SOME INFORMATION FROM THE 5/16/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING AND ACCREDITATION ADVICE
I, Jerry Johnson, am the sole coordinator for the California Coalition of Foster Family Agencies (CCOFFA). As such, I am wholly and solely responsible for the production and content of the CCOFFA newsletter and any other CCOFFA related communications, whether by phone, email, or other means. I am employed by an FFA, but any communications on my part on behalf of CCOFFA should not be viewed as reflective of the opinions, views, or preferences of the FFA for which I work.
5/16/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING
The Mental Health sub-group meeting began with some updates from Sara Rogers, acting chief of the Child and Youth Permanency Branch:
- CDSS will soon be sending out clearer definitions of the Levels of Care (LOC) referred to in the new FFA rate structure.
- CDSS is on target for a June release of the new Program Statement guidelines to support the FFAs in enhancing their current program statements to meet the requirements of both RFA and CCR.
- In the May revision of the State budget, Mental Health was additionally funded to be able to send Mental Health representatives to CFT (child family team) meetings for assessment and support of children/youth who are receiving Mental Health Services. Please note, not every child/youth in placement will need a mental health representative at their CTF meetings.
- On a related note, for a child/youth to receive Mental Health services through EPSDT (Early and Periodic Screening, Diagnostic and Treatment) it has to be a medi-cal covered benefit (see: http://www.dhcs.ca.gov/services/MH/Documents/EPSDT_TBSEng.pdf)
Additional pertinent information:
- CCR requires an assessment of each child/youth which will help define the Level of Care (LOC) they require. There are currently 6-month trial runs of select counties using CANS (Child and Adolescent Needs and Strengths) and TOP (Treatment Outcome Package) to determine a child/youth’s required Level of Care (LOC). At the end of the 6-month trial period, the data will be analyzed to determine which method works best for determining Level of Care. Whether CDSS decides to use CANS or TOP, these are not a replacement for a Mental Health assessment.
- In response to CCR requirements, the Mental Health Services Division has identified 12 issues that will require examination and work to come under compliance with CCR. The 12 issues are:
- Mental Health core services for STRTPs (Short Term Residential Therapeutic Programs)
- Mental Health core services for FFAs
- Out-of-county placement implications (which county pays for a child/youth’s mental health services – the placing county or the county of residence?)
- SED (severe emotional disturbance) definitions
- Interagency collaboration and coordination
- Documentation requirements
- Capacity to provide Specialty Mental Health Services including personnel with culturally reflective staffing
- Shared and distinct definitions (trauma informed, assessment, outcomes, certification, etc.)
- Fiscal implications
- Parent and youth involvement in all efforts
- Continuity of care with the goal of permanency
- Role of managed care plans
- A primary topic of conversation was concerns regarding capacity, including having permanency/ adoption options for the youth that will be stepping down from STRTP placements and having competent support services available for those youth. Methods exist for helping youth with such a transition, but they are not currently widely available.
- FFAs are expected to link their children/youth to needed Mental health services, but are those services available?
- Since there are more children/youth in care who, due to having mild to moderate needs, are not in managed care than are in managed care. How will those needs be met? Can they be met with a fee-for-service structure? Who would determine reasonable costs? How can an FFA know that an agency/company offering fee-for-services is qualified to do so? At this point, there are more questions than answers.
- CDSS has developed a CCR Implementation Guide and expect to put it out for general release in about two weeks. This guide is a tool to support FFAs in implementing CCR, but FFAs are not required to use it.
- It was stated that it would be helpful for the State to create some guidelines for developing MOUs to support the need for increased capacity.
- Sara Rogers did state that, regarding core services, an FFA must either provide, or have access to, each of the core services. She did state, however, that that the State is NOT requiring actual contracts for such services, but rather a working relationship (level of engagement) to ensure the children/youth have access to required services.
- There are teams working on what is needed for an FFA to become “medi-cal certified.”
- There was some discussion about the challenge of a child/youth needing a diagnosis in order to receive services and the fact that diagnosis can act as negative labeling. However, with the current structure, a diagnosis is needed in order to access services.
A few weeks ago CCOFFA requested that FFAs send in advice about accreditation to those FFAs early in the process. Thanks so much for those willing to share with other FFAs.
- We just submitted our application to CARF for the accreditation survey to take place in late August early September. We went to both the COA and CARF introduction seminars and decided to proceed with CARF. We put together an accreditation team within the organization consisting of social workers, administration and our bookkeeper (we are a small Agency with 14 employees, 10 Social Workers, 1 Foster Parent Coordinator, 1 Bookkeeper, 1 Administrator and 1 Program Director) As the Program Director I took the lead in the accreditation process but would not have been able to do it alone. We broke up the standards and worked on them individually noting what we are currently doing to meet the standard and what is needed to fully meet the standard. We met weekly and brought to the table what we had done while creating the list of what was needed. This took about 3 months to complete. Once what was needed was compiled we started to work on those needs as a group. We often broke the staff up into subcommittees to address the program material so that everyone was involved in the process. For full implementation of the standards it took us a little over a year. I would be happy to speak with you if you would like with any suggestions and/or questions that you or anyone else may have about how we proceeded with this.
Eric Mortensen, M.S. – Program Director
Kamali’i Foster Family Agency
- We found COA to best meet our needs as we are mostly child welfare focused vs Mental Health. Some advice is to identity a Lead person in collaboration with the CEO to champion the accreditation process. Do kickoff and try to make it fun. There are designated number of standards and each manager or director should be assigned as the lead for the standard which is most relevant to them- i.e. HR, Ethics, governance, risk prevention and management, foster care, counseling, etc. Each standard lead can then enlist the help of certain “subject experts” i.e. foster care supervisor- to provide feedback and input on the multiple policies and procedures needed for each standard. There are many more steps in between …
Carol Ramirez, Lilliput
- San Diego Center for Children and our foster agency Special Families Foster Care have been accredited through Joint Commission for 3 years now (May 2013) and just went through the re-accreditation last month. We were accredited through Joint Commission years ago and let that lapse because we were then doing accreditation through CA Alliance. We chose them because they had what we felt was the highest standards in the industry, the higher name recognition, and the fact that they accredit hospital facilities as well. Only advice I would give is that you really need to identify a point person who can dedicate a lot of time to this project, be ready to formally revise and create new policy and procedures, look to utilize outside consultants to help the process (we have done this both times and their feedback has been very helpful), and have plan to maintain standards. That being said, the accreditation organizations want us to get accredited (it’s in their best interest) and once it’s done you will be a better organization for it.
Program Manager, Special Families Foster Care/TFCO
- We are going through CARF. The thing I am most pleased about is that we used a consulting agency to assist us. The firm is Powderhorn.
- I just submitted our application to CARF last Friday! We are scheduled for site visits in Oct/Nov. My advice would be to just make a decision and go for it. All have their pros and cons. I felt CARF was the most experienced in our field of social work of children, and that there wouldn’t be too much of a “square peg in a round hole.” From the time I received CARF’s information to application was 2 months for me. I just decided to hammer it out and it was long days and many weekends. This was my trick to CARF. I went through their handbook and made a spread sheet in excel of what I needed to do in all the different areas. I also put check boxes next to the items in their handbook of where the different information needed to go. I then took each item, which ranged from Board stuff, policy manuals, social worker manuals, foster parent manuals etc., and updated them with all the required information and check the items off as I went. The biggest decision we made was about our quality assurance and ETO measures. I had to create questionnaires and satisfaction surveys, but we decided to go with a data management system to gather all of this information. More of a quantitative route and not a qualitative route. A qualitative route would mean hiring an individual to monitor and provide oversight for quality assurance. A data management system will track all of our information in real time with feedback. I went with Social Solutions (Apricot system) after sitting in about 10 different data management pitch sales and demonstrations. They are well suited to meet the needs of any FFA/Adoptions/STRTC. They only work with nonprofits and understand our unique needs and their prices are reasonable. I want to do a big plug on them to all the COFFA FFAs later. The cost of a data management system is about 1/3 the cost of an employee. The other thing about CARF, which is not necessarily advertised is that they do not have monthly fees. Just the application fee and then the site visit fees, which are every 3 years.
Ok, I can keep you posted on the process as we go!
Dr. Shauna Rossington, DBA, MFT (Nevada & Oregon)
Mountain Circle Family Services, Inc
CCOFFA’s request for advice and wisdom about the accreditation process also lead to a couple of companies contacting CCOFFA who help FFAs with accreditation. Their information is below. Sharing this information does not constitute an endorsement by CCOFFA, nor did CCOFFA receive any form of compensation for sharing this information:
- Viable Solutions LLC (com) The following is from their website:
Viable Solutions has created materials that allow an organization to successfully and confidently pursue the time consuming task of national accreditation.
Viable Solutions has worked with approximately 195 agencies during the past several years assisting in meeting and implementing the standards of national accreditation through COA, CARF and the Joint Commission. The results for these agencies have been a 100% accreditation success rate. We are pleased to now offer our time tested, copy protected materials in an electronic format. In an effort to respond to the requests of organizations across the county, Viable Solutions will be offering a separate group of electronic services. Please call 1-888-378-6880 or 1-866-571-8312 to discuss how your accreditation needs can be met.
When an organization is searching for assistance with achieving national accreditation, it is imperative that they understand that a few policies and some suggestions as to how to create some of the other required areas will not meet the standard requirements of national accreditation. In order to meet the requirements for national accreditation, an organization needs to have the required materials in the areas of:
Policy and Procedures (Copywritten) (View Sample Document)
Corporate Compliance (Copywritten)
Health and Safety
Orientation and Training
All Viable Solutions materials have been surveyed approximately 195 times and have successfully met all required standards. These copy protected materials are fully editable and can be adopted as is or can be adjusted to any degree necessary to meet your organizations internal needs. It is very important for an organization to understand what materials are needed and understand the standards well enough to recognize how the materials meet the required standards. Viable Solutions provides the most comprehensive and tested accreditation materials available.
- Relias/Learning (https://reliaslearning.com/courses/product-library/children-youth-and-families) The following is from an email I received:
So who are we and how can we help Foster & Adoption Agency’s in California with the accreditation process? 14 years ago Relias Learning set out to lead the world in online staff training and development, and we have done just that. Along the way we have developed a partnership with COA and established strong relationships with both CARF and The Joint Commission. Our relationship with each of these accrediting bodies is so strong that we have custom engineered Learning Crosswalks for each of them that align our courses of training with their high standards. As their standards change over time, so too does our content. The guarantee of updated/new content over the course of time assures that a very strong training platform can be built from the beginning with Relias. Add to that the over 600 hours of CEU’s that are in our database, at no added charge, and you can see why we have such a strong reputation across the country/world.
If you have any questions or concerns regarding RFA, you can email the state directly at email@example.com
Or concerns regarding CCR at firstname.lastname@example.org. Please remember, all the specifics regarding RFA and CCR are still being worked out.