- Report Published -
|Senate Document No. 9|
PUBLICATION YEAR 2009
|Executive Summary of the Joint Subcommittee to Study the Comprehensive Services for At-Risk Youth and Families Program Pursuant to SJR 75 (2008)|
|Division of Legislative Services, Joint Subcommittee|
|SJR 75 (Regular Session, 2008)|
|Senate Joint Resolution 96 (2006) established the Joint Subcommittee to Study the Comprehensive Services for At-Risk Youth and Families Program, and charged the joint subcommittee with evaluating the cost effectiveness of the Comprehensive Services for At-Risk Youth and Families program and collaborating with the Joint Legislative Audit and Review Commission regarding the Commission's evaluation of the administration of the program. SJR 96 provided that the study be conducted in two phases. In the first phase of the study, during the 2006 interim, the joint subcommittee held three meetings to review the administration of the Comprehensive Services Act program by state and local governments, including projections of caseloads, service needs and costs, and quality of services provided, and to develop recommendations for improvement of program services and strategies for cost containment. In the second phase of the study, during the 2007 interim, the joint subcommittee held three meetings to continue processing recommendations provided by the Joint Legislative Audit and Review Commission and working to identify and evaluate options for improving program services and strategies for cost containment. |
Senate Joint Resolution 75 (2008) continued the Joint Subcommittee to Study the Comprehensive Services Program for At-Risk Youth and Families for a third year, to continue to review the administration of the Comprehensive Services program and to develop additional legislative recommendations for the 2009 Session of the General Assembly. The joint subcommittee held three meetings during the 2008 interim to carry out this work.
October 6, 2008
The first meeting of the Joint Subcommittee Studying the Comprehensive Services Program for At-Risk Youth and Families was held on October 6, 2008 in Richmond. Senator Emmett W. Hanger, Jr. was elected chairman and Delegate Philip A. Hamilton was elected fice-chairman. Following introductory remarks by the chairman, presentations were heard.
Update on Activities of the Office of Comprehensive Services
Charlotte McNulty, Executive Director of the Harrisonburg-Rockingham Comprehensive Services Board gave the update on behalf of the Office of Comprehensive Services. She reported that Kim McGaughey, former Director of the Office of CSA, has left the Office of Comprehensive Serivces, so she (Ms. McNulty) is acting as interim Co-Director. Ms McNulty updated the subcommittee on implementations of the legislative actions from the 2008 General Assembly Session. She first spoke about the 50% reduction in locality match rates for community-based services that went into effect on July 1 of this year. Ms. McNulty stated that the Office of CSA conducted six regional trainings on the match rate changes in July and August, with a total of 219 attendees. Ms. McNulty also stated that there had been some discussion and debate regarding classification of services as residential or community-based services, for purposes of determining what the new match rate, as the State Executive Council developed guidelines for implementation of the differential match rates. Delegate Hamilton pointed out that there was frustration in some of the localities, where program staff felt they were being required to implement changes with definitions that weren't entirely clear. It was agreed that there should be ample training for localities to explain the new definitions.
Ms. McNulty also discussed implementation of data set changes, which were part of the regional trainings, and implementation of the Indiana assessment tool, the Child and Adolescent Needs and Strengths (CANS). Through various trainings, 355 users have been certified in using the tool. Finally, Ms. McNulty updated the subcommittee on the work of various CSA workgroups.
Update on Children's Mental Health Services
Next, Raymond R. Ratke, Special Advisor for Children's Services, gave an update on children's mental health services. He spoke of the Council on Reform's (CORE) role in leading reform in this area. The four critical reform areas are to (i) to adopt a statewide philosophy of care and practice model, (ii) implement a training program based on the practice model, (iii) increase family-based placements (as opposed to congregate care), and (iv) improve the use of data as a management tool. Currently, the Council is in Phase I of the reform effort, which involves working with 13 localities in these areas, before going statewide in Phase II. He gave an overview of the reform process and spoke of some success the council has seen already in the reduction of congregate care in Phase I localities. He also gave a timeline for reform going forward, which includes a plan to take the reform statewide in January of 2009.
Discussion of Study Plan
Following presentations, the joint subcommittee discussed the study plan for the remainder of the 2008 interim. All agreed that it would be valuable to get input from localities at various locations. Members tentatively agreed on three future meetings in Northern Virginia, Portsmouth, and Roanoke, in order to hear from both local CSA workers and local government representatives.
November 17, 2008
The second meeting of the Joint Subcommittee Studying the Comprehensive Services Program for At-Risk Youth and Families was held November 17, 2008 in at the Fairfax Government Center in Fairfax, Virginia. Following opening remarks, presentations and remarks were heard.
James Gillespie, CSA Program Manager, Fairfax CSA
The meeting began with presentations from local CSA program staff. Mr. James Gillespie, CSA Program Manager for Fairfax-Falls Church described the activities and successes of the Fairfax-Falls Church program. He noted that the Fairfax-Falls Church program was a large program, and that the program's caseload had been stable, with about 1100 cases served each year over the past three years. At the same time, however, program costs had risen, growing at a rate of 11% during the past year.
Sharon Minter, CSA Coordinator, Manassas City CSA
Ms. Sharon Minter, CSA Coordinator, Manassas City CSA, described her program as a small, urban program. She stated that the program received approximately 140 referrals each year, and provided services to approximately 50 cases per year, at a cost of $1.9 million. Cases referred but not served through the CSA program were served through other programs. Ms. Minter stated that for her program, cost containment was a key effort. One of the largest expenses for her program was treatment foster care, which received about 40% of the total budget. Residential treatment costs were minimized, she stated, by seeking other alternatives and using residential care as a treatment of last resort. In closing, Ms. Minter offered three recommendations to the joint subcommittee: (1) increasing administrative funding to localities, (2) changing restrictions on funding to enable localities to start up new services, and (3) reducing the community-based treatment services match rate and increasing the range of services eligible for the community-based services match rate.
Lisa Dunn, CSA Coordinator, Staunton/Augusta/Waynesboro CSA
Ms. Lisa Dunn, CSA Coordinator, for the Staunton, Augusta County and Waynesboro CSA Program, described how her multi-locality program served at-risk youth and families. She stated that while each locality had its own Family Assessment and Planning Team (FAPT), the program was served by a single Community Policy and Management Team (CPMT) and that planning was community wide, including all three localities in a unified plan. Ms. Dunn indicated that each locality served by the program had experienced increases in demand, but that the program had taken steps to contain costs associated with this growth, including efforts to link families with existing resources and other programs in order to divert families from the CSA program where appropriate. One problem that Ms. Dunn identified for the joint subcommittee was that of judicial referrals to the program. Ms. Dunn noted that in cases in which children are referred to the program by the court, time for service planning is drastically reduced and some children end up in residential care when other, community-based services could have met their needs. To address this problem Staunton/Augusta/Waynesboro staff was working with local judges to educate the courts on options for at-risk youth beyond residential care. In closing, Ms. Dunn described a new project undertaken by the Staunton/Augusta/Waynesboro program whereby the program utilized two 10-bed "pods" at the local juvenile detention facility as an assessment facility, providing short-term placement for at-risk children. She also stated that utilization review procedures implemented by the program had resulted in substantial savings over the past year.
Local Government/Private Provider Comments
Following presentations by local program staff, the joint subcommittee received comments from local government representatives and private providers. Mr. Dean Lynch of the Virginia Association of Counties, recommended additional flexibility in funding, to allow localities to establish new services; increasing the number of local government representatives on the State Executive Council; and increasing administrative funding for the CSA program. Victor Evans, CSA Coordinator for Prince William, urged greater collaboration between localities, state government, and private providers. Representatives from Loudon County stated that they had seen a substantial caseload increase, partially due to local growth. Janet Areson of the Virginia Municipal League suggested concentrating on training coordinators, FAPT team members, and others involved in the process to increase efficiency and effective planning, and increasing administrative costs. Annette Bowler, Director of the Department of Family Services for the County of Fairfax described a model, currently utilized in Michigan and being evaluated in Fairfax County, through which family resource centers were established in elementary schools, to provide single point of entry into the service system, to allow coordinated planning for family services agencies including the Comprehensive Services Act program. Such resource centers, Ms. Bowler stated, had worked in Michigan to reduce the number of children moving into the family services system. Several other speakers echoed suggestions to increase administrative funding for localities, and also suggested reevaluation of the local match rates for residential and community-based services.
December 1, 2008
The third meeting of the Joint Subcommittee Studying the Comprehensive Services Program for At-Risk Youth and Families was held on December 1, 2008 in Portsmouth. Senator Emmett W. Hanger, Jr. gave opening remarks, and announced that a final meeting of the subcommittee would be held in early January, in Richmond.
Nathalie Molliet-Ribet: CSA Administrative Costs and Funding
The first speaker was Nathalie Molliet-Ribet, who spoke on issue of administrative costs and funding for the CSA program. Ms. Molliet-Ribet stated that the Joint Legislative Audit and Review Commission had first studied this issue in 2006, and that the data presented was drawn from this study. Ms. Molliet-Ribet went over the purpose of administrative funding, and the role of CSA staff in administering this program. She stated that localities received an average of $14,600 per year from the state to administer CSA; the amount has been leveled since 1997. Localities are often required to supplement this money with local funds. Ms. Molliet-Ribet also pointed out that localities with CSA coordinators had lower overall costs than localities that did not. However, most still do not have full-time CSA coordinators. Some have part-time staff, but many have none at all. This adversely affects localities in many areas, including negotiating contracts with providers, monitoring outcomes, and identifying alternate funding sources.
Delegate Hamilton pointed out that funding for this program is skewed against localities, more so than other programs.
Gail Schreiner/Reynold Jordan/Dr. Roderick Hawthorne: Portsmouth CSA
The next speakers were representatives of Portsmouth's CSA program. They discussed some of their more innovative programs. One such program includes therapeutic day treatment in public schools for students with emotional problems. They also discussed the importance of holding FAPT meetings in schools, in order to bring in more parents. They stressed that going into schools is key to early intervention.
Portsmouth also has innovative foster care programs, including the CARES program, which includes parent/family training for foster families and individualized services for children. This program is a public/private partnership, which creates more value, with higher quality services for the children. Portsmouth also operates a homeless brokerage program, which finds ways to keep children out of foster care by keeping families from becoming homeless. The program looks for landlords to lower rents, waive deposits, and also offers to oversee tenants. Keeping families together is ultimately less traumatic for the child as well as cost effective for the state.
Portsmouth has had some success with its CSA program: 271 children were served in FY 08, and for past two years the congregate care rate has been 11% (national best practice is 10%). However, there are still problems: for example, program staff has found that permanency for 16-year-olds coming into foster care is often not feasible before the children age out of the system. The team's final message is that CSA can work, and the culture change in Portsmouth DSS is proof.
Dr. Susan Dye: Virginia Beach CSA
The next speaker was Dr. Susan Dye of the Virginia Beach CSA program. She also gave an overview of some of its successful programs, including the Pendleton Child Service Center, which is a private facility that offers a three-month residential program for children in Virginia Beach. The program requires intense parental involvement; in fact, parents must be there five days a week. The program also starting to use professional foster homes, which are homes with highly trained parents who do not work outside of the home. These parents have shown some success in working with challenging children. However, recruitment of such parents is difficult.
Virginia Beach currently has about 40 of its 700 CSA children in residential care. Many of the 40 children in residential care are also involved with the juvenile justice program. Dr. Dye stated that in some cases, community-based group homes seem more appropriate for these children, perhaps because their backgrounds have made them so unaccustomed to a family environment. Dr. Dye also reported that Virginia Beach is facing challenges with its CSA program, including children who are not responsive to treatment, children who age out, and especially in this area, problems with military families. Military families with special needs children are often transferred here because of the specialized services available. However, no additional funds, federal or otherwise, are appropriated for this purpose. For this reason, military families are adding strain to the Virginia Beach CSA budget.
Denise Gallop/Mike Terkeltaub: Hampton/Newport News CSA
Denise Gallop of the Hampton CSA program, spoke about how the program is currently focused on evaluating and analyzing previously collected data, and using information gathered through this evaluation and analysis to improve the program. One important lesson the staff learned from the data is that families need to be more involved in the service-planning process. As a result, program staff had increased efforts to improve family involvement. Ms. Gallop also discussed a program called Youth in Fast Forward, initiated by Judge Jay Dugger. The program is modeled after a program to send adults back to work; it has now been modified for young adults aging out of the foster care system. The program brings public and private providers together to help these young people transition out of foster care and into successful adult lives. Ms. Gallop concluded by restating the core values of the program: a one-child-at-a-time approach, a belief that families are the experts about their families, any program must be child-centered and family-focused, and planning must begin with the outcome, not process.