There are no fiscal implications associated with this report.
REASONS FOR RECOMMENDATION
At its November 5, 2019 meeting (Item No. 18), the Board of Supervisors (Board) issued a referral to Administration to consider a range of options with respect to closure of the Department of Family and Children’s Services (DFCS) Receiving, Assessment, and Intake Center (RAIC). The referral requested that Administration consider, among those options, an immediate moratorium on new placements of children at the RAIC. At the Board’s November 18, 2019 and December 10, 2019 meetings (Item Nos. 19 and 8, respectively), Administration provided information regarding DFCS’s plan to close the RAIC and replace it with a continuum of care that can address the unique needs of each child and their family. This report provides updates to the Board regarding further steps taken and progress made since the last report provided on December 10, 2019.
Closure of the RAIC:
As of December 17, 2019, DFCS was serving a total of 1990 children. Of these, 934 children were in out-of-home placement, with approximately 38% (356 children) residing with a relative or other person known to the child and 47% (443 children) residing in traditional foster homes. Twenty-six children were residing at a Short-Term Residential Therapeutic Program (STRTP) and as of November 27, 2019 there were no children residing in a group home (congregate care). Among the youth served by DFCS, 24 children were jointly receiving services from a regional center. In the months of November and December, DFCS received 53 children who were new to the County’s child welfare system.
For most of December 2019, DFCS had six youth at the RAIC, all of whom were on a wait list for a higher level of care including Short Term Residential Treatment Programs (STRTP), care through a specialized provider through San Andreas Regional Center (SARC), or some other special service environment. DFCS, Behavioral Health (BHSD), and Probation worked diligently to support the small group of children with higher care needs who were at the RAIC awaiting placement, and were pursuing every lead to ensure they were promptly moved to a more suitable and permanent placement. As of December 31, 2019, the last child at the RAIC was moved into an alternative placement, and all RAIC operations on Enborg Lane were closed by the release date of this report.
Short-Term Plan for Receiving and Intake and Short-Term Care for Children Entering the Child Welfare System or Experiencing A Placement Disruption:
As the Board is aware from prior reports, DFCS has been doing a majority of the receiving and intake of children entering the child welfare system at the Keiki Center for the last few months. DFCS sees the Keiki Center as only a temporary location for assessment and intake until this function can be move to a better location and ultimately transitioned to a community-based provider, as other counties in the Bay Area and elsewhere have done, and as described in further detail below. The overwhelming majority of children receiving intake and assessment services at Keiki are placed within 24 hours, and DFCS anticipates it will continue to be able to facilitate rapid placement at the Keiki Center.
With the closure of the RAIC, which was functionally serving as a short-term placement for children with complex needs for which no other appropriate placement could be quickly identified, DFCS will be working closely with BHSD and Probation to provide children who would have stayed temporarily with the RAIC with individualized care in home-like settings. As more intensive community-based placements become available, those will be immediately utilized. But over the next few months, DFCS anticipates providing care to these youth in five homes and apartments that DFCS is in the process of securing. As of December 23, 2019, DFCS has secured 1 home and apartments, and is working with BHSD, Probation, and several key CBO partners to create individualized care plans for any youth who need to be cared for in these homes while long-term placements are secured. A lease for second location has been cleared by FAF and is awaiting signature by the landlord.
Development of a New Continuum of Care Model:
The County Executive has convened multiple administrative meetings with DCFS, Probation, Behavioral Health, and County Counsel in order to elucidate the core issues that have created dysfunction in the system of care for youth who have been separated from their families. The transition by the state to a new approach under Continuum of Care Reform, the closure of group homes through that process, and the current paucity of community services that are available to implement such a new and better continuum of services for children, particularly those with higher needs, has created profound challenges statewide and within our county. Because of this fact and many other issues, we believe that the County must approach our children with a different perspective.
Historically, the primary goal of the receiving and intake center was to quickly find appropriate placement for children separated from their families, and to also connect the child with appropriate services to be provided after placement. As described, most children in the foster care system are well treated with this approach.
However, a small percentage of children entering the child welfare system or experiencing a placement disruption need far more than simply a placement and referral for supportive services. Certain children have very acute and chronic challenges such that they need much more. The RAIC was not designed to be a long-term acute care and treatment center for children with developmental disabilities, extreme trauma, or very significant behavioral health needs. DCFS social workers and staff are not trained to appropriately manage these complex individuals on their own. Thus, it is important for us to treat these children more as patients than individuals simply in need of placement and permanency.
An enhanced continuum of care plan is being developed by DFCS, Behavioral Health, and Probation to ensure service needs of all children are met. These departments are committed to providing compassionate care for the children and families served. The expansion of the continuum of care offers an opportunity for the County to fill critical gaps in existing services, ensure care is provided by staff with appropriate expertise, as well as enhance and customize supports for our most vulnerable youth.
DFCS, BHSD, and Probation staff continue to work with the County’s provider network to expand key services and create new service types to establish a more robust, child-centered, and trauma-focused continuum of care framework that would ensure permanent placement opportunities for all children under the County’s care. This continuum will be redesigned to meet the needs of every child who comes into contact with the three agencies and is purposely built to meet both urgent placement needs as well as long-term permanency services. This continuum will encourage compassionate care with an emphasis on a client-centered approach. Since the December 10, 2019 report, BHSD, DFCS, and Probation have been engaged in discussions regarding the following services, which will help fill key gaps in the County’s current continuum of care. Updates on the full continuum will regularly be made to the Board.
Receiving and Intake Services
While there has been discussion regarding the long-term operation of a County-operated intake center, DFCS believes this function can be more effectively provided through community-based organizations with whom DFCS, BHSD, and Probation work to serve youth entering the child welfare system. This model, which has been implemented in other counties, would allow for more seamless transitions between intake and service provision, and would facilitate the more robust and flexible staffing model needed to appropriately serve the complex needs of children currently served at the RAIC. Such a model would include the following services and supports:
· Staff at the provider’s intake and assessment center would attend to each child’s physical, emotional, and mental health needs, including crisis de-escalation interventions, as needed. Staff will also help to inform placement decisions based in their interactions and assessments of each child.
· On-call nursing, psychiatry, and medical services would also be accessible. Master’s degree-level clinicians would be on hand for assessments and could quickly create a report for County staff about the kind of placement that would best meet the child’s needs.
· Screening would be completed to assess for current risk behaviors, behavioral and emotional symptoms, life domain functioning, and juvenile justice involvement. If indicated by the screening, the clinician would lead staff in creating and implementing a safety plan for the child during their stay. Additional assessment would include screening for medical needs, communication levels, and suicide risk.
· The clinician would be responsible for compiling all information gathered from screening into a comprehensive report for DFCS to drive placement decisions for the child.
DFCS hopes to launch this service structure in the first half of 2020.
Emergency Foster Care
DFCS’s goal is to place all children as quickly as possible into a family-like setting where each child could be safe, healthy, and thrive. At times, DFCS works with children who have a unique constellation of needs that present a challenge in finding the best placement, or who could potentially be placed with relatives or non-relative extended family members (NREFM), that may need several days to prepare a placement plan. In these situations, an emergency foster care (EFC) home may present the best option for children.
Based on several listening sessions with current County foster homes, DFCS has identified three homes who have agreed to function in an emergency placement capacity. These homes would be available to take all youth during all hours and would provide time-limited care.
DFCS is seeking two additional County resource families who would service as emergency foster care homes. DFCS anticipates April 1, 2020 as the target date for the homes to fully function as an emergency foster care placement option.
As part of DFCS, BHSD, and Probation’s efforts to address the trauma children may experience with initial removal from a parent or caretaker, or to help them stabilize with a current caretaker, the expanded continuum will include additional stabilization services. These services would be available to youth regardless of where they are placed.
Stabilization services would provide an in-person response for youth who are experiencing crisis in the community that may jeopardize their foster placement or place them at risk of removal from the home. DFCS anticipates adding the following stabilization services to the existing service continuum:
· For dependent youth experiencing crisis, a community-based response designed to provide an immediate intervention to assist families with minimizing risk, maintaining youth in their current living arrangement, preventing repeated hospitalizations, stabilizing behavioral health needs, and improving functioning across life domains.
· Preventative interventions made available to all County-dependent youth with staff available 24 hours a day to provide phone-based assessment, in-person stabilization, and short-term intensive services designed to improve youth safety, wellbeing, and placement stability.
· In moments of escalating challenge, stabilization services would provide triage over the phone and respond to the applicable community location within one to two hours (based on geographic range) for further assessment and stabilization.
· Short-term interventions, including crisis counseling, supervision, stabilization support, case management, and linkage would also be provided to further address identified needs and support ongoing stability in a youth’s current placement.
DFCS anticipates these service expansions will launch in the first quarter of 2020.
Permanency and Family Finding
The County currently contracts with Seneca for therapeutic visitation and family finding services for families newly entering into the child welfare system. DFCS is expanding these services in order to meet expanded needs. The augmented services would include performing all necessary relative notifications, initiating family finding activities for all youth who have experienced two or more placement disruptions, and providing Therapeutic Visitation and Family Finding trainings to County staff. This expansion will allow Seneca to significantly increase the number of staff assigned to family finding services and would increase the number of children served at any one time from 20 up to 40.
DFCS anticipates January 11, 2020 as the targeted start date for these expanded services.
Enhanced Intensive Services Foster Care (Enhanced ISFC)/Professional Parent
To support youth with ongoing intensive placement, permanency, and mental health needs, the County is partnering with its Foster Family Agencies to develop a new Enhanced ISFC (professional parent) model. This model integrates additional supports into specified ISFC homes to provide home-based care for youth with the most complex and challenging emotional and behavioral needs with the of goal of preventing the need for a more restrictive placement. Each home has at least one dedicated resource parent who has educational, work, and/or lived experience with youth that helps them to understand and respond to the needs of youth placed in their care.
Enhanced ISFC parents differ from traditional ISFC resource parents in several key ways: (1) capacity for 24/7 availability to respond to youth needs with at least one parent not working outside the home; (2) a commitment to providing unconditional care for the youth regardless of any behavioral challenges that emerge with a no eject, no reject policy; and (3) successful completion of rigorous supplemental training and continuing education.
To augment the level of support and therapeutic intervention available within the Enhanced ISFC model, clinicians, support counselors, and family partner are available to provide support in the home 24 hours per day, seven days per week. This could include scheduled therapeutic support, check-ins during challenging periods, or responding to crises in the home as they arise. Enhanced ISFC homes can provide placements for up to 12 months to support youth stabilization and creation of a sustainable permanency plan and they are linked directly with supportive community-based services, such as Wraparound and Therapeutic Behavioral Services (TBS), to prevent placement disruption and to build natural support systems around a youth with intensive needs.
DFCS anticipates that its providers will have several of these homes in operation by mid-2020.
Intensive Services Foster Care
The County currently has an agreement with several providers for Intensive Services Foster Care (ISFC) services. ISFC provides youth with intensive treatment needs in home-based placements with specially trained and supported caregivers. For youth with complex permanency and behavioral health needs, ISFC provides home-based placement options with caregivers who are able to flexibly meet the needs of each individual youth.
Within the ISFC model, a treatment team of master’s degree-level clinicians and bachelor’s degree-level counselors provide permanency and placement services to support a youth’s placement stability. Additionally, specialty clinical services are integrated to address the intensive behavioral health challenges that contribute to a youth’s need for ISFC-level care. Such services include intensive care coordination, case management, individual rehabilitation, and individual, collateral, and family therapy.
DFCS anticipates expansion of County ISFC capacity to occur throughout 2020, with approximately 11 additional ISFC homes in place by the end of the year.
The actions described will have a positive impact on children and youth through the Safe and Stable Families indicator by developing a system of care that will provide individualized care with goal of planned permanency and family connections.
The recommended action will have no/neutral impact on seniors.
The recommended action will have no/neutral sustainability implications.
During the last several years, the RAIC has provided temporary care to children entering the dependency system following removal from their families or when they had a disrupted long-term placement. As discussed in prior reports, the vast majority of such children are placed with relatives or a foster family in less than 24 hours and many children never enter the RAIC. However, it has become increasingly more difficult to find placements with youth who previously served within a group home setting. The enactment of Continuum of Care Reform (CCR) and the high cost of living in Santa Clara County has limited the options available for older children with special needs. DFCS, Behavioral Health, and Probation Departments have been developing plans to place children currently in the RAIC and diverting whenever possible youth that in the past would have entered the RAIC. In addition, this cross-system team has explored existing resources and identified strategies to address anticipated gaps.
In 2009, DFCS closed the County’s Children’s Shelter and establish the RAIC as a short-term (under 24-hours) program to facilitate the placement of children and youth. At the time of the Children Shelter’s closing, there were a number of placement options for children experiencing placement disruptions and for children coming into care with DFSC for the first time. In 2015, Assembly Bill 403 was enacted and initiated Continuum of Care Reform (CCR), which was designed to phase out the use of group homes and to limit the use of other forms of congregate care. The changes in part included the development of STRTPs with a maximum 6-month length of stay, a change in the approval process for Resource Families (foster homes), a new rate setting process for levels of care based on children and youth’s needs, and use of the child and family teaming process to include the voice and choice of families and youth. While these reform efforts drove important and needed changes, they also decreased the number of placement options and reduced the number of viable placements available for some of the highest need children in the child welfare system.
In addition to the reforms driven by CCR, the County has invested significantly in the provision of culturally responsive and evidenced-based practices. DFCS in recent years has implemented the Child and Family Practice Model with emphasis on the Child and Family Teaming process and use of Child Family Team meetings as a strategy to improve both the understanding of family needs and strengths, and to identify the most appropriate services/resources. The implementation of the two aforementioned practices have reinforced the need for an integrated practice of assessment and service delivery among DFCS, BHSD, and Probation. The Title IV-E Waiver likewise provided a venue for cooperative program development and the sharing of knowledge and resources among these agencies and their respective teams.
The implementation of CCR has presented a challenge for counties throughout the State and has greatly impacted the three departments. While there is broad agreement that family settings are best for all children, the population formally in group homes often require a flexible, integrated service delivery model with customized interventions that meet the unique needs of each child and youth. These children and youth, while having experienced significant past trauma, have talents and strengths that must be rediscovered and nurtured.
Between January 2019 and October 2019, DFCS had 670 children who required placement. There were 848 episodes of placement required for this cohort of youth. Six hundred and thirty-nine (639) of these children entered the system for the first time (non-dependents) and 209 were already in out-of-home placement (dependents) and required a new placement. Historically, all such children would have possibly entered the RAIC for some period of time while waiting for a more permanent placement option.
Of the 670 children entering the RAIC during the mentioned period, 251 were placed in a County-supervised foster home, 176 were placed in foster homes supervised and supported by one of the Foster Family Agencies (FFA) with which the County contracts, 35 were placed in group homes, and 57 were in a medical facility. During the 10-month period 104 or 15.5 % of the youth required a higher level of care than they did at the point of entry.
CONSEQUENCES OF NEGATIVE ACTION
The Board would not receive this report