Final Recommendations Governor

Final Recommendations
Governor’s Action Group for Safe Kids
Fall, 2003

Staff and Work Force Issues
Reduce caseloads: Continue the reduction of caseloads for all case managers with the long-term goal of meeting appropriate Child Welfare League of America standards.
Knowledgeable case managers: Define the education, training, experience,and pay for case managers that allow the development of effective personal relationships with families and children so that the case plan can be implemented. Make these requirements consistent across agencies. Culturally competent case managers: Ensure that case managers are culturally competent and are customer/family friendly. Define the types and numbers of case managers required to respond to cultural differences and move toward fulfilling the need.
Incentives to attract the right staff: Create incentives for the most qualified staff members to become case management coordinators, such as lower caseloads (15-17 cases for DFCS; 15 cases for DJJ) and job rotation.
Assessment and Screening
Shared assessments: Require all state agencies that come in contact with a family or child for out-of-home placement to use and make available to authorized users common data components including assessment information, demographics, and family history. Existing data sources will be reviewed prior to authorizing expenditures on collection of new information. All common data component information should: • Be automated • Be web-based, and • Populate the appropriate agency specific assessment records.
Common assessment components: Common data components shared by the agencies should include information on: • Safety (the child’s and the community’s) • Risk factors • Resources (strengths), and • Family dynamics
Time frames for data collection: Establish standard time frames for collection of common data components; e.g., immediately, within 24 hours, within one week, within one month.
Assessment “menus”: Encourage the agencies to establish “menus” of assessment instruments to use in specialized situations following collection of the common data components.
Required acceptance of assessments: Require agencies that deliver services to children (DJJ, DFCS, DOE, MHDDAD, DCH) to accept one another’s assessment findings once the assessment measures have been found to be: • Culturally sensitive • Developmentally appropriate, and • Methodologically sound.
Cross-training: Provide cross training to DJJ, DOE, DFCS, juvenile court judges, DCH, private and non-profit service providers, Special Assistant Attorney Generals (SAAGs) and MHDDAD staff on the benefits and limitations of the assessment process, interpretation of information, and knowledge of available resources to serve children and families.
First staff is the right staff: Involve trained and experienced staff in making critical intake decisions. Involve a sufficient number of experienced staff (24/7 “real time”) as early as possible in the assessment process.
Early assessment to prevent outof-home placements: Provide comprehensiveassessments (including family conferencing) when a child initially comes in contact with agencies (i.e., Child Protective Services) to prevent outof-home placements.

Family-Based Placements
Increase the availability of fostercare. Increase the availability of high quality foster care, including familybased and group care.
Single system for foster care recruitment, training, and retention. Establish one system for foster care recruitment, training and retention for all agencies placing children.
Dedicated positions for foster care recruitment and retention. Create state-funded positions serving counties or regions whose responsibility is to 1) recruit new foster parents and 2) retain existing foster parents by ensuring that their needs are addressed. These positions should be at the community level, with the allocation of positions tied to the caseload of children in out-of-home placements. These positions should serve all state agencies that place children in keeping with Recommendation 2 above.
Privatization of recruitment. Consider further privatization of foster care recruitment.
Statewide marketing campaign. Conduct a statewide marketing campaign to recruit new foster families.
Identify and target messages to groups that are most likely to respond and to demographic groups where homes are particularly needed
Coordinate brochures, a website, and other supportive materials
Operate a statewide toll-free number, including nights and weekends when working adults are most likely to call
Consider separate campaigns for adoptive and foster parents
Positive agency response. Make prospective foster parents feel “welcome, respected, accepted, and needed” from their very first contact with the state. Staff the toll-free foster care number with trained, consumer-friendly staff, including nights and weekends. Expand the state’s role in providing training to the county/regional foster care recruitment and retention staff on how to make foster parents welcome and support their needs.
Raise foster care rates. Implement basic foster care rates that address the inadequacy of current compensation.
Increase supplemental payments. Implement payments to foster parents to address the inadequacy of reimbursement for supplemental expenses. Develop a system that balances accountability with timeliness of payments.
Increase state reimbursements for certain allowable “special” expenses such as school clothes.
Address timeliness of reimbursements.
Review policies regarding “allowable expenses”.
Enhance other incentives. Consider other possible incentives for foster parents, such as state tax credits, making foster parents eligible for participation in the state health benefits plan, or student loan forgiveness.
Professional foster parents. Develop and evaluate a pilot program for professional foster parents as part of the placement continuum. Professional foster parents receive a salary and benefits for their work as foster parents, in addition to the regular per diem cost payment for each child. Professional foster parents may be an appropriate option for difficult-to-place children with special needs.
Improve foster care training. Modify foster parent training to add more material identified by foster parents. Make training schedules more flexible and consumer-friendly. Explore utilization of privatized training options and/or training through the Department of Technical and Adult Education.
Increase emotional support. Explore and implement effective models for emotionally supporting foster parents.
Increase involvement of foster parents. Increase involvement of foster parents as part of the child’s case management and planning team. Allow and encourage foster parents to testify at the child’s court hearing through steps such as providing adequate notification to foster parents of upcoming hearings.
Encourage foster parents to be heard. Ensure that foster parents receive notice and an opportunity to be heard consistent with federal and state law.

Non-Family Based Placements

Increase availability of therapeutic services: Increase therapeutic services of various intensities and types, including: • Acute emergency placements • Therapeutic emergency placements • Appropriate options for children dually diagnosed with mental retardation (MR) and severe emotional disturbance (SED) • Substance abuse services • Placements for youth with mental illness and chronic violent behaviors • Programs for sexual offenders and for victims of sexual abuse • Placements for children who are medically fragile • Treatment alternatives for children age 12 and under who would otherwise be committed to DJJ • Therapeutic transitional programs for DJJ and MATCH youth
Increase independent living/transitional programs. These programs help youth in their late teens that are in out-of-home placements to successfully make the transition to adulthood and full emancipation at age 18.
Increase availability of emergency placements: Increase the statewide availability of emergency placements, including family-based and group care.
Monitor Level of Care system: Monitor implementation of the Level of Care system to determine the adequacy of the payment rates. Monitor whether there are adequate placements for the numbers of children at various levels. If the available number of placements is inadequate in some or all categories, determine the source of the barrier.
Incentive system for gap services: Institute an incentive system for hard-to-fill gaps in service defined either by type of placement or geographically.
Identify fair rates for gap services: Develop a methodology throughcollaboration of the public and private sectors to identify a fair rate for hard-to-fill gaps in services.
Start-up funding: Support the identification and development of start-up funding for new services.
Overcome zoning barriers: Develop state incentives for communities to overcome zoning barriers to allow for successful implementation of services and programs in underserved areas.
Provider input: Encourage provider input in state contracting and licensing policies.
Consistent licensing rules for public and private foster homes: Establish licensing standards for all public and private out-of-home placements – with the exception of DJJ secure juvenile detention facilities – under an independent Office of Regulatory Services. DJJ secure juvenile detention facilities will adhere to accepted professional juvenile justice standards. The licensing authority shall require the public agencies, as well as private providers providing out-of-home placements to meet the same rigorous standards. The Office of Regulatory Services shall also be responsible for approval of all waivers and shall maintain current and accurate data on all waivers.
Maternity and Second Chance homes: Integrate the licensing standards for maternity homes and Second Chance Homes to 1) require reasonable standards of care and 2) allow them to maintain placements of pregnant youth and new adolescent mothers with their infants for the time necessary to ensure a positive transition to a permanent living arrangement.

Support Services

Make educational services a priority: Make provision of public education and related services (including special education) to children and youth in out-of-home placements a priority in order to assure that no gap occurs in children’s education when they 1) come into state custody, 2) change placements, or 3) move to a permanent placement. Ensure that children who are in state custody are afforded the same rights as children who are homeless and protected by the federal McKinney Act.
Active participation of local schools: Require local school systems’: (1) Active participation in the assessment, treatment, planning and/or service delivery for children at risk for out-of-home placement, children who are in out-of-home placements, and children who are making a transition between placements; and (2) Provision of support to case managers including use of space with the child’s school when space is available.
Case-by-case assessment of children returning from DJJ: Establish a process with the state Board of Education, DJJ and/or DFCS to assess each child returning from a juvenile justice placement on a case-by-case basis to allow direct placement of the child into his or her home school when appropriate.
Comprehensive MHDDAD system: Develop a comprehensive system of services and placements to treat mental health problems, developmental disabilities, and/or addictive diseases in children and in families with children. Children in need of MHDDAD services shall receive services in a timely manner. These services shall follow the child when placement changes.
MHDDAD service delivery areas: As a short-term goal, have MHDDAD communicate and implement a plan for delivery of mental health services within the existing service delivery areas used by DHR and DJJ. Require MHDDAD to share the plan with system partners, consumers and their families. As a long-term goal, establish uniform service delivery areas for all state agencies that serve children and the judicial circuits.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT): Further explore and research maximizing utilization of EPSDT and coordinating it with the First Placement, Best Placement assessment process to ensure that Georgia addresses the mental health needs of its children.

Case Management
New case management system: Develop a case management system that has the following attributes: • Case management and all services are easily accessible by any child, parent/guardian or referring agency and are in place to guide the child/family through the system of programs and services towards positive outcomes. Services can be accessed without stigma. • All programs and services for children are cost- and outcome accountable and based upon best practices research or evaluation. • Designation of case plan coordination shall be by Memorandum of Understanding (MOU). Such coordination shall require a timely single case plan based on multi-agency assessment, linking the professionals involved with the child and family. • The designated case plan coordinator shall have the authority to direct inter-agency participation and regular inter-agency plan updates to be provided in writing to the court and/or families. Assessment will include Early Periodic Screening, Diagnosis and Treatment (EPSDT) in order to maximize Medicaid funding. • Treatment plans shall include measurable outcomes that shall include an internal treatment team (including the family, child and providers), assessment of satisfaction with the process and the outcomes. • Case management always involves the family and, where appropriate, also involves the child. Sibling groups and adolescents with children shall be seen as family units and, where consistent with treatment plans, are placed together. • Case management shall coordinate and present assessment information and treatment plans to the courts/agencies prior to disposition to inform the court. • Agencies responsible for case management actively participate in community planning to ensure coordination of services.
Consistent framework and release points: The system of coordinated case management needs to have a consistent framework, including appropriate ‘release’ points.
Community- or school-based case management: Case management is community- or school-based and includes the school and the school counselor as an integral part of case management.
MHDDAD single point of entry: MHDDAD regional offices’ singlepoint-of-entry provider shall identify an individual to actively participate in case planning and case coordination for children who are served by other agencies and who need MHDDAD services.
Agencies held responsible: No agency is absolved of responsibility for the care of a child because the child falls under the jurisdiction of another agency.
Standards for providers of wrap-around services: All inhome treatment providers of wraparound services shall be required to meet appropriate standards.
Pilot system with special populations: Develop, implement, and evaluate a new collaborative case planning and coordination system for children on the MATCH waiting list and/or for children before the juvenile court for status or delinquent offenses who are under the age 13.
Prevention and intervention prototype: Design, implement and evaluate a prototype and/or research project for case planning and coordination that is directed at prevention and intervention.

Cross-Agency Collaboration,Organizational Structure and Evaluation
Organizational structure: Explore organizational structures focused on children’s issues. Such structures may include program budgeting, blended budgeting, a children’s cabinet and/or a children’s agency that coordinates all programs and services for children and for families with children. The organizational structure shall include: • Case management • Mental health, developmental disability, and addictive disease services • Juvenile justice services • Child welfare and family support and preservation services • Public health services • Other physical health services • Education partnership • Other related services • Nutrition • Expectant mothers • Coordination and maximization of Peachcare, Title IV-E, etc.
Requirements of the organizational structure: The organizational structure requires:
Accountability for results based on a common set of outcomes, objectives, and measures.
Planning of and funding for services provided by all the agencies shall be to the organizational structure and/or shall be accomplished in a collaborative and cooperative manner with common objectives and outcome measures.
Communication system or link with the Board of Education that requires joint planning, case management, and outcome evaluation. The link between the structure and the Board of Education shall include funding and authority to ensure the active participation of local school systems in the assessment, treatment planning and service delivery for all children at risk of out-of-home placement.
Funding structured to allow the flexible purchase of services from public or private providers that changes as the needs of individual children change over the course of involvement with the organizational structure. Funding is flexible enough to allow constant budget updates/modifications to reflect needs, results and priorities.
Geographic divisions and organizational structures shall be consistent across agencies serving children and families with children. Until that is accomplished, where differences exist, clear, written communication shall designate the service delivery persons and locations for all children.
Linking, coordinating, and/or leveraging to welfare systems, economic development organizations, local government and private providers to maximize services, eliminate gaps, understand the role of each entity and establish effective communications among entities.
Values of the organizational structure: The organizational structure honors and rewards: • Creative thinking • Community involvement • Fiscal responsibility • Open communication and information-sharing at all levels • Communications within the organizational structure and with service partners to encourage open discussion and information sharing • Family (biological, foster, adoptive)
Joint planning: Require the major state agencies with children in out-of-home placements (DFCS, DJJ, MHDDAD) to plan together for (changes in) service provision.
Involve DOE: Develop an agreement with the Department of Education (DOE) that ensures the active participation of Education in the development of treatment plans, the provision of services, sharing of information, and the possible location of case management services within schools.
Evaluation: Evaluate the effectiveness and efficiency of any new state program/initiative. Ideally such evaluations should: • Use appropriate measures; e.g., outcome measures • Be conducted by a qualified, independent evaluator • Be an ongoing part of program implementation to ensure ongoing quality improvement • Be conducted before a previously unevaluated program/initiative goes statewide; and • Be subject themselves to a cost/benefit analysis

Data Systems and Information Sharing
Effective data system: The state must develop an effective data system to maintain and track programmatic and financial information on children in its custody.
Needed information: DHR and DJJ should institute procedures to ensure that children’s electronic records contain complete information on: • Prior incidents of maltreatment • Mental and physical health assessments • Special needs • Services received • Service results
Shared access: All system partners who are authorized users shall have access to child-related data systems.
Statutory authority to share information: Statutory authority for authorized users to access and share information on all children in or at risk of out-of-home placement shall be established.
HIPAA compliance: GTA, DHR, DJJ, DCH, the juvenile courts, and providers must ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other confidentiality requirements.
SACWIS schedule: The schedule as submitted to the Federal Government in the Implementation Advance Planning Document in December 2002 shall be adhered to by DHR and GTA and monitored.
SACWIS project accountability: Decentralized management has helped ensure that SACWIS addresses information needs. It is important to clearly define project roles and authorities. The DHR Commissioner and GTA Executive Director shall regularly advise the Governor on SACWIS progress, explain barriers to implementation, and share plans for dealing with anticipated problems.
SACWIS updates: DHR shall routinely update its web page to disclose progress and milestones in SACWIS development.
SACWIS functionalities: SACWIS must include: • Tracking • Reporting • Outcome measures • Case management • Relational databases • Alerts and reminders • Protocols to ensure consistency • Data entry and system use as part of routine activities
SACWIS planning: The SACWIS project team shall begin developing protocols and procedures for transferring information from existing systems to SACWIS. The project team shall: • Ensure that inaccurate and incomplete data are not carried over to SACWIS • Help ensure that data can be transferred as various SACWIS functionalities go online
Juvenile Tracking System (JTS): DJJ shall continue its efforts to provide juvenile and family courts appropriate access to JTS information, including the development of access and confidentiality protocols.
Child welfare module of the Health and Human Services Portal: GTA shall continue to work with DHR, DCH, DJJ, the juvenile courts, the State Data Research Center, and DOE to plan for a seamless system of inquiry, including the development of timelines and milestones for the state’s Health and Human Services Portal’s child welfare module.
Training: GTA, DHR, DJJ, DCH, the juvenile court system, and providers shall work together to ensure that staff members obtain training in the use of SACWIS and Georgia’s Health and Human Services portal.
Online listing of placement options: DHR, DJJ, and GAHSC shall collaborate to build and make available a complete and current online listing of placement options.

Community Collaboration
National models of collaboration: Investigate and review national models of collaboration specifically related to child welfare reform, such as the Decategorization Program in Iowa and the Edna McConnell Clark Foundation sites. Transfer knowledge and lessons learned to communities in Georgia for possible replication.
Faith-based strategy: Develop a strategy with major faith-based organizations to enhance the involvement of the faith-based community in local and state-level collaborative efforts around the issue of child protective services.
Bottom-up and top-down communication process: Building on the existing network of county collaboratives, create a process to communicate local priorities, best practices and policy barriers to state partners to influence state policy and decisions. Conversely, develop a strategy to connect major policy initiatives at the state level to communities that are demonstrating results in related priority areas.
Evaluate community initiatives: Evaluate initiatives across Georgia’s communities specifically related to out-of-home placements that have been successful for replication to other communities that have an interest in similar collaborative work and strategies.
Entity to support statewide capacity-building: Determine and support a statewide vehicle to direct the development, implementation, and capacity-building of local collaboratives with built-in measures of accountability and monitoring.
State-level collaboration in support of community collaboratives: Establish through a Memorandum of Agreement or interagency agreements, a similar model of collaboration at the state level that will support local decision-making, address barriers to collaboration experienced by communities, and promote state priority initiatives (such as child welfare) in communities through resources and technical assistance.
Out-of-home placement benchmark: Add an out-of-home placement benchmark to the set of indicators used by the Family Connection Partnership to measure the well-being of children in Georgia. Use the Family Connection Partnership’s process for reviewing its 26 current benchmarks to develop the new benchmark.

Legal
Standard legal definition of “child”: Move toward a standard definition of “child”. Support continuation of services to children who “age out” of the system beyond age 21.
Competent legal representation for children in court: Children who are subject of proceedings in court shall have competent legal representation. Work with the State Bar of Georgia to establish and monitor standards for the legal representation of children.
Immigrant children: Examine and develop consistent policies across all state agencies to facilitate timely placement for children who are legal or undocumented immigrants.
Children convicted of federal offenses: Negotiate an agreement with the federal government to allow placement of a child who is found to have committed a federal offense in an appropriate placement within Georgia and develop appropriate placements for these children.
CHINS, PINS, and FINS: Introduce legislation based upon best practices for early intervention with at-risk youth and/or families. Such mechanisms may include statutory approaches from other states creating categories for services such as Children in Need of Supervision (CHINS), Persons in Need of Services (PINS), and Families in Need of Services (FINS).
Children’s right to mental health services: Modify state legislation and policy to recognize the rights of Georgia’s children to mental health and other appropriate services, treatment and placements.

Innovative Financing
Level of Care system: Proceed with development of a level of care system to finance placement based on the needs of the child.
Criteria for the Level of Care system: The Level of Care system will allow DHR and DJJ to purchase care from private providers based upon individualized assessments and established treatment plans for each child and family. It builds on the expanding partnership between DHR, DJJ, DCH, and the private provider community, and it supports program development to meet the increasingly difficult and complex needs of the children who are served by DHR, DJJ, and DCH. The system change has promise for Georgia, and it should be vigorously and carefully pursued to avoid possible pitfalls that will stand in the way of its successful There are a number of criteria that must accompany the system design. The Level of Care system must: Plan around trends that support positive outcomes. Be driven by the needs of children. Serve children in whatever is the best placement setting for them, whether family-based or residential- or even in the child's own home. Serve children regardless of which agency is responsible or who has custody. Involve Georgia's private sector partners every step of the way- in planning, implementation, and operation of the system Build on the base of public/private partnership at the state and local levels as demonstrated by the Multi Agency Team for Children (MATCH) Make decisions on level of care by qualified, credentialed and trained staff with input from the family, case manager, and provider, using the current MATCH utilization review process, where appropriate, to meet the needs of the child Maintain a unified system of outcome-based data to track children regardless of which agency sponsors the placement to measure the progress of children while they are in placement and after they return home or move to independence. Use the experience of providers, families, communities, and public agencies to predict (and eliminate) possible unintended consequences. Fairly assess the needs of children and establish realistic payment rates that are adequate to support the services, supervision, and treatment required to meet those needs. Develop adequate resources to fill in system gaps (identified elsewhere in this report) so that services are available to meet the individualized needs of children identified for their level of care Follow the tenets of the Action Group Guiding Framework so that services are individualized based on the assessed needs of each child and family- not based on labels
Rate system that supports case management: Develop a rate system that supports case management, is consistent with the services that are needed and provided, is tied to the needs assessment, and includes policy and procedures consistent with the rate system adopted.
Funding follows the child: Ensure that necessary fiscal resources follow the child based on the Level of Care system regardless of placement
Outcome-based: Begin using "outcome-based" contracts in the delivery of placement services for children.
Maximize federal funding: Continue state agency efforts to maximize federal sources. Reinvest those resources in expanding or enhancing services for children
Flexible blended funding: Have state and local agencies work together to identify opportunities to blend funding and to increase funding flexibility and coordination. Minimize categorical funding.
Outcomes and accountability: Develop a consensus on desired outcomes and results, identify data measures and design accountability systems for Georgia's child placement system
Out-of-home services budget: Publish a Children's Budget of services for children in or at risk of out-of-home placement. Such a budget would ensure that the accountability of government programs and expenditures for children could be monitored and presenter annually to policy-makes and the public.