Georgia Association of Homes and Services for Children
Background Paper - Children's Agenda
Very much working Draft Paper
July 28, 1999

Executive Summary -  As Georgia debates the shape of human services in the state, it is imperative that those who are providing the services also provide their input.  We have watched as various State Departments responsible for human services develop models of care that have unintended consequences for the person in care (you might want to explain this statement- clarify meaning and how it relates to the next sentence).  This is never more evident than in the case of care to children and their families.  This paper will present thoughts on how the State can better serve children and families in Georgia.

The present system for children is too fragmented, is geared primarily toward adults, and is more attuned to specialized services than to the specific task of caring for children within families.  The needs of children are often omitted from the discussion of human services.  Children have been historically cared for within families and communities, and it is imperative that any discussion regarding services to children keep these important systems preeminent.

This discussion needs to bring forth bold proposals if the needs of children are going to be met.  This paper will propose the creation of a new department to serve children and families in Georgia.  This is not a remake of the present Department of Human Resources, but the creation of a Department for children and their families. This new department would be state directed, utilize a county governance system, and be driven by goals and outcomes.  The department would coordinate an integrated delivery system of care for families and their children.  The First Placement / Best Placement and the Georgia Family Connection Sites would provide the model of care delivery.

A Presentation of a Model

Georgia stands at the threshold of an unprecedented opportunity to take care of its most vulnerable citizens, its children and adolescents. Certain forces of reform have come together in the last four (4) years to provide a fully integrated system of care for Georgia's families and children. These forces of reform are: the Children and Youth Policy Council and its Family Connection sites,  the Department of Human Resources' First Placement/Best Placement foster care initiative and GAHSC's Community of Care initiative.

Guiding Principles

These initiatives all advocate certain guiding principles for services to Georgia's Children and Families:

1. Community and family based services - implement prevention strategies that seek out at-risk children and families early and provide them with the supports they need to promote good health and development.

2. Family self-sufficiency - focus on families early and build on their strengths and resources.  Families are the best place to nurture and care for children.

3. Integrated system delivery - weave support for families and children into an integrated comprehensive system of health, education, social, and employment services.

4. Cost and outcomes accountability - seek results that reflect the status desired for children and families and link money to results.

5. Public/Private Partnership - bring consumers and public and private organizations together to make decisions about which strategies work best for children and families.

These initiatives have spoken with one voice concerning the vision for children and families. This paper will address how children and families can be supported and  best served using the guiding principals stated above.

Background-Georgia has made progress in improving the status of children over the past few years--moving from 47th to 43rd in measures of children welbeing among the 50 states according to national Kids Count data.  Too many problems remain.  With over two million children under the age of 18 in Georgia, it is important to continue to address this poor showing .  In 1997, 24,893 families began at an increased risk of poverty because the mother was a teenager, was unmarried, or had not completed high school.  Babies in these families represented half of all first births to Georgia mothers.  These families need increased support if they are to become to self sufficient families with healthy children.

The problems affecting Georgia's children are numerous and serious in nature.  In 1997, there were about 23,000 confirmed incidents of abuse or neglect in Georgia. Over 10,000 children are currently in the custody of the state because of abuse and neglect.  Over 23,000 children are involved in the juvenile justice system.  These children are at a much higher risk to have related adult health risk behaviors and diseases.  They are more likely to become heavily involved in alcohol and drugs,  to suffer from emotional disturbance, to have severe health problems, and to be involved in the criminal justice system.   Georgia has a vested interest in making sure that its families and children are healthy.  The children of today are our adults of tomorrow.

Current System of Care-Presently, children and families are served in a very fragmented system that presents very differing models of care.  They are primarily served by three divisions, which are the Department of Human Resources (DHR), the Department of Community Health (DCH) and the Department of Education (DOE). The Divisions of DHR that serve children are the Division of Mental Health, Mental Retardation and Substance Abuse (DMHMRSA) and the Division of Family and Children's Services (DFCS).  DFCS serves mostly children and families who are in need of protection, support, and custody.  DMHMRSA serves all children and adults who need mental health services. DOE provides for the educational needs of children.  The Office of Adoptions attached to DHR coordinates all adoptions of foster children in the state. The Department of Community Health provides physical and mental health care through Medicaid to both public and private providers.

The manner in which these departments and divisions serve children vary as well. The Department of Community Health (DCH) serves primarily as a gatekeeper for federal funds and contracts for these services with DHR or private providers.  The Division of Mental Health, Mental Retardation and Substance Abuse (MHMRSA), through its Regional Boards and Community Service Boards, provides mostly outpatient services to children and adults.  The Division of Family and Children Services provides both professional and para-therapeutic services through their local county offices,  volunteer foster parents, and privately contracted agencies.  The Department of Education works through local county boards of education and local schools to provide education.

DHR, through its Division of Family and Children Services, provides family support, child protective services, and foster care.  These services are coordinated through county DFCS offices statewide.  Children and families most often do not get help unless they are already in trouble.  (Explain This) The Work First TANF program is a notable exception to this model of care.

For families and children who are in need of significant help in relationships and mental health, some in-patient mental health services are provided through these departments and divisions.  DMHMRSA provides very little substance abuse treatment to adult family members and what little exists is located primarily within the metropolitan areas of Atlanta.  DMHMRSA provides in-patient services to children through their Regional Hospitals and therapeutic foster homes within the Community Service Boards.  The Division of Family and Children Services provides mental health services through its Multi Agency Team for Children (MATCH) for severely emotionally disturbed children.  These children are screened through county MATCH boards, and, if they qualify, are then recommended to the State MATCH Committee.

Children needing less therapeutic services and non-residential services are referred to the DMHMRSA Community Service Boards for mental health or other services through private providers.  Children who for one reason or another  cannot stay in their homes (due to abuse, neglect or lack of parenting skills by a provider) are referred to the state foster care system.  Mostof the children currently in the foster care system need high levels of mental health services and therapeutic environments (FP/BP Study, 1999).

Present Service Delivery

The current system is too fragmented  to effectively serve the needs of families and children.  What is needed is a system that allows "one stop shopping" for families and children.  A new Department could provide these services if certain changes were brought about.  A common county governance system would ensure the fair and equitable delivery of services.  The paradigm of care would  include children within their families and communities.  First Placement / Best Placement provides a working model of how that may work.

We propose to call this new department,  the Department of Family and Children Services.

Vision - One Department Serving the full spectrum of Children and Family Needs.

We envision one Department, the Department of Family and Children Services, dedicated to serving the needs of children and families.  We envision a Department that has one system of governance statewide, providing a full array of services that fully meets the needs of families and their children.  We envision a Department that serves children within the context of their families and communities.  As Georgia reorganizes its human service delivery system, we envision the state creating a  Department of Family and Children Services that truly serves children and families comprehensively and effectively.  The shape of change in the future depends upon thoughtful consideration of what consequences change will bring about.

Principle #1 - Children and families should be served within their communities-The Department of Family and Children Services (Dept. of FCS) will be the portal of entry for all children and families in need.  Dept. of FCS will create an integrated delivery system that will meet the needs of children and families at the earliest indication of need.  The services provided will include:

Early support for expectant mothers,
Financial and employment support services to families,
Child protective services,
Custodial care for children who are victims of abuse and neglect,
Permanency planning for every child in care,
Coordination of  the mental health needs of children, and
Development of a public / private partnership in the care of children.
 
First Placement / Best Placement will form the model for the delivery of these services.  The local county offices of the Dept. of Family and Children Services (Dept of FCS) will coordinate all services such as welfare support, employment readiness, child support, adoption, and child protective services.  The role of the public sector will be contractual and regulatory.  The private sector will partner with Dept. of FCS to provide services to the communities, families, and children.  Children and families will again belong to all Georgians.  Its institutions will be partnering with the state to care for its own.

Children needing mental health services will be served within their families and communities. With proper supports  these children can do well within their families and communities. The clinic option (only available through a select group of providers ie-Community Service Boards) provides only reasonable availability and quality for these children. We believe that both availability and quality can be enhanced by the expansion of the clinic option by all private providers. Patient choice would be enhanced by allowing private providers to receive Medicaid reimbursement. The new department would be the portal of entry for children needing mental health services.  Private providers would provide the services.
 

Principle #2 - Family Self Sufficiency - This system of care would provide the means by which families could become self sufficient.  The cycle of generation after generation existing on welfare has far too many dire consequences.  Family self sufficiency occurs when parents can find gainful employment, when children are healthy and educable, when adults are free of substance abuse, and when children can grow up in nurturing and loving homes.  The success of the Department and its services would be measured by how and when they lead families to self sufficiency and by the well-being of the children in those families.

Principle #3 - Integrated System Delivery  - Under this system, children needing SED services could secure the services that they need in an integrated system. Under this system, any child, regardless of his/her custody status, could receive services. Children in state custody would be able to access services as easily as children who reside in the custody of their parents. Medicaid and non-Medicaid eligible children would be served equally. Services would be rendered based on identified needs rather than on custody or third party status.

A continuum of services could be most readily provided through Dept. of FCS since most children needing in-patient services are in the custody of  this Department.  Those children who are not in Dept.of FCS custody could still contract with the private agencies to provide these services. explain this- the children will contract with private agencies? do you mean through DFCS, even if they are not in custody?

Principle #4 - Cost and outcomes accountability - DFCS continues to move toward a system that incorporates assessment into the case of every child that is received into care.  First Placement/Best Placement (FP/FP) has developed outcome instruments that measure results and require budget accountability. MATCH program has required outcome measurement instruments for two years.  These instruments promise the accountability required by both State and Federal agencies.

Principle #5 - Public and Private Partnership -  The citizens of Georgia need to have ownership of their children.  Our private agencies represent our communities' efforts to care for its children's mental health needs.  The governmental sector cannot do it alone.  It must be done with the support of communities represented by the care provided by private agencies.  The system proposed represents this private community support that can be offered when collaboration and partnership happen.

In Conclusion

In the system that we have described, all the guiding principles are supported.  This system would operate in concert with the present consensus of the state, the current initiatives, and the best thinking about how care could be rendered.  It also provides consistent governance for services to children and families through county control.  Children would move through a system that is concerned about their families and communities, is well integrated within Georgia's infrastructure, contains outcomes and cost accountability, and provides a partnership between the private and public sector.   This system would be beneficial for both children and state policy. It would represent a step toward providing integrated services and away from the fragmented system that presently serves children.

For more information contact:
Normer Adams
normer@gahsc.org
404 572 6170

For Discussion Purposes Only - For Executive Committee Eyes Only.