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State Executive Council / State & Local Advisory Team

DRAFT MINUTES - January 8, 2009
STATE & LOCAL ADVISORY TEAM (SLAT)
COMPREHENSIVE SERVICES FOR AT-RISK YOUTH & FAMILIES
Richmond Room
1604 Santa Rosa Road, Richmond

Members Present: Charlotte McNulty, SLAT Chair, VACSB; Mike Mastropaolo, SLAT Vice Chair, Association of Court Service Directors; Mark Hinson, Parent Representative; Gail Schreiner, CSA Coordinators Network; Penny Combs, VCOPPA; Judith Lemke, VCOPPA; Paul Raskopf, DOE; Janet Lung, DMHMRSAS; Katharine Hunter, DMHMRSAS; Scott Reiner, DJJ; Catherine Hancock, DMAS; Therese Wolf, DSS; Shel Douglas, League of Social Services Executives

Members Absent: Buz Cox, League of Social Services Executives; The Honorable Sharon Will, Virginia Council of J& DR Judges; Kim Barnes, VDH

Guests and OCS Staff: Rebecca Paris, Jessica McClary, Denise Gallop, Helen Curtis, Susie Cumbia, Di Hayes, Brady Nemeyer, Dave Nichols, Dawn Howard, Marsha Mucha

Call to Order: Mike Mastropaolo, Vice-Chair called the meeting to order at 9:40 a.m. and asked for introductions. He reported that Charlotte McNulty would be delayed because of bad weather.

Approval of Minutes: The minutes of the December 4, 2008 meeting were approved on a motion from Catherine Hancock, seconded by Scott Reiner and carried.

Update on Position of Special Advisor for Children’s Services Reform
Ray Ratke reported that he is now working full-time in the position of Special Advisor for Children’s Services Reform. He will be working to coordinate and merge service delivery, technical assistance and policy development across Virginia’s child serving agencies in effect creating a virtual office of children’s services. He will continue to work out of his office at the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS).

Executive Director - Office of Comprehensive Services (OCS)
Ray reported that the recruitment and hiring process for the position of Executive Director at the Office of Comprehensive Services (OCS) had been completed. He was pleased to announce that Charlotte McNulty has been selected and she has accepted the position effective February 10, 2009. He noted that Charlotte will bring a wealth of experience and depth to the position.

Ray also thanked Keith Sykes for serving as the OCS Co-Acting Executive Director over the past six months and commended him on a job well done.

Public Comment:
There were no public comments.

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. 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.

Workgroup Reports and Updates
Match Rate Workgroup Interim Report – Scott Reiner reported that the Appropriations Act required that the Secretary of Health and Human Resources establish a match rate implementation workgroup. The workgroup was mandated to examine several aspects of the CSA in addition to the impact of the match rate changes.

Several aspects of the mandate were/are being examined external of the Match Rate Workgroup. Those include:
? Care coordination guidelines – Approved by the State Executive Council (SEC) in August 2008. The SEC will continue to monitor the implementation of the guidelines.
? Communication and coordination between the CSA program and the local schools are being addressed through a partnership with OCS staff and Department of Education (DOE) staff. An initial report was presented to the SEC at its September 2008 meeting. A follow-up report will be presented to the SEC in the spring of 2009.
? Improving coordination and communication between local CSA programs and court systems and judges –The Council on Reform (CORE) and the Special Advisor for Children’s Reform are working closely with the First Lady on this initiative.

The workgroup will be reconvened in April 2009 to discuss the impact of the match rate changes and further assess program performance when more data is available. In the absence of more complete data on the impact of the match rate changes, workgroup members agreed to dedicate their first meetings to an evaluation of current OCS performance measures and make recommendations for new measures.

The workgroup recommended to the SEC that 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 SEC adopted and re-endorsed these performance measures at its December 19, 2008 meeting.

The workgroup recommended 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 will 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 recommended that 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.

Managed Care Options for the CSA Program - Scott reported that the other charge to the Match Rate Workgroup was to examine 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.

At the end of Scott’s presentation, Ray was asked about possible CSA legislation. Ray explained that because of the number of legislative changes from last year’s General Assembly Session, it was not anticipated that there would be a lot of activity during the 2009 Session. Two issues that may come up are the phase-in of the match rate changes and budget language from the 2008 Session encouraging all localities to utilize Medicaid funding whenever feasible.

Intensive Care Coordination Workgroup
Pam Fisher with the Office of Child and Family Services at the DMHMRSAS reported. Pam reported that the Workgroup has met three times with the last meeting being held on January 8, 2009. After the Intensive Care Coordination Guidelines were developed and adopted, an Implementation Workgroup was formed to address the issues of role confusion and functions, rates for intensive care coordination and provision for technical assistance.

A one page document is being developed to address the role and function of the intensive care coordinator in an effort to clear up any confusion that may exist with other positions (i.e. case managers, foster care workers, etc.). The workgroup did not think it appropriate to set a state rate for intensive care coordination services. A chart of rates established by localities that are already providing intensive care coordination services is being developed. The chart will be provided as part of a tool-kit to help address technical assistance needs.

Also, an intensive care coordination network/technical assistance support group is being formed to assist localities with implementation of intensive care coordination. This group will initially be meeting monthly.

Pam reported that the Implementation Workgroup discussed several issues that may be brought before the SEC.
? The overlap of intensive care coordination services with Medicaid targeted case management.
? Coordination of training needs with the Council on Reform (CORE) and the CSA Best Practices, Training and Technical Assistance Workgroup.
? Confusion of mandatory guidelines versus mandatory intensive care coordination.

In concluding her report, Pam noted that currently 10 community service boards (CSBs) are providing intensive care coordination services and an additional 6 CSBs are in the discussion phase. Janet Lung thanked Pam for her work in this area.

Discussion of CORE Concepts
Therese Wolf reported on the December 10, 2008 CORE presentation prepared by Ray Ratke. Therese noted that it was important to keep in mind that the philosophy of the transformation process is consistent in the themes that child serving agencies already promote (i.e. family-focused, child-centered, etc.). The goal for 2009 is to spread the transformation to all child serving agencies so that everyone takes ownership and that all are operating from the same beliefs.

Data is becoming a driving force in the way child serving agencies provide services and how they plan for the future. Therese pointed out several sides from the presentation that reported a decrease in case loads, a rise in the number of family-based placements (as of 12/4/08, CORE surpassed its one year goal in this area) and increases in discharges to permanency. What is happening can be attributed in part to better practices by agencies, data clean up and consistency in data reporting. One area that needs further attention is kinship care placements. CORE localities have done better in this category than the state as a whole.

The plans for 2009 include quickly spreading the transformation statewide and expanding to engage other child serving agencies. This will be accomplished through four strategies:
? Education and Information Sharing – Beginning early in 2009, a series of two or three initial statewide meetings will be held to get buy-in and bring all localities up to speed on the transformation. These meetings will set the stage for regional collaboration. A certain number of representatives from each locality will be invited to attend.
? Training: Becoming the Experts – Short term goals include providing a Transformation Tool Kit. A Transformation Academy will also be instituted (beginning early in 2009) to get key leaders up to speed quickly. The Academy will include a wide variety of staff from Virginia’s child serving agencies. Topics will include data, the practice model, family engagement models, etc. and will include trainings from national experts. There will also be the opportunity for on-going regional trainings. The long-term goal is to rebuild a competency based in-service training program which incorporates the practice model and building blocks of the Transformation.
? Building Regional Capacity: Rolling Out the Transformation Statewide - Build and train five regional leadership teams consisting of DSS, CSA, the Department of Juvenile Justice (DJJ) and DMHMRSAS. Regional Transformation meetings will be held within the regions and include representatives from all localities. The meetings will focus on building momentum, providing technical assistance and resolving local implementation issues. These meetings 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. CORE meetings will serve as check-ins on implementation planning 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 at this time.

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 conclusion, Therese asked that any questions, input, etc. for consideration by the Transformation Team be forwarded to either Mary Nedell at mary.nedell@dss.virginia.gov or to Hayley Brooks at hayley.brooks@dss.virginia.gov. The CORE website is www.vafamilyconnections.com.

Development of Flexible Funding Policy Statement
Keith Sykes noted that, as part of today’s discussion, the document developed for the November 2008 SLAT meeting presenting basic issues and facts relating to flexible funding had been redistributed. Today’s discussion would center on what types of support are needed by localities to assist them in their efforts to use CSA funds flexibly. Ray Ratke had asked Denise Gallop the CSA Coordinator from Hampton to provide guidance on five questions that relate to flexible funding. Those questions and her responses were provided to SLAT members.

During discussion several issues were identified that can constrain the use of CSA funds flexibly:
? New program needs are often identified but at the time of development can’t be tied to the needs of a specific child. Localities don’t have funds available for up-front program costs. Recovery of start-up funds through CSA would come after programs have already been established, if the programs are eligible for CSA reimbursement.
? Perspectives and attitudes within local governments make it difficult to be creative and think outside of the box. In some instances, local governments only want to serve those children that they are mandated by Code to serve and they follow strict parameters of what can and can’t be done.
? Some localities feel that OCS has not always provided sufficient encouragement and/or guidance to localities in flexible use of CSA funds.
? Training is needed. Examples from other localities on how they have used CSA funds flexibly would be beneficial as well.

It was generally felt that additional guidance is needed but perhaps in a question and answer format. It was also noted that training and technical assistance is a CORE priority area.

Other Business
Since Charlotte has been hired as the new OCS Executive Director, she recommended that SLAT Vice-Chair, Mike Mastropaolo, chair SLAT until new officers are elected in June. A motion made by Mark Hinson, seconded by Shel Douglas and carried.

Judith Lemke asked about the plans in the Governor’s proposed budget for closing the 15-bed adolescent unit at Southwestern Mental Health Institute and the Commonwealth Center for Children and Adolescents, located adjacent to Western State Hospital in Staunton. Janet Lung responded that the Commissioner of DMHMRSAS must begin planning for closure of the facilities regardless of any actions the General Assembly may take during its upcoming session. An advisory group is being formed to focus on closure plans. That advisory group will meet monthly between now and the July, 2009 expected closure dates. There will also be a parallel process established that would allow for stakeholders to express concerns about the closures.

Next Meeting and Adjournment: The next SLAT meeting will be held on February 5, 2009 in the Richmond Room, 1604 Santa Rosa Road in Richmond. The meeting was adjourned at 11:30 a.m.

 

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