FY 2012 Community Integration (Olmstead) Performance Measure:
In collaboration with DMH, CFSA continues to make significant progress in reducing the number of youth placed in Psychiatric Residential Treatment Facilities (PRTF), including those placed more than 100 miles from the District. Each month the agency continues to discharge or transition a steady stream of eligible youth to local community-based services.
FY 2012 Community Integration (Olmstead) Plan Outline:
The Child and Family Services Agency (CFSA) is the District of Columbia’s cabinet-level, child welfare agency. CFSA is charged with protecting children and youth from abuse and neglect and for those removed from their homes, ensuring safe, permanent placements that can effectively support them in meeting their goals for well-being.
The mission and commitment of CFSA is rooted in protecting child victims and those at risk of abuse and neglect up to age 21. CFSA’s goal is to ensure children have safe, permanent homes with their birth parents, relatives, or adoptive families, or otherwise support and prepare them to function as competent, independent adults with connections to the communities in which they reside whenever possible. When children and youth are removed from their homes to ensure their safety, CFSA’s goal is to provide them with a family setting that promotes a continued connection to their siblings, parents, extended family members, and communities. CFSA seeks to place all children and youth in its care in family-based settings first, before seeking congregate care placement alternatives.
Agency’s identified Population and the Definition of this Population:
CFSA closely monitors this population; reviews are conducted on a monthly basis and are discussed at meetings with CFSA leadership. In order to address the lack of local treatment services for youth with serious emotional, behavioral, and mental health, or who have certain disabilities, CFSA is participating in a city-wide conversation about how to bridge the service gaps in the District’s continuum of care for youth. Partner agencies will focus on incentivizing the development of appropriate and effective services in the District.
FY 2008 was the first year of the multi-year mental health plan, during which time CFSA and DMH assessed the array of existing services to determine the extent to which they met the needs of the population they served.
Rate increases for counseling/therapy and medication management services went into effect on November 1, 2008, with the expectation of increasing the pool of providers who participate in providing community services to the target population. Four Core Service Agencies through the DMH have been selected as Choice Providers to provide evidenced-based, effective and quality services to the children and families served through CFSA.
In addition to the action steps already described, the Agency is proposing implementation of a Nurse Case Management Model in FY 2010 that will greatly enhance the supports available to resource families, particularly for those families caring for children who are medically fragile or developmentally delayed. Under this new approach to service delivery, nurses in CFSA’s Office of Clinical Practice, Clinical and Health Services Administration, will each carry a caseload and provide support to children in care. The nurses will review individual service needs and assist resource families in navigating the health care and related service systems. The Agency projects that the addition of this particular support will increase the willingness of resource families to care for medically fragile children who otherwise must remain in a congregate or hospital setting.
CFSA is also reviewing its current MOU with the Department on Disability Services Developmental Disability Administration (DDS/DDA) to ensure the terms are aligned with new proposed legislation that would enable CFSA to refer eligible youth for services prior to their 18th birthday.
Number of People Currently Living in Institutions:
Children who require the highest level of specialized care are placed in residential treatment centers (RTC’s) or psychiatric residential treatment facilities (PRTF’s). This type of specialized care may include treatment for neurological impairments, medically fragile conditions, sexual abuse and/or sexual offense, as well as treatment for youth in foster care who have also been in the juvenile justice system for various crimes (assault, possession of weapons, robbery, theft, etc.).
The Demographics of the Individuals in Institutions:
The children in the District’s foster care population are older than in most jurisdictions, largely African American (at approximately 90%, an over representation compared with the district’s overall ethnic population profile), and about equally distributed between male and female.
Agency’s Identified Barriers Unique to Population:
Due to a lack of local treatment services for youth with serious emotional, behavioral, and mental health, or who have certain disabilities, CFSA is participating in a city-wide conversation about how to bridge the service gaps in the District’s continuum of care for youth. Partner agencies will focus on incentivizing the development of appropriate and effective services in the District.
Number of Individuals who were Transitioned or Diverted out of Institutions Safely for the Fiscal Year:
CFSA’s primary goal is to transition all children and youth to the least restrictive environment possible. This is based on the treatment progress of the children or youth in these settings. Currently, CFSA participates in treatment planning meetings to determine if the children/ youth are meeting the goals for discharge.
The Following Resources have been Instrumental in Safely Diverting Children from Institutional Care:
Wraparound Pilot: CFSA’s implementation of the mental health wraparound pilot (2008) was designed to result in a fundamental shift in the way the District delivers services to children and youth with complex emotional and behavioral needs. Wraparound is an approach to care that has evolved through efforts to help families with the most challenging children function more effectively in the community. More specifically, rather than relying on PRTFs, wraparound services incorporate a definable planning process that results in a unique, individualized set of community services and natural supports that “wrap around” a child and family to further their efforts towards safety, permanency, and well-being. The philosophy that led to wraparound is relatively simple: identify the community services and supports that a family needs and provide them as long as they are needed. The wraparound process is expected to help build the District’s capacity to serve children. This pilot is jointly funded by CFSA and the District’s Department of Mental Health.
Family Team Meetings (FTM’s): FTM’s are a child welfare strengths-based, family conferencing model. FTM’s are employed to increase family and community involvement at times of critical decision-making. System of Care (SOC) meetings are designed to identify the level of supports and services that a child/ youth will require. Department of Mental Health (DMH) coordinated network of agencies and providers that make a full range of mental health and other necessary services available as needed by children with mental health problems.
Mobile Crisis Response: The District is also planning to implement new crisis-management services to include “crisis beds” as well as a Mobile Response Stabilization Team. One of the primary objectives of crisis beds is to circumvent psychiatric inpatient hospitalization for youth ages 6 to 21. The crisis beds will provide psychiatric stabilization and rehabilitative services that address the psychiatric, psychological, and behavioral needs of the children and youth who need support.
Available Services for Individuals with Disabilities that Support Self-Determination, Transitioning, and/or Diverting Individuals from Institutional Placements:
All staff is charged with supporting the mission of CFSA and ensuring the overall safety, permanence and well-being for the children and families served by the Agency. CFSA employs a multidisciplinary team approach which includes but is not limited to staff from: Program Operation (case managers), Office of Clinical Practice (Residential Treatment Center Specialist (RTC), Health Services (nurses), Special Needs Liaison, and Mental Health Specialist. Each child also has a Guardian Ad Litem (GAL) advocating on their behalf.
In addition to the case management services provided by CFSA, the Agency also utilizes:
- Mobile Crisis
- Crisis Behavioral Intervention
- Wraparound Services
- Intensive Home and Community-Based Services
- Multi-Systemic Therapy
Other District Agencies that are Currently Coordinating or Providing Services and/or Financial Assistance to People Currently in Institutions:
CFSA’s Office of Clinical Practice works closely with the District’s Department of Mental Health (DMH) to meet the needs of the target population. DMH is responsible for coordinating and facilitating the family-focused System of Care (SOC) meeting to develop individual service plans required to meet the needs of the child or youth. These meetings are used as tools to help identify the least restrictive settings possible.
Barriers to Providing Self-Determination and Transitioning and Diverting the Agency’s Population Away from Institutions:
The major barrier is the lack of provider capacity in the local DC metropolitan area for any such specialized population.