CCSHCN S FOSTER CARE COLLABORATION MEDICALLY FRAGILE PILOT FOSTER CARE EXPANSION

1. CCSHCN�S FOSTER CARE COLLABORATION MEDICALLY FRAGILE PILOT&FOSTER CARE EXPANSION September, 2007 Good Afternoon. I want to welcome you to the CCSHCN�s Foster Care Collaboration Presentation and thank you for your interest in this program. I am Darlene Cain, Nurse Service Administrator and Foster Care Support Branch Manager for the CCSHCN. Approximately 4 years ago through a chance meeting at a CCSHCN retreat a collaboration began between the Medical Support Branch with DCBS and the CCSHCN. Peggy Arvin, who is a Nurse Service Administrator for the Medical support Branch and the Program Coordinator for the Owensboro CCSHCN office began talking about a proposal that had been a dream of Peggy�s for over 10 years. She had the vision to understand that the DCBS social workers that were involved with the medically fragile foster care children could benefit from the expertise of nurses to assist them with these cases. So a pilot program began in Owensboro that had the CCSHCN nurses from Owensboro going out on home visits with the social workers to the medically fragile fragile foster care chuildren in their area.. Good Afternoon. I want to welcome you to the CCSHCN�s Foster Care Collaboration Presentation and thank you for your interest in this program. I am Darlene Cain, Nurse Service Administrator and Foster Care Support Branch Manager for the CCSHCN. Approximately 4 years ago through a chance meeting at a CCSHCN retreat a collaboration began between the Medical Support Branch with DCBS and the CCSHCN. Peggy Arvin, who is a Nurse Service Administrator for the Medical support Branch and the Program Coordinator for the Owensboro CCSHCN office began talking about a proposal that had been a dream of Peggy�s for over 10 years. She had the vision to understand that the DCBS social workers that were involved with the medically fragile foster care children could benefit from the expertise of nurses to assist them with these cases. So a pilot program began in Owensboro that had the CCSHCN nurses from Owensboro going out on home visits with the social workers to the medically fragile fragile foster care chuildren in their area..

2. MISSION STATEMENTS CCSHCN: Our mission is to enhance the quality of life for Kentucky�s children with special health care needs through direct service, leadership, education and collaboration. DCBS: Our mission is to provide leadership in building high quality, community based human service systems that enhance safety, permanency, well being, and self sufficiency for Kentucky�s families, children and vulnerable adults. In developing this pilot program, our Executive Director, Eric Friedlander, determined the similarities of both the CCSHCN�s and DCBS�s Mission statements and realized that we were working toward the same goals in serving the needs for Kentucky families.In developing this pilot program, our Executive Director, Eric Friedlander, determined the similarities of both the CCSHCN�s and DCBS�s Mission statements and realized that we were working toward the same goals in serving the needs for Kentucky families.

3. STRATEGIC GOALS Not only were our Mission Statements after mutual goals but the strategic goals of our Cabinet for health and Family Services were in sinc with this collaboration. And so, we started down the path that was rarely, if ever, traveled in state government by collaborating between the two agencies for a common goal. Not only were our Mission Statements after mutual goals but the strategic goals of our Cabinet for health and Family Services were in sinc with this collaboration. And so, we started down the path that was rarely, if ever, traveled in state government by collaborating between the two agencies for a common goal.

4. MEDICALLY FRAGILE FOSTER CARE PILOT Initiated 2/1/2005 in Owensboro. Expanded statewide 7/1/2006. Approximately 130 - 140 medically fragile foster children statewide. Currently all 14 CCSHCN offices participating with the 9 DCBS regions to provide services to the medically fragile foster care children. So here is the history of how the medically fragile foster care program collaboration between the CCSHCN and DCBS progressed.So here is the history of how the medically fragile foster care program collaboration between the CCSHCN and DCBS progressed.

5. MEDICALLY FRAGILE FOSTER CARE PILOT Collaboration between the Kentucky Cabinet for Health and Family Services, Department of Community Based Services Department of Protection and Permanency, DCBS Medical Support Branch and the Commission for Children with Special Health Care Needs. The DCBS Social worker maintains his/her professional obligation for the medically fragile foster child�s care and well being and completion of the Individual Health Plan (IHP). The CCSHCN Nurse provides nursing consultation for the DCBS Social Worker and for the medically fragile foster care children through once a month home visits with the DCBS Social Worker and provides education and on-going training for the foster parents. This collaboration involved multiple departments within the agencies and responsibilities were clearly determined with each department and/or agency remaining true to their expertise that they could provide to this effort.This collaboration involved multiple departments within the agencies and responsibilities were clearly determined with each department and/or agency remaining true to their expertise that they could provide to this effort.

6. FOSTER CARE EXPANSION With the success of the Medically Fragile Foster Care Program, expansion to the entire foster care population seemed the natural next step. If successful, all foster care children will have the expertise of CCSHCN nurses to increase their access to care and quality services. With the success of the medically fragile foster care program, it was determined that we would initiate Phase 2 of the program and begin a pilot program for the overall foster care population.With the success of the medically fragile foster care program, it was determined that we would initiate Phase 2 of the program and begin a pilot program for the overall foster care population.

7. Looking at this map with the delentiation of the DCBS regions and the number of foster care children in each of the counties of those regions you can see that the Phase 2 undertaking would be a much larger program to initiate. Looking at this map with the delentiation of the DCBS regions and the number of foster care children in each of the counties of those regions you can see that the Phase 2 undertaking would be a much larger program to initiate.

8. CASE FOR CHANGE Foster children are the most underserved yet the most expensive pediatric population in terms of health care: Medical, Dental and Behavioral Health. 70% of these children are in need of Behavioral Health services. Many children receive multiple front end services while their chronic healthcare needs are neglected. The system is fragmented and often ineffective. Why attempt to undertake such a huge project?Why attempt to undertake such a huge project?

9. IDENTIFIED SYSTEMIC PROBLEMS Children move frequently within the system yet their records often do not follow them. Healthcare providers do not have the benefit of health histories and records of previous diagnoses, treatment modalities and medications. CPS Social Workers have limited medical background and training and often experience difficulty interpreting medical records or health care reports. This frustrates the physicians, the foster care families and the workers within the foster care system. This also exposes the children, who have already been traumatized, to the possibility of unnecessary tests and possible duplication of vaccines that have already been previously administered. This frustrates the physicians, the foster care families and the workers within the foster care system. This also exposes the children, who have already been traumatized, to the possibility of unnecessary tests and possible duplication of vaccines that have already been previously administered.

10. CURRENT STATUS Initiated extended foster care pilot 1/1/2007. Continued expertise from the DCBS Medical Support Branch Dr. Allen Brenzel Peggy Arvin, Nurse Service Administrator Jeanmarie Piacsek, Nurse Service Administrator This department of DCBS determines when a child can be deemed �Medically Fragile�. Nine Nurse consultants hired for The Lakes, Two Rivers, Eastern Mountain, Northeastern, Cumberland, Salt River Trail, Jefferson, Southern Bluegrass and Northern Bluegrass Regions. 100% or 7000 foster care children, their foster care families and their social workers now have access to services from Nurse Consultants. Where are we now?Where are we now?

11. INTENSIVE ORIENTATION Extensive training for all Nurse Consultants from 1/1/07 through 6/15/07: U of L Academy Protection & Permanency Course (Master�s Degree) U of L Academy Family Violence Course (Master�s Degree) Sexual Assault Nurse Examiner Training (SANE) U of L Academy Child Sexual Abuse Course (Master�s Degree) TWIST Training Medical Indicators of Child Abuse Class Shadowing DCBS Social Workers, attending family team meetings, attending family judicial hearings Foster parent training course

12. Current Pioneers of the Foster Care Support Branch Ashley DeJarnette � Two Rivers Region/Warren County Nurse Consultant Donna Doyle � Jefferson Region/Jefferson County Nurse Consultant Gency Fowler � Salt River Trail Region/Bullitt County Nurse Consultant Diane Glenn � Northern Bluegrass Region/Kenton County Consultant Helen Stringer � Southern Bluegrass Region/Pulaski County Nurse Consultant Mary Thompson � The Lakes Region/McCracken County Nurse Consultant Shanna Thompson � Northeastern Region/Rowan County Nurse Consultant Dinah Thornsberry � Eastern Mountain Region/Floyd County Nurse Consultant Helen Vogelsburg � Southern Bluegrass Region/Fayette County Nurse Consultant Mike Weinrauch � MSSW Health Program Administrator Darlene Cain � Nurse Service Administrator Branch Manager I would like to take this opportunity to introduce you to the real pioneers of the Phase 2 foster Care Program.I would like to take this opportunity to introduce you to the real pioneers of the Phase 2 foster Care Program.

13. FOSTER CARE SUPPORT PROGRAM CURRENT PROGRAM IMPACT With the Phase 2 of the program only completing their pilot phase in June we wanted to be able to let all of you know just some of the positive impacts the program has made to date. With that said I would like to turn the presentation over to the nurses that have currently been involved with the pilot program who will impart a couple of the positive effects their presence has had on the program. Let�s start with Mary Thompson. Story Time!!With the Phase 2 of the program only completing their pilot phase in June we wanted to be able to let all of you know just some of the positive impacts the program has made to date. With that said I would like to turn the presentation over to the nurses that have currently been involved with the pilot program who will impart a couple of the positive effects their presence has had on the program. Let�s start with Mary Thompson. Story Time!!

14. ADDRESSING THE NEEDS CCSHCN to provide Nurse Consultants to each of the 9 DCBS regions for: Consultation to the Social Workers and the foster care families on medical issues. Interpretation of medical records and reports. Assure updated, current Medical Passports. Enhance Care Coordination of all services: Physical, Dental and Behavioral Health. Tracking the utilization of all health services, including prevention and wellness programs. Mary will now talk to you about how we are addressing the needs of the foster care program.Mary will now talk to you about how we are addressing the needs of the foster care program.

15. Medical Passport It is to be used for all children in out-of-home care. Designed to keep all pertinent information pertaining to the child�s health in one place. Continuity of medical care is provided. State Law requires all children in out-of-home care receive regular medical care and State Law requires documentation of this care. Care Provider Liability � Lack of documentation is equal to lack of services.

16. Medical Passport One goal of the Nurse Consultant is to ensure foster families are aware of how to use the Medical Passport when a child is placed in out of home care. The Nurse Consultant can discuss this with the foster families and answer any questions the foster family may have. The Nurse Consultant can assist the SSW and foster family in helping arrange a physical health screening within 48 hours once the child enters custody and a complete medical, dental and visual exams within 2 weeks of entering care.

17. How Can You Help? Who Are Our Children In Care? Most have been abused or neglected. Some have nowhere to go. Their parents and other relatives are unable to take care of them. Some have physical, mental, or emotional challenges that developed at birth or later as a result of their abuse, neglect or abandonment. With support, many will return home to their birth families. Many want to stay in their community, but most have to move.

18. Foster or Adopt a Child What Does It Take to Become a Foster/ Adoptive Parent? Be financially stable, that is, be able to meet the needs of your family as it currently exists. Be at least 21 years old. Be single, married (for at least two years), widowed, or divorced. Be able to provide a safe, secure, and healthy home for a child or children. Successfully complete our pre-service training and all required paperwork. Diane Glenn would now like to speak to you about how you can personally help this program and offer a positive impact on the foster care program.Diane Glenn would now like to speak to you about how you can personally help this program and offer a positive impact on the foster care program.

19. What Types of Children are in Foster Care? Children placed in foster care are between the ages of 0-21 years. Many have been dependent, abused, neglected, emotionally maltreated, exploited or sexually abused. Special needs children are those with multiple or severe problems, including medical disabilities, physical handicaps, special dietary needs, birth defects or chronic illnesses.

20. What are the Different Types of Foster Homes? Regular foster homes Medically fragile homes for children with unstable medical conditions Care Plus homes for children who have behavioral problems and have not been successful in regular foster care placements. Emergency shelters for children 12 and older who are in need of immediate, unplanned placement for less than 30 days. Relative foster homes or Kinship Care

21. How Can You Become a Foster Parent To receive information describing the steps to becoming a foster parent, contact your local Department of Community Based Services office or call 800-232-5437. You will receive a packet of information that describes the different types of foster homes, different types of children and the requirements for being approved as a foster parent.

22. What Happens After I Receive My Packet? You will then want to attend a meeting for families interested in foster care. This will give you an opportunity to ask questions, as well as speak with experienced foster parents. Please call you local DCBS office or call 800-232-5437 for times and dates of information meetings.

23. Get The Facts You may accept any child, or children, that is referred by DCBS for temporary foster care. You will receive financial assistance in the form of a daily rate based on the needs and age of the child and the training and skill of the foster parent/s. You may assist in a more temporary manner by offering to provide respite services. The daily rate includes medical, mental health, school, diapers, day care, haircuts and other special expenses.The daily rate includes medical, mental health, school, diapers, day care, haircuts and other special expenses.

24. Medically Fragile Foster Children The Children Documented by a physician that medical condition may become unstable and change abruptly resulting in a life-threatening situation; Chronic & progressive illness or medical condition; Has a need for special services or on-going medical support; Has a health condition stable enough to be in a home setting only with monitoring by an attending: A. Health Professional B. Registered Nurse as defined by KRS 314.011(5); C. Licensed Practical Nurse as defined by KRS 314.011 (9). May only be determined by the Medical Support Branch at DCBS Some of these children : Were born with congenital health conditions Had prenatal drug exposure Were born healthy, but became medically fragile because of accidents or abuse.

25. Medically Fragile Foster Parents The Foster Parents People who become foster parents of children with serious health problems: Can be married or single Must get basic foster parent training and special training before being approved for medically fragile children. A physician, RN, or LPN would not require special training. Often help birth parents learn how to care for their child before the child returns home. Will be reimbursed for the cost of the child�s care. Are caregivers, teachers and advocates for this special population of children with the foster care system.

26. Training & Support to Foster Parents DCBS provides training that meets the needs of foster parents. Applicants must complete 30 hours of training to help them understand the needs of children in foster care. Foster parents are required to receive a minimum of six hours of on-going training each year. On-going support can be found through the Kentucky Foster/Adoptive Parent Support Network at 877-704-3278.

27. Future Advancements Nurse Consultants assume responsibility for the 24-48 Hour Screenings and Assessments Proven Value of Foster Care Support Branch Hire Additional 9 Nurse Consultants Preferred Provider Clinics for the Foster Care Population So where do we see this program advancing in the future?So where do we see this program advancing in the future?

28. CCSHCN�s Foster Care Collaboration Thank you!!