The Katie A Advisory Panel
Fifth Report to the Court
Highlights
The Advisory Panel submitted a report on August 16, 2005 on progress by the
Los Angeles County Department of Children and Family Services (DCFS) toward
achieving the objectives of the 2003 settlement agreement in the Katie A
case. The following is an overview of the Panel’s findings and recommendations.
The full 75-page report is available in Word or PDF format by request to
leec@bazelon.org.
Noncompliance
DCFS is not in compliance with the Settlement Agreement, for the following
reasons.
1. Implementation of initiatives such as team decision-making (TDM), family
group decision-making (FGDM), multidisciplinary assessment team (MAT), Hubs
and Wraparound is either quite small in scope or at the early planning stage.
As a result, these initiatives affect only a small percentage of class members.
2. There has been little or no expansion of home- and community-based mental
health services for the plaintiff class, and staff in the field report that
access and wait lists are a significant problem.
3. The collective data systems of DCFS and DMH do not yet permit the services
provided and outcomes of class members to be tracked over time.
4. Members of the class have not been identified and unknown numbers of them
are not receiving necessary mental health services because their needs for
those services are not being assessed (DCFS expects that the Hubs and MATs
that are under development will eventually help address this deficit) and because
existing services are insufficient or inadequate.
5. It is the Panel’s opinion that DCFS’ failure to implement the
provisions of the settlement agreement significantly contributes to the problem
of class members’ being housed overnight in DCFS offices.
6. Two years after approval of the Katie A. Settlement, DCFS has still not
demonstrated a commitment to achieving its objectives. It has not even developed
the detailed and comprehensive plan for implementation anticipated by the agreement.
The Panel believes that the failure to develop a viable plan is a consequence
of low priority given the settlement agreement by DCFS and a lack of internal
ability within the Department to analyze information, develop organizational
strategies and engage in planning. The Panel has little confidence that the
process outlined in the agreement will produce the commitment and planning
needed to achieve the objectives of paragraph 6.
The Panel offers to take a larger role.
As a solution to this lack of action, if the court desires, the Panel is willing
itself to develop a detailed and comprehensive corrective action plan, with
the discretion to involve DCFS and DMH in designing the details to operationalize
the plan and the funding to involve consultants as necessary.
The Panel recommends that it be authorized to identify key elements of the
completed plan that would become enforceable and enable compliance measurement.
The County has no plan.
Two years after the settlement agreement was approved, there is no detailed,
comprehensive and integrated DCFS implementation plan regarding Paragraphs
6 and 7
The County Department of Mental Health (DMH) plan does not present any estimate
of the number of children, families and foster families who will require various
level of intensity of services, particularly services that do not now exist
or are provided only in small quantities. Nor does the DMH plan indicate how
its directly operated children's mental health services and contract providers
will rapidly expand evidence-based services throughout the county, both for
class members in their own homes and for those in foster care. .
However, DMH has recently directed 3.2 million more dollars of Medi-Cal in
FY06 to meet the mental health needs of class members served through the MATs
and Assessment Hubs. This modest step represents one of the first tangible
efforts to expand availability of mental health services. Yet no plan describing
this initiative has been provided to the Panel.
DCFS and DMH staff and providers show little understanding of treatment methods
more effective than traditional outpatient services and no information about
the size of the population in need. They could not answer the question, AIf
more than 50% of the children in foster care in this SPA require intensive
home-based services, what would it take for your mental health providers to
meet their needs and guide their caretakers?@
The County needs intensive home-based services.
It is clear that a significant percentage of the children served by DCFS (conservatively
estimated by the Panel to be at least 50%) have diagnosable mental health conditions.
This incidence is what makes creation of individualized, home-based mental
health services so vital and so urgent. Two years after the settlement agreement,
the County has just begun addressing this need.
The settlement places strong emphasis on the creation of services that support
family-based living arrangements, as opposed to congregate settings. Most of
the innovations and expansions in the DMH plan and by DCFS, such as the MAT
and the Hubs, are front-end assessment and referral. The Panel sees no evidence
that DCFS and DMH are building intensive home-based services to support families
in raising their children who have serious emotional disorders. These services
are essential to keep the children from entering foster care
Mental health services lag.
Without a significant expansion of mental health services, DCFS cannot comply
with the provisions of either Paragraph 6 or 7. The Panel has urged DCFS and
DMH to ensure widespread expansion of Medicaid-funded, intensive, home-based
services, pointing out that expansion of the same interventions currently being
used is unlikely to meet the class members’ needs.
DCFS appears to be moving faster than DMH, and the lag in expanding mental
health services and the failure to design new, more effective mental health
services will be harmful to class members. The Panel believes this harm could
be avoided.
New approaches are required.
If a child in an FFA or D-Rate foster home requires daily support to change
behaviors and the foster parent and parent with whom reunification is planned
require assistance in understanding and intervening in the child’s behaviors,
DCFS and DMH respond that Wraparound is the only alternative to Level 12 or
14 group care. They know that an expansion of Wraparound to serve hundreds
more children is not going to occur, yet they appear not to be thinking about
other methods supported by Early Periodic Screening, Diagnosis and Treatment
(EPSDT) for dramatically expanding home-based services for these children.
Intensive home-based services must be provided for thousands of class members
in Los Angeles County. They must be individualized and planned with families,
foster families and teenagers. They must have the possibility of daily intervention
over durations longer than a year, while being flexible to taper as quickly
as permitted and still meet needs or increase quickly in response to a crisis.
These services must be implemented both in foster homes (FFAs and D-Rate) and
with relative caretakers as well as during visits in preparation for reunification
and in the homes of children who are not in care.
These services are not available, except in rare circumstances, in Los Angeles
County. The current children's mental health service array lacks intensity,
duration, and comprehensiveness, and this deficiency severely affects class
members. At best, Aoutreach therapy@ is provided, but typically not more often
than once a week, and it is not designed, consistent with the clinical principles
of evidence-based practice, to guide caretakers in managing children's difficult
behaviors. Moreover, while staff can be assigned to work with a child as often
as daily in the home, the clinical training of these individuals is limited
and typically they do not function as a member of the clinical team and their
supervision does not come from the child and family clinician.
Neither the current functioning of the outreach therapist nor of Therapeutic
Behavioral Services (TBS) staff allows for adequate crisis intervention to
prevent placement breakdown. All the key elements of intensive home-based servicesCa
clinical team working with the child and family, assessment of the child's
needs that guides the family and providers, as much as daily in-home therapy
and behavior support for the child and intensive guidance for the caretaker,
and crisis intervention by clinicians who know the child and familyCmust be
provided to each class member and his or her family.
To provide all the elements of intensive home-based services for at least
10,000 class members will require a dramatic change in all the children's mental
health service providers in the county. It
necessitates not only a huge expansion of mental health services but a change
in the types of interventions provided, the training and supervision of the
staff providing them, and the way MediCal billing codes are used. DCFS and
DMH, providers-FFAs, Wraparound, mental health, TBS, family preservation, group
care and others must be supported in overhauling what they now offer. In addition,
improved outcome data and quality data must be consistently produced so that
DCFS, DMH and providers can refine their interventions and systems over time
A cross-system commitment to a specific set of practice principles is required.
Designing individualized services to build on the strengths of families and
meet the needs of children requires a fusion of children's mental health principles
and child welfare principles that are embraced and practiced at all levels
of DCFS and DMH and among their contractors. These cannot be practices unique
to a particular provider or pilot project, but rather are principles that cut
across both staff preventing children from entering care and those serving
children in care in FFAs, D-rate and relative homes and group care and staff
attached to specialized outpatient, Wraparound and intensive home-based services.
• Treatment Planning and Assessment: The Panel believes
that in regard to two vital elements of practice with children and families— family
team planning and problem solving, and assessment of needs— more
than the currently envisioned DCFS Team Decision Making initiative and
MAT assessment
initiatives are needed. We believe that the larger DCFS work force needs
to become more competent in contributing to teaming and assessment through
an
intensive training and coaching process, not just a small number of experts.
This recommendation is based on the Panel's successful prior experience
with improving the level of practice at the front line in other systems
and on the
practical reality of available resources. The Department will never be
able to acquire enough external practice capacity to improve practice and
outcomes
for the plaintiff class and will be unable to meet the needs of the class
unless it also uses its own frontline casework staff to engage in these
new approaches.
• Treatment Foster Care: Substantial numbers of class members who are
seriously emotionally disturbed experience placement in congregate settings
inappropriate to their needs, frequent placement disruptions, failure in school,
lack of permanency and/or entry into the juvenile justice system. Many may
become runaways. When they leave DCFS custody at age 18, many become homeless,
are unemployed and/or enter the adult correctional and mental health systems.
The Department has no effective clinically appropriate resource for these youth
and spends countless dollars ineffectively responding to the impact of unmet
needs. To meet the needs of these children and youth, DCFS should implement
a treatment foster care initiative, with the assistance of the Oregon Social
Learning Center (OSLC), employing their approach. This initiative should be
coordinated with DMH.
• Wraparound: The Panel commends the county’s
achievement, shown by data indicating that L.A. children who graduate from
Wraparound are significantly
less likely to re-enter DCFS jurisdiction six months later compared to children
who did not get Wraparound. In a follow-up of 12 children who graduated from
Wrap, only one re-entered foster care a year later.
The Panel has consistently
raised the issue of quality in Wraparound, but there has not been a concerted
DCFS effort to address this issue. DMH recently
acknowledged that the quality of Wraparound services was variable across
the eight providers, with the original three Wraparound providers (who received
longer and a higher-quality training) providing the best services. However.
the current Wraparound providers cannot expand to serve thousands of class
members. Growth of the Wraparound effort has stalled and the plan for expansion
is under development and has yet to be fully approved by the Board of Supervisors.
The
resources currently committed to this service fall far short of meeting
the needs of the plaintiff class. The information DCFS shared orally in August
2005 about the Department's anticipated expansion of Wraparound is not in
their
draft plan, so the relevance and likelihood of this initiative occurring
is not known. Expansion is needed and the Department must strengthen the
quality
of Wrap programs now in operation and to assure the quality of new programs
that are developed. Expanded and improved Wrap programs should be a form
of intensive home-based services. The Department should expand eligibility
for
Wraparound services to include children who do not have intact families and
those placed in Level 10 and above residential settings.
• Funding: DCFS does not yet have a comprehensive
strategy for funding the changes required by the settlement agreement. It
has not engaged the FFA's
in delivering new, more effective services for class members, is not maximizing
Medical/Medicaid reimbursement or IV-E training dollars, and has been slow
to consider a comprehensive strategy for reinvesting savings from reduced
placement costs into front-end services.
The County has access to federal
financial resources that could be used to
expand intensive home-based services. In fact, the Panel has identified to
DCFS a significant opportunity to expand mental health services by making
more efficient use of the federal EPSDT dollars that would significantly
expand
mental health services with primarily federal funds. To date, DCFS has taken
little, if any action.
To identify the cost of needed system improvements
and maximize the use of existing county, state and federal financial resources,
the Department should,
with the advice and approval of the Panel, retain the assistance of consultants
expert in the claiming of Medicaid and Title IV-E training funds, in California
funding procedures and in redeployment of existing funds. The consultants,
with the participation of the Panel and DCFS staff, should analyze opportunities
to increase revenue available for the needs of the plaintiff class and identify
the changes and actions needed to maximize existing resources and develop
new resources. Regarding plan for use of new Proposition 63 dollars, the
County
should insure that the services identified as needed in this plan are included.
• Family
meetings: The training staff have acknowledged that a major problem is the
lack of agreement about a single method for family meetings,
making it very difficult to train staff to convene some of their own family
meetings as the Panel has recommended. Because of the approach used for meetings,
which focuses primarily on responding to crises rather than preventing them,
and because of the limited numbers of facilitators available and affordable,
few families experience the value of these meetings when they are needed.
• Training:
DCFS has provided little or no training to prepare line casework staff
to improve its work with children with mental health needs.
Efforts to train line staff about current reforms have been essentially superficial.
Teaching the effective assessment of children's needs and engaging family
members and others in designing individualized services, whether in the classroom
or
in the field, requires trainers who themselves are experienced in strengths/needs-based
work with families and crafting services with providers and are up-to-date
on the practice principles embraced by DCFS and DMH.
Core competencies and
enabling abilities should enable staff to practice consistent with the
Panel’s
practice principles.
As DCFS develops the methods of assessing
the children's needs and DMH develops the services that will meet those
needs, the line staff of both agencies must
have improved skills (and reasonable caseloads) to engage families and support
collaboration among professionals and families and foster families which
results in the achievement of permanency and child well-being outcomes. Parallel
to
these changes in DCFS and DMH, their providers—FFAs, Wraparound, mental
health, TBS, family preservation, group care and others—must be supported
in overhauling what they now offer. It is critical that DCFS give urgent priority
to providing better training to frontline staff and their supervisors that
will enable them to improve their assessment of, planning for and services
to the plaintiff class.
• Three-day training: With the advice and approval
of the Katie A. Panel, the Department should develop a three-day training
initiative in a strengths/needs-based
family child and family team meeting approach that has individualized planning
as well as crisis resolution as its purpose. The three-day training will be
delivered to existing facilitators, DCFS trainers and expert coaches in each
office, who will be responsible for training (on the part of trainers), and
coaching all front line staff in the office. Coaching in this context means
demonstrating child and family team meetings in actual practice for participants
and co-facilitating/mentoring participants in the facilitation of actual meetings.
These new coaches will occupy new, full time roles. Each staff member trained
will be coached by a facilitator (hired as staff or under contract), skilled
in the strengths/needs based family child and family team meeting approach.
Family meeting facilitators and case-carrying front-line staff should possess
core competencies and enabling abilities: [listed in report]
• Additional
four-day training: As a second stage, with the advice and approval of
the Katie A. Panel, the Department will develop a four-day training
session on strength based assessment and individualized planning, which may
be delivered in two, two-day sessions. Each case-carrying front line staff
member and supervisor will complete the four-day training.
The Department should issue policy expressing the right of all class members
to a functioning child and family team, facilitated by a trained facilitator
and utilized to plan the delivery of services needed to achieve safety, permanency,
stability and well-being. Training recommended by the Panel should be developed
collaboratively with DMH. DCFS should expand the number of staff available
to coach and mentor new and experienced staff in new approaches. The Department
should hire 80 staff mentors, who will supplement the mentoring available from
existing facilitators. To the extent possible, this new training and staff
mentoring will be funded out of Title IV-E training dollars by changing the
pre-service and in-service training now offered by the universities
• Group
care: The John Lyons report suggested that 57% of the children and youth
in level 12 and 14 group care could be effectively served with home-based
services options. The Panel has repeatedly suggested that the county develop
a comprehensive Clinical Utilization Management Process to effectively manage
the intake into and discharge from congregate care, coordinated with the Department
of Mental Health.
• Data: After two years of effort by the Panel and
the Department, DCFS still cannot track the most basic indicators of progress
for the plaintiff
class. It cannot be determined whether DCFS has achieved the goals of 7(f),
the first portion of 7(g), or the entirety of Paragraph 6 because of the County's
inability to produce the data necessary to make those determinations. The Department
has no reliable method for tracking the long term outcomes for the plaintiff
class, for assessing the degree to which their current status is acceptable,
for evaluating the quality of DCFS and mental health services or the types,
intensity and duration of the mental health services they receive. As a result,
DCFS and the Panel are unable to provide to the Court any reliable data on
whether the Department is making progress in improving outcomes and/or achieving
greater access to mental health services for the plaintiff class, based on
evidence found in data trends. Improved outcome data and quality data must
be consistently produced so that DCFS, DMH and providers can refine their interventions
and systems over time.
• Medicaid: The Panel has identified the problem
of the lack of guidance and consultation to providers by DCFS and the State
on maximizing claiming
for federal funds. This underclaiming impedes the expansion of services for
the plaintiff class. Elsewhere in the country intensive home-based services
have been defined and paid for through Medicaid. The current Medicaid claiming
system in Los Angeles County requires that discrete services be documented
in records, reported and billed. So for a Wrap provider, dozens of individual
professional contacts and activities would have to be reported and claimed
separately for the same day for each child. This process creates a burdensome
and expensive record-keeping system and requires significant expertise on
the part of providers to take maximum advantage of available federal funds.
Without
that expertise, opportunities to expand services to children through greater
recovery of federal dollars are being lost.
This problem would be almost
eliminated if the State created broader categories of services that encompassed
most of the professional activities of services
such as therapeutic foster care or Wraparound services within one service
definition. The result would be a rate for therapeutic foster care for example,
dramatically
simplifying the claiming process and expanding the costs that can be recovered.
Such Abundled rates@ have proved to be very effective in implementing new
services and expanding others. . .
Identifying the plaintiff class: There is currently no mechanism to accurately
identify the size and needs of the plaintiff class. The proxy definition used
by the Panel as a temporary measure identifies only a small percentage of class
members in custody and fewer who remain in their own homes. To plan effectively
for development of needed mental health services and assure that class members
are appropriately served, DCFS and DMH should implement a process to identify
and track class members at the SPA level. Using a tool and process approved
by the Panel, DCFS and DMH should identify the class members in each SPA, describe
their needs and the services currently received, and ensure that they are tracked
by the DCFS information system.
Expanding Mental Health Services
DCFS and DMH must develop an expanded array of services available to the
plaintiff class, specifically to provide intensive home-based mental health
services, provide clinical interventions for traumatized children, and create
stable family homes for seriously emotionally disturbed children and youth.
- Develop countywide intensive home-based services: Using baseline data,
design a comprehensive process for developing intensive home-based services
throughout the county to meet the needs of the class. This process should
include RFP(s) for contractor(s) to manage the expansion of service capacity
in various
providers, including centralized technical assistance and training.
Intensive
home-based services include a coordinated combination of services, uniquely
designed for the child and family, including:
- a clinical team working with the child and family
- assessment of the child's needs that guides the family
and providers
- in-home therapy, including trauma treatment
- behavior support for the child by clinically trained individuals
- guidance for the child's family/foster family in managing the child's
behavior
- crisis intervention by clinicians who know the child and family
Intensive home-based services should be developed within each SPA but through
a countywide process so that all the providers and DCFS and DMH staff are held
accountable to the same outcomes across SPAs. This cannot be accomplished through
expansion of existing children's outpatient mental health services, crisis
services or TBS. It requires a complete overhaul of the county's mental health
services for class members and change in practice by DCFS, DMH and provider
staff, and should be coordinated with the financing strategy consultants.
Providers need assistance in developing their expertise in delivering these
services. This need is particularly acute for providers who deliver trauma
treatment for children. DCFS should, with the assistance of DMH and the Panel,
enlist external consultants to provide training and consultation in these areas
for the provider community.
- Expand Wraparound services: The information DCFS shared orally in
August 2005 about the Department's anticipated expansion of Wraparound is not
in their draft plan, so the relevance and likelihood of this initiative’s
occurring is not known. Expansion is needed and the Department must strengthen
the quality of Wrap programs. In concert with DMH, the Department should implement
a two-year initiative to significantly increase available Wraparound slots
and to provide training and technical assistance to Wrap providers. With the
advice and approval of the Panel, the Department should retain waparound consultants.
The Department should expand eligibility for Wraparound services to include
children who do not have intact families and those placed in Level 10 and above
residential settings.
- Create treatment foster care: A substantial number of
class members who are seriously emotionally disturbed experience placement
in congregate settings
inappropriate to their needs, frequent placement disruptions, failure in
school, lack of permanency, entry into the juvenile justice system and/or
may become runaways. The Department has no effective clinically appropriate
resource for these youth and spends countless dollars ineffectively responding
to the impact of unmet needs. To meet the needs of these children and youth,
the Department should implement a treatment foster care initiative, with
the assistance of the Oregon Social Learning Center (OSLC) coordinated
with DMH.
- Transitioning youth from group care to family based settings:
The Department needs to establish an aggressive downsizing and redirection
target
for group care. Dollars should be redirected to help fund the development of
home-based options. If State approval is required for the state dollars, immediate
steps should be taken to secure the necessary waivers.
To prevent back-filling
of group care a systematic clinical utilization management system needs
to be established to ensure that only appropriate referrals to
group care are made and that children and youth instead are provided
intensive home-based services with families and foster families
- Implement a financing strategy: To identify the cost of needed
system improvements and to maximize the use of existing county, state and
federal
financial resources, DCFS should, with the advice and approval of the Panel,
retain the assistance of consultants expert in the claiming of Medicaid and
Title IV-E training, California funding procedures and redeployment of existing
funds. The consultants, with the participation of the Panel and DCFS staff,
should analyze opportunities to increase revenue available for the needs of
the plaintiff class and identify the changes and actions needed to maximize
existing resources and develop new resources. In planning for use of new Proposition
63 dollars, the County should insure that the services identified as needed
in this plan are included. In addition, financing consultants should be made
available for technical assistance to providers on making maximum use of Medicaid.
Improve Data Outcome Trend Analysis and Implement a Qualitative Review Process
- Data trend analysis reporting: The ability to track outcome
trends is crucial to determining the Department's compliance with the Katie
A.
settlement agreement.
It is the opinion of the Panel that additional external technical
assistance is needed to facilitate the design of the process for providing
trend
data. In consultation with and with the approval of the Katie A. Panel,
DCFS should retain a research organization, such as the Chapin Hall Center
for Children,
to assist it and the Panel in measuring the progress of the plaintiff
class.
Tracking mental health services provided to each class member by
SPA is necessary, including the needs of each child, the specific services
provided to the child
and family, the outcomes, and the refinement of services for the child
and family to achieve improved outcomes.
- Development of a qualitative review process: A qualitative
review process that examines current child and family status and system performance
would significantly enhance the planning for and measurement of progress within
the system. The Department should participate in the qualitative review of
200 cases of plaintiff class members, selected randomly and stratified by the
percentage of children in group care, foster care and bio-family/kinship settings
in the general population of the class. The Panel will develop the qualitative
protocol and reviewers will be selected and trained by the Panel. DCFS staff
should be assigned to observe (shadow) the case reviews and key stakeholders
will be invited to observe as well. The Panel would prepare a report of findings.
For the period of the settlement agreement's term such a review will be conducted
annually. A goal of the process will be to train and develop reviewers within
the DCFS workforce, who can constitute a portion of the review work force in
future reviews.
This is also the basis for the federal government's state child
welfare
performance measurement process, the Child and Family Service Review (CFSR).
It is used
as a practice-improvement tool in state child welfare systems and in a growing
number of states where child welfare class action settlement agreements are
in place, it is used by court monitors to judge compliance and progress.
Alabama, where the process originated, Utah, Hawaii, Washington DC, Tennessee
and New
Jersey are states where the process is a part of formal court monitoring.
Because
it examines current child and family status (safety, stability, emotional
well-being, progress in school, for example), the qualitative review approach
provides immediate feedback about the level of child and family functioning.
The process also helps identify why outcomes are not being achieved, information
vital to developing plans for corrective action.
Interview information
collected in person from parents, foster parents, children, caseworkers,
mental health therapists, teachers, attorneys and other providers
on each case and aggregated across the entire sample gives an accurate picture
of current status and the system's performance. Performance is quantified on
a six-point scale and when aggregated to provide an acceptability score for
the population reviewed, helps identify if the system is being successful over
time and how it is achieving success (or failing to achieve it). The case stories
also identify themes regarding system performance that guide system improvement
efforts to address those themes. An approach such as this, even for a relatively
small group of children and families, would provide current critically important
feedback on an ongoing basis about outcomes and the areas of system performance
that need improvement to affect outcomes
Standards for Exit
The parties did not choose to set specific exit criteria at the time of settlement,
but the Panel believes that such a step is now timely if there are to be clear
targets for improvement. The Panel recommends the following three areas be
adopted as exit criteria. The Department would have to achieve all three of
the standards listed below.
- Successful completion of a meaningful implementation plan: The Panel
recommends that it be authorized to identify key elements of the completed
plan that would become enforceable and serve a key element of compliance
measurement.
- Acceptable class member status and system performance scores on
a qualitative review process: In an annual review, exit standards would require
an overall score of 85% on status and system performance, with at least the
following elements core of system performance measurement each achieving at
least 70%:
- assessment
- long-term view
- service planning
- teaming
- family engagement/involvement
- plan implementation
- Acceptable progress on outcome trend indicators: the Panel is not comfortable
recommending specific outcome targets as a standard, such as ANo more than
15% of class members will experience more than three placement changes during
a placement episode. What the Panel does recommend is that once a baseline
is established, the Panel be authorized to recommend to the court exit standards
for achievement of outcomes.
Relief
The Panel believes there are at least 10,000 class members whom DCFS and DMH
must be able to identify efficiently. These children and their foster families,
families and other caretakers require intensive home-based services which necessitates
not only a huge expansion of mental health services but a change in the types
of interventions provided, the training and supervision of the staff providing
them, and the way current MediCal billing codes are used. As DCFS develops
the methods of assessing the children's needs and DMH develops the services
that will meet those needs, the line staff of both agencies must have improved
skills (and reasonable caseloads) to engage families and support collaboration
among professionals and families and foster families which results in the achievement
of permanency and child well-being outcomes. Parallel to these changes in DCFS
and DMH, their providers—FFAs, Wraparound, mental health, TBS, family
preservation, group care and others—must be supported in overhauling
what they now offer. In addition, improved outcome data and quality data must
be consistently produced so DCFS, DMH and providers can refine their interventions
and systems over time.
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