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State Executive Council / State & Local Advisory Team

DRAFT MINUTES

STATE EXECUTIVE COUNCIL (SEC)
COMPREHENSIVE SERVICES FOR AT RISK YOUTH AND FAMILIES
Charlottesville/Powhatan Rooms
1604 Santa Rosa Road, Richmond, VA
Friday, December 19, 2008

SEC Members Present:
Secretary Marilyn Tavenner, Office of Health and Human Resources
Raymond Ratke, Special Advisor for Children’s Services Reform
Trudy Ellis, Parent Representative
Woody Harris, Councilman, City of Emporia
Lelia Hopper, Office of the Executive Secretary of the Virginia Supreme Court
Tony Conyers, Commissioner, Department of Social Services
Barry Green, Director, Department of Juvenile Justice
Tim Howard, Deputy Director for Community Programs, Department of Juvenile Justice
Jim Burns for Karen Remley, Commissioner, Department of Health
Cindi Jones for Pat Finnerty, Director, Department of Medical Assistance Services
Doug Cox for Superintendent Patricia Wright, Department of Education
Greg Peters, Virginia Coalition of Private Providers Association
Charlotte McNulty, Co-Acting Executive Director for the Office of Comprehensive Services
and State and Local Advisory Team Chair

SEC Members Absent:
Delegate Phillip Hamilton, Virginia House of Delegates
Senator John Edwards, Virginia Senate
David Canada, City Manager, City of Petersburg

Office of Comprehensive Services Staff Present:
Keith Sykes, Co-Acting Executive Director
Carol Wilson, Technical Assistance Coordinator
Chuck Savage, Business Manager
Marsha Mucha, Executive Assistant

Call to Order
Ray Ratke called the meeting to order at 9:40 a.m. He noted that, due to a previous commitment, Secretary Tavenner could not be present for the first part of the meeting but would assume the chair upon her arrival. A quorum was present.

Approval of Minutes
The minutes of November 21, 2008 were approved on a motion from Greg Peters, seconded by Cindi Jones and carried.

Governor’s Proposed Budget for CSA
Ray reported that Governor Kaine presented his Executive Amendments to the 2008-2010 Biennial Budget on December 17, 2008 to the Joint Money Committees. He reminded Council members that previous reductions made in October 2008 did not include the Comprehensive Services Act (CSA).
Recommended operating budget amendments for CSA for FY 2009-FY2010 include:

• Eliminating $500,000 in each year of the biennium for grants to localities intended to encourage localities to create community based services.
• Recovering $5M in each year of the biennium for unused funding for services for children accessing services through parental agreements. The number of children qualifying under a parental agreement is significantly less than previously anticipated.
• Reducing by $700,000 (FY2009) and $1.3M (FY2010) the number of children placed in out of state residential facilities. The current trend shows the number of children in out of state placements is declining, with 176 children placed out of the state in FY2008, at a cost of $17.2M. Efforts to bring children back into Virginia are continuing, and will result in a currently unbudgeted savings in FY2009-2010. A reduction of 10 percent in each year is anticipated.

Public Comment
Josh Ellis a student and son of Council member Trudy Ellis – Josh asked that, during these tough economic times, funding not be cut for children’s services. He said that it was hard for kids in foster care to have to change and move to new families. These kids have made friends and are involved in their schools and communities and moving around disrupts the progress they have made.

Matt Ellis a student and son of Council member Trudy Ellis – Matt also asked that funding for children’s services not be cut. He stated that when he was young doctors said that he would never be able to read or do math. He said that with the help of his parents, his school, doctors and programs that were available for him, he now is able to read adult level books, does well in school and wants to go to college. He told Council members that kids look up to them and to please not let people give up.

Update on the Council on Reform (CORE)
Ray reported that CORE met on December 10, 2008 and included remarks by Governor Kaine and Secretary Tavenner. He provided a brief update on data comparing December 2007 to December 2008 in the areas of foster care caseloads, family based placements and kinship care. Data collected on the 13 CORE localities supports a decrease in the foster care caseloads, a rise in family based placements and a slight rise in the number of kinship care placements. Data collected on the 13 CORE localities also indicated a rise in the number of children discharged to permanency and a decrease in the number of children in congregate care.

Ray next reported on CORE’s goals for 2009. In 2009, CORE will begin to spread the transformation effort statewide by engaging other child serving agencies. The planning to date has centered around four strategies:
• Education and information sharing – A series of two or three initial statewide meetings will be held to get buy in and to bring all localities up to speed on the Transformation effort. This effort will begin in early 2009.
• Training: Becoming the Experts – In the short term, a transformation Tool Kit is being prepared for localities. A Transformation Academy will be established to get leaders up to speed quickly and will include leaders and staff from across the child serving agencies. Topics will include things such as data, the CORE practice model, family engagement models, resource family recruitment, development and support, etc. Trainings from national experts and ongoing regional training opportunities are also planned. This effort will begin in early 2009. The long term goal is to rebuild a competency based in-service training program which incorporates the CORE practice model and building blocks of the Transformation.
• Building Regional Capacity: Rolling out the Transformation Statewide – Building and training five regional leadership teams consisting of the Department of Social Services (DSS), CSA, the Department of Juvenile Justice (DJJ) and the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS). Regional Transformation meetings will be held within the regions and include representatives from all localities. Meetings will focus on building momentum, providing technical assistance and resolving local implementation issues. This effort will begin in the spring of 2009 (after training has occurred and statewide meetings have been held).
• CORE – In 2009, CORE will meet quarterly. CORE group membership and meeting participation will consist of the original 13 localities and the members of the state staffs (from across agencies) that are directly supporting their work. The CORE meeting will serve as check-ins on implementation for both the state and local implementation teams and will provide an opportunity to troubleshoot and share promising practices together. The role of the workgroups is still undetermined for 2009.

CORE localities will have the opportunity to send a staff member to specific training opportunities at the state level which are not available to other localities (i.e. training the trainer on a family engagement model). Ongoing technical assistance will be provided as needs are identified through CORE meetings and addressed through trainings, speakers, etc. CORE localities will be asked to provide support to other localities by serving as a resource to them in their Transformation implementation.

In closing his report, Ray noted that CORE anticipates continued support from the Casey Foundation in the Transformation effort. He also reported that he will now be serving full-time as the Special Advisor for Children’s Services Reform.

Lelia Hopper noted that grant funds will be available in early 2009 through the court improvement process to provide training mini-grants to localities on particular areas of training interests. These mini-grants may provide an opportunity to spread the word about CORE. Also in 2009, a state Court Best Practices Conference will be held. There may be an opportunity to incorporate CORE into the themes and content of the conference.

Report on the Number of Children Being Served Outside the State
Chuck Savage began his report by noting that Phyllis Ross with the Department of Education (DOE) has been serving as the CSA Fiscal Agent for a number of years. He further noted that Phyllis will be retiring on December 31, 2008 and he expressed his thanks on behalf of the Office of Comprehensive Services (OCS) for her dedication and hard work over the years. Chuck stated that Phyllis was always accurate and pleasant to work with. During the past 14 years, OCS has never had an Auditor of Public Accounts audit exception due in large part to Phyllis.

Chuck reported that Secretary Tavenner had asked for a report on the out of state placements. He presented three schedules that included information on the out of state placements as of June 30, 2008 for program years FY2006 through FY2008:
• Expenditures by Age – Over 90% of children in out of state placements are age 13 and above. The average expenditure for all children in out of state placements for program year FY2008 was $97,903 per child. Most of these children are in congregate care. The average length of stay was approximately 4 years.
• CSA Out of State Placements General Child Demographic Information – In program year FY2008 there were 176 children in out of state placements down from 199 in program year FY2006. The largest population was white males. Most children were referred through DSS, Education or Interagency Teams/Offices. Major reasons for referrals were special education and/or emotional/behavioral issues. Most were being served in residential treatment facilities.
• Out of State Placement Analysis by Locality – Four localities made up 51% of out of state placements in program year FY08. Those localities were Fairfax with 55; Richmond City and Roanoke City each with 9; and Alexandria with 6.

After Chuck’s presentation, Ray noted that OCS would be making phone calls to localities with children out of state to see what some of the common service areas are that need to be addressed to bring these children back to Virginia. A letter will be sent out from Secretary Tavenner to these localities letting them know that they will be contacted by OCS staff. Ray also noted that Richmond City (one of the 13 CORE localities) now has no out of state placements.

Match Rate Workgroup Report
Ray reported on two documents. The first document was an interim report from the Match Rate Workgroup and the second was a report on managed care options for the CSA program (as part of the Match Rate Workgroup’s report). These reports are required by Item 283 #3 of Chapter 879 of the Appropriations Act. Ray asked that Council members review the reports and let him know if they had questions.

One of the charges to the workgroup was to “examine the impact of the match rate changes on local and state administration of the program.” In the absence of more complete data on the impact of the match rate changes, the workgroup has agreed to reconvene in April 2009 to discuss the impact of the match rate changes. The workgroup will examine the impact of the match rate changes on children’s quality of care, localities’ program administration, and the impact on overall program growth. The workgroup will then make recommendations to the SEC regarding changes to the match rate incentives and disincentives to ensure the best quality of care for CSA children.

The Match Rate Workgroup made the following recommendations regarding performance measures:
• Program monitoring is essential to determine the impact of match rate changes on program administration, service development and delivery, quality of care, utilization management, and care coordination for children. The workgroup recommends OCS staff, in cooperation with the workgroup and the SEC, collect data for the following performance measures:
1. Improvement in level of child’s functioning
2. Child’s success in school
3. Percent of children receiving services in the community
4. Family engagement/satisfaction
5. OCS and locality performance

The workgroup recommends that the SEC monitor measures 1 and 2 as soon as the Child and Adolescent Needs and Strengths Assessment (CANS) data are available. OCS staff should work with DSS staff to align definitions for measures 3 and begin tracking the change in community-based services as soon as data is available. The Match Rate Workgroup recommends measures be examined quarterly or at least every six months. The Match Rate Workgroup will examine recommendations 4 and 5 more closely when it reconvenes in April 2009 and provide specific measures to the SEC for approval during the summer of 2009.

The second report was on managed care options for the CSA program. Ray reported that the Match Rate Workgroup examined the feasibility of using managed care models and strategies to improve the CSA program. During its examination, the Match Rate Workgroup did not find reason to recommend a managed care option for the CSA program. Some elements of managed care are already being used by CSA and the workgroup recommended that:
• OCS, in cooperation with the SEC and in consultation with localities, provide technical assistance and guidance to localities to improve utilization management techniques. Utilization management is a primary strategy employed in managed care models.
• SEC continue to monitor the impact of intensive care coordination and the match rate changes on the quality of care provided to children, the outcomes achieved by children, and the financial implications for localities. Care coordination and other cost containment strategies are important managed care tools.
• OCS, localities, and the SEC see through the full implementation of the CANS tool to ensure an improved uniform assessment instrument that can determine outcomes for children.

The Match Rate Workgroup will continue its work during 2009 to monitor recent CSA program changes and follow these recommendations. The workgroup will provide periodic follow-up reports to the SEC during 2009 to outline progress to date on these recommendations and the financial impact of the match rate changes.

Impact of Final Interagency Guidelines on Foster Care Services for CHINS
Carol Wilson reported on the findings of the draft report. Carol explained that the 2008 Appropriations Act requires that the State Executive Council (SEC) conduct an analysis of the impact of the Final Interagency Guidelines on Foster Care Services for Specific “Children in Need of Services” (CHINS) funded through the Comprehensive Services Act (CSA), effective December 3, 2007, to assess the fiscal impact on the state and localities of serving these additional children through CSA.

Carol provided background information on the custody relinquishment issue as well as on the Attorney General’s opinion that ultimately led to the passage of House Bill 1489 (2008 legislative session). The Guidelines provided for agencies other than DSS, who were designated by the CPMT, to enter into parental agreements with parents who retained legal custody. An obstacle was the statutory language which required all children placed through either non-custodials with DSS or parental agreements with other agencies to submit a service plan to the Court within sixty days. The Attorney General’s opinion sought to remove any court requirement for parents when seeking mental health treatment for their children. This statutory language meant than even though they did not have to have a Court determine the child needed services, the family would still be involved with the Court after sixty days. Another practical issue was resolving how to submit a plan for a child who was not known to the Court through a petition. HB 1489 revised the Code of Virginia (§16.1-281, §16.1-282 and §16.1-282.1) to remove the requirements of submission of the service plan to the Court and ongoing periodic Court reviews for agencies other than DSS who are providing case management services effective July 1, 2008.

In conclusion, Carol reported that there has not been a significant fiscal impact yet realized as a result of the implementation of the Final Interagency Guidelines on Specific Foster Care Services for Children in Need of Services. In FY 2007 there were 395 non-custodial agreements. In FY 2008, there were 281 non-custodial agreements (DSS case managing) and 95 parental agreements (agencies other than DSS case managing). It appears that the number of agreements with parents has not changed significantly, but rather that case management is shifting to other local agencies rather than DSS. Additionally, the number of children receiving community based services in the overall CSA population has declined; so it does not appear that additional children are receiving foster care prevention services in the community because of the implementation of the foster care guidelines.

Past experience by OCS indicates that policy changes require an 18-24 month window to realize the full impact of the change.

A short question and answer period followed Carol’s presentation. Lelia Hopper commented that there is still some unsettled practice in communities on proper use of the guidelines. Some communities are more comfortable with the processes they already have in place with the Courts making the CHINS determinations. Trudy Ellis stated that, while great progress has been made, she would like to see a statement included in the guidelines that, if a child is not abused or neglected, the child should be case managed by another agency other than DSS. DSS should only manage the cases that are considered abuse or neglect. Carol added that emphasis should be placed on using the parental agreements for those families for whom it was intended; those who would have been at risk of custody relinquishment in order to obtain mental health treatment for their children.

Secretary Tavenner noted that a number of changes have taken place over the last 15 months and the impacts of these changes are still unknown. The SEC will need more time before making legislative changes or mandating policies based on these current initiatives.

Closed Session to Discuss Employment of OCS Executive Director
A motion was made by Cindi Jones, seconded by Ray Ratke and carried that “the State Executive Council convene in a closed meeting pursuant to Virginia Code § 2.2-3711(A)(1) to discuss personnel matters related to the employment of the Office of Comprehensive Services Executive Director and that the Council request that Jane Hickey, legal counsel to the Council whose presence will aid in the Council’s consideration of this matter, participate in the closed meeting.”

Reconvene in Open Session
Upon reconvening in the open session, Secretary Tavenner took a role call vote whereby each Council member certified “that (i) only public business matters lawfully exempted from open meeting requirements under the Virginia Freedom of Information Act and (ii) only such public business matters as were identified in the motion by which the closed meeting was convened were heard, discussed or considered in the closed meeting.”

A motion was made by Jim Burns, seconded by Ray Ratke and carried that “the Council authorize Secretary Tavenner to negotiate with the finalists for the position and that she make an offer of employment for the position of Executive Director of the Office of Comprehensive Services.”

Adjournment
There being no other business, the meeting was adjourned at 11:30 a.m.

 

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