MONDAY REPORT
October 21, 2002
SPECIAL NOTE: Copyright 2002. The Monday Report is produced each week as a benefit to the member agencies of the Child Care Association. Please protect this membership benefit - DO NOT copy and distribute this report to agencies/staff that are not members of CCA. Thank you for your cooperation.
CHILD
WELFARE ADVISORY COMMITTEE (CWAC) REPORT
Draft
Protocol on Missing Children
Cook
County Performance Ranking and Contract Adjustments
RESIDENTIAL
NETWORK (PPN) WORK GROUP REPORT
RESIDENTIAL
SERVICES NETWORK (RSN) -NEEDS BASED PLANNING MODEL
TRAINING
WAIVER AND FOUNDATION TRAINING PROGRAM ADVISORY GROUP
Comprehensive
Services Survey Summary
Part
132 Review Processes and Reports
Requirement
for Checking Nurses Aid Registry
�SUBSIDIZED
GUARDIANSHIP-EXPERIENCES�
CWAC met in Chicago on October 17.
Budget: Director McDonald reported that the current state budget situation remains grim. There is a deficit in the state budget. Current funding payments were delayed in the Illinois Comptroller�s Office for the first time this month, due to a $2.5 billion cash deficit. DCFS finance staff are working with the Comptroller�s staff on long-term forecasts for current funding needs from GRF.
Residential Issues: Director McDonald reported that as a result of recent press reports regarding a residential facility, the ACLU was raising issues about the effectiveness of residential care in general. Karl Dennis has been asked to work with DCFS to address the opportunities for serving children with high-end needs in the context of community-based placements. Additionally, DCFS will speed up its efforts to implement the 30 day integrated assessment requirement from the BH consent decree. Co-chair Tom Vanden Berk reported he had met with Chicago Tribune staff this week to share his perceptions and thoughts on the recent press coverage.
Kinship: As reported in previous Monday Reports, DHHS has suspended implementation of its policy decision on reimbursement to states for unlicensed homes. This means the immediate threat of loss of funds to DCFS has been removed. However, the feds will be examining the policy in more detail and may mount a rule change process, so there is still a need to be diligent in tracking this issue. Current DCFS initiatives and expectations for diligent licensing of kinship homes will continue.
(See Monday Report of 9/23 for full report)
Rate Methodology: No rate methodology will be applied at this time. DCFS and the FAS work group continue to look at trends in utilization of high-end programs, and to examine possible variations in the methodology formula. Based on current utilization trends and status of the budget, DCFS cannot afford to implement the methodology at this time. Additionally, because of utilization in some facilities, a number of agencies face a significant cut in their rate. This will not advance the total system. The FAS work group will continue to review the data with DCFS and attempt to arrive at some solution. However, agencies should not expect to see a change in rate in the immediate future.
The Residential Services Network discussions (See full report elsewhere in this Monday Report) should provide some solution to this problem. As the system is redesigned and expectations for treatment of children with certain types of needs are defined, a rate system can be developed based on a different mix of variables. The work group will continue work on this throughout the fall.
Clothing Vouchers: DCFS has agreed on a system for direct reimbursement to agencies for advances for clothing and equipment vouchers for foster parents. This should eliminate delays in obtaining equipment and clothing while agencies wait for DCFS processing. Agencies will need to track DCFS response on the requests for reimbursement to assure the system works as envisioned. Foster Parent association members are concerned that they will see delays and/or inconsistencies from agencies once the responsibility is transferred.
Bed Hold/Case Management: As reported in previous Monday Reports, some confusion exists regarding application of the Case Management system and the bed hold policy for specialized foster care. DCFS policy staff will conduct a cross review of the two procedures to assure there is consistency and clarify areas of confusion.
(See Monday Report of 9/23 for full report.)
Behavior Management Plans: Seven agencies have neglected to submit plans. These agencies are on hold for referrals. All other plans are in the process of the first level of review. Responses to agencies should go out within the next 2 weeks. A draft protocol for the Level III reviews will be developed under the guidance of the oversight committee.
SED Waiver: DCFS is reconsidering its approach to the waiver as a full-fledged MST approach. The advisory group is looking at the process of deflection from and step-down from residential and how to link cases to clinical services.
The next meeting in October will begin to look at reunification services and how to implement best practices into these services.
Family Centered: Initial reviews of proposals recommended 113 programs. Following regional reviews, 12 programs in 8 LANS were declined, and following Central Office reviews, 10 additional programs in 3 LANS were declined. Decisions were based on programs� approaches to safety issues. Final program decisions are targeted for October 25 with final funding notices going out soon after.
Intake and Child Abuse/Neglect Report Decisions: Questions were raised about whether Illinois was seeing trends common in New York and other areas in which state budget problems were impacting protective service decisions. DCFS and DCP Directors responded they are confident that DCP workers are making decisions based on evidence and not on budget issues. There has been a 13% decline in reports that DCFS attributes to better practices at DCP that make for better decisions, including fewer cases per worker.
Questions were raised about the recent reports that DCP and the SCR hotline are declining reports due to quotas or instructions not to take in more children. DCFS and DCP Director vehemently denied the existence of quotas, and stated clearly that no one has been given any such instructions to limit intake considerations. All SCR calls, both accepted and declined, are taped. Any agency that receives any response they feel is questionable pertaining to decline of taking a report should assure that the reporting worker notes the name of the SCR worker, date and time of call and case name. The agency director should then contact John Goad with these concerns. He will run the tape and report to the agency on his findings.
DCFS staff shared current draft procedure 329 for Locating and Returning Missing, Runaway and Abducted Children. Agencies are expected to make all diligent efforts to locate children who are absent from approved placements and to report these efforts regularly. There is some confusion about the duplication of reports for the new policy and previous reporting requirements pertaining to form 680. DCFS staff is working on integrating the procedures. Letters with the draft procedures were sent to all agencies on October 11. Any agency wishing for a copy of the letter or draft procedure can contact the CCAI Springfield office at 217-528-4409. Comments can be made to Melissa Ludington or Denise Gonzalez.
Performance ranking for Cook Traditional and HMR programs was completed. System-wide, Cook HMR showed a permanency rate of 34.7% and Cook Traditional showed a permanency rate of 25.6%. Based on permanency rankings, cumulative permanency rating, and stability performance, agencies were ranked for overall performance. In HMR, fourteen agencies for HMR will go on half-hold for new cases with a net result of 16.5% shrinkage. Two agencies and Cook North will go on full hold, with a shrinkage rate of 20%. In Traditional, one agency, Cook North and Cook South will go on half-hold with a shrinkage rate of 12%. One agency will go on full hold with a shrinkage rate of 20%. Copies of the permanency ranking charts and overall ranking for contract charts can be obtained by contacting the CCAI Springfield office. (MB)
The PPN work group
met in Chicago on October 15. The network concept for residential services was
renamed RESIDENTIAL SERVICES NETWORK (RSN.)
DCFS staff presented a conceptual model of the key components of the network as a framework for the work group�s focus. The outline is included below.
Access to tiers will be based on a case mix evaluation demonstrated by the Outcomes Module
TIER I
Children in need of Residential treatment with the most severe
mental health conditions; will include programs that serve the following
population:
-Severe Mental Illness
-Severe Sexual Behavior Problems
-Severe
Emotional Disturbance
-Co-morbid Conditions e.g. severe -profound developmental delay with a mental illness
diagnosis
TIER II
Children in need of Residential treatment with moderate mental
health conditions; will include programs that serve the following population:
-Oppositional Defiance Disorder
-Conduct Disorder
-Behavior Disorder
-Delinquents
TIER III
Children in need of Residential treatment with mild mental health
conditions; will include programs that serve the following population:
-Adjustment
Disorder V-Codes
-Transitioning
Youth
-Substance Abuse Treatment
PREFERRED PROVIDERS WITHIN TIERS
Outcomes Goals
-Providers that demonstrate intervention effectiveness; decreased symptomatology and
increase functioning
-Providers that stabilize children such that the child can be step down - i.e. next placement
Process Measures
-Unusual Incident Reports (UIR) -Number and type of Airs with the norm for children in that
Tier/subtype
including number of arrests, runaways and psychiatric hospitalization
-Length of Stay -Projected and actual length of stay are within the norm for that Tier
University of Illinois at Chicago
Providers that are rated highly by the CATU at UIC
-Information
provided in a review of programs on the Profile Review Panel
-Experience with programs through RTS and CARTS where the program has demonstrated
clinical effectiveness
Network Business Rules
Network
Providers are part of a centralized intake and referral process
-Every
child gets reviewed
-Providers
matched based on the child's need and the provider's capacity
Network
providers serve all children appropriately matched to their program
Network
providers submit and operate from their current program plan
Network
providers participate in a joint provider/Department QA/I process
Network
providers employ appropriately trained childcare staff
Network
providers expand child welfare capacity under a certificate of need model
Network
providers are currently licensed, accredited and Medicaid certified �
The
work group determined that part of previous discussions related to separating
institutional/residential from group home programs as the network is developed
could be addressed in the context of the tier considerations. Medically complex
children will probably be treated within a different program plan. The group
also questioned whether Tier III behaviors actually call for high-end
residential care. In Tier II, the category of �delinquents� is actually a
legal term and there may be some element of children with a legal history in all
categories, just as there may be some degree of behavior problems associated
with all other categories.
The
existences of the characteristics listed in the tiers will not mean that
children with those characteristics will only be served in the residential
network. The determination will be overall assessment of all characteristics and
current need. Under
the Process Measures section, there must be more discussion on whether data on
length of stay is accurate to use as a way to judge a provider. Some stays are
extended when a suitable step-down resource is not available even when the
residential provider deems the child is ready for a different level of care.
A
discussion of tiers raised several issues. Some facilities may lend themselves
better to certain populations or tiers than others. There is also a case mix
consideration. How many of the various types of kids per tier is a reasonable
mix? DCFS staff suggested the tier classification is an initial attempt to order
the types of behaviors but will be flexible in the long run depending on the
program�s ability to manage these tiers.
The
suggested Network Business Rules were discussed. Provider members questioned
whether the section, �network providers serve all children appropriately
matched to their program� means that DCFS was moving to a �no-decline�
policy. There should be further definition of appropriateness of the child
referred at the time and the suitability of the slot open at the time. Providers
must be able to make decisions about the balance of the milieu at any given
time. How a system of available slots can be developed given these
considerations will be challenge. The group also discussed the concept of a
shrinking market for residential and how the market figures in intake decisions.
Although DCFS may not require a precise �no-decline� policy, providers will
need to be aware that as they decline referrals, they may risk shrinkage. This
is the same dynamic as is used in the downstate foster care rotation system.
The
group agreed it is reasonable to expect all residential programs to be
accredited and Medicaid certified. DCFS staff reported that about 10 programs
statewide are not yet accredited or certified. DCFS will be conducting
individual discussions with these facilities about future expectations. All
agencies should be engaging in their own QA/CQI processes and should be tracking
and analyzing their UIR and restraint and seclusion patterns. They should be
able to report trends in their facilities to DCFS and their other customers.
A
sub-group of the work group has begun meeting to discuss barriers to
movement/step-down in residential treatment. Discussion has focused on:
Transitions
to the adult service providers DD/MI
Educational
services
Transition
to/from DOC
Use
of Service Plan as consistent treatment plan tool
Identification
of appropriate use of group home model as a step down resource.
Intake
information--completeness and accuracy
Lack
of consistent discharge planning
Lack
of communication between DCFS and private agencies
Residential
Reviews
Need
for Residential Foundation training
Child
and Family teams--consistency, involvement
Need
for community linkages
Identification
of step down resources
Balancing
risk.
Next
steps of the work group will involve reviewing the information DCFS is
finalizing on the profile of the eligible population for high-end treatment.
Once this is completed, the group should be able to identify 4-5 indicators that
will permit agencies and DCFS to determine how an agency program can be
classified in response to the profiles of the population. The next meeting is
scheduled for December 10 at 10:30. (MB)
The
Training Waiver and Foundation Training Advisory Group met in Chicago on October
17. The following topics were addressed:
 | Enhanced
Training Stipend |
DCFS
training staff will assume primary responsibility for processing agency
stipends. Once they notified that a worker from a designated experimental team
has signed up for the training, they will work with the DCFS business office to
process the stipend. An agency will not have to submit a voucher. Exceptions to
this process will be made for those agencies that failed to submit the required
cost report for the past training grants. That amount will be deducted from
stipend allocations until the full amount is received back by DCFS. Agencies
that failed to submit the training cost reports and that are not participating
in the enhanced training program will see notification of the funds being taken
back from future other payments.
| Evaluation
Process |
The
formal evaluation process for the waiver training will start in January 2003.
Surveys will be administered at 6, 12 and 18-month intervals. The pre and
posttest subject matter will be extracted from subject matter experts.
| Phase
II Best Practice |
The
focus of the Training Advisory Group will be expanded to include providing
advice on implementation of the Phase II Best Practices training. DCFS staff
described the plans for the Best Practices/Expanded training. Phase II best
practices material will include material on core casework functions including
concurrent planning, assessment/service planning and family meetings. The SACWIS
functionality that will be released next year supports these key casework
activities. Initial training sessions will target permanency workers, child
protection investigators, supervisors and regional management. Supervisors and
managers will be trained in advance of their staff.
After
Best Practice training:
| Staff
will be familiar with the model and understand how the model impacts work
with children and families |
| When
staff participates in SACWIS training, design of the system will appear
logical to them because they will see the principles reflected |
| Supervisors
will not only understand the model, but will also be prepared to guide and
support their staff into implementation. Supervisors will encourage their
teams to practice elements of best practice on current cases. |
After SACWIS training and implementation:
| Staff will be expected to utilize SACWIS tools in their work. Because SACWIS tools are being designed to support Best Practice; this will lead them naturally into implementation of fundamental best practices concepts for all cases. |
| Supervisors will support ongoing learning and skill development through use of individual and group supervision. |
 | Rollout
Strategy |
Orientation for Supervisors and Managers
Orientation for Staff
Best Practice Fundamentals for Supervisors and Managers
Best Practice Fundamentals for Staff
Advanced Skills/Preparation for Supervisors and Managers
SACWIS Training
Anticipated rollout will focus first on DCFS staff and then move to voluntary agency staff. Because of the IV-E waiver program and the opportunity it presents for Cook area staff, the Expanded Best Practices and SACWIS training will begin for the voluntary sector first in downstate (non-Cook) areas and then move to Cook. This will also minimize the �contamination� factor that must be accounted for in the research component of the waiver.
Training will be conducted using a cohort model for rollout. Regions that complete best practices training first will complete SACWIS training first and will implement SACWIS first. For voluntary agencies, monthly cohort groups will be established but will not be regionally based. Training will be conducted in multiple locations for each region to minimize the need for travel and lodging.
An expanded Training Advisory Committee will be assembled in order to provide a good mix of input into the various functions of foundation, waiver and expanded best practices/SACWIS training. Any CCAI member who wishes to be part of the Advisory Committee should contact Marge Berglind ([email protected].) (MB)
The CWAC Medicaid
Workgroup met on October 17, 2002 in Chicago.
The agenda included the following items: Comprehensive Services Provider
Survey; Part 132 Review Processes and Reports; Part 132 Revisions; Requirement
for Checking Nurses Aide Registry; HIPAA; Medicaid Revolving Fund and
Residential Program Plan. A large
portion of the meeting was spent on discussion of the shift summary
documentation for comprehensive services and what should consist of an adequate
summary to support billing reviews.
A total of 52
providers were invited to participate in the survey based on their experience
with the transition from the Fee-for-Service option to the Comprehensive Service
option. Many of the providers
received multiple surveys to collect a variety of staff perspectives (e.g.
Executive Directors, QA/UR staff and clinical staff). A total of 109 surveys were sent out and 49 surveys were
returned to the Infant Parent Institute. Some
of the overall results of the survey are listed in the following summary.
Of the 49 surveys
that were returned, 45 of the respondents indicated that the transition from
Fee-For-Service to Comp Services was either very favorable or favorable.
Comments indicated that, even though the transition was time consuming
(developing new forms and procedures) the Comprehensive Service option is more
efficient. It has decreased the amount of time direct care staff are
required to spend in documenting services and increases the time staff are able
to spend providing services to clients.
It was also noted that it has reduced the stress of documenting services
in 15-minute increments. The
advantages noted by staff included: shift treatment summaries are a more
accurate reflection of services provided over the entire shift instead of
reporting individual units of service; more time is spent with clients; less
paperwork is generated; less overtime is needed for staff to complete
documentation and less administrative time is spent on billings.
One of the disadvantages noted is that some staff struggle with
summarizing mental health interventions and connecting their interactions with
client treatment plans; however, overall staff felt that comprehensive services
improved quality, ease of use and usefulness.
There was extensive
discussion on the review process and reports that are used by DCFS for the
Medicaid program. Since DCFS has
moved to a tiering process in rating compliance of agencies in meeting
requirements of the rule, the suspension and termination action has not been
applied. There are still some
differences between DHS and DCFS in how records are reviewed.
Since DHS will not do reviews of providers that they have certified
because they do not contract with for any services, DCFS has implemented a
review process with those agencies. One
of the big differences between the record review requirements for both
departments is with services that are provided prior to the treatment plan, even
though they may be identified as part of the assessment.
DHS allows for these services to be covered whereas DCFS does not.
The Infant Parent
Institute also asked providers if the reporting format and process that was
being used was helpful. The
providers indicated that sometimes that the final reports after a site review
did not get sent out in a timely way. It
would be helpful if a checklist stamped draft could be left at the site the day
of the exit conference so that agencies would be able to work with staff.
Staff members working on the case can look at the checklist versus a
narrative report. A small workgroup
was formed to review the differences between how DHS and DCFS conduct the
Medicaid reviews.
In the discussion
related to what needs to be in the shift treatment summaries, examples were
provided as to the types of language that were being included in the summaries
by agencies. People noted that what
is in the rule should be used as a guideline and that additional information
should not be requested beyond the rule. However,
in looking at the language in the rule it was unclear as to how much should be
included in the narrative. In order
to prevent agencies from having to reenter information that may be required on
other forms, it was suggested that the shift summary could reference other
documents that would provide the additional detail.
Agencies from the Medicaid Workgroup were asked to go back to their
agencies prior to the next meeting and determine what documents might be
included and how it might work in their agency.
DCFS is still
waiting for a draft from DHS regarding revisions to Rule 132. As soon as that is available providers will be included in
the review process.
This is a
requirement that was added to the Medicaid rule mainly in response to adult
services and was as the result of nursing homes or mental health facilities.
However, it needs to be implemented with all Medicaid providers to check
if there has been any abuse for a person applying for employment.
DCFS will be sending out a notification to all providers regarding the
requirements. The question was also
raised if this applied to new employees and were current employees grandfathered
in?
DCFS at this time is
still taking the position that they are not covered by the HIPAA regulations
since they are the parent and guardian for the wards. DCFS has contracted with a consultant on this issue for
further review. The Medicaid
workgroup made the recommendation that a letter be sent through the SED
committee to DCFS noting the concerns of these regulations and the impact that
they will have on providers if DCFS is not required to implement the changes.
It was noted that DCFS is ready with the code set changes if they need to
be done but not for the privacy requirements.
It was also reported that CCAI held a HIPAA session on Sept. 17, 2002 for
providers and has another session scheduled for Nov. 14, 2002.
(JMS)
The African-American Family Commission will present two dates for �Subsidized Guardianship-Experiences�. The first date and location is Friday, November 8, 2002 at Ada S. McKinley, 2907 S. Wabash, Chicago, IL from 10 a.m. to NOON. The second date and location is Thursday, November 14, 2002 at Tri-County Urban League, 317 S. MacArthur Highway, Peoria, IL from 10 a.m. to NOON. The intended audience is Child Welfare Staff and Foster Parents. For more information and to RSVP � please contact Wasi Young, African-American Family Commission (312) 326-0368.
The African-American Family Commission will present �Systems of Care� on Thursday, December 5, 2002 at the Juvenile Court Auditorium, 2245 W. Ogden Avenue, Chicago, IL from 10 a.m. to NOON. The intended audience is Child Welfare Staff and Foster Parents. For more information and to RSVP � please contact Wasi Young, African-American Family Commission (312) 326-0368.
Oct. 23-24 CCAI�s Fall Membership Meeting, Starved Rock Lodge and Conference Center
Nov. 7 First NonProfit Free seminar--Charitable Giving with Randy A. Fox�For more
information call toll-free 800.526.4352, X. 1531
Nov. 14 HIPAA
Seminar � Wyndham Lisle � 10 to 3:30
Nov. 18 Healthy
Families Illinois Policy and Advocacy Committee
|
For
further information on any of the above, contact the staff member noted in
parentheses at the end of the text: MB = Marge
Berglind 312/819-1950
([email protected])
JMS = Jan Schoening
217/528-4409, ext. 25 BRH=
Bridget Helmholz 217/528-4409,
ext. 24 BMO=Barb
Oldani
217/528-4409, ext. 21 |
Sandy Armstrong
217/528-4409 ext. 22 ([email protected]) CMS=Cindy
Stich 217/528-4409
ext. 23 ([email protected]) Kelly
Pantaleone 217/528-4409,
ext. 26 ([email protected]) |
|
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