The Katie A. Advisory Panel
Seventh Report to the Court
Highlights
On September 28, 2007 the Advisory Panel submitted a report
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. Of significance, detailed in the report is the agreement
that the parties and the panel have reached on principles of practice that
will guide the design and implementation of a Corrective Action Plan to comply
with the court’s November 2006 order and on an operational definition
of the Intensive Home-Based Mental Health Services that plaintiff class members
are entitled to receive.
A. Practice Principles Guiding the Design and Implementation of the Corrective
Action Plan
Fusion of Practice Principles
Child Welfare and Children's Mental Health
Ensuring that the needs of children are identified and that individualized,
intensive home-based services to meet their needs and build on the strengths
of their relatives and foster families are provided in order to increase placement
stability and permanency requires a fusion of practice principles from child
welfare and children's mental health.
The shared goal of DCFS, DMH, and private providers in Los Angeles is a comprehensive,
interagency, community-based system of care in which service providers, relatives,
foster families and informal supports work together collaboratively to meet
children's emotional needs to prevent them from entering foster care and while
they are in foster care. Improvement in the well-being of children and families
is measured by achievements in five outcome areas: safety, health, social and
emotional well-being, economic well-being and education/workforce readiness.
This fusion of practice principles from child welfare and children's mental
health is organized around the three main elements of systems of care: family
strengths/child needs-based approach, multi-agency collaboration in the community
and cultural competence.
1. Services are driven by the needs of the child and preferences
of the family and are addressed through a strengths-based approach
• Children and families are more likely to enter into a helping relationship
when the worker or supporter has developed a trusting relationship with them.
(KA) Staff and families work together as partners in relationships based on
equality and respect (SOC).
• The quality of this relationship is the single most important foundation
for engaging the child and family in a process of change. (KA)
• Children and families are more likely to pursue a plan or course of action
that they have a key role in designing. (KA)
• When children and families see that their strengths are recognized, respected
and affirmed, they are more likely to rely on them as a foundation for taking
the risks of change. (KA) Programs focus on the families' strengths and enhance
their capacity to support the growth and development of all family members, adults,
youth and children (SOC).
• Assessments that focus on underlying needs, as opposed to symptoms, provide
the best guide to effective intervention and lasting change. (KA)
• Plans that are needs based, rather than driven by the availability of
services, are more likely to produce safety, stability and permanency. (KA)
• Children receive the care and services needed to prevent removal from
their families or, when removal cannot be avoided, to facilitate reunification
and to meet their needs for safety, permanence and stability and that they be
afforded stability in their placements, whenever possible, since multiple placements
are harmful to children and are disruptive of family contact, mental health treatment
and the provision of other services (SOC).
• Provide incentives for scientifically proven and cost-effective prevention
and treatment interventions that are organized to support families and that consider
children and their caregivers as a basic unit (e.g., family therapy, home-based
treatment, intensive case management). (SG)
2. The locus and management of services occur in a multiagency
collaborative team and are grounded in a strong community base
• Children experience trauma when they are separated from their families.
When children must be removed to be protected, their trauma is lessened when
they can remain in their own neighborhoods and maintain existing connections
with families, schools, friends and other informal supports. (KA)
• The family's informal helping system and natural allies are central to
supporting the family's capacity to change. Their involvement in the planning
process provides sustaining supports over time. (KA)
• Decisions about child and family interventions are more relevant, comprehensive
and effective when the family's team makes them. Families should always be core
members of the team. (KA) The family serves as a principle decision-maker in
collaboration with members of a multidisciplinary team and a facilitator who
assists in the coordination of needed services (DMH).
• Coordination of the activities of case contributors is essential and
works most effectively and efficiently when it occurs in regular face-to-face
meetings of the family team. (KA)
• Success in school is a reliable predictor of child well-being. When the
direction of planning for safety, stability and permanency is fully integrated
with school plans and services, children are more likely to make progress. (KA)
Systems of behavior support at the school level should emphasize universal, primary
prevention methods that recognize the unique differences of all children and
youth, but should include selective individual student supports for those who
have more intense and long-term needs. (SG)
• A common language must be used to describe children's mental health,
emphasizing adaptive functioning and taking into account ecological, cultural
and familial context. A common language is important to facilitate service delivery
across systems. (SG)
• Issues of confidentiality must be addressed in ways that respect a family's
right to privacy, but encourage the coordination and collaboration among providers
in different systems. (SG)
• Youth must be included in treatment planning by offering them direct
information, in developmentally appropriate ways, about treatment options. As
much as possible, allow youth to make decisions and choices about preferred intervention
strategies. (SG)
• Untreated mental health problems place children and youth at risk for
entering the juvenile justice system. Mental health programs designed to divert
youth with mental health problems from the juvenile justice system must be supported.
(SG)
• An infrastructure must be provided for cost-effective, cross-system collaboration
and integrated care, including support to healthcare providers for identification,
treatment coordination, and/or referral to specialty services and the development
of integrated community networks to increase appropriate referral opportunities.
(SG)
3. The services offered, the agencies participating and programs
generated are responsive to cultural context and characteristics
• Many of the services and resources that children and families find
most accessible and responsive are those established in their own community,
provided within their own neighborhoods and culture. (KA) A comprehensive and
culturally competent continuum of care for all children. Services and supports
are available and accessible to children and families in their respective local
communities. (DMH)
• Programs acknowledge cultural differences, provide culturally competent
services, and affirm/strengthen families’ cultural, racial, and linguistic
identities, while enhancing their ability to function in a multicultural society.
(SOC)
• Programs are embedded in their communities and contribute to the community
building process. (SOC)
• Families are resources to their own members, to other families, to programs,
and to communities. (SOC)
• Practitioners work with families to mobilize formal and informal resources
to support family development. (SOC)
• Reunification occurs more rapidly and permanently when visiting between
parents and children in custody is frequent and in the most normalized environment
possible (office based visits and supervised visits are the least normalized
environment). (KA)
• Children in foster care who are transitioning to adulthood are most successful
in achieving independence when they have established relationships with caring
adults who will support them over time. (KA)
• The service array should be sufficiently flexible to be adapted to the
unique needs of each child and family. Services and supports best meet child
and family needs when they are provided in the family's natural setting or for
children in custody, the child's current placement. Services should be flexible
enough to be delivered where the child and family reside. (KA)
• A menu of seamless (non-categorical) mental health, substance abuse and
related support services and resources should be provided. (DMH)
• Programs should advocate with families for services and systems that
are fair, responsive, and accountable to the families served. (SOC)
• Accessible, culturally competent, scientifically proven services that
are sensitive to youth and family strengths and needs must be provided. (SG)
B. Defining Intensive Home-Based Mental Health Services
To provide greater clarity for the County and service providers about the
approach to serving children and families, the parties and the Panel developed
the following working definition of Intensive Home-Based Mental Health Services.
Intensive Home-Based Services
Based on the federal Child and Adolescent Service System Program (CASSP) principles
and the literature on evidence-based services for SED children and families,
intensive home-based services can be defined as:
Intensive home-based services are a well-established intervention designed
to meet the child's needs in his/her birth, kinship, foster or adoptive
home and in the community where the child lives. The planning and provision
of intensive home-based services require an individualized process that
focuses on the strengths and needs of the child and the importance of the
family in supporting the child. Intensive home-based services incorporate
several discrete clinical interventions, including, at a minimum, comprehensive
strength-based assessment, crisis services, clinical case management, family
teams, and individualized supports including one-on-one clinical interventionists.
These services must be provided in a flexible manner with sufficient duration,
intensity, and frequency to address the child's needs and guide his/her
caregivers.
Individualized services must be designed to meet the unique needs of each
child and build on the child's and family's strengths. It is essential to have
birth, kinship, adoptive and foster families involved in planning services
with professionals from mental health, child welfare, school and other agencies
and the family's informal supports. The complex needs of these children require
integrated services, and team planning is essential and cannot be separated
from the interventions. Intensive home-based services are an individualized
child-focused, family-centered approach that is offered by a range of providers
and is not limited to wraparound, system of care, MST, MTFC or FFT programs.
If providers are not offering one of these programs, they will be given guidance
to incorporate the clinical principles and approaches of evidence-based practices
as they design culturally-competent intensive home-based services. Effective
services for emotionally disturbed children require enhanced care coordination,
often daily individual clinical interventions for the child, and guidance for
caregivers (including teachers) for which traditional outpatient therapy is
not sufficient in number of hours, flexibility, or family functioning focus.
Safety, stability and permanency for children are most likely when birth, kinship,
adoptive and foster families are guided to manage their behaviors and do not
have to travel to receive intensive services. Usually the team will not plan
office-based services for the child and family, with the exception of medical
services and medication management that cannot be provided in the home or community.
Intensive home-based services do not designate a position to provide one-on-one
support to the child (such as a mentor or Therapeutic Behavioral Services)
or to guide the caregiver (such as a parent advocate or a family specialist):
the team decides whether a therapist or a paraprofessional can most effectively
meet this child’s needs and the provider ensures that this person has
the clinical training and supervision to do so. Usually the team will provide
crisis services so the child and family know the individuals helping them in
a crisis (instead of an unknown mobile crisis team). When the child is living
with kin or a foster family, not only will that family be provided guidance
for caring for the child, but the prospective permanent home where the child
is likely to be placed will also be prepared for meeting the child’s
needs with similar intensive home-based services during visits. When the child
is living with his/her siblings, a team will be assembled with all the individuals
supporting all the children to develop a needs list for each child and tailor
intensive home-based services to meet their needs and support their caretakers.
When the child is a teenager, he/she will be actively involved in the team
with the goal that she/he will agree with his/her needs list and contribute
to the design of services.
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