Pennsylvania Association of County Human Services Administrators

1. Pennsylvania Association of County Human Services Administrators Office of Children, Youth and Families March 14, 2019

2. Needs-Based Plan and Budget FYs 2019-20 and 2020-21

3. CCW FY 2018-19 CCW proposed budget totals $1,259,322,000 (increase of $33.968 million (2.77%) from FY 2018-19) • $1,111,381,000 Needs-Based Budget • $22.805 million reduction for County Share of Youth Detention Centers • $153.064 million rolled forward from FY 2018-19 • $176.701 million rolled forward to FY 2020-21 appropriation request • $8.599 million Operating • $185.784 million Grants

4. FY 2020-21 NBPB Timeline: • Draft documents (bulletin, excel templates, etc.) distributed for review by March 25, 2019. • Draft review period March 25 - April 3, 2019. • Final documents distributed by May 14, 2019. • Training dates for counties TBD - June 2019. • Submission of Narrative Template and GI file by August 15, 2019. • Submission of Excel templates by September 1, 2019. • Meeting dates for counties TBD – September and October 2019.

5. FY 2020-21 NBPB OCYF currently drafting documents. Planned changes for the Budget Excel file, Grant Excel file, and content changes to the Bulletin and Narrative Template. Additional detail not yet available. CCYAs and JPOs advised in January that they should be: • Engaging private providers, advisory boards, families, and other partners and stakeholders in planning for the upcoming budget: • Reviewing data available to them and determining what data they still need to drive analysis; • Discussing needs in programming with community partners; • Determining whether the programming solution fits with current initiatives and whether the agency/community has the capacity and resources to implement; and • Whether the planned solutions are supported with evidence and how desired outcomes will be measured.

6. FY 2020-21 NBPB NBPB Dos and Don’ts as shared with counties: DO: • Write for the general public – no names, case details, spell out acronyms, etc.; • Keep it simple (short, sweet and to the point); and • Provide detailed calculations and justification for agency increases AND provider increases. DON’T: • Assume the reader knows the agency; • Assume the connections between resource requests are obvious; and • Request COLAs on behalf of private providers.

7. Family First Prevention Services Act Implementation Update

8. Family First: Legislative Delays • OCYF requested a legislative delay (until 4/1/2020) for the following provisions: • Protocols to prevent inappropriate diagnosis that lead to inappropriate placements in non-foster family settings. • Considering amending Juvenile Act. • Fingerprint-based criminal records checks of national crime information databases, and child abuse and neglect registry checks on any adult working in a child care institution. • Child care institution includes group homes, residential treatment centers, shelters and other congregate care settings. • All adults, including those who do not work directly with children, are subject to this requirement. • No exception for conducting checks. • Amending the CPSL – will affect provisional hire process

9. Family First: Chafee • PA Child Welfare Council developing recommendations for DHS regarding whether extension of Chafee aftercare services to former foster care youth to age 23 and Education and Training Vouchers to age 26 is appropriate. Considerations include documented and expected outcomes for youth receiving these services and the availability of state and local funding as the expansion would need implemented absent additional federal funding. • To exercise this option and begin offering Chafee-funded services to an expanded population, the state must have an approved Title IV-E State Plan Amendment.

10. Family First: Model Licensing Standards • Model licensing standards for foster family homes: • HHS will identify national model licensing standards for foster family homes. • Proposed standards released August 1, 2018; comments were due October 1, 2018. • Final standards released February 4, 2019. • By April 1, 2019, PA must document in the Title IV-E State Plan whether: • Our foster family home licensing standards meet the model standards; • We approve waivers of non-safety licensing standards for relative caregivers; and • We provide caseworker training regarding standards and waivers. • Legislation delay permitted. • OCYF determining if legislation is needed..

11. Family First: Model Licensing Standards Model licensing standards categorized into eight categories to cover the essential components for licensing a foster family. • Ensure 1) applicant has capacity to care for a child in foster care and 2) the physical home of the family is appropriate and safe for a child in foster care: • Foster Home Eligibility • Threshold Requirements • Physical and Mental Health • Background Checks • Home Study • Foster Family Home Health and Safety • Living Space • Condition of Home • Foster Home Capacity • Foster Home Sleeping Arrangements • Emergency Preparedness, Fire Safety and Evacuation Plans • Transportation • Training • Foster Parent Assurances 

12. DHS decision re: Congregate Care Limitation In consultation with the Pennsylvania Child Welfare Council, system stakeholders and our state level partners, DHS has decided to delay the effective date for the Title IV-E funding limitation until October 1, 2020.  This decision is based upon the need to: • Expand the array of relative and non-relative foster family homes and expand the supports available to these families to promote placement stability; • Expand the use of evidence-based prevention programs that meet the needs of children and families served; • Determine the need for Qualified Residential Treatment Programs; and • Update information systems to collect data elements to meet federal reporting requirements.

13. DHS decision re: Congregate Care Limitation The decision to delay the effective date will give us needed time to continue to analyze and prepare to take advantage of the opportunities provided under FFPSA, including the use of Title IV-E funding for certain evidence-based and trauma-informed prevention services.  We intend to use the next year to build the necessary system capacity to meet the needs of our children and families and to prepare our workforce for these transitions.  The following provisions are also affected by the delay: *Assuring no impact to Juvenile Justice *Prevention Services *Number of children in a foster family home *QRTP

14. Family First: Prevention Services Clearinghouse Initial Criteria • ACF outlines the criteria for reviewing EBPs for the purposes of rating them as well-supported, supported or promising. • Clearinghouse will select additional services and programs for review on a rolling basis. • Title IV-E Prevention Services Clearinghouse Procedures Handbook – forthcoming. • Includes initial list of EBP’s to be reviewed. Ratings of those EBP’s will be available in the spring of 2019.

15. Family First: Prevention Services The initial EBPS are as follows: • Mental Health: • Parent-Child Interaction Therapy (PCIT) • Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) • Multisystemic Therapy1 (MST1) • Functional Family Therapy (FFT) • Substance Abuse: • Motivational Interviewing • Multisystemic Therapy2 (MST2) • Families Facing the Future (FFF) • Methadone Maintenance Therapy (MMT) • In-Home Parent Skill-Based: • Nurse-Family Partnership (NFP) • Healthy Families America (Healthy Families) • Parents as Teachers

16. Family First: Prevention Services Eligibility for review by the Clearinghouse: • Limited to mental health and substance abuse prevention and treatment services and in-home parent skill-based services as well as kinship navigator programs; and • Program must have a book/manual/other written documentation that specifies the components of the practice protocol and describes how to monitor. Eligible services will be prioritized for review: • Practice is in use/active and book/manual/other written documentation is in English. • Have implementation training and support staff and/or fidelity monitoring tools and resources available to implementers in English. • Aim to impact target outcomes identified by the Clearinghouse.

17. Family First: Prevention Services The timeframe for opting into the prevention provision is contingent upon the state’s selection of the effective date of the congregate care Title IV-E reimbursement limitation so the earliest we can opt in is October 1, 2020.

18. Kinship Navigator Program

19. Project Overview • OCYF issued a Request For Proposals (RFP) for a Kinship Navigator Program. • Program funding was offered through the Administration for Children and Families (ACF). • OCYF applied for and received $479,304 from ACF to start program. • Kinship Navigator Program will serve all kinship families, those involved with child welfare and those who are not involved with child welfare. • The Bair Foundation was selected as the grantee. • Services should begin before the end of the fiscal year.

20. Project Overview (cont.) • As required by ACF, the Kinship Navigator Program will consist of the following: • Kinship Navigator Advisory Committee; • Kinship Support Center; • Kinship Navigators • Toll-free telephone line • Outreach Campaign; and, • Kinship Navigator Program Informational Website.

21. RTF Convenings

22. RTF Convenings Workgroups were convened in all four regions that are focusing on root cause analysis and strategy recommendations in the following areas: • Identification and characteristics of the needs of the population; • RTF Clinically Based Programming (specialized services, clinical treatment services necessary for identified populations); • Workforce • Retention and Recruitment • Qualifications • Workforce development • Service array and continuum of care • Cross system collaboration

23. Child Abuse Fatality and Near Fatality Trend Analysis Team

24. Act 33 Overview Act 33 of 2008 requires that Child Fatalities and Near Fatalities, where abuse is suspected, be reviewed at both the state and county levels. Child Fatality/Near Fatality Teams: • County Fatality and Near Fatality Review Teams • Office of Children, Youth and Families Review Team • Statewide Child Fatality and Near Fatality Trend Analysis Team

25. Statewide Child Fatality and Near Fatality Trend Analysis Team The Child Abuse Fatality and Near Fatality Trend Analysis Team’s mission is to collaborate with multidisciplinary partners to analyze trends related to child abuse fatalities and near fatalities and to implement research-informed recommendations. Through collaborative efforts and improvements, preventable child abuse fatalities and near fatalities are eliminated and the health, safety and well-being of Pennsylvania’s children and families are enhanced.  Role of the Statewide Child Fatality and Near Fatality Trend Analysis Team: • Identifying trends across cases to inform changes to policy at both the state and county level • Identifying gaps in education, outreach and service availability and accessibility • Use findings and recommendations to promote and support implementation of prevention efforts to reduce likelihood of future incidences • Creating a collaborative community approach to effectively reduce child abuse

26. Statewide Child Fatality and Near Fatality Trend Analysis Team Trend Analysis Team Process: • Review and interpret content and data analysis and recommendations from State Fatality/Near Fatality Report, Data Collection Form, and the Investigation Outcome Report • Conduct research to aid in development of recommendations • Develop findings, focus areas and recommendations • Develop and publicly provide a consolidated report of the findings and recommendations found at http://dhs.pa.gov/publications/childfatalitynearfatalityreports/ • Partner with those who can implement the recommendations • Monitor the outcomes

27. Pennsylvania Compared with National Data - 2015 Overall, Pennsylvania’s rate per 100,000 falls within the lowest 25% of all states.Though the state did have a lower fatality rate than seen nationally, the demographics of the victim children were similar. 27

28. Fatality and Near Fatality Incidents 2009-2016 • 50% increase in fatality/near fatality reports where abuse was suspected between 2014 to 2016 • 48% increase in substantiated fatality/near fatality reports • Increase is impacted by contributing factors such as societal, educational and legislative changes 28

29. Fatalities and Near Fatalities 2015 - 2016 Of the 405 fatalities and near fatalities (166 fatalities and 239 near fatalities) subject to a review by OCYF, 54% (n=220) were incidents that were later substantiated as child abuse. 29

30. Fatalities and Near Fatalities 2015 - 2016 • 83% (n=182) of the 220 substantiated child abuse fatalities and near fatalities involved a victim child under the age of five. • 44% (n=97) involved a child under the age of one. • Comparatively, 41% of all CPSs involved a child under the age of five. 30

31. Fatalities and Near Fatalities 2015 - 2016

32. Fatalities and Near Fatalities 2015 - 2016

33. Fatalities and Near Fatalities 2015 - 2016

34. Fatalities and Near Fatalities 2015 - 2016

35. Fatalities and Near Fatalities 2015 - 2016

36. Fatalities and Near Fatalities 2015 - 2016 • Develop regionalized child abuse fatality and near fatality review teams. • Enhance technical assistance, mentoring, and support to all county review teams. • Evaluate and enhance online training for county review team chairs and members. • Develop best practice guidelines and tools for county review teams to enhance review quality and consistency. • Provide education on child abuse fatality and near fatality reviews to all disciplines recommended for inclusion in county review teams pursuant to 23 Pa.C.S. §6365 (d), specifically health care, the education system, law enforcement, and mental/behavioral health and substance use treatment providers.

37. Fatalities and Near Fatalities 2015 - 2016 • Provide educational materials and training on child maltreatment risk factors to physical health providers, schools, and community agencies. • Provide universal education and resources to parents for healthy parenting. • Research the implementation, operationalization, and effectiveness of existing supports, such as crisis hotlines, text-lines, and social media for families in crisis. • Determine the feasibility of devising an alert system by which physical health care providers and managed care organizations monitor frequency of missed pediatric appointments to enhance parent engagement and increase the frequency of pediatric visits, while establishing a recommended threshold for child welfare referrals when child protection services may be necessary.    • Identify state-approved functional assessment tools that ensure quality assessments that lead to linkages with appropriate services that meet individual child and family needs.

38. Fatalities and Near Fatalities 2015 - 2016 • Refine child abuse and neglect investigation and assessment policies and practices for incidents involving a child age four or younger. • Enhance statewide policy and guidance regarding General Protective Service (GPS) screen out guidelines and protocols for county children and youth agencies. • Develop policy guidance on when it is critical to consult with medical professionals for the evaluation of suspected child abuse or neglect. • Amend the CPSL to extend CPS and GPS expungement timeframes to allow for a more comprehensive understanding of a child and/or family’s prior child welfare involvement. • Amend the CPSL to streamline and eliminate duplication in the fatality and near fatality review process, allowing for a more comprehensive assessment.

39. Next Steps • Review recommendations with the Child Welfare Council and additional stakeholder groups. • Prioritize and develop workplans for recommendations. • Coordinate with existing structures and entities for planning and implementation of prioritized recommendations. • Complete analysis of 2017 data and combine with prior analyses. • Evaluate and monitor trends and effectiveness of implemented recommendations.

40. Child and Family Services Review and PA’s Program Improvement Plan

41. CFSR/PIP Update • OCYF continues to participate in ongoing negotiations with ACF to move towards approval of the Program Improvement Plan (PIP) • Pennsylvania’s PIP will continue to focus on four main goal areas: workforce, engagement, investigations/assessments, and planning/monitoring • Many of the activities outlined in the PIP have been moving forward; there is commitment to the efforts regardless of whether they are ultimately contained in the final version of the PIP or not

42. CFSR/PIP Update • Regardless of whether the state has an approved PIP, ACF has been permitting and encouraging states to begin conducting the ongoing case reviews that are part of the PIP monitoring process • Provides additional time for Pennsylvania to show achievement of improvement benchmarks • State must generally show 10% increase from baseline year (2017) in number of cases found to be a strength on certain CFSR safety, permanency and well-being outcomes • Once a state meets an improvement benchmark, the state is considered to have successfully achieved the benchmark, even if it is not met in later PIP monitoring case reviews • Failure to achieve benchmarks within 2 years from the date the PIP is approved results in a financial penalty being applied against state title IV-E dollars

43. CFSR/PIP Update CFSR Outcomes Monitored in Determining Financial Penalty (in bold) • Safety Outcome 1: Children are first and foremost protected from abuse and neglect • Safety Outcome 2: Children are maintained safely in their home whenever possible • Permanency Outcome 1: Children have permanency and stability in their living situations • Permanency Outcome 2: The continuity of family relationships and connections in preserved for children • Well-Being Outcome 1: Families have enhanced capacity to provide for their children’s needs • Well-Being Outcome 2: Children receive appropriate services to meet their educational needs • Well-Being Outcome 3: Children receive adequate services to meet their physical and mental health needs

44. CFSR/PIP Update • First round of PIP monitoring case reviews will begin in April 2019. Individuals interested in serving as a reviewer can sign up through the CWRC website at http://www.pacwrc.pitt.edu/CFSR.htm.