Big Bend Community Based Care. Network Management Manual

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

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..... 8 BBCBC Organizational Structure...8 A. Core programmatic areas... 8 Quality management and Data Analysis...8 Training... 12 Fiscal management... 13 Utilization management... 15 Intake and Placement... 16 Diligent Search..17 Foster Home Re-licensing Attestations. 17 Contract Administration... 17 B. Supervision, Support, Employee Recognition and Grievance Procedures... 18 Supervision and Support... 18 Employee Recognition... 19 Grievance Procedures... 19 C. Cultural Competence... 19 Collaboration and Partnerships.....20 Programs and Services... 23 A. Case Management... 23 Case Management as it Relates to Family Preservation Cases... 25 Case Management as it Relates to Parent Needs Assistance referrals 26 B. Adoption and Post-Adoption Services... 27 Adoption Services... 27 6/15/2011 2

Post-Adoption Services... 30 C. Independent Living... 31 Independence Village...34 Independent Living Pilot.. 34 D. Foster Home Management... 36 E. Prevention and Intervention... 40 Prevention... 40 Family Intervention... 40 F. Other... 40 Well Being... 41 Initial Assessment & Care... 41 Medical, Dental & Vision Assessments... 41 Behavioral Health Assessments and Services... 42 Point of Contact... 42 Education... 42 Documentation in FSFN... 43 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

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 www.bigbendcbc.org. 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 2005. 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

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 12.5. 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

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

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

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

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

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 6/15/2011 10

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. 6/15/2011 11

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. 6/15/2011 12

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 email 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 6/15/2011 13

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 1306. 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. 6/15/2011 14

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. 6/15/2011 15

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. 6/15/2011 16

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 http://www.dcf.state.fl.us/cbc/) 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 6/15/2011 17

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 emailed 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 6/15/2011 18

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. 6/15/2011 19

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 2007-2012 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, 6/15/2011 20