Minnesota Department of Human Services Child and Family Service Review

SSIS Conformance reports are reviewed at monthly meetings with the HSPHD Executive Committee. The following report is provided as an example of this work.

HSPHD Executive Committee Update from August 23, 2010

SSIS Coordination, Mentoring, and Support Status Report

Prepared by Ms. Berg

Key Activities and Issues

•  Adoption and Foster Care Analysis & Reporting System (AFCARS) Compliance Report – Hennepin County’s SSIS AFCARS data submission for the reporting period that ended in March 2010 complied with the “acceptable” Federal data error rate threshold of 10%. However, the Administration for Children and Families (ACF) is asking the State to achieve a “target” error rate of only 2%. All Hennepin County AFCARS adoption and foster care data had an error rate less than 2% except for data on court activity (3.06%), Social Security benefit information (3.48%), placement discharge (7.65%), and 46% of the most recent monthly foster care payments were not in SSIS by the end of the reporting period.

•  Expanded Use of SSIS – To look at the extent to which SSIS Fiscal functionality could be used for payments and claiming for child and adult services, 15 counties were asked to provide feedback regarding their use of SSIS Fiscal. The Minnesota Department of Human Services’ (DHS) SSIS Fiscal Project Manager was also contacted for information on statewide use of SSIS Fiscal.

Of the 87 counties in Minnesota, Hennepin is the only county that does not use SSIS for the majority of their adult services (adult protection, adult mental health, adult disability, etc.). Moreover, Hennepin and Dakota are the only two counties that do not use SSIS for the majority of their payments and claiming (CW-TCM, MH-TCM, RSC –TCM, VA/DD – TCM, LTCC, Rule 5, Waiver and AC). All counties use SSIS for IV-E claiming.

Of the 16 counties contacted, the following provided information on their use of SSIS Fiscal: Aitkin County, Anoka County, Blue Earth County, Carver County, Dakota County, Faribault/Martin Counties, Kandiyohi County, Pope County, Roseau County, St. Louis County, Stearns County, Ramsey County and Washington County. Olmsted County and Scott County have not yet responded to the request for information.

Of the 13 counties that responded and use SSIS for the majority of payments and claiming, all reported satisfaction with SSIS fiscal functionality and highly recommended its use except for MCO billing.

•  SSIS Notice of Determination (NOD) Letters – DHS SSIS is recommending that HSPHD Child Protection Investigators use the Notice of Determination (NOD) letters in SSIS by October 1, 2010 with the release of SSIS version 5.4. DHS SSIS also encourages HSPHD to use one of their county attorneys to train investigators how to complete the NOD summary of the reasons for the determination of abuse/neglect.

•  Hennepin Use of SSIS for TCM Claiming – On August 26, 2010 DHS SSIS Fiscal representatives will meet again with HSPHD SSIS and Accounts Receivable staff to provide further training and assistance on using SSIS to claim CW-TCM.

•  DHS SSIS Partnership Meeting on July 21, 2010 – Region 3 Directors have submitted a MACSSA legislative position requesting unified billing for MH‐TCM for all health plans through SSIS to simply county MCO billing.

DHS announced that SSIS must cut 12% of its budget ‐‐ approximately $1 million. Counties will be impacted by DHS SSIS’s reduced ability to support county operations, integrate with COMPASS, and replace servers.

DHS SSIS is also proposing a money‐saving Enterprise Architecture investment to centralize the SSIS database which goes beyond the recent pilot of consolidating county servers in a virtual environment at DHS.

•  Preparation for October 2010 Release of SSIS Version 5.4 – The SSIS Mentors are piloting the new version and preparing new release materials that will be presented to Child Protection Screening & Investigations workers and staff who work with Chafee/SELF/Transition Youth during their unit meetings.

Version 5.4 includes the following new functions:

o  Minnesota Youth in Transition Database (MNYTD) replaces the Chafee/SELF screen and includes the ability to enter survey information for 17-year-olds in out-of-home care and contact information for surveys of 19- and 21-year-olds to be completed by DHS contracted agencies.

o  Changes to the Continuous Placement screen and IV-E Submission screen to accommodate foster care extension for youth ages 18–21.

o  Statewide Case Access changes allow immediate access for reasons of Child Protection, Non CP Emergency and Adult Protection.

o  DD Screening Claiming Category, including a DD Screening Supplemental Healthcare screen.In addition, in 2008 Hennepin County began implementation of the Enterprise Communications Framework (ECF) - a single, shared electronic file system for all clients served by HSPHD. ECF is a workflow management system for the forms, documents, and digital information collected or produced in the course of service delivery. ECF improves LAN files by making more content available, easier to find, accessible from multiple workgroup files, and supporting HIPAA and data practices rules. ECF uses software from FileNet to store and manage documents and workflow, and uses the State Master Index (SMI) and connections to case management systems (SSIS, MAXIS, MMIS, and PRISM) to get the data it displays and the data it needs to deliver documents and work to case workers.

ECF requires a dual log-on to both ECF and to SMI (DHS' Shared Master Index). The staff SMI logon controls security for the data ECF receives from SMI, and determines what each user can or cannot see. The SMI connection "times out" after 30 minutes of inactivity in ECF. Staff are required to sign-in again to reestablish the connection. If the SMI system is down, a message appears in the ECF header stating the SMI is down, and limited functions are available.

The Forms used in ECF are from the current templates workers use in the course of service delivery. Workers upload the template to ECF for editing and storage. Eventually all templates will be eforms in ECF and accessbile only through ECF for creation, modification, edits, and storage.

A variety of approaches have been used in the Federal review in 2007. Beginning in 3rd Quarter 2008, the review sessions were held quarterly and a sample of cases were reviewed by 2-person HSPHD teams. This process included participation by a DHS staff member who served as a resource consultant. The process yeilded 5 to 6 cases per quarter. This process was suspended in 4th Quarter 2009 with the introduction of the DHS case review. The internal review process was found to be resource consuming and yeilded limited data. Cost per completed review was not efficient.

For 2010 an interim process was introduced which involved using one internal case reviewer who completes a sample of 10 cases per month. To date this has resulted in 80 cases reviewed through 2010. In addition, an additional reviewed has been added to the process in September 2010. After completion of training and orientation this individual will be reviewing approximately 25 to 30 cases per month.

Preliminary discussions have been held with DHS CFSR personnel to review the development plan detailed in the PIP. Pursuant to the completion of the October DHC CFSR review discussions will resume on options for HSPHD internal reviews and options to maximize process improvement activities.

Describe the county’s process for ensuring foster parents receive notice of court hearings and their right to be heard at hearings regarding children in their care.

We will send a response to this item as an addendum.

HSPHD's Corporate Compliance and Quality Assurance (CC-QU) system covers all service areas of the department (including Children's Services.) Drawing down from the County's strategic plan, mission, and vision, HSPHD has developed a strategic plan which includes key CC-QA activitites.

CC-QA's scope includes compliance responsibility for accreditation reviews and readiness; the child mortality review and near death panel,; participation on the DHS state child mortality review and near death panel,; conduct of child protection appeals and reconsiderations; conduct of economic assistance appeals; oversight fiscal and progam audits including interface with HC Internal Audit and approval of all PIPs; and operation of HSPHD Research Review Committee.

CC-QA is also responsible for the development and maintenance of the HSPHD balanced scorecard strategy map, balanced scorecard data on customer, finance and internal process and learning and growth objectives; maintenance of the performance dashboards; conduct of participant surveys at both directly operated and contract program sites; and condcut of quarterly employee surveys.

CC-QA took over responsibility for SSIS compliance in the first Quarter of 2010. As a compliance and performance improvement initiattive, the SSIS coordinator and mentors are fully integrated in to the QA team. Working closely with DHS personnel, this team is working on smooth implementation of SSIS updates, correction of errors and related problems, and ensuring performance improvement in AFCARs, Title IVE and CFSR data related areas.

All data is presented on the HSPHD intranet site.

Since the last assessment Child Protection staff have participated in the following training opportunities:

TOPIC / TRAINER:

Cultural Competency Workshop / Dr. BraVada Akinsanya

Trauma Informed Practice / Dr. Dante Cichetti, Dr. Betty Carlson, Dr. Ann Gearity, Dr. Megan Gunnar

Signs of Safety / Connected Family Andrew Turnell International Conference

Allegheny County Child Welfare Presentation / Dr. Marcia Sturdivant

ICWA Ed Days (Regularly scheduled training events for staff and community partners on Indian Child Welfare Act and Native American Culture.) / Esie Leoso, Sandra Whitehawk, and others

Lessons from the Field Training Series (A collaboration with University of Minnesota and Minnesota County Social Services), including:

"Historical Trauma / Dr.Karina Walters

"Intersection of Culture and Children's Mental Health in Working with Immigrant and Refugee Families" / Dr. Goh

"Promoting Child Well Being and Early Childhood Intervention within a Cultural Context" / Dr. Brenda Jones Harden

"Child Welfare Supervisor Seminar" / Dr. Brenda Jones Harden

"Claiming Fiscal training" delivered by DHS SSIS Fiscal Business Analyst on 2/3/2010

Child Parent Psychotherapy in a Cultural Context / Dr. Alicia Liberman on 8/26/2010

Managing Difficult Decisions / DHS SSIS Policy Coordinator on 7/15/2010 & 9/14/2010

Hennepin SSIS Primary Mentor training / DHS SSIS Policy Coordinator on 5/4/2010.

Hennepin SSIS Primary Mentor training / DHS SSIS Policy Coordinator on 5/4/2010.

Hennepin SSIS CW-TCM 2009 SSIS training activities:

Hennepin IV-E Claiming and Error Clean up Training / DHS SSIS Fiscal Mentor Coordinator and DHS SSIS Worker Mentor

Coordinator on 9/28/2010.

Use of SSIS for Foster Care Licensing training / DHS SSIS Worker Mentor Coordinator on 12/2/2009 & 12/10/2009

"SSIS Entry and Title IV-E Foster Care Eligibility" training / DHS SSIS Policy Coordinator, DHS Title IV-E Policy Foster Care Specialist and DHS SSIS Trainer on 4/30/2009, 5/27/2009, 5/28/2009 & 6/11/2009

SSIS New Worker Trainings - Bjorn Basics and CP Focus

SSIS also communicates related DHS training called Quarterly Supervisory Forums and VPCs related to new version releases, e.g. 18 - 21 Extended Foster Care, and MNYTD

Court Mediation Training / Julie Harris, County Attorney's Office

Minnesota Social Service Association Conference, Staff attend and participate in presentations

National Association of Black Social Workers Conference, Staff attend and participate in presentations

Hennepin County Foster Parent Trainings, Becky Richardson and Guest Speakers for staff and foster parents

Hennepin County Staff Development Program, Numerous speakers and topics presented to staff in relation to direct practice and career advancement

The following text is taken from a brochure "Shaping HSPHD." This brochure has also been provided as an attachment to the report.

Client-Focused Service Integration: Key HSPHD Initiatives for 2009–2010

Created in 2004, the vision of Hennepin County’s Human Services and Public Health Department is Better Lives, Stronger Communities. We built HSPHD on the theory that the best way to serve our clients and communities and to achieve this vision is through sharing information, expertise and resources. Through HSPHD’s service integration efforts and community partnerships, we are working toward improving access to services, as well as improving results and outcomes.

As we strive to make the most effective, efficient use of resources, we also are looking at how we manage systems from a horizontal perspective—across the department. Key HSPHD initiatives for 2009–2010 that focus on service integration, community partner¬ships and horizontal management include:

* Redesigning our Call Center to provide one phone number for all initial HSPHD »»services inquiries. Ongoing.

* Redesigning our services for children and adults. This involves integrating »»child-based services (e.g., Child Protection, Children’s Mental Health, Early Childhood Intervention and Out of Home Placement) and focusing on a client-centered approach. It also involves merging adult services (e.g., Aging and Disability Services, Adult Behavioral Health and Eligibility Supports) to provide comprehensive case assessment and help clients establish and maintain eligibility for financial and health care programs. Implementation underway.

* Redesigning how we provide “Case Management” to serve clients according to level »»of need, utilizing a common core assessment and case plan. Ongoing.

* Creating a contract management structure that standardizes business practices and »»gives vendors a single contact point per contract. Implementation beginning in early 2009.

* Creating a Regional Services Plan through which we have identified six geographic »»regions for hub offices where residents can apply for programs, make appointments and receive information about county and community services. Site in the NW Suburban region is expected to open at 7051 Brooklyn Boulevard, Brooklyn Center in 2010.

* Establishing an Office of the Ombudsperson to coordinate and manage responses to constituent concerns and address information requests and complaints. The office tracks contacts to discover trends and systems issues and will use this information to recommend

improvements. Office of the Ombudsperson began its work in November, 2008.

If applicable, describe how changes in service availability or accessibility have impacted agency efforts to prevent entry or re-entry and achievement of timely permanency since the last review.

The Hennepin foster care re-entry rate has declined over the last two years. This trend may be attributed to the restructure of the CP field area, Risk re-assessment and Family Group Decision Making.

Two years ago the Child Protection Case Management area was redesigned. The goal of the redesign was to eliminate the process of transitioning cases between an initial worker called the upfront worker to a permanency worker. This practice meant that families would transition from worker to another during the life of their case. This posed many challenges in the areas of family engagement and case longevity. For instance under the old upfront/permanency framework family engagement and trust were threatened by the hand off between workers. Workers didn’t have the full picture of the strengths and risks of the families from start to completion of their case plan goals. However with the one worker framework staff are able to monitor child/parent progress before reunification. This is particularly helpful in re-assessing risk and determining improvements in this area.

In addition to the case management redesign and risk re-assessment staff use our family group conferencing resources. Family group conferencing facilitates the families in developing safety plans that are congruent with their natural support systems. Trusted friends and family who are a part of the client’s network can provide a foundation of support and accountability for them post discharge from Child Protection.

There is no empirical data to support the correlation between the above strategies and foster care re-entry. However we believe that the practice enhancements of the one worker model, Family Group Conferencing, and risk re-assessment are on going strategies that promote best practices.

Two important initiatives that are part of HSPHD's responsiveness to Hennepin County's needs include the Family Health and Restoration Network project and the Omniciye project, as described below.

Family Healing and Restoration Network: In 2005, HSPHD initiated a community-based effort to address the disproportionate representation of African American children in the Child Protection system. As a key component of this effort, the county established partnerships with African Americand faith communities from the Minneapolis area. Over the next several years, representativesfrom the county and community began working together to discuss ways to help families in need and prevent child maltreatment within the African American community. In 2007, as a result of these efforts, county and community partners founded the Family Healing and Restoration Network (FHRN) project.

The mission of the Family Healing and Restoration Network is “to provide families with a viable network to heal through the collaboration between community, church and government.” The primary target population for the FHRN project is African American

residents of north and south Minneapolis. This population was selected because of high rates of poverty and distress, and the disproportionate number of families involved in the county Child Protection and Corrections systems. The project adopted the following four components as central to its work:

n Healing (e.g., basic needs such as food, clothing, shelter; public benefits)

n Family preservation (e.g., parenting supports and Doula services)

n Education (e.g., training for paraprofessionals and system professionals working with

families; community forums that educate residents about community resources)

n Restoration (e.g., intervention and reunification supports for families; domestic abuse

resources)

Omniciye: Through an exciting new partnership with Hennepin County, Little Earth has a one-stop case management empowerment program for Little Earth households. The goal is to help Little Earth families move off of federal assistance and into secure employment. Rather than juggling multiple case workers, Little Earth adults now work with just one case manager who advocates for the entire family. Just half way through the first year of the program, Omniciye, 50 households, or almost 25% of all Little Earth households are now actively involved in this new self-sufficiency project-exceeding the required households for the first year in our Hennepin County contract.

At any given time, Hennepin County has about 446 licensed foster families. About one-third of these home are relative/kin homes. Hennepin County is dedicated to placing children with family members or kin. There are identified staff whose function is to explore relative/kin resources for children.

Hennepin County has 1.8 FTE s dedicated to foster and adoption recruitment. In addition there are three intake social workers, 2 FTEs for training, and 13 Licensing Social Workers carrying an average full-time provider-load of around 40 foster homes. They visit their families at least once a quarter.

Staff have developed hand fans featuring African American Children that we distribute to churches that have a large African American membership. The County has contracted with American Indian artists to create artwork for use in advertising targeted at the American Indian population. This artwork had been used in ad brochures, posters, bus benches and a hand fan, which are distributed at Powwows and other community functions. Various brochures feature a variety of ethnic groups and are distributed to libraries and community centers throughout Hennepin County. Diverse images of children needing foster and adoptive home are features on billboards and bus benches.

Hennepin County works closely with the Dave Thomas Foundation for Adoption Foundation, Wendy's Wonderful Kids, Child Specific Recruiters who work with our difficult-to-place children. We partner on recruitment events and children who need specialized recruitment. We also partner with the state's private agencies on recruitment and placement efforts. We are in process of assessing our recruitment program as it suports kin/relative searches and placement with relatives to ensure placement with relatives and sibliings is a priority.

Recruitment for concurrent planning program, the foster care adoption option program, has been especially promoted in communities of color. A barrier we encounter is that daycare is not subsidized for foster parents. In addition, Adoption Assistance administered by DHS does not allow for financial assistance to adoptive parents unless the child has special needs. Many of the younger children do not qualify for the financial aspects of adoption assistance and daycare because their special needs manifest themselves later in the child's development as they get older.

A searchable database of licensed non-related foster care resources is maintained in the placement request system.

The past 2 years have been a continued challenge for Hennepin County as we try to meet the ever-growing needs of families facing harsh economic conditions and dwindling financial resources and supports. We have been required to make reductions in both staff and services while Federal and State service funding diminishes. The entire county has been under a “hiring freeze” for more than 2 years, and all employees have been asked to take a minimum of 32 hours per year in “Special Leave Without Pay.” There are scarce training funds available to support on-going skill and professional development, and staff frequently supplement available training money out of their own pockets.

Supervisory and staff positions have been "drawn-down" in certain “non-critical” functions in order to maintain our core service responsibilities and mandates. An example of this can be seen in the elimination of overnight Child Protection staff working in our Community-Based First Response program, which has been replaced by a contracted service provider offering “call center” functions only from the hours of 11pm – 8am.