMENT BBCBC uses data to understand as fully as possible the individual and aggregate needs of our consumers to best marry those with the available resources. We are systematically and analytically assessing the clients coming through our doors, paying special attention to those being diverted from the foster care system, those being served in their own homes or relative/non-relative care, and the number of those that are in licensed out-of-home care. The objective of Utilization Management is to assure optimal effective services and appropriate allocation of the system of care resources. In this process, the necessity of services for an individual child, and the overall utilization of all services are reviewed on an ongoing basis through a variety of mechanisms, including the use of management reports and monitoring of service delivery through the Purchase of Service (POS) system. BBCBC uses data from a variety of management reports, looking at static data points at a high frequency and trend data over time. This information informs our decisions on a day-to-day basis, allowing us to make adjustments mid-year as deemed necessary. Trend data allows us to use data over the course of the year or several years to make sound budget, policy, and service planning decisions. The data is shared with our provider network and those partners are engaged in change planning sessions as necessary. Some examples of these reports are as follows: DCM to Child Ratio Report This report is monitored to assure appropriate utilization of staff resources. Special Populations Report - The population for this report may change based on BBCBC goals and priorities. The current Special Populations Report focuses on children eligible for Agency for Persons with Disabilities (APD) services being served in high-end placement settings. The report is used to track placements, monitor progress, and assure the least-restrictive and most appropriate placements for children. The report also provides information used to monitor placement expenditures. Case Status Summary Report This report is reviewed weekly for sharp fluctuations in the number of clients served in both in-home and out-of-home care. Reducing Out-of-Home Care Reports This report is reviewed monthly and annually and contains data over time on the number of removals, cases initiated, cases closed, adoptions, children in out-of-home care longer than 12 months, and the number of children in out-of-home care (licensed and relative/non-relative care). Utilization Report This monthly report contains data in chart and graph format that reflect trends over time for the number of children in licensed care, relative/non-relative placement, and receiving in-home services. It also contains comparative data for the numbers of children placed in foster verses group homes and the proportion of group home placements of those in out-of-home care. Budget Variance This report reflects the variance of expenditures to budget by line item on a year-to-date basis. 6/15/

16 Estimated Cost of Care Report This report contains both static data points and corresponding trend lines on the cost of licensed care per child, per day, and per placement type. A well-designed Utilization Management process ensures that children and families receive appropriate services to meet safety, permanency, and well-being goals, as well as maximize available resources. BBCBC provides administrative support for Utilization Management, which includes tracking service referral authorizations, service delivery, and reconciling and paying claims for services delivered by network providers. Utilization management falls within the case planning process conducted by the Case Management Organizations. As the child and family progress through the service delivery system, a continual review of the necessity and appropriateness of services occurs. The following is considered during review: Have the goals of the service/placement been met? Are the child and family being treated at the appropriate level of care/service intensity? What is the evidence that the placement or services are working? Is there evidence they are not working and changes are needed? The utilization management process is continuous and involves reviewing admission decisions, services provided, length of service, level of care, and termination of service decisions. BBCBC has implemented two processes to ensure the constant review of services provided to children and families is appropriate and fiscally responsible including: Increased number of permanency staffings to be conducted, a minimum of every 3 months beginning by month 2 of the case, to insure services recommended during the Case Transfer process and/or those included in the case plan are completed. High End Placement Staffings are completed every other month to review all children in a placement higher than the standard board rate and to ensure that BBCBC has current information regarding the benefit to the child, the discharge plan, and to monitor the out of home care expenditures. BBCBC is committed to making responsible, well-informed decisions related to our System of Care and the clients we serve. We strive to be open to new ideas and services as the needs of our communities change. It is vital to have solid relationships with our entire network and as such, we work closely with our providers. BBCBC continuously works toward better data tools to assure that we are doing all we can to be accountable to the network, be fiscally responsible, and make sound strategic planning decisions. INTAKE AND PLACEMENT Intake and Placement are centralized functions directly performed by BBCBC staff in our System of Care. Our Specialists provide direct oversight for Engagement and Permanency staffings and perform placement duties for children in and entering licensed out of home care. The centralization of these functions allows for comprehensive data gathering and analysis, sharing of knowledge and resources, shared observations of system of care functionality, risk management, and utilization management. 6/15/

17 When out of home placement is necessary, the ideal placement is often with the child s relatives or approved non-relatives known to the child. When a child must be removed from their home and placed into licensed care, Placement Specialists are responsible for the approval, placement and tracking of children into the most appropriate level of care while meeting the child s needs. Several considerations are made when identifying placement: Placement of all siblings together, when possible and appropriate, Placement of the child in close proximity to the parent s home to facilitate maintenance of the parent-child bond through planned visitation, Placement of the child in the same school, or in close proximity, to minimize disruption to the child s education needs and maintain relationships, and; Placement of the child in the least restrictive, family-like setting that meets the child s needs. Maintaining a child in a stable placement is imperative for healthy development and functioning. BBCBC requires Placement Stabilization staffings at any point that a licensed foster home placement becomes at-risk or by request of the foster parent, child, DCM, licensing counselor, or Placement Specialist. Efforts are made to identify needed wrap around services to stabilize placements and prevent disruptions. DILIGENT SEARCH BBCBC staff are responsible for diligent search activities related to missing parents for all counties in Circuits 2 and 14. FOSTER HOME RE LICENSING ATTESTATIONS Effective no later than September 30, 2011, BBCBC will perform foster family relicensing functions by the attestation model. Designated BBCBC staff will review and approve all re-licensing packets for traditional and medical foster homes licensed through all BBCBC subcontracted Foster Home Management agencies. A notarized Attestation for Foster Home Re-licensure form and the Licensing Standards Checklist (incorporated by reference and maintained on the DCF website at will then be submitted to the Department for license approval. BBCBC agrees to support and participate in subsequent DCF reviews using the Department s approved requirements specified in the Licensing Standards Checklist. CONTRACT ADMINISTRATION BBCBC, as a Lead Agency, is responsible and accountable for subcontractor performance. It is BBCBC s goal to coordinate a network of organizations and individual providers designed to meet the needs of children and their families. Our network provides a comprehensive range of services that strengthen and stabilize families, maintain children in their communities, and lead to permanency and 6/15/

18 well-being. Creating and maintaining a full array of services and supports requires the cooperation of all of our community stakeholders. We actively seek to include agencies and individuals based upon the anticipated or identified needs of the children and families served. Our approach to ensure quality delivery of services goes beyond traditional contract management, and is based on a philosophy of partnerships and accountability. BBCBC purchases services via subcontracts with provider organizations or via service agreements with organizations or individuals with appropriate licensure and credentials. BBCBC has procedures for recruiting and developing both subcontracts and agreements for services within the network. For subcontracts, BBCBC utilizes a competitive solicitation process for procurement. Notices are posted on the agency s website and mailed or ed to current and prospective bidders. A review panel is selected for each solicitation process to evaluate, score, and select proposals to be considered for contract award. BBCBC is responsible for clearly defining the scope, requirements and parameters of subcontracts and providing the necessary oversight to ensure that subcontractors meet the conditions of their contract. BBCBC has developed contract monitoring policies, procedures and tools that guide the process. BBCBC monitors each new Contractor twice during the initial contract year. In subsequent contract years, the frequency and extent of monitoring is dependent upon an Annual Risk Assessment, the Contractor s accreditation status, and the Contractor s previous monitoring data. BBCBC revisits Contractors required to complete corrective action plans to verify evidence of implementation and effectiveness of corrective actions. BBCBC conducts management and monitoring activities through on-site visits to providers and the review of required reports. Reviews are completed by BBCBC s Contract Unit and the QM s QAS assist with monitoring quality and service delivery data. Administrative and fiscal monitoring of subcontracted providers assure necessary administrative, personnel, and contractual compliance for service provision subcontracts. BBCBC uses a variety of tools, checklists, desk reviews and site visits to monitor subcontract compliance and includes reviewing quarterly financial reports, audits, invoices, match data, and timeliness. Performance monitoring of subcontracted providers occurs through a number of mechanisms including analysis of outcome and performance data (ongoing), quarterly case file reviews, quality of practice monitoring, performance improvement plans, customer satisfaction surveys, and complaint monitoring and investigation. In the event that corrective measures fail to improve performance, appropriate action will be taken to change contractors. B. SUPERVISION, SUPPORT, EMPLOYEE RECOGNITION AND GRIEVANCE PROCEDURES SUPERVISION AND SUPPORT BBCBC s model for supervision is a reflection of our agency s culture and the geographic territory we are responsible for managing. With the exception of our fiscal team, BBCBC supervisors are responsible for serving staff that work in different offices within 12 counties. This creates barriers for 6/15/

19 the use of a traditional supervision model. To this end, each supervisor maintains frequent, individual contact with their staff. BBCBC has implemented a performance management model that incorporates organizational strategic measures, department performance measures, individual performance goals, and individual development planning. Employees are evaluated on these measures through the annual review process. In addition, BBCBC employees attend a full-day company-wide All Staff Training and Planning Meeting every six months. This bi-annual opportunity builds teamwork throughout the organization and fosters effective internal communication. All sessions are organized by a group of staff members who plan the theme, agenda and activities. For subcontracted agencies, we have established standards to ensure adequate and appropriate supervision occurs. EMPLOYEE RECOGNITION BBCBC recognizes employees for demonstrating excellence in job performance and service delivery. BBCBC nominates staff regularly for statewide and national recognition awards and members of our System of Care have been recognized internally and externally. Case management agencies within our System of Care maintain additional staff recognition activities including staff appreciation week, themed monthly meetings, team building luncheons, holiday events and other activities that promote team building and appreciation. GRIEVANCE PROCEDURES BBCBC utilizes a progressive disciplinary action process which is detailed in Policy 1113 Employee Conduct and Corrective Action. Employee conflicts are governed by Policy 1114 Employee Conflict Resolution, which allows employees to escalate complaints to the CEO if necessary. Grievance procedures are also described within in the Employee Handbook. C. CULTURAL COMPETENCE BBCBC values the development of a diverse work force that meets the cultural needs of our service area. We recognize our responsibility not only to employees and contractors, but also to the communities in which we operate. BBCBC and the majority of subcontracted partners are nationally accredited. Cultural competence is an area of focus for accredited organizations. In addition, all policies, procedures and practices of BBCBC and our contracted providers recognize, respect, and respond to the unique culturally-defined needs of various client populations. Finally, diversity practices and associated training sessions have been integrated into our training catalog. 6/15/

20 COLLABORATION AND PARTNERSHIPS BBCBC takes a leadership role in developing, participating and leading collaborative efforts that move the system in a positive family-centered direction, meet strategic objectives designed to improve services to families and children, and, ultimately, improve outcomes. The overarching goals and objectives of the BBCBC Strategic Plan for support our commitment to collaboration and creation of local ownership of the child protection system: Create local ownership of the child protection system in each of our 12 communities. Increase community awareness of the needs of our children and families. Develop partnerships with community resources and coordinate local service delivery. Earn the trust and respect of our communities by exemplifying high standards of financial excellence. Maintain an organization wide balanced budget. Achieve funding stability through diversification. Improve the quality of service for children and their families throughout the variety of services provided by BBCBC. Provide effective diversion, prevention, and intervention services. Provide high quality case management. Provide high quality pre-adoption, adoption, and postadoption services. Provide high quality independent living services. Provide high quality out of home care. Serve children in their home communities. Employ an analytic and systemic quality management approach that informs our stakeholders, and provides the foundation for our planning and performance management. Develop and sustain exceptional child welfare professionals to serve in all areas of our programs. Institute high quality, professional certification for case managers and supervisors. Assure high quality and innovative pre-service training for case management staff and supervisors. Assure high quality and innovative in service training for BBCBC and partner agency staff. A wide range of individuals, groups, agencies and systems are important partners in our efforts to build better lives. Stakeholders in our System of Care are: Children, youth and their families, including present and former clients, youth, parents and kinship families, Foster and adoptive parents, Advocates for foster children, youth and parents such as GALS, Public and private providers of services, Federal, State, and County administrators, Court, law enforcement, and legal community, Florida State Legislature, Universities and Colleges such as Florida State University, Florida A & M University, Tallahassee Community College, and Chipola College, Children s Programs such as Healthy Families and Early Childhood Development Services, Community representatives including shared service alliances, faith-based organizations, professional and civic voluntary associations, 6/15/

21 Early Learning Coalition of Northwest Florida and KIDS Inc. of the Big Bend, Early Start, Agency for Persons with Disabilities, Department of Juvenile Justice, All 12 School Districts, Community Alliances, and Department of Health Children s Medical Services Program. BBCBC and partner agency staff members participate in numerous stakeholder-sponsored activities. Some of these activities include: Speaking opportunities to civic clubs, school personnel, service providers, and other community organizations Participation at provider and church fairs Foster Parent Associations Dependency Court Improvement Project meetings Community Alliances; Community Action Team Florida Coalition for Children Whole Child Leon and Whole Child Gadsden Appearances on local radio and television stations Legislative Delegation meetings Chamber of Commerce meetings Local Community Events Florida Children s Week Public Policy Institute meetings Presentations at local/state conferences Brown Bag Lunches with Dependency Judges and the Parent s Bar Collaborative projects in the System of Care include: Everybody s a Teacher: BBCBC was the first CBC in the state to launch the Everybody s a Teacher initiative, a statewide initiative which includes BBCBC, DCF, Agency for Workforce Innovation, Office of Early Learning, Department of Education (DOE), Guardian Ad Litem (GAL), Department of Juvenile Justice (DJJ), Foster Parents, local school districts and local childcare providers. This initiative encourages the identification of dependent children to local school districts to enhance the possibility that dependent children will receive all available services. The goal is local ownership, with each individual plan listing the specific needs for each dependent child in the area. At a minimum, the plan will include how to identify dependent children in the school districts, increase access to educational services, improve communication of all parties and identify educational surrogates for all dependent children. 6/15/

22 Safe and Together Model: Comprehensive training initiative to increase expertise amongst partners in the System of Care in order to better respond to and support victims of domestic violence. The training initiative results in a cadre of designated Subject Matter Experts in our Circuits. Heart Gallery North Florida: BBCBC has provided extensive support to Heart Gallery North Florida (HGNF) since it s inception in It is a traveling museum-quality exhibit featuring portraits of children in the BBCBC s foster care system available for adoption. The gallery is dedicated to increasing awareness of the children in a 12-county area in North Florida who are in foster care and need permanent homes. BBCBC staff members serve on the HGNF board of directors and HGNF uses the BBCBC administrative office for mailing and storage of materials. Transitional Housing for Independent Living: BBCBC partners collaboratively with state and local governments to establish transitional housing for Independent Living youth in both Circuits. BBCBC was the first recipient for the State of Florida Housing Finance Corp. funds ($1,600,000) for special populations which will pay for construction of a 24 unit housing complex in Panama City. The project also relies on a partnership with a private financial institution, Summit Bank of Panama City to finance the mortgage ($600,000) at a governmental rate. The project has enjoyed the support of the City of Panama City, Mayor Scott Clemons and the local legislative delegation. Additionally, BBCBC developed in partnership with DISC Village and the City of Tallahassee a Scholarship House to provide transitional housing for Independent Living youth in Tallahassee. Quality Parenting Initiative (QPI): In partnership with DCF, the Youth Law Center, Eckerd Family Foundation, and other Community Based Care Lead Agencies, BBCBC embraces the opportunity to focus on quality improvements to existing recruitment and retention services. QPI workgroups involving foster parents, adoptive parents, staff members and community providers are charged with developing and implementing strategies to maintain and enhance the quality of our child welfare and foster family community. As the primary funder of child welfare services, DCF is a critical partner in the System of Care. BBCBC values opportunities to partner with DCF. These opportunities include: Child Abuse and Prevention Permanency Plan Meetings: Under the direction of the Chief Child Advocate in the Governor s office, BBCBC participated with DCF and representatives from advocacy groups, consumer organizations, and providers of children s services to develop a local 5 year plan for each Circuit. The 3 major areas of focus are prevention of abuse, abandonment and neglect of children; promotion of adoption; and support of adoptive families. Circuit 14 Substance Abuse Advisory Group Meetings: This group is comprised of local substance abuse providers, DCF management staff, BBCBC management staff, local Dependency Court Magistrate, and a representative from the National Center on Substance Abuse and Child Welfare. The goals of the group are to inventory and assess local attitudes and beliefs regarding substance abuse and services; inventory and assess local resources and services; and to develop a plan to achieve a local substance abuse System of Care based on evidence based practices that maximizes the resources 6/15/

23 available and promotes the best possible outcomes for children and families involved in the child welfare system. Circuit 2 and 14 Family Preservation Committees: BBCBC and DCF staff are committed to assuring that the local Family Preservation protocols are amended on an ongoing basis as needed. The initial protocols were developed to provide guidance to CPIs, case managers and service provider staff related to children at imminent risk of removal without immediate provision of key services and supports. BBCBC and DCF Management Meetings: These meetings are co-hosted by DCF and BBCBC. The purpose of the meetings is to identify and discuss key System of Care issues. Permanency Staffings: These meetings are held every month and are attended by BBCBC staff, case management staff, GAL, CPI staff and CLS staff. The primary purpose of the meetings is to identify and resolve permanency issues for children. Challenge and Local Review Team Meetings: These meetings occur in each Circuit and provide the opportunity to identify and resolve child specific and system issues and opportunities for children who are served by multiple state agencies. The primary focus is to assure interagency coordination for children who require out of home care or step down from out of home care. The meetings involve BBCBC, DCF Family Safety, DCF Substance Abuse and Mental Health, Department of Health Children s Medical Services, Agency for Health Care Administration, Department of Juvenile Justice, Agency for Persons with Disabilities, local school districts and other organizations as appropriate. Circuit 14 Children s Forum Meetings: These meetings involve DCF, BBCBC and multiple local agencies that provide services to children and families. The purpose of the meetings is to increase awareness of community resources, promote partnerships, share best practices and promote System of Care concepts and ideas. PROGRAMS AND SERVICES As a network management organization, we are accountable for developing and coordinating a network of subcontracted organizations and providers designed to meet the needs of children and their families. The primary components of our System of Care are described below. A. CASE MANAGEMENT Dependency Case Managers (DCM) and DCM supervisors are at the forefront in making a difference in the lives of the children and families we serve. We must recruit, retain, and adequately support the front line child welfare professionals and assure they are in turn supported by skilled supervisors. The DCM owns the case and serves as the single and continuous point of contact for the child and family from entry until exit from services. 6/15/

24 Family Centered Practice is a core strategy for building effective and ethical child welfare practice. One of the most significant changes that can be made in child welfare case practice is a renewed focus on engaging and supporting families whether they are birth, relative, non-relative, foster or adoptive families. Family Centered Practice means more than engaging the parents in the development of the case plan; it means identifying and focusing on meeting families needs and linking families more effectively with supports and community resources. BBCBC is committed to helping children achieve permanency through reunification, guardianship, or permanent placement with fit and willing relatives by the twelfth month. Permanency staffings occur at a high frequency to promote close monitoring of service provision and case plan progress. The initial staffing is held by the second month and subsequent staffings are held at least every three months thereafter. Participants include the BBCBC Intake/Placement Specialist, DCM, Adoption Specialist, CLS, parents, children, caregivers and service providers. Families are engaged in the development of individualized, strength-based case plans that promote safety, well-being, and permanency for the child within established federal and state mandates. BBCBC expectations for case management services and supports to facilitate consistency across the service area and among subcontractors include: 1:20 caseload ratio (DCM to child) 1:5 supervisor to DCM ratio FSFN is the legal case record Use BBCBC decision support tools in their work Follow BBCBC s Operating Policies and Procedures Specific DCM responsibilities include: Joint home visits and Engagement Staffings Case Plan development Obtain needed assessments and services Ongoing coordination and communication Ongoing Family and Safety Assessment Psychotropic Medication compliance Coordinate well-being needs - medical, dental and behavioral health care services Permanency Staffings Judicial involvement including court reports, appearances and follow up Visitation with child and family 6/15/

25 Critical Incident Reporting Use of Family Centered Practice and Trauma Informed Care principles Strong supervision is critical to providing quality services for children and their families. Supervising for Excellence training is required for all case management supervisors. This training is used to promote effective supervision that will increase staff stability and assure the provision of quality case management services. In the case management component of the System of Care, we have incorporated a number of positive case management practices that result in more timely and sustainable permanency, thus resulting in the continued reduction of overall caseload and removal episodes. Early Engagement and Case Transfer: This engagement process supports a joint CPI/DCM visit early in the life of a case to support relationship building and early service provision. Case transfer occurs at the Engagement Staffing following the first visit and includes the parent, child, the family s supports and service providers. The Engagement Staffing focuses on the strengths and needs as identified by the family. Permanency Staffing: The initial staffing occurs by month two with subsequent staffings occurring at three month intervals. These staffings are open to include the child, parents, caregivers, attorneys, GAL, CPI, and treatment providers. The discussion is strength-based and emphasis is placed on developing solid plans to move the case through the system to permanency. Multidisciplinary Staffing: Staffings between the child and family, CPI, CM, and service providers are held on an ongoing/as needed basis to facilitate effective communication, assess family strengths and needs, update case plans, and assure child safety and well being. Examples include critical juncture staffings, placement stabilization, closing the loop, and the Medicaid related MDT. CASE MANAGEMENT AS IT RELATES TO FAMILY PRESERVATION CASES In our System of Care, there are three case types: Shelter, In-home Judicial, and Family Preservation. Family Preservation, as a case type, is a new concept in our System of Care initiated by DCF and formalized in local protocols in The criteria for a Family Preservation case include: Call to the hotline and subsequent investigation, Investigative findings that do not warrant removal of a child, and; Safety assessment indicates imminent risk of removal if services fail. The primary goal in working with Family Preservation cases is to maintain children in their own homes and divert them from entering out-of-home care. 6/15/

26 As Lead Agency for Community Based Care in Circuits 2 and 14, BBCBC is involved in every aspect of planning for and implementing Family Preservation services. To effectively develop Family Preservation services, BBCBC has: Actively partnered with DCF in developing the Family Preservation Protocols in Circuits 2 and 14, Actively participated in developing enhancements, including the amended Circuit 14 Family Preservation Protocol, Multidisciplinary and Child Protection Team (CPT) Staffing Protocol, Bay County Family Support Team Protocol, and the Operating Procedure for Family Intervention Specialist, Initiated the development of a new policy on the case transfer process, Actively partnered with DCF to provide training to child protective investigations, case management, supervisory, management, intake and key subcontracted service provider staff in both Circuits 2 and 14 regarding the Family Preservation Service Protocols, Amended all BBCBC subcontracts for case management services to assure that all cases that meet Family Preservation criteria are assigned a Certified Child Protection Case Manager and to incorporate all of the required Family Preservation Services components as case management requirements, and; Reviewed the current array of services directly purchased with BBCBC funds to identify possible enhancements related to Family Preservation Services and to identify gaps. Our approach to implementing family preservation services has been facilitated through staff training, the utilization of intensive case management services, the procurement of family intervention services designed to prevent removal, and a commitment to the continuous review and revision of Circuit Protocols through collaboration with DCF. To facilitate the success of families engaged with family preservation services, BBCBC requires that all cases that meet Family Preservation criteria (imminent risk of removal if services fail) receive the benefits of case management services delivered by a Certified Child Protection Professional. According to a memo on Family Preservation Services released by DCF in May 2010, Family Preservation Services are intended to respect the intensity of the struggles that our families are facing by getting them help which is sufficiently intense and comprehensive to enable them to overcome their problems and raise their own children. The memo cites recurring themes in failed cases as: Ownership - no case management established; extensive long term history of problems, patterns of substance abuse, domestic violence and mental illness; lots of referrals no follow through or follow up; no feedback loop when services fail; families simply drift away from help and service providers fill the slot off the waiting list; results of service interventions are not recorded and tracked in FSFN. BBCBC believes that case management assignment, from a system design perspective, provides the best path to avoiding the recurring themes in failed cases by: assuring ownership; service integration; realistic safety plans; long term child and family support generally needed by the complex type of cases Pete Digre identifies; accountability for following through on service referrals and for closing the loop when services fail; and FSFN documentation. 6/15/

27 BBCBC has implemented several strategies to enhance communication between all network partners and ensure the loop is closed for every case engaged with Family Preservation Services. These strategies include: Incorporation of clear language into contracts between DCF and BBCBC as well as between BBCBC and subcontract providers, Provision of training to all Family Preservation staff in order to ensure that case monitoring and communication procedures are understood and followed, Within the System of Care, we clearly establish ownership of cases by assigning a certified case manager who is accountable and responsible for ensuring progress is made towards individual goals and, when necessary, calls a staffing with all engaged service providers, CLS, and Protective Investigators to evaluate the case plan and establish a plan of action, Case ownership is officially transferred at the Engagement Staffing, and; The development of quality assurance and contract management protocols designed to monitor and evaluate the efficacy, quality, and impact of Family Preservation services. CASE MANAGEMENT AS IT RELATES TO PARENT NEEDS ASSISTANCE REFERRALS DCF currently has established guidelines for Special Conditions Parent Needs Assistance (PNA) referrals received from the Florida Abuse Hotline. A PNA is an alternative to acceptance of a report for investigation in marginal situations with potential for maltreatment, but where no actual abuse, neglect or abandonment is alleged. BBCBC and its subcontracted case management partners are responsible for assisting with these referrals in accordance with the procedures set forth in the Circuit 2 and Circuit 14 Parent Needs Assistance Protocol. The Protocol is jointly developed and agreed to by both DCF and BBCBC and is incorporated by reference. B. ADOPTION AND POST ADOPTION SERVICES The philosophy of BBCBC is to provide each child the opportunity to have permanency in a secure environment through adoption with an adoptive family who understands and meets his/her needs. BBCBC understands that adoption is a life-long process and is committed to providing adoptive families with support and services after adoption finalization through post adoptive services. ADOPTION SERVICES BBCBC is committed to achieving permanency in a timely manner for children who have adoption identified as their primary goal. To facilitate permanency an Adoption Specialist is assigned as soon as the goal for a particular child is changed to adoption. The Adoption Specialist actively partners with the primary case manager and follows the case through adoption finalization. 6/15/

28 BBCBC employs a full time Permanency Specialist who serves as the liaison for our subcontracted adoption providers. All other remaining adoption staff are employed by Life Management Center in Circuit 14 and Children s Home Society in Circuit 2, our subcontracted adoption providers. Children moving through the adoption process whose experiences include foster care placement will face significant challenges in coping with abuse and neglect, attachment and residual loss issues. Adoption Specialists are committed to engaging children and preparing them for adoption placement. The following practices are aligned with the principles of Family Centered Practice and Trauma Informed Care, and have been established in our System of Care: It is BBCBC s practice to fully inform adoptive families of the child s history of trauma, wants, needs, and strengths prior to introduction thus reducing instances of rejection and retraumatization. BBCBC s adoption provider s staffing structure supports the assignment of a single Adoption Specialist to a child who will work with the child from the point that adoption is identified as the permanency goal to adoption finalization. By providing consistent staffing, our system of care is able to ensure that child and prospective adoptive family issues are fully and effectively addressed. All adoption staff are trained in Trauma Informed Care. To address trauma-related issues, children and adoptive families are referred to adoptioncompetent therapists who understand the tenants of Trauma Informed Care. Match Staffings are held to ensure a child s desires and special needs are considered in relation to a prospective adoptive family s strengths. A transition plan is developed for contact and visitation between children and the prospective adoptive parent prior to placement. Support Groups designed to address concerns related to adoption are available for prospective adoptive families, finalized adoptive families, and youth in both Circuits. Recruitment efforts take into account the unique strengths and needs of each child, as well as their cultural background and family history. BBCBC and the adoption service providers value and respect the unique strengths, needs and culture of families that are being recruited. Each member of the family is engaged in decision making and encouraged to explore the impact of adoption on the family as a whole. Each child is also engaged in decision-making regarding their adoption and selection of a family (depending on their age and maturity). BBCBC s adoption service providers use a variety of general and child-specific targeted strategies to recruit and retain adoptive parents that reflect the racial and ethnic diversity and who can meet the special needs of children awaiting adoption. BBCBC and our adoption providers access and use a variety of proven, evidence-based recruitment strategies including: Individualized Targeted Recruitment: Targeted Recruitment is the individualized recruitment of a family for a specific foster child. Children referred to Child Specific Recruitment have had parental rights terminated and do not have an identified adoptive resource. Individualized Targeted Recruitment identifies a child s specific wants, needs, desires, characteristics, history, behaviors, and idiosyncrasies. Additionally the process acknowledges and celebrates a child s culture, religion, 6/15/

29 language, and traditions. This information is utilized to build a specific recruitment strategy for the child and identify potential adoptive parents who will embrace the child s needs. Multi-media outlets are used to inform the public about the adoption process as well as about specific children available for adoption. Wendy's Wonderful Kids: The Foundation supports the implementation of child-focused recruitment programs targeted exclusively on moving children from foster care into adoptive families. The Foundation funds a position with our network partner, CHS, to execute aggressive, child-focused recruitment programs targeted exclusively on placing foster care children with adoptive families. Wendy's Wonderful Kids is a proven program that demands results, accountability and quality service on behalf of the children who need us most. Explore Adoption: Explore Adoption is a public awareness campaign that spotlights the importance of finding "forever families" for foster children. Floridians can access profiles and photos of children available for adoption at AdoptUsKids : BBCBC actively utilizes the AdoptUSKids website and tools to raise public awareness about the need for foster and adoptive families and provide child specific recruitment across an expanded area. Heart Gallery North Florida: The Heart Gallery is a traveling, museum-quality exhibit featuring portraits of children in the BBCBC s foster care system that are available for adoption. Collectively, this exhibit brings the faces and voices of thousands of waiting children into the hearts and homes of Florida citizens. Our customers are making a life changing commitment and, in turn, deserve a commitment from us. BBCBC is committed to the customer service and support for adoptive families beginning with the initial inquiry and continuing after adoptions are finalized. BBCBC s goal is to make sure every customer (potential adoptive parent) is properly informed and feels comfortable and confident about the adoption process. Furthermore, the commitment to customer service continues throughout the adoption process. Our prospective adoptive parents are provided with the necessary guidance and encouragement to keep them engaged. They are also provided with information related to realistic timeframes and expectations. The adoption process can be overwhelming and families may become frustrated when trying to navigate the system. BBCBC recognizes that are several things that can be done to increase the number of families who adopt. These include: friendly and responsive customer service, predictability about the adoption process, and support during the waiting period. As families need consistent, ongoing support throughout the process, BBCBC has implemented a number of strategies designed to reduce attrition of adoptive parents while they are waiting for placement of an adoptive child in their home. Adoption Orientation: Prior to beginning MAPP Training, prospective adoptive parents are provided with a realistic overview of the adoptions process that allows them to make informed decisions about 6/15/

30 adopting or fostering. By providing this information, the prospective parent is much less likely to lose interest or feel disenfranchised. MAPP Training: MAPP training is designed to educate prospective adoptive parents about specific emotional, developmental, and behavioral needs of children who enter the child welfare system. The training specifically incorporates components of Family Centered Practice so adoptive parents are better equipped to address any challenges that they may face and recognize a child s specific strengths. Furthermore, Trauma Informed Care concepts have been integrated into MAPP Training to allow adoptive parents to understand the impact of specific trauma on a child s development and behaviors. Support Services and Engagement: Finally, BBCBC provides extensive support to prospective adoptive families during the waiting period. We actively engage families and involve them in existing support groups so they can connect with other adoptive families and identify ways that they can become involved with the dependency system. Additionally, a quarterly newsletter is published to perspective adoptive parents in order to keep them informed about adoption-related issues and events. The Multi-Ethnic Placement Act (MEPA) is designed to remove the barriers to achieving permanency by reducing the length of time that children wait to be adopted, facilitate the recruitment and retention of adoptive parents who can meet the needs of children awaiting placement and eliminate discrimination based on racial or ethnic factors of the child or prospective parent. MEPA requires the recruitment of adoptive parents that reflect the racial and ethnic diversity of children awaiting adoptive placements. In Circuits 2 and 14, BBCBC has accomplished this through specific targeted recruitment strategies designed to consider these specific needs of children awaiting adoption. Specifically, we have 1) partnered with other licensed Child Placement Agencies, faith-based organizations, community organizations and local advocates to identify adoptive parents for individual children; 2) developed recruitment materials that reflect the racial and ethnic images of children available for adoption; and 3) held recruitment events in targeted communities. Additionally, we support the retention of ethnically and racially diverse prospective adoptive parents through the attention to specific cultural differences and needs. POST ADOPTION SERVICES Families adopting children whose experience includes foster care placement will face significant challenges in coping with abuse and neglect, attachment and residual loss issues. BBCBC recognizes the need to have services in place and available to families to successfully meet the lifelong challenges of adoption. Post-Adoption Services encompass a broad range of services including but not limited to education and information services; referrals, counseling, mental health and behavioral services; assistance related to adoption subsidy payments; crisis intervention services; assistance with obtaining resources and connecting with adoption support groups. BBCBC has responded to this challenge by hiring a Post- Adoption Services Specialist in both Circuits 2 and 14. The Specialist: 6/15/

31 Provides an adoptive family with a single point of contact who will respond to all inquiries and other requests within 72 hours, Provides families with information and referral to needed services such as mental health counseling for parents or children, a list of adoption competent therapists in the area and schedules for adoption support groups, Makes contact with all families seeking post-adoption services within 24 business hours of the request for services, and completes referrals for needed services for those families, Documents the provision of post-adoption services in Florida Safe Families Network (FSFN), Works in conjunction with Child Protective Investigators (CPI) on investigations that involve children in adoptive placement and adoption finalization, Maintains a library of electronic and conventional resources for adoptive family members (special emphasis placed on resources for parenting children with special needs), Facilitates and participates in the development of monthly support groups for adoptive families and/or children, including a support group for adoptive teens and children without an identified adoptive family, Creates a newsletter that is distributed or made available to adoptive families (quarterly), and; Creates/maintains a webpage within the agency s website specific to the needs of adoptive families (providing links to a wide variety of information and service sites that may be of assistance to adoptive families as well as information about adoption training, workshops and support groups). C. INDEPENDENT LIVING Preparation for adulthood is a complex process, even for those who have a loving family and generous support systems. Most successful adults learn life skills through their integration into a family in which adults and older youth model the critical thinking activities that lead to responsibility and success. Rarely is one able to accomplish the goals of employment, money management, and career development without the help of a variety of advocates, mentors, coaches, educators, and people who care. The IL program is designed to work in collaboration with youth, caregivers, case managers, IL Specialists, educators, counselors, physical and behavioral health providers, to develop a continuum of services to support foster youth, ages 13 22, as they transition to adulthood. The service planning process is client centered and addresses the youth s needs and focuses on the youth s strengths and assets. The IL program focuses on the creation of supportive partnerships in the community in four primary areas: Caregivers, Housing, Life Skills, and Education. The key components of the Independent Living program include: 6/15/

32 Provision of supportive services that allow youth to grow, develop emotionally, and learn key skills that will enable them to live independently, Active engagement of youth in development of their own plans, Coordination and provision of high quality, relevant education regardless of the placement setting, Opportunities to develop social, civic and leadership skills that allow youth to feel valued in the community, Connection to caring adults that can mentor youth, and; Interaction of youth with peers in a safe, supportive environment. To ensure youth are actively involved in their own transition to adulthood, youth are engaged in the development of their individualized IL Plan. The plans are developed in partnership with caregivers in order to ensure that they will be fully implemented while the child is residing in their home. The present economic situation in Florida has created a challenge for youth, especially inexperienced and undereducated youth, to find employment. To address this and ensure that youth in the IL Program are able to develop skills that allow them to become employed, the IL Program includes two educational advocates (one for each circuit) and an additional advocate designated to work with the Fostering Achievement Fellowship (FAF) program through Tallahassee Community College. These advocates are responsible for career assessments, tutoring, academic advising, and helping youth become engaged with training and educational activities that will enhance their ability to become employed. Recognized by the National Governor s Association as a national best practice, the FAF program is designed to 1) support the implementation of programs offered by BBCBC, Tallahassee Community College (TCC), and other partners; and 2) enhance communications between partners to gain clearer visibility of which youth are being served through which programs. The role of the foster family is important in the development of day to day living skills and decisionmaking processes. We collaborate with and train foster parents to become core partners in the Life Skills Training process which will support a youth s transition to independence. IL services are implemented through a combination of subcontracted case management services and the DISC Village IL subcontract. The case manager maintains primary case responsibility while the IL Specialist identifies and creates opportunities for the youth to be able to participate in community services, administers life skills assessments, provides hands on life skills training and establishes connections to a support system. In addition, the IL Specialist provides relevant information to case managers and caregivers on the development of Normalcy Plans. Life Skills Training: The IL Program includes a comprehensive, evidence-based Life Skills training program which involves an online assessment of each youth s current proficiency in specific areas. This assessment results in an individualized Life Skills Plan for each youth. These Life Skills Plans become a roadmap for working with youth to successfully enter adulthood. The Life Skills curriculum is available in an electronic format so that youth can access all of the training through a secure website. Each course has a mandatory online quiz that youth must successfully complete to pass the course. 6/15/

33 Youth in our System of Care now have online access to over 70 courses that are divided into the following key life skill areas: Job Seeking Skills Job Maintenance Skills Personal Appearance Community Resources Interpersonal Skills Legal Skills Housing Money Management and Consumer Awareness Food Management Emergency and Safety Skills Health Housekeeping Transportation Educational Planning Youth Input/Involvement in Program Planning and Design: Florida Youth SHINE Tallahassee Chapter is BBCBC s youth advisory board. Florida Youth SHINE (Striving High for Independence and Empowerment) is a youth-run, peer-driven organization working hard to change the culture of Florida s foster care system. Members identify the challenges and successes for youth in foster care and educate the public to create a better child welfare system. Members from the Tallahassee chapter currently serve on the State of Florida s Fostering Success Task Force, IL Re-design Committee, and the Youth Dependency Summit s Planning Committee. The advisory group alerts us to various issues and areas for improvement, such as: ensuring normalcy and permanency for all youth in care, assuring youth are present at court hearings, providing youth access to their personal records and documents, and making sure youth receive their allowance. Our Florida Youth SHINE (Tallahassee Chapter) has a strong voice which helps us better understand what we can do to better meet the needs of our youth in terms of preparing them for adulthood. Transition Planning: It is important for youth who are transitioning out of foster care to have opportunities to enhance their own capabilities and exert their own control over the course of their future. Successful transition to adulthood depends to a large degree on the youth s ability to make appropriate decisions regarding his or her case plan. Youth who have a sense of self-esteem and who feel empowered are often better equipped to deal with the barriers as well as the opportunities that arise during and after care. By encouraging youth and adults to become partners in making decisions, youth learn to take responsibility and become empowered. Beginning with the special JR at 17 years and 3 months and continuing through age 18 the IL Specialists work with the youth, foster care provider, relative/non relative caregiver, the case manager and other youth-connected parties in the community to assist the youth in their transition from care to their own home. The key domains addressed are budgeting for housing, food, clothing, and transportation for education and/or work. The need for integrated services within these key domains for youth transitioning is well documented. BBCBC responds to that need by providing a comprehensive continuum of services and programs in 6/15/

34 an integrated fashion, with an emphasis on youth involvement in all aspects of planning, implementation and evaluation. Again, the IL Specialist serves as a mentor for these youth in planning and transition activities. This includes taking the youth to find housing, obtain furniture, and set up utilities. Once the youth is 18, the IL Specialist continues to monitor the youth s progress through regular contact. Monitoring of Educational Progress: Our System of Care empowers and encourages the foster parent to be the responsible party for each youth s education. The IL Specialists closely monitor the academic progress of youth as satisfactory educational progress is a basic tenant of the program. Relationships are built with high schools and GED programs so that information on progress can be obtained regularly. The IL Specialist receives information of attendance and either grades or progress toward test readiness. Youth enrolled in Vocational-Technical programs must provide course enrollment information, test scores and lesson progress both during and at the semester close. Youth enrolled at the College or University level must provide the class schedule at the start of the semester and grades at the end. Mentoring of Youth: Youth need to develop positive, supportive and enduring relationships. BBCBC has experienced extraordinarily low turnover among the IL staff and, because of this, youth are able to develop long-term relationships with their IL Specialist. The FAF program provides both mentors and advocates for each youth in the program, which reaches our Circuit 2 youth. Other mentors are Attorney Ad Litems, Guardian Ad Litems, Agency for Persons with Disabilities Support Coordinators, faith-based and natural mentors that the youth has connected with either through the dependency process or in their studies. Due to our small communities, the youth themselves serve as mentors and supports to each other which are fostered by our IL program through the provision of monthly meetings. Permanent Connections with Adults: Assisting youth to successfully sustain life-long emotional relationships with adults is essential to their successful transition to adulthood. In order to effectively prepare young person to transition to independence, it is important that the youth become engaged with formal and informal supports in their local community. Community involvement can lead to additional financial resources, in-kind contributions and support. Community members can be helpful to youth who are looking for housing, seeking employment and finding ways to fill their free time. Collaboration with community organizations can lead to job shadowing experiences, mentoring opportunities and long-term personal connections. Through each youth s involvement in the IL program, they have many opportunities to develop permanent connections with adults in the community. Each of the actors in our System of Care recognizes and supports our youth in development of these relationships. BBCBC conducts permanency staffings on out of home cases at a more frequent rate as this is recognized as an essential element for success. The IL program in Circuit 2 has developed relationships with many community organizations that provide workshops and other support. Examples of various activities implemented include, but are not limited to: 6/15/

35 Just Us Girls Workshop facilitated for year old girls focused on healthy food choices, exercise, beauty and self-esteem. Partners in this event included Gold s Gym, a Mary Kay representative, Olive Garden, and a Zumba instructor. Man Up! Boys Workshop facilitated for year old boys features motivational speakers and donations provided from community partners, including: Florida State University, City of Tallahassee, Mr. Roboto s, Bagel Bagel, Chik-fil-A, Fire House, Tallahassee Car Museum, and a local politician from the school board. Thanksgiving Baskets are provided for young adults formerly in foster care. This is made possible through generous donations from community partners. Monthly IL meetings for young adults formerly in foster care include guest speakers and workshops on resume writing, job skills and job shadowing opportunities. Fostering Achievement Fellowship (FAF) is a group sponsored by the Tallahassee Community College Foundation. The FAF program philosophy believes that all youth who desire to achieve a college education can do so with the right supports and was developed to support the IL youth. The group holds monthly meetings with the youth and has a point person on campus that is available for mentoring as needed. There is an application process and the Foundation seeks recommendations from the IL program. BBCBC is committed to pursuing similar opportunities for our youth in Circuit 14. INDEPENDENCE VILLAGE BBCBC was awarded a grant for Independent Living Housing. Construction on the project is scheduled to begin in July Independence Village will contain 24 affordable housing units. Our Independent Living youth will have first priority in accessing these accommodations. INDEPENDENT LIVING PILOT BBCBC is working collaboratively with DCF and Andrea Moore (Child Advocate/Consultant) to develop an Independent Living pilot designed to demonstrate best practice and to inform the development of proposed legislation for the 2012 legislative session. The primary need to be addressed by the pilot is that foster youth transitioning to adulthood are not successfully achieving education outcomes or stable employment at the rate of their peers. According to DOE statewide data, 47% of foster youth are on track for a High School diploma versus 83% of the general population; 18% of foster youth passed FCAT - Reading at 10th grade; 30% of foster youth passed FCAT - Math at 10th grade; and foster youth are twice as likely as the general population to require Special Education or Exceptional Student Educational Services. The Guiding Principles of the Pilot are: Foster youth have hopes, dreams and challenges not dissimilar from any other child transitioning to adulthood. They want to succeed and be independent, self supporting, successful citizens. 6/15/

36 Engaging older children in a broad range of the usual activities of family, school, and community life during adolescence will help to empower the children in their transition into adulthood and in living independently. Foster youth demand and deserve opportunities for success in education and employment. We must focus on education as the vehicle for transforming youth outcomes. Success in education leads to employment opportunities and the personal development necessary for self sufficiency. Education is both a formal and informal process for all children. We recognize that foster youth lack opportunities for school success afforded to other children. We recognize that foster youth are far less likely to have a positive role model or support system. We will build on existing community supports and engage non-traditional members of the community for support as we seek to provide foster youth the academic resources, services, and extracurricular and enrichment activities that are available to all children. Our work will be informed by the youth, both those who are still in care and those who have aged out. The Evaluation Phase of the Pilot includes the following major activities - recruit executive sponsorship from DCF; determine project scope; define measurable success indicators; contract for technical assistance (using the Everybody's a Teacher initiative as a model); use a single case bore methodology to develop an Individualized Treatment Plan for all active cases in Pre-Independent Living; evaluate and determine opportunities for improvements based on the information obtained from the single case bores; conduct focus or planning groups with Independent Living youth, Foster/Adoptive parents, Independent Living and Case Management staff, and community members; define and collect ad hoc data to develop a data profile for the IL program; if indicated by research - design and develop Service Learning projects for youth; report the findings and opportunities identified by the research to the BBCBC Board of Directors and to DCF; and establish an IL Liaison/Advocate. The Implementation Phase of the Pilot includes the following major activities - program implementation; review of cases from the single case bore evaluations to determine progress and provision of feedback on identified problems and new successes; and measurement of success. D. FOSTER HOME MANAGEMENT BBCBC subcontracts Foster Home Management and related services within the System of Care. These sub-contracted providers are responsible for the recruitment, training, licensing, and retention of family foster homes within our Circuits. A key function is the initial and re-licensure of foster homes which are governed by Statute, Florida Administrative Code, and contractual time frames. All initial licensing packets are submitted to BBCBC for review prior to delivery to DCF for review and license issuance. All re-licensure packets are submitted in accordance with the attestation model. 6/15/

37 A quality foster home system is dependent upon recruiting and retaining a network of foster parents that are neighborhood-based, culturally sensitive, supportive of the Quality Parenting Initiative (QPI) and well-versed in Family Centered Practice (FCP) and Trauma Informed Care (TIC). Our approach to foster home recruitment, training and retention is based on a partnership between foster parents, biological parents, and dependency case managers. This approach depends upon the full engagement and support of foster parents in the process of meeting the needs of children in out-of-home care, establishing a sense of normalcy in the lives of these children, and facilitating foster and biological parent interactions. When foster parents are supported and experience a positive relationship with case managers, child protective investigators and licensing staff, care for the children in their homes is of a higher quality. Our foundational belief about the foster care system that guides our work is captured by the following BBCBC QPI brand statement: Children need families that will love, heal and nurture them. Our team is made up of equal and distinct partners committed to communication, support encouragement and mutual respect. This statement has been incorporated in agency brochures and communications and is posted in each service center as way of infusing a culture aligned with the QPI, FCP and TIC. Our plan to engage the foster parent community begins by identifying resources dedicated to supporting the foster parent program and providers. BBCBC sub-contracted foster care providers have staff responsible for local recruitment, selection, training, licensing, re-licensing, support, retention, and management of foster families within their service area. BBCBC s commitment to ensuring high quality licensing programs has resulted in a dual support system from an administrative level. Our BBCBC Placement Director and Training Coordinator jointly provide support and direct oversight of licensing and foster care support activities. Together they serve as a direct Lead Agency contact for foster families as well as a bridge between the licensing agencies and state licensing staff. This layer of support is vital in the maintenance of the relationship with the foster family, the transmission of information, on-going support, and provision of resources. BBCBC identifies specific needs of foster families and through education, training, support and communication we respond to those needs. Quarterly licensing meetings are also facilitated by BBCBC, in partnership with DCF, to monitor performance, provide support and create consistency among multiple entities. Our recruitment and retention strategies have been strengthened through our participation in the Quality Parenting Initiative. We engage foster and adoptive families in circuit wide meetings with representatives from all service programs and BBCBC and DCF leadership. Through this team approach we collaboratively developed the following circuit strategies to improve the overall quality of foster care, redesign recruitment materials, and work more collaboratively with foster parents: All recruitment materials now feature the Quality Brand Statement, Families featured on materials reflect more accurately the cultural demographics of our community, Recruitment brochures feature messages from children that have experienced foster care, 6/15/

38 There is one toll-free number for Circuit 2 and one toll free number for Circuit 14 to provide a single point of contact for prospective parents, and; Our MAPP Parent Preparation Program includes a discussion of the QPI Brand, Family Centered Practice and Trauma Informed Care as the expected practice models. MAPP also addresses the expectations for foster parents to work in partnership with birth parents. Partnerships between the Early Learning Coalition and foster parents have eliminated waiting periods related to child care enrollment and placement. Increased foster parent attendance and participation in Court proceedings as a result of discussions between foster parents and CLS regarding roles and responsibilities. Modification of marketing materials to emphasize sibling placement needs. BBCBC emphasizes recruitment efforts in areas where there is a high concentration of removals. This helps to maintain children close to their homes, allows children to remain in their own school, enhances school attendance, and facilitates parental/family visitation and involvement. In addition to geographic considerations when recruiting foster family homes, BBCBC routinely analyzes childspecific demographics, such as age, race, emotional and physical needs, therapeutic needs, and disability to strategically focus recruitment efforts. Through this approach we are able to decrease placement disruption by recruiting foster parents who are specifically equipped to provide necessary supports ameliorating many child need-specific challenges they may encounter. Parent Preparation Training of all foster parents is coordinated by the BBCBC Training Coordinator and facilitated by certified professionals. Additionally, BBCBC draws upon the expertise of dependency case managers, behavior analysts, current and former foster youth, and foster parents as trainers to ensure a full array of information and education is presented and made available to new foster parents. Over the course of training and licensing, prospective foster parents are continuously assessed and engaged through one-on-one meetings with the trainers. This allows specific concerns or questions they may have to be addressed immediately. Such individualized attention permits us to complete a more comprehensive assessment of the family, identify concerns both from the foster family and from the foster parent trainer perspectives, and identify strengths, weaknesses and possible barriers that may be arise during the training and licensing process. This information is discussed with the foster parent as well as our contract licensing agencies who utilize the information when completing the home study and licensing processes. All foster parents have an opportunity to learn about the Quality Parenting Initiative adopted by BBCBC, which specifically addresses the importance of foster parent relationships with birth parents. During QPI workgroup meetings, foster parents and staff create ideas for opportunities to increase foster parent interactions with birth parents. These ideas include the following: Ensure that foster parents transport children to visits as much as possible, Encourage foster parents and birth parents to attend school meetings together, 6/15/

39 Encourage foster parents and birth parents to attend medical appointments together, Encourage foster parents to supervise birth parent visitations at the home of the foster parent, Encourage birth parents and foster parents to plan birthday celebrations together, Encourage birth parents and foster parents to share pictures of the children with each other, and; Encourage foster parents to become mentors for birth parents. To further encourage this relationship, Intake/Placement Specialists attend shelter hearings for children who enter licensed care in all counties. The goal of this initial contact with birth families is to share information from foster parents, ask any questions about the child s needs or preferences and to introduce the relationship between the foster family and the birth family. Recognizing that youth have a need for normalcy, BBCBC has worked actively with foster parents and youth to establish expectations for the integration of appropriate activities into a child s daily life. As a result, foster parents have received training on normalcy. Each child in care has an individual normalcy plan developed citing age and developmentally appropriate activities in which the child will participate. Foster parents play an active role in the implementation of these plans. In addition to providing ongoing support services via contracted licensing agencies and training for foster parents, strategies for retention include annual appreciation events, enhanced financial support, and engaging foster parents in the planning process to improve the training and support. For example: BBCBC Christmas Wishes Initiative assists in the donation of holiday gifts for kids in care, BBCBC provides scholarships to foster parents so they can attend relevant conferences, BBCBC pays an enhanced rate for behaviorally challenged children, Foster parents are recognized through the provision of gift baskets, additional respite days and special events during the year, Foster Parents are invited to participate in BBCBC Board meetings, The BBCBC CEO makes personal one-on-one visits to our foster families on a regular basis to build an open, supportive relationship, Foster Parents have a point of contact through the BBCBC Training Coordinator and BBCBC Placement Director, BBCBC staff attend local foster parent meetings and assist with coordinating and providing childcare, and; BBCBC coordinates a Foster Parent Appreciation Committee that includes membership from case management organizations, licensing agencies, DCF and community providers. 6/15/

40 E. PREVENTION AND INTERVENTION PREVENTION Subcontracts with the Ounce of Prevention Foundation s Healthy Families Florida Program since January 1, 2011 have provided funding for the expansion of evidence based prevention services to families in C2 and C14. Healthy Families Florida is nationally accredited and voluntary. The program offers mothers and families experiencing stressful family situations home visiting services during pregnancy or shortly after the birth of a baby and can be extended long term until age 5 delivered by trained Family Support Workers. The program is based on the theory that families characterized by particular high-risk factors as defined according to community standards can be positively affected by direct prevention and intervention strategies. These strategies are directed toward reducing the risk factors that have been linked with increased incidence of child abuse and/or neglect. FAMILY INTERVENTION In October 2010, BBCBC initiated a competitive bid process to secure Family Intervention services in all 12 counties of Circuits 2 and 14. The primary purpose of the process was to assure that families in need are able to access services designed to prevent removal of children from their home. Four subcontracts were awarded assuring availability of Family Intervention services in all counties. Providers utilize best practice and evidence based in-home intervention services to families who are involved in the dependency system or who are at risk of becoming involved in the dependency system. Services are also provided to families whose children have been removed from the home and placed in foster care and are being reunified. The primary goal of the family intervention program is to maintain children in their homes while ensuring their safety and well-being. Services are provided in an effort to prevent the occurrence or recurrence of abuse, neglect or abandonment. F. OTHER In addition to the major sub-contracted services identified above, BBCBC also purchases the following, either directly or through the Purchase of Service budgets allocated to each case management organization: Visitation centers, including evidenced based parenting, Intensive Crisis Counseling services in Leon, Behavior Analyst services, Foster Home placement, Residential Group Care, and Residential Treatment, Network provider services such as parenting, counseling, assessment. These services and strategies are all designed to build upon family strengths and identify formal and informal supports. 6/15/

41 WELL BEING The true measure of a community s standing is how well it attends to its children their health and safety, their material security, their education and socialization, and their sense of being loved and included in families and communities who value and nurture them. No single child serving agency has the ability to provide all services and supports needed by families vulnerable to abuse and neglect. We believe that as an agency, we best serve families by creating and sustaining an alliance with other community groups who share our commitment to supporting families and keeping children safe. Historically, our System of Care has placed a greater sense of urgency on safety and permanency than on well being. That is no longer the case. Leaders in the Child Welfare arena are now systematically and emphatically focusing on processes and outcomes associated with medical, dental, vision, behavioral health, intervention, and educational assessments and services. INITIAL ASSESSMENT & CARE Upon removal, the CPI is responsible for making an appointment for the child s Medical Screening (EPSDT) within 72 hours and for making a Comprehensive Behavioral Health Assessment (CBHA) referral within seven (7) days. At the point of case transfer, BBCBC s Intake Specialists validate that the Medical Screening (EPSDT) appointment and the CBHA referral has been made. Case managers ensure that results of the assessments are entered into the child s resource record and shared with caregivers and service providers. Results and recommendations from the assessments are used to drive case decisions including: further assessments, service referrals, identification of mental health, substance abuse, medical, vision, and dental treatment needs. Through our Quality Assurance and Contract Monitoring procedures, BBCBC actively monitors and validates that required assessments are completed, referrals to service providers have been made, and that well-being factors (including medical, mental health, dental, vision, substance abuse and educational) are addressed through the provision of needed services. MEDICAL, DENTAL & VISION ASSESSMENTS BBCBC has entered into agreements with multiple providers. One purpose of the agreements is to ensure timely services so that children receive their Medical Screening (EPSDT) within the required 72 hours of removal. As part of the agreement, BBCBC guarantees that children in care are Medicaid eligible. However, should there be a delay or problem arranging for Medicaid payment, BBCBC reimburses the provider at the Medicaid rate. Although a key component of our System of Care is to make services as accessible as possible, many specialized medical services and dental care are typically limited in our rural communities. In any case where there is a medical or dental emergency and a Medicaid provider is not available or Medicaid 6/15/

42 does not pay for a certain procedure, BBCBC will fund the service through Purchase of Service dollars. BEHAVIORAL HEALTH ASSESSMENTS AND SERVICES Children ages 0-17 are referred for a CBHA. The CBHA is a comprehensive assessment of the child s physical and emotional health. If, based on the screening, there is a need for additional assessments or therapeutic services, children are referred to the local providers in their area. Our System of Care includes a comprehensive array of mental health and substance abuse providers available to work with our children and parents. The primary resources used for children and families to access these services include Medicaid (including the Child Welfare Prepaid Mental Health Plan), Medicare, private insurance, DCF Substance Abuse and Mental Health (SAMH) contracts, and self-pay. The most significant gap in coverage is for low-income adults who do not qualify for Medicaid, who cannot afford private insurance or self-pay, and who are not designated as a priority population for services under the DCF SAMH contracts because they do not have a serious and persistent mental illness. If a child or family is suspected of substance abuse or there is evidence of substance misuse, then the CPI or case manager will make a referral to the Family Intervention Specialist for an assessment and treatment recommendations. Family Intervention Specialists are co-located in each major service centers. POINT OF CONTACT The trauma experienced by abused and neglected children frequently results in behavioral symptoms that require more intensive levels of placement, such as Specialized Therapeutic Foster Care, Specialized Therapeutic Group Care, Statewide Inpatient Psychiatric Programs (SIPP), and services from mental health or substance abuse specialists. As a limited partner of the CBC Partnership (Child Welfare Prepaid Mental Health Plan), BBCBC collaborates on the authorization and provision of therapeutic services. Our designated Point of Contact is responsible for Multi-disciplinary Team staffings, Suitability Assessment coordination, and resource gap identification. EDUCATION Our System of Care values and understands the important role that education plays in the lives of our children. The System of Care goals related to education are to 1) increase access to education for all dependent children, 2) assist dependent children in meeting their educational needs, 3) empower dependent children to reach their educational potential, and 4) ensure dependent children receive equal access to educational services, and on a broader level, 5) improve the quality of education available in the catchment area. Our approach to supporting academic progress and success begins with the CBHA and Medical Screening (EPSDT). These assessments provide a comprehensive review of a child s functional capabilities and needs. Specifically, the assessments identify cognitive functioning, development 6/15/

43 milestones, medical needs, special needs, and educational strengths and deficits which may present a barrier to education. The assessments also offer recommendations for follow-up services or additional assessments (such as psycho-educational assessments, developmental assessments, and psychological evaluations with IQ testing). When case managers suspect that a child has specific developmental issues, referrals are made to a variety of educational resources spanning the educational continuum including: Early Steps and other early intervention programs in our communities (for children birth-3), At Risk Pre-School (for children age 3 school age), and the special education and vocational programs within the public school system (for children and youth of school age). Case managers are responsible for working closely with the school system to advocate for a child s needs and ensure those needs are addressed in an Individualized Education Plan (IEP). An IEP is developed by the child s school with the involvement of teachers, a psychologist, parents (or surrogate parents), and other school officials to identify learning goals and educational services for the child. BBCBC has procedures in place to ensure that a surrogate parent who knows the child and is willing to advocate for the child s educational needs is appointed within (30) days of the determination of need. Partnerships and effective communication with school personnel are necessary to support appropriate integration of education related issues with case planning and service delivery activities. One example of our collaboration is the Everybody s a Teacher initiative. DOCUMENTATION IN FSFN It is important to document the assessment and provision of well-being related factors in FSFN in order to ensure that all case parties have accurate, up to date information related to children in care. Gaps in this information can result in the provision of ineffective or inappropriate services. BBCBC requires that DCMs enter data into FSFN within 48 hours of any event or receipt of information. FSFN provides specific functionality and chronological entry capability that allow wellbeing related data (including medical, mental health, dental, substance abuse, and education to be documented). Entry of this information in FSFN is regularly monitored by Data Systems Training Coordinators in each Circuit. PROPOSED CHILD, ADOLESCENT AND FAMILY ASSESSMENT CENTER BBCBC is currently working to develop an integrated approach designed to more fully and effectively address the health needs of foster care children and families. While the initiative is in its early stages, we are optimistic that the effort will significantly increase the availability and delivery of behavioral health, medical and dental screenings and assessments. For more information regarding this initiative, refer to the attached document - "Proposed Child, Adolescent and Family Assessment Center" - dated April Our intention is to replicate the initiative throughout Circuits 2 and 14 after full implementation and evaluation of the initial Center in Leon County. 6/15/

44 SYSTEM COMPONENTS FOR MEDICAL HOMES FOR CHILDREN IN THE CHILD WELFARE SYSTEM BBCBC is currently working with multiple community partners including DCF, Children's Medical Services, FSU Center for Prevention and Early Intervention, Tallahassee Pediatric Foundation, and others to determine the feasibility and subsequently operationalize a Medical Home concept. The current work is limited to Leon County, but the long term goal is to replicate successes in all areas of Circuits 2 and 14. The primary components of the Medical Home concept are: Quickly determine Medicaid eligibility, status, health plan and primary care physician, Efficiently collect basic medical information at the time of removal, including immunization status, Schedule and complete the 72 hour well being child check-up including vision and dental screen, Coordinate sharing of results of well-child check-up with all involved parties and caregivers and determine any immediate follow up actions, Establish the primary care physician (PCP), Complete the Comprehensive Behavioral Health Assessment (CBHA), Synthesize the results of the well-being child check-up and the CBHA and determine necessary follow up actions including consideration of a comprehensive 30 day well child check up with the PCP, Schedule medical, dental, vision, developmental, and behavioral follow-up, Provide health education, developmental guidance and other support to family caregivers, Track and coordinate follow-up of well-child check up, adherence to periodicity schedule, immunization, and CBHA recommendations, Transition health care coordination to permanent family and natural resources. 6/15/