BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 403
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|Author: |Mark Stone |
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|Version: |July 7, 2015 |Hearing | July 14, 2015 |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sara Rogers |
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Subject: Public social services: foster care placement:
funding
SUMMARY
This bill, effective January 1, 2017, sunsets existing
licensure, rate setting and other provisions for group homes and
Foster Family Agencies (FFAs), and establishes interim
provisions. It provides for licensure of Short Term Residential
Treatment Centers (STRTCs) and FFAs and requires the California
Department of Social Services (CDSS) to develop a new payment
structure for STRTCs and FFAs and requires both to receive
mental health certification and accreditation, as specified.
Codifies and expands use of child and family team in case
planning and enacts provisions pertaining to the Resource Family
Approval (RFA) Program. The bill establishes Legislative intent
to improve California's child welfare system by using
comprehensive initial child assessments, increasing the use of
home-based family care and providing services and supports to
home-based family care, reducing the use of congregate care
placement settings, and creating faster paths to permanency to
shorten the duration of a child's involvement in the child
welfare and juvenile justice systems.
ABSTRACT
Existing law:
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1)Provides that any child who has suffered, or is at risk of
suffering, serious physical or emotional harm, as defined,
shall be within the jurisdiction of the juvenile court which
may adjudge that person to be a dependent child of the court,
as specified. (WIC 300)
2)Establishes CDSS as the single state agency required by Title
IVB and IVE of the federal Social Security Act to distribute
federal funds and supervise Californias county administered
child welfare system which includes child protective services,
foster care placement services, and adoptions services.
Requires the state,3) through CDSS and county welfare
departments, to establish and support a public system of child
welfare services to protect and promote the welfare of
children. (WIC 10600 and 16500)
4)Following a court order to remove a child from parental
custody, requires the court to order the care, custody,
control and conduct of the child to be under the supervision
of a social worker and permits a social worker to place the
child in any of the following (WIC 361.2):
a. The home of a noncustodial parent.
b. The approved home of a relative, as defined
c. The approved home of a nonrelative extended family
member, as defined.
d. A foster home in which the child has previously
placed, if it is in the best interest of the child and
space is available.
e. A suitable licensed community care facility.
f. With a foster family agency to be placed in a
licensed foster family home or certified family home.
g. A home or facility in accordance with the Indian
Child Welfare Act.
5)Provides for the licensure of group homes, defined as a
residential facility providing 24-hour non-medical care and
supervision to children, delivered by employed staff in a
structured environment. Requires CDSS to establish a rate
classification level (RCL) structure for group homes with a
corresponding rate structure according to the level of care
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and services that will be provided, as specified. (HSC 1502
and WIC 11462)
6)Permits a group home to be classified as an RCL 13 or 14 if
the program only accepts children with special treatment needs
and meets other requirements. Additionally requires the
California Department of Health Care Services (DHCS) to
certify group homes annually seeking classification as RCL 13
or 14 and permits such facilities to accept minor dependents
who are seriously emotionally disturbed if certain conditions
are met. (WIC 11469, WIC 4096.5 and HSC 1502.4)
7)Provides for licensure of FFAs, defined to mean any
organization engaged in the recruiting, certifying, and
training of, and providing professional support to, foster
parents, or in finding homes or other places for placement for
children for temporary or permanent care, as an alternative to
group care. (HSC 1502)
8)Establishes California's Medicaid program, Medi-Cal, though
which eligible low-income individuals receive health care and
mental health services, including foster youth, eligible
recipients of the Adoption Assistance Program, and Kin-Gap.
(WIC 14000 et seq. and 42 USC Section 1396 et seq and 42 CFR
435.145.)
9)Establishes the federal Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) program to provide
comprehensive and preventive health services including
specialty mental health services to Medi-Cal beneficiaries
under the age of 21 who have full scope Medi-Cal eligibility.
(42 USC Section 1396d)
10)Requires county mental health departments to provide children
served by county social services and probation departments
with mental health screening, assessment, participation in
multidisciplinary placement teams and specialty mental health
treatment services for children placed out of home in group
care, for those children who meet the definition of medical
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necessity and to the extent resources are available. Requires
first priority be given to children currently receiving
psychoactive medication. (WIC 5867.5)
11)Provides for the establishment of interagency placing
committees to establish procedures whereby a ward of the court
or dependent child of the court who is to be placed in a RCL
13 or 14 group home is assessed as seriously emotionally
disturbed. (WIC 4096)
12)Requires CDSS to authorize county welfare departments to
undertake comprehensive recruitments programs, as specified,
to ensure an adequate number of foster homes are available to
meet the child welfare placement needs in each county. (HSC
1515)
13)State law establishes the Resource Family Approval (RFA)
process, initially as a five-county pilot, to replace the
multiple processes that currently exist for licensing foster
family homes, approving relatives and nonrelative extended
family members as foster care providers and approving adoptive
families. The new process is expected to be implemented
statewide as of July, 2017. (WIC 16519.5)
This bill:
1)Establishes Legislative intent to improve California's child
welfare system by using comprehensive initial child
assessments, increasing the use of home-based family care and
the provision of services and supports to home-based family
care, reducing the use of congregate care placement settings,
and creating faster paths to permanency to shorten the
duration of a child's involvement in the child welfare and
juvenile justice systems.
2)Establishes Legislative intent that because the act will
result in overall fiscal savings to local agencies, the act
shall not have the overall effect of increasing the costs
already borne by a local agency pursuant to the 2011 Public
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Safety Realignment, and shall not require the state to provide
annual funding after the state provides short-term funding.
3)Establishes Legislative intent that all children live with a
committed, permanent, and nurturing family. Services and
supports should be tailored to meet the needs of the
individual child and family being served, with the ultimate
goal of maintaining the family, or when this is not possible,
transitioning the child or youth to a permanent family or
preparing the youth for a successful transition to adulthood.
4)Establishes Legislative intent that, when needed, STRTC
program services are a short-term, specialized and intensive
intervention that is just one part of a continuum of care
available for children, youth, young adults, and their
families.
Group Home and Residential Care Reforms
5)Creates a new licensure category of "short-term residential
treatment centers" (STRTCs), on or after January 1, 2017,
defined to mean a residential facility licensed by CDSS and
operated by a public agency or private organization that
provides short-term, specialized and intensive treatment,
including core services, as defined, and 24-hour care and
supervision, as specified.
6)Strikes references to "seriously emotionally disturbed," a
determination currently used to permit admission of a child
into a level 13 or 14 group home programs, and replaces
references with "emotional disturbance" as defined in federal
special education law.
7)Effective January 1, 2017, sunsets existing law permitting a
group home for children to accept children assessed as having
an emotional disturbance (providing for one-year conditional
extensions to individual group homes).
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8)Adds new statute, effective the same date, permitting STRTCs
to accept for placement children who do not require inpatient
care in a licensed health facility and who have who has been
assessed as requiring the level of services provided in the
facility to maintain the safety of the child or others, as
specified, and who meet one of the following additional
conditions:
a. The child has been assessed as meeting the medical
necessity criteria for specialty mental health services
under the Medi-Cal Early and Periodic Screening Diagnosis
and Treatment (EPSDT).
b. The child has been assessed as having an emotional
disturbance, as defined.
c. The child has been assessed as requiring the level
of services to meet his or her behavioral or therapeutic
needs. Additionally the bill provides that in appropriate
circumstances this condition may include the following
children:
i. A commercially or sexually exploited
child.
ii. A private voluntary placement, where the
youth exhibits status offender behavior that the
parents or other relatives feel they cannot control,
as specified.
iii. A juvenile sex offender.
iv. A child who is affiliated with, or
impacted by, a gang.
9)Effective January 1, 2017, sunsets the existing rate
classification structure for group homes, and establishes an
interim rate classification process for each individual group
home based on the existing point system developed by CDSS.
Provides that the interim rate classification process will
sunset January 1, 2018.
10)Permits CDSS to grant extensions for group homes to receive a
rate for up to one year on a case-by-case basis, when the
county chief probation officer documents a significant risk to
the safety of the youth or the public, as specified, until
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December 31, 2017, followed by case-by-case extensions to be
reviewed every six months.
11)Requires CDSS to develop a new payment structure for STRTCs
claiming funding under Title IV-E based on specified factors
including specified core services, specialized and intensive
treatment supports that cannot be met in a family based
setting, staff training, licensing requirements,
accreditation, mental health certification, and maximization
of federal financial participation.
12)Prohibits CDSS from establishing a rate for STRTCs or FFAs
that provides intensive and therapeutic services unless the
provider submits a recommendation from the host county or the
primary placing county that the program is needed and that the
provider is willing and capable of operating the program at
the level sought.
13)Describes "core services" provided to children and their
families that are required to be specified in the STRTC
program statement and are to be considered in rate setting.
States that core services encompass community service and
supports, physical, behavioral, and mental health support and
access to services, including specialty mental health
services, educational support, life and social support,
transitional support services for children, youth, and
families who assume permanency, and for children, youth, and
families who step down into lower levels of foster care,
services for transition-aged youth, services for nonminor
dependents, and trauma-informed practices and supports for
children and youth, including treatment services.
14)Requires STRTCs and Community Treatment Facilities as a
condition of licensure, and as a condition of eligibility for
Aid to Families with Dependent Children-Foster Care (AFDC-FC)
placement, to receive accreditation from a nationally
recognized accreditation agency, identified by CDSS, with
expertise in programs for youth group care facilities.
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15)Requires all STRTCs as a condition of licensure, and as a
condition of eligibility for AFDC-FC placement, to maintain in
good standing a mental health certification from DHCS, or from
a county to which the department has delegated certification,
oversight and enforcement authority (currently only RCL 13 and
14 group homes must obtain and mental health certification).
16)Requires DHCS to promulgate regulations for oversight,
enforcement, and due process for the mental health
certification of STRTCs and FFAs that provide intensive or
therapeutic treatment services.
17)Requires STRTCs to include, in the program statement,
protocols for developing a needs and services plan, in
collaboration with a child and family team, that includes a
description of the services to be provided to meet the
treatment needs of a child, the anticipated duration of the
treatment and the timeframe and plan for transitioning the
child to a less restrictive environment. Requires that such
information be included in the child's case plan prior to
court approval for placement, and similar information as a
condition of placement eligibility for AFDC-FC.
18)Requires interagency placement committees (IPCs) to establish
procedures for a ward or dependent of the court, who is to be
placed in an STRTC or FFA that provides treatment services, is
assessed as having an emotional disturbance. Additionally
provides that IPCs or a licensed mental health professional
shall perform assessments for specialty mental health services
under EPSDT and emotional disturbance.
19)Conforms applicable administrative, administrator
certification, plans of operation, complaint and incident
response, and other licensure requirements for group homes to
STRTCs as well as audit, overpayment and collections
requirements pertaining to federal and state requirements.
20)Authorizes CDSS to license a temporary shelter care facility
operated by a county or agency on behalf of a county, and
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requires CDSS to consult with counties operating shelters to
develop a transition plan, as specified.
21)Amends court determinations proceedings to reflect the
establishment of STRTCs and conforms placement prohibitions
for young children with those applying to group homes.
22)Requires CDSS to develop a system of governmental monitoring
and oversight that shall be carried out in coordination with
DHCS, to ensure conformity with federal and state law,
including program, fiscal and health and safety audits and
reviews.
23)Permits CDSS to license a county as a foster family agency or
an STRTC and provides that any existing county-operated FFA or
group home, including the group home operated by San Mateo
County, shall meet the requirements pertaining to STRTCs and
FFAs to receive AFDC-FC funds. Establishes
conflict-of-interest provisions pertaining to placement
decisions, complaint reporting requirements, cross reporting
requirements, disclosures of fatalities and near fatalities.
24)Establishes practice standards and minimum services for a
county child welfare agency operating a licensed temporary
shelter care facility. Provides that in no case shall the
detention or placement exceed 10 calendar days unless the
child welfare agency submits a written report to CDSS within
24 hours, as specified.
25)Effective January 1, 2017 provides that the amount paid for
care and supervision of a dependent infant living with a
dependent teenage parent receiving AFDC-FC benefits living in
an STRTC shall equal the infant supplement rate for STRTCs.
Child and Family Team
26)Defines child and family team as a supportive team comprised
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of the child or youth, the child's family, the caregiver, the
placing agency caseworker, a county mental health
representative, and a representative of the child's or youth's
tribe or Indian custodian, as applicable, that informs the
process of placement and services to children and youth in
foster care or who are at risk of foster care placement.
Permits other individuals to serve on the team, as specified.
27)States that child welfare services, as defined in existing
law, are best provided in a framework that integrates service
planning and delivery among multiple service systems,
including the mental health system, using a team-based
approach, such as a child and family team.
28)Requires a child's case plan be developed in collaboration
with, and with input from, the child and family team and
requires the child welfare agency to consider the
recommendations of the team and document the rationale for any
inconsistencies between the case plan and team
recommendations.
29)Effective January 1, 2017, provides that, if a treatment
placement is selected for the child, a child and family team
meeting shall be convened for the purpose of identifying the
services and supports needed to achieve permanency and enable
the child to be placed in the most family-like setting.
30)Permits members of a child and family team to receive and
disclose specified information and records, with members of
the team, subject to state and federal law, and excluding
adoption records
31)Establishes new case plan protocols for probation youth in
foster care. Requires case plans to be developed in
collaboration with a child and family team and requires the
probation agency to document the rationale for any
inconsistencies between the case plan and the child and family
team recommendations.
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32)Requires an interagency placement committee to include
recommendations of the child and family team in its
determination for placement in an STRTC or FFA and to include
such recommendations in transmitting an approval or
disapproval to the placing agency and facility.
33)Requires the child and family team to periodically review the
placement of a child or youth in an STRTC or FFA that provides
intensive and therapeutic treatment, and if the team
recommends that the youth no longer needs that placement,
requires a disapproval be transmitted to the placing agency
and the child or youth be referred to an appropriate
placement.
Foster Family Agency (FFA) Reforms
34)Permits probation agencies to place probation youth into a
certified family home of a Foster Family Agency.
35)Requires all FFAs that provide treatment services to maintain
in good standing a mental health certification from DHCS, or
from a county to which the department has delegated
certification, oversight and enforcement authority.
36)Permits an FFA that provides treatment services to accept for
placement children who do not require inpatient care in a
licensed health facility and who meet one of the following
additional conditions:
a. The child has been assessed as meeting the medical
necessity criteria for specialty mental health services
under EPSDT.
b. The child has been assessed as having an emotional
disturbance, as defined.
c. The child has been assessed as requiring the level
of services to meet his or her behavioral or therapeutic
needs.
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37)Provides that assessments pertaining to EPSDT medical
necessity determinations and emotional disturbance shall be
made by an interagency placement committee or a licensed
mental health professional.
38)Requires an FFA provider, prior to receiving a rate from
CDSS, to submit a recommendation from the host county of the
primary placing county that the program is needed and that the
provider is willing and capable of operating the program at
the level sought.
39) Effective January 1, 2017, sunsets the existing rate-setting
system for FFAs and establishes an interim rate system for
FFAs that have been granted an extension. Provides that the
interim rate classification process will sunset January 1,
2018. Permits CDSS to provide an exception to new FFAs to
receive a rate under the former rate structure for up to one
year.
40)Requires CDSS to develop a new payment system for FFAs that
provide nontreatment, intensive treatment and therapeutic
foster care programs which considers federally eligible
administrative activities social work activities, social work
and mental health services, as well as intensive treatment or
therapeutic services, core services, staff training, licensing
requirements, a process for accreditation, as specified,
mental health certification, populations served, as specified.
Other Foster Care System Reforms
41)Effective January 1, 2017, sunsets existing foster parent
training provisions and replaces statute with revised
requirements and structure. Provides that the training must
include a minimum of 8 hours annually, permits training to be
conducted in a classroom setting, online, or individually, and
provides that a portion of the training be from a series of
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topics (instead of requiring a uniform list of training
components):
a. Age-appropriate child and adolescent development.
b. Health issues in foster care, including the
administration of psychotropic medication.
c. Positive discipline and the importance of
self-esteem.
d. Preparation for youth and youth adults for a
successful transition to adulthood.
e. The right of a foster child to have fair and equal
access to all available services, placement, care,
treatment, and benefits, and not to be subjected to
discrimination or harassment on the basis of actual or
perceived race, ethnic group identification, ancestry,
national origin, color, religion, sex, sexual
orientation, gender identity, mental or physical
disability or HIV status.
f. Instruction on cultural competency and respect
relating to, and best practices for providing adequate
care to lesbian, gay, bisexual and transgender youth in
out-of-home care.
42)Permits respite care services to be extended for up to 14
days in any one month pending the development of policies and
regulations in consultation with county placing agencies and
stakeholders.
43)Enacts various implementation provisions pertaining to the
Resource Family Approval process, which pursuant to current
law is anticipated to be implemented statewide July of 2017,
including:
a. Establishes procedures pertaining to denials,
rescissions, or exclusion actions.
b. Ensures completion of caregiver training, as
specified.
c. Provides for FFAs to approve resource families in
lieu of certifying foster homes.
d. Permits resource families caring for a person with a
developmental disability under certain circumstances to
install and use delayed egress devise that delay
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departure for no more than 30 seconds.
e. Permits a resource family to administer emergency
medical assistance and injections for severe hypoglycemia
and anaphylactic shock, and insulin, as specified.
f. Provides that a resource family shall not be subject
to civil penalties pertaining to licensure requirements.
44)Requires that out-of-state group homes shall meet all
licensure standards required of short-term residential
treatment centers operated in the state including an
accreditation and mental health certification, as specified,
unless granted an extension.
45)Effective January 1, 2017, sunsets existing rate for
wraparound services and establishes new rate structure,
effective same date, as specified, to which annual
cost-of-living increases shall be applied.
46)Authorizes the continued licensure of San Pasqual Academy
permitting it to continue to offer residential placements for
the purpose of attending an onsite high school as long as it
submits a transition plan describing how the program will
comply with provisions of this bill.
47)Requires CDSS to provide periodic progress updates to the
legislature.
FISCAL IMPACT
An Assembly Appropriations Committee analysis notes that the
2015-16 Governor's Budget includes $9.6 million ($7 million GF)
to begin implementation of the CCR reforms contained in this
bill. The current provisions of this bill have not been analyzed
by a fiscal committee.
The final human service trailer bill included $25 million
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General Fund to support foster parent recruitment, retention,
and support; $7 million General Fund for housing supports for
child welfare families, and $3 million General Fund to support
the federal Strengthening Families Act.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, this bill is a comprehensive reform
effort to make sure that youth in foster care have their
day-to-day physical, mental, and emotional needs met; that they
have the greatest chance to grow up in permanent and supportive
homes; and that they have the opportunity to grow into
self-sufficient, successful adults. The author states that, to
the extent that children are provided needed services and
support, this bill transitions children away from congregate
care into home-based family care with resource families. In
addition to new services and supports for resource families, the
author states that this measure establishes targeted training
and support that can better prepare families to help care for
foster youth.
The author further states that this bill is necessary to advance
California's long-standing goal to move away from the use of
long-term group home care by increasing youth placement in
family settings and by transforming existing group home care
into places where youth who are not ready to be placed with
families can receive short term, intensive treatment. The
measure creates a timeline to implement this shift in placement
options, and it calls for the adoption of new standards and
performance measures.
Background
California is home to more than 67,000 child welfare and
probation foster youth who have been removed from their homes as
a result of traumatic life events usually involving severe abuse
and neglect. Studies show that children who come into contact
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with child protective services are likely to have many "adverse
experiences" including physical, mental and emotional
maltreatment, homelessness and domestic violence, among
others.<1> Moreover there is growing evidence that a child's
removal from home is itself a direct cause of trauma, and
frequent placement changes and long-term placement in foster
care exacerbate the impact.<2>
According to the American Orthopsychiatric Association, a
child's long-term residence in congregate group care, which
relies on shift staff to serve as caregivers has been shown to
have "inherently detrimental effects on the healthy development
of children, regardless of age" and "should be used for children
only when it is the least detrimental alternative."
Additionally, research shows that group care may inherently
increase problematic behaviors in children, cause psychological
and physical harm to children, and that long-term placement in
congregate care has no therapeutic benefit to traumatized
children.<3>
In recent years, federal law<4> has increasingly directed states
to implement policies designed to ensure that children are
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<1> Ensuring Safety, Well-Being and Permanency for Our Children.
University of North Carolina, Chapel Hill Injury Prevention and
Research Center.
http://www.unc.edu/depts/sph/longscan/pages/DDCF/LONGSCAN%20Scien
ce%20to%20Practice.pdf
<2>
http://tucollaborative.org/pdfs/Toolkits_Monographs_Guidebooks/pa
renting/Factsheet_4_Resulting_Trauma.pdf
<3>
http://dev.jimcaseyyouth.org/sites/default/files/Group%20Care%20C
onsensus.pdf
<4> Fostering Connections to Success and Increasing Adoptions
Act of 2008 (P.L. 110-351) and the Preventing Sex Trafficking
and Strengthening Families Act (P.L. 113-183)
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placed in a permanent home quickly, either through
reunification, adoption, guardianship, or permanent placement
with a fit and willing relative and to reduce congregate care
and long-term foster care. To that end, federal law has
prohibited long-term foster care for children less than 16 years
of age, strengthened case plan requirement, expanded relative
notification efforts, increased incentives for adoption and
guardianship and expanded reporting requirements.
A recent federal study published by the US Administration for
Children and Families states "stays in congregate care should be
based on the specialized behavioral and mental health needs or
clinical disabilities of children. It should be used only for as
long as is needed to stabilize the child or youth so they can
return to a family-like setting." However the study found that a
large percentage of children in congregate care had no apparent
clinical indicators, potentially indicating that placing
agencies "may be placing children in congregate care settings
due to limited alternative placements." <5>
In the case of youth who do have clinical indicators associated
with trauma and abuse or personal characteristics (such as
delinquency status, sexual orientation, etc.), it is often
believed that a group home is the only possible placement for
the child because finding a willing permanent home is not
possible. As of January 2015, 48 percent of dependent youth
placed in group homes in California had been there more than two
years, and 23 percent had been there over five years. Many of
these children who linger in congregate care receive a case plan
designation of "long-term foster care" which means the child is
expected to reach adulthood while in foster care, without ever
finding a permanent family. Studies show that foster youth who
can not be reunified with their parents only to emancipate from
foster care without finding a permanent home have substantially
higher rates of homelessness, unemployment, incarceration and
arrest and lower graduation rates.
Increasingly, and aided by recent lawsuits, the development of
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<5>
http://www.acf.hhs.gov/sites/default/files/cb/cbcongregatecare_br
ief.pdf
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intensive treatment services provided in a home based setting,
wraparound service models, respite care and family finding
services have called into question the need for such widespread
use of congregate care and long-term foster care. Pilot projects
have found that in even the most challenging of circumstances,
"forming permanent connections for older foster youth is
achievable; it increases their likelihood of avoiding dire
consequences and achieving successful independence" and that
"after a startup period, services can be sustained long term at
no net cost to the counties or state."
Continuum of Care Reform Efforts
In response to SB 1013 (Committee on Budget and Fiscal Review,
Chapter 35, Statutes of 2012), which called for the department
to establish a working group to develop recommended revisions to
the current rate-setting system, services, and programs serving
children and families in the continuum of foster care settings,
CDSS led a three-year stakeholder effort. Early this year the
department published a report entitled "California's Child
Welfare Continuum of Care Reform." which outlined a
comprehensive approach to improving California's child welfare
system by reforming the system of placements and services
directed at youth in foster care.
The report envisions new models of care for foster youth,
including providing all foster youth with access to a child and
family team - instead of relying solely on a single social
worker - and empowering those child and family teams to utilize
a more consistent assessment tool that identifies the needs of
the child. Rather than leaving a child to "fail upwards" into a
group home before the child is provided more intensive services,
the report envisions providing needed treatment and services in
homes, and relying on group homes only for short-term treatment
placements.
Child Welfare Services
California has a complex child welfare system incorporating
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federal, state and local funds expended for the broad purpose of
child welfare, including prevention services, family
maintenance, foster care, adoption and guardianship assistance,
case management, family finding, family engagement, needs
assessments, and other services. The federal Administration of
Children and Families (ACF) administers numerous federal grants
intended to assist states with child abuse prevention and
response and to support the foster care system which provides
board and care payments for eligible dependent children. Within
the statutorily established parameters for each grant, states
have substantial flexibility in how to apportion funds but are
accountable to significant federal oversight of program
administration.
Prior to realignment, the annual Budget Act included funding
estimates for a variety of child welfare programs and services
designed to help prevent children from out of home placement, or
if removal from home is necessary, to notify, search for and
engage potential relative caregivers, to support youth with
therapeutic supports in the placement, foster and adoptive
family recruitment programs, foster parent training programs,
identification of a "special relationship" with an adult for
children in long term group care, programs to coordinate the
health and mental health needs of children, family based case
planning and others. Subsequent to realignment, county spending
on some of these services is largely discretionary.
To the extent that this bill reduces reliance on congregate
care, any savings would accrue to the county for other child
welfare services uses. This could allow for new opportunities
for counties to better maximize federal reimbursement for more
clinical child welfare services that are eligible for funding
under Medi-Cal.
Under Realignment, CDSS and stakeholders will be reliant on
county welfare and mental health departments to direct monies
toward increased services and supports for children residing in
foster homes and relative homes. Successful implementation of
this bill will depend on the availability of these services and
supports for children and families in order to ensure sufficient
availability of homes and stable placements.
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Mental Health Services for Foster Youth
A principal point of access for mental health services for
foster youth is though specialty Medi-Cal mental health
services, provided by county-operated mental health plans.
County mental health plans may provide mental health services
directly, or by contracting with local providers. Foster youth,
like all children enrolled in Medi-Cal, are eligible for the
EPSDT benefit. This uncapped entitlement provides for periodic
screenings to determine a child's medical needs and, based upon
the identified health care need, treatment services are to be
provided. EPSDT mental health services provide Medi-Cal
enrolled children access to a continuum of mental health
services including:
Mental health assessment;
Crisis Intervention/Stabilization;
Day Rehabilitation/Day Treatment Intensive;
Intensive Care Coordination;
Medication support services;
Targeted case management;
Therapeutic behavioral services.
EPSDT provides children with a benefit at an exceptionally high
standard of care. According to the U.S. Department of Health
and Human Services:
"While there is no federal definition of preventive medical
necessity, federal amount, and duration and scope rules
require that coverage limits must be sufficient to ensure
that the purpose of a benefit can be reasonably achieved.
Since the purpose of EPSDT is to prevent the onset of
worsening of disability and illness and children, the
standard of coverage is necessarily broad... the standard
of medical necessity used by a state must be one that
ensures a sufficient level of coverage to not merely treat
an already-existing illness or injury but also, to prevent
the development or worsening of conditions, illnesses, and
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disabilities." <6>
California's system of children's mental health care is highly
fragmented with significant geographic gaps in access to
services as each county prioritizes resources and develops its
network of providers with little oversight or statewide
standards. Stakeholders widely describe the limited availability
and scope of county mental health services for children despite
repeated assurances from the DHCS and county mental health
departments that services are available to all children who meet
very broad medical necessity criteria under EPSDT.<7>
Katie A. Settlement
Recently, the state settled the Katie A. v Bonta case, a lawsuit
filed on behalf of children in California who are in foster care
or at imminent risk of foster care placement, have a documented
mental health need, and who need certain individualized mental
health services to treat or ameliorate their illness or
condition. The lawsuit centered on a finding that certain foster
youth who meet the medical necessity criteria for Specialty
Mental Health Services or EPSDT were not receiving the mental
health benefits for which they were eligible.
In response, the state of California has agreed to establish
three new Medi-Cal specialized mental health services aimed at
meeting the needs of the youth who are covered under the
settlement.<8> In fulfilling the obligations of the settlement,
DHCS and CDSS have drafted a Core Practice Model to provide
---------------------------
<6> http://mchb.hrsa.gov/epsdt/mednecessity.html
<7>
http://www.kidsdata.org/topic/64/special-needs-referrals-difficul
ty/table#fmt=323&loc=1774,2&tf=74&ch=136,135
<8> "Medi-Cal Manual for Intensive Care Coordination (ICC),
Intensive Home Based Services (IHBS) and Therapeutic Foster Care
(TFC) for Katie A. Subclass Members." DHCS and CDSS. 2013.
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guidance and establish a standard of care for county child
welfare and mental health agencies, and other service providers
that provide services to youth covered under the settlement. The
departments have jointly released two documents, however, these
services are targeted at youth exhibiting significant mental
health challenges, and do not address the consistent lack of a
trauma-informed mental health services aimed at serving youth
who exhibit indicators of trauma, but have yet to develop severe
symptoms.
Reforms Envisioned by AB 403
This bill reflects a substantial, though incomplete, effort to
begin implementation of the ambitious "continuum of care reform"
that is described in the departmental report. This bill
incorporates several primary areas of reform:
Dismantles the existing rate classification structure,
licensure, and eligibility criteria for group homes, replacing
it with STRTCs that incorporate increased standards of care,
shortened duration of stay, and stricter criteria for initial
placement. This policy is likely to have the effect of
reducing the overall number of beds available for congregate
care, and will make it harder for placing agencies to place a
child who does not have a true clinical need for congregate
care. As a result counties will need to quickly increase the
availability of foster homes or relative caregivers.
Revises the existing licensure, rate structure and eligibility
criteria for Foster Family Agencies, which recruit, certify
and provide services to foster family homes. The new structure
envisions a model of FFAs that are prepared and funded to
provide intensive treatment level services (currently often
unavailable outside of a group home) in a foster home setting,
enabling children with emotional or behavioral health
challenges to remain with a family.
Expands the role of the child and family team in guiding the
development of a child's case plan, so that a social worker is
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not solely responsible for decisions about the care of a
child. Existing use of child and family teams has shown the
model to be an important tool for flexibly building a network
of child welfare mental health and educational services to
best support the child and his or her family.
Expands the level of integration between mental health
services and child welfare services available to children who
either reside in an STRTC or who are served in a home through
an FFA. By requiring STRTC or FFAs to obtain a mental health
certification, and including an EPSDT specialty mental health
assessment as one criteria for placement, this bill is likely
to have the effect of encouraging greater interdepartmental
collaboration at the local level, and increase providers'
ability to provide a more complete range of child welfare and
mental health services to the child.
Addresses some barriers to achieving an adequate supply of
relative and foster family homes. This bill continues
implementation of the Resource Family Approval (RFA) Program,
which was established as a permanent statewide program through
SB 1013 (Committee on Budget and Fiscal Review, Chapter 35,
Statutes of 2012). Under the program, CDSS is required to
implement a unified, family friendly, and child-centered
resource family approval process to replace the existing
multiple processes for licensing foster family homes,
approving relatives and nonrelative extended family members as
foster care providers, approving guardianships, and approving
adoptive families. This model is currently being implemented
as a five county pilot, however it is anticipated to take
effect statewide July 2017.
This bill modernizes foster parent training programs, making
curriculum more flexibile according to the specialized
training needs of individual children and families.
By providing for the establishment of a series of "core
services" that FFAs are required to provide, including
specialty mental health services, and by enabling FFAs to
approve and serve all resource families this bill is likely to
enable counties to better support foster parents and relative
caregivers with the services needed to maintain stable
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placements and prevent the need for STRTC placement.
Related legislation:
SB 1013 (Committee on Budget and Fiscal Review, Chapter 35,
Statutes of 2012), called for CDSS to establish a working group
to develop recommended revisions to the current rate-setting
system, services, and programs serving children and families in
the continuum of foster care settings. Additionally this bill
enacted the Resource Family Approval (RFA) Program.
COMMENTS
1.Several sections of this bill reference the need for CDSS to
consult with stakeholders regarding specific aspects of the
implementation of this legislation. In the interest of
ensuring that such consultation and oversight is coordinated
and comprehensive, staff recommends that the author add a
provision as this bill moves forward for the convening of a
larger workgroup or workgroups that would include legislative
staff, counties, and advocates to address critical issues in
the initial and ongoing implementation of this legislation.
Subjects addressed by this workgroup may include, but are not
limited to the following:
Rate development for STRTCs, FFAs and across the
continuum of care
Assessments
Recruitment and retention of home-based family
caregivers
Availability of core services, including specialty
mental health services, across placement types
Meeting the needs of special populations within the
child welfare system
Mental health certification process
Licensure simplification for foster homes
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Outcomes and Accountability measures and data collection
1.The author and CDSS have worked continuously with stakeholders
to address both technical and substantive concerns. Following
recent and ongoing meetings, the author and CDSS propose a
number of technical or clean-up amendments in the following
general areas: Clean-up language related to parallel
requirements for FFA and STRTCs plan of operation and training
requirements across provider groups; grandfathering language
for existing RFA homes, additional language on foster
parent/relative recruitment and retention; reversion of
"emotional disturbance" language to "seriously emotionally
disturbed;" amendments to Provisional Rate Language related to
the accreditation timeline; removal of the distinction between
treatment and non-treatment FFAs; clean-up language around
core services; and additional amendments responding to
feedback from stakeholders. A mock-up of the 200-page
amendments is available from the committee upon request.
PRIOR VOTES
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|Assembly Floor: |79 - |
| |0 |
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|Assembly Appropriations Committee: |17 - |
| |0 |
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|Assembly Human Services Committee: |7 - |
| |0 |
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POSITIONS
Support:
California Department of Social Services (Sponsor)
California Alliance of Child and Family Services
California State Association of Counties
County Behavioral Health Directors Association of
California
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County of Yolo, Board of Supervisors
County Welfare Directors Association of California
Youth Law Center
Oppose:
Beta Foster Care
Orange County Board of Supervisors
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