HomeMy WebLinkAboutMINUTES - 07082003 - C108 FHS #14
TO: BOARD OF SUPERVISORS .....L Contra
FROM: FAMILY AND HUMAN SERVICES
COMMITTEE
Costa
DATE: June 24, 2003 °sra'c vK G�� County
SUBJECT: CC Futures Status Report
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION(S):
1. ACCEPT the attached report on the status of CCFuture and the recommendations
contained within.
2. AUTHORIZE Contra Costa County Administrator's Office to accept the Stuart Foundation
second grant payment of$125,000 from the East Bay Community Foundation who is
acting as fiscal intermediary.
FISCAL IM'P'ACT: None
BACKGROUND/REASON(S) FOR RECOMMENDATION(S):
On June 16, 2003, the Family and Human Services Committee received a status report on the
CCFutures project. Supervisor Mark DeSaulnier provided an introduction. Sara Hoffman,
Assistant County Administrator, gave a brief overview and background of the project. Sherry
Rufini and Mary Kay Millier updated the Committee on the progress made by the Welcome
Home Baby program and the success associated with the services provided. Ruth Ormsby
provided an update on the Spirit of Caring project. Kathy Armstrong also gave an update on
the Data Archive,
CONTINUED ON ATTACHMENT: X YES ---SIG,CATURE:------ ------------------------------------------ --RECOMMENDATION OF COUNTY ADMINISTRATOR RECOION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S): jF DERAL GL VER,CHAIR J� tZ41MA,MEMBER
ACTION OF BOARD ONJITLY 8-_2003 APPROVE AS RECO M LADED OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS{ABSENT IV AND) CORRECT
AND ENNTERED ON TACTIONY OF AN EN
HE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN,
ABSENT: ABSTAIN:
DISTRICT III SEAT VACANT ATTESTED QTLY 8,2Q43
CONTACT: Dorothy Sansoe JOHN SWEETEN,CLERK OF THE
335-1009 BOARD OF SUPERVISORS AND
CC: Sara Hoffman
COUNTY ADMINISTRATOR
CAO
ry
DEPUTY
BY
..........-................
FHS #14
Contra Costa County has a long standing commitment to moving our systems from crisis,
safety net and remediation services to early intervention and prevention. CCFutures was
conceived to support the move toward increased investment in early intervention and
prevention programs. A work plan for June 2003 through December 31, 2004 was developed
which includes the following objectives and program activities:
1. Maintain and update the Children and Family Data Archive and make it available to all
County agencies for program planning, development, and evaluation purposes.
2. Document the effectiveness of Welcome Home Baby and Spirit of Caring reinvestment
strategies by collecting data on program performance and cost avoidance to the
County.
3. Initiate The Future Fund, a sustainable funding resource for effective prevention
programs and investigate the feasibility of augmenting it with additional revenue
sources.
County of Contra Costa
OFFICE OF THE COUNTY ADMINISTRATOR
MEMORANDUM
DATE: June 16, 2003
TO: Family&Human Services Committee
Supervisor Federal D. Glover, Chair
Supervisor John Gioia, Member
FROM: Sara Hoffman 5(
Assistant County Administrator
SUBJECT: CCFUTURE STATUS REPORT
RECOMMENDATIONS:
Recommend that the Board of Supervisors:
1. ACCEPT the report on the progress of CCFuture in developing and testing the
Children's Prevention Strategy and Investment Tools.
2. DETERMINE that Welcome Home Baby(WHO)and Spirit of Caring(SOC)
proposed data collection plans are sufficient to demonstrate cost avoidance,
thereby making the programs eligible for funding from The Future Fund.
3. AUTHORIZE Contra Costa County Administrator's Office to accept the Stuart
Foundation second grant payment of$125,004 from the East Bay Community
Foundation who is acting as fiscal intermediary.
4. EXPRESS appreciation to the S.H. Cowell Foundation, East Bay Community
Foundation and The Stuart Foundation for their financial support of CCFuture and
their commitment to prevention and early intervention programs for children and
families
5. Accept CCFuture Status Report and approve CCFuture's work plan for June
2003-December 31, 2004,which includes the following three objectives and
program activities:
1.Maintain and update the Children and Family Data Archive and make it
available to all County Agencies for program planning,development, and
evaluation purposes by.
• Once fully installed in Children's Mental Health,the SOC Policy and
Planning Council and Children's Policy Forum Executive Committee will
be given a demonstration of the Data Archive's capabilities;
• Update the Data Archive with data from all sources through 2002;
• Seek Health Services Department's permission to install County birth
certificate data;
• Program and input data on child care from Community Services, 1995-
2003;
• Use the Data Archive to map community status on VVHB and SOC
outcome objectives from 1995-2003;
• Provide access to Data Archive to all interested County Departments
serving children.
• Explore all available funding sources to maintain and expand the Data
Archive.
2. Document the effectiveness of WHB and SOC reinvestment strategies by
collecting data on program performance and cost avoidance to the County.
• VVHB and SOC will document,relying upon program performance
software and Data Archive,achievement of children and family
outcomes as well as community outcomes;
• WHB and SOC will track historical data related to each outcome;
• WHB and SOC will develop cost estimates of the services provided;
• WHB and SOC will document the value of avoided costs to the
County General Fund.
• Prepare reports describing program achievements, cost of providing
services,and tally of estimates of general fiord dollars saved through
WHB and SOC program activities.
3. Initiate The Future Fund, a sustainable funding resource for effective
prevention programs and investigate the feasibility of augmenting it with
additional revenue sources.
• Initiate a process to implement The Future Frond, as directed by the
Board of Supervisors,including criteria for fund allocation,process for
applications,review of proposals and monitoring of grants;
• Develop a concept paper on The Future Fund outlining the purpose,
value,funding alternatives and stakeholders;
• Engage other stakeholders in a dialogue on the concept paper;and
• Explore additional possible funding alternatives,identify their
potential revenue stream; necessary actions to capture those revenue
streams;necessary governing body approvals;and next steps.
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BACKGROUND:
CSC UT7141RE. Purpose and Project Background
Over the last three years foundation grants from S.H. Cowell Foundation, East Bay
Community Foundation, and The Stuart Foundation have provided resources to develop
and test the application of"CCFuture Children's Prevention Strategy and Investment
Tools" in two inter-agency, comprehensive systems of care pilots:
❑ Welcome 11tone Baby(tl'HI3) -in-home visitation to all first-time parents,
regardless of income. The program goals are to increase well baby care,
immunization rates, enrollment in a primary health home,parenting skills, and
reduce abuse and neglect, thereby reducing out-cif-home placements. WB B
program was first piloted in Concord's Monument Corridor and is currently
serving first time families at selected hospitals countywide. It hopes to expand to
Alta Bates Medical Center in 2003-2004. The County's Employment and Human
Services Department(EHSD)initially funded WHB through federal TANF.
Proposition 10 funds now also support the program.
❑ S'pi'rit of'Caring Progrmn (.V00 -comprehensive and integrated service
delivery system for children and adolescents with serious emotional and
behavioral difficulties,utilizing a wraparound model consistent with core System
of Care values(individualized, family driven, culturally competent, least
restrictive, community based). SCC focuses on children and adolescents at high
risk of residential placement, referred by Probation, Employment and Human
Services, Children's Mental Health and/or the schools. The program goals are to
improve the ability of youth to function in society, succeed in school and remain
at home, thereby reducing the need for/length of stay in cut-of-home placement.
SOC program is funded under a six-year federal grant(commencing October
1999).
WHB and SOC Programs are testing the applicability of the CCFuture's re-investment
tools and strategy for documenting the improved well-being of children and families and
cost avoidance of negative outcomes by:
➢ Working with County Leadership to sustain prevention programs that demonstrate
achievement of their program goals and thereby avoid the more costly
interventions associated with negative outcomes;
➢ Testing how well the Children and Family Data.Archive supports program
planning efforts to target program resources to high need neighborhoods and to
substantiate changes over time in the health and well being of communities.
➢ Using program performance software to track services provided, outcomes
achieved and County-avoided costs through reduced out-of-home placement
and/or inappropriate emergency room use as well as increased enrollment in
Medi-Cal's EPSDT/CHDP and Healthy Families health insurance programs.
{Welcome Home Baby's vendor is Corporation for Standards and Outcomes
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(CS&0) whip Spirit of Caring is using the Clinical Data Solution's Clinical
Manager software]; and
➢ Leveraging or braiding eligible categorical dollars and private funds to maximize
dollars available for prevention and early intervention programs.
By December 31, 2444 the two pilots will be able to provide Contra Costa County
Supervisors with sufficient documentation of cost avoidance of County General Fund
dollars and thereby help ensure their sustainability. The data will show that each pilot:
+ Improved specific children's outcomes,
• Leveraged all relevant categorical funding and
+ Helped the County"avoid expenditures" for high end, costly services.
11. Progress On Achieving CC I{uture Objectives/Goals.
In this section we describe progress made in accomplishing CCFuture's four program
implementation objectives during the time period January 2042-April 2003. Each pilot
program has just recently became fully operational and therefore has limited data
available at this time on their performance in achieving children/family and community
level objectives. This data will be available by December 31, 2004,
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TABLE A: CCFUTURE STUART FO NDATION GRANT OBJECTIVES
Program implementation Objectives:
1) Welcome Home Baby and Spirit of Caring Programs will use the Children and
Family Hata Archive for planning,targeting of services,and evaluation.
2) The two programs will gain increased,unprecedented access to children and family
related categorical dollars and private resources.
3) Each program will implement program performance software to document
programmatic impact on improving children and families' outcomes.
4) The County will reinvest a significant portion of identified county dollars saved
through the Welcome Home Baby and Spirit of Caring programs into the expansion
of each program.
Improved Children And Family Outcomes:Objectives For The Welcome Home Baby
Program:
1) 85%of first babies in select hospitals will be served.(As of this year,WHB has
served 1,200 of 12,000 county births,about 100%and about 25%of all first babies--
1,200 of 4,800.)
2) 85%of all new parents eligible for Healthy Families and Medi-Cal will be enrolled
and have access to health prevention and early intervention services.
3) 85%of families enrolled in the Welcome.Home Baby program will be under the care
of a primary health care provider.(As of this year,960/0 are enrolled.)
4) The number of reports of child abuse and neglect among 0-3 year old children
enrolled in the Welcome Home Baby Program will be significantly less than a
comparable sample of children living in Contra Costa County.
5) The number of out-of-home placements of children served by the Welcome Home
Baby Program will be significantly less than a comparable sample of children living
in Contra Costa County.
6) 95%of parents will report that they read to their baby.
7) The number of second births to teen mothers served by the Welcome Home Baby
Program will be significantly less than a comparable sample of teen mothers living in
Contra Costa County.
8) 35%of mothers enrolled in Welcome Home Baby Program will be breastfeeding their
babies.
9) 801/o of parents served by Welcome Home Baby will report a sense of increased
parenting skills directly related to the assistance they received.
10) Contra Costa County will realize a cast avoidance in three areas:
a. Reduced number of substantiated cases of child abuse and neglect in
children ages,0-3,living in selected zip cedes;
b. Reduced number of hospitalizations for unintentional injuries by of children
ages 0-3
c. in selected zip codes;
d. Reduced number of out of home placements by children,ages 0-3,in
selected zip codes.
Improved Children And Families Outcomes: The Spirit Of Caring Program will ensure:
1) 25$/0 of youth referred to the Spirit of Caring Program from Mental Health,Probation,
Social Services,and Schools who are identified at high risk of out-of-home placement
in residential treatment programs or psychiatric hospitals will be maintained in their
own home,receiving"wrap-around services."
2) County rate of out-of-home placements in residential treatment programs or
nsvchiatric hospitals for youth with senously emotional Droblems is reduced by 25%.
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(Given the complicated influences affecting the county wide placement rate for youth
with emotional problems being placed in residential programs or psychiatric
hospitals,SOC believes a 25%reduction in total number of days is achievable,but
uncertain if a 25%reduction in the actual number of childrentyouth being placed can
be achieved by the enol of the three year project period.)
3) Youth served by Spirit of Caring will have reduced length of stays in residential
treatmentprograms compared to a comparable sample of youth not receiving wrap
around services and family support.
4) Participating families will report a high level of satisfaction with wraparound services
and decreased family stress.
t
risk communities th re will be:
A reduction of out-of-home placement by children,ages 4-5 and by youth
experiencing seriously emotional problems compared to the number placed in the last
five years.
2) Increase enrollment in Healthy Families,Medical,and EPSDT compared to
enrollment in the last five years.
3) Increased immunizations of children compared to the number immunized in last five
years.
Progress to date and challenges Faced in accomplishing each of the four
programmatic objectives listed in Table A are discussed below,
1). Welcome Home Baby and Spirit of Caring Progrc nis will use the
Cliddren and Fainily Data Arehive for lrlrrr nirtg, targeting oJ'services, and
evaluation.
Progress to Date: In January 2003, the Children and Families Policy Forum Executive
Committee authorized the Children's System of Care Planning and Policy Council to
assume oversight responsibility for the transition and maintenance of the Children and
Families Data.Archive, replacing the ad hoc data user group committee.
The Children's System of Care Planning and Policy Council, initially established three
years ago to oversee the Spirit of Care Project, consists of representatives of the school
districts, as well as those County Agencies serving children and families. Most members
of the Executive Committee also have representation on the Policy Council. The Policy
Council routinely reports to the Executive Committee and can provide annual updates on
the Data Archive's progress. The Policy Council is able and willing to provide the
managerial support and guidance now required to ensure a smooth transition of the Data
Archive from the contractor,Resource Development Associates(RDA)to County
supervision.
Children's Mental Health is an ideal sponsor to Douse and oversee the Data Archive
because its Research and Evaluation Unit has the expertise needed to successfully
manage its operations.. Also, SCLC has access to highly competent information system
consultation and technical assistance provided by the Health Services Department(HSD)
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that has agreed to commit resources for oversight, programming, and maintenance of the
system.
In January 2003, RDA completed programming of the Data Archive and has begun
installing it in the Children's Mental Health Division. At this time the Data Archive
contains data on all sources from 1995-2000 and data on SOC, Probation, and EHSD
through 2001. During March and April, SOC will test the reliability of the Data Archive
and work with RDA to complete final programming modifications. During this testing
period, SOC will team how well the Data Archive supports its program planning,
monitoring, and evaluation efforts.
When SOC's has completed its internal test of the Data Archive, it will sponsor a
demonstration of the Data Archive to all County participants. RDA will make any further
programming modifications noted in the demonstration as a part of its existing contract
with the County.
WHB will be able to use the anonymous statewide birth and death certificates data base
programmed into the Data Archive to track numbers of children born to teens, births by
geographical location and ethnic groups. However, this public data set is always two to
three years behind actual time so it is not an ideal substitute for County birth certificate
data. The Data Archive will become more useful to WHB once HSD agrees to input
County birth certificate data and Community Services inputs its data on childcare.
Until the Data Archive can include all data sources required by WHB, we are relying on
aggregated, anonymous data received from Proposition 10 evaluation and EHSD. Also,
WHB is hoping to obtain needed data from Health Services regarding primary care
physician, medical data, breastfeeding, immunization, prenatal care, and CCRMC
hospital data. WHB also hopes to compare Contra Costa County results with findings
obtained in national evaluations and data analyses by Debra Daro at Chapin Hall.
Zellerbach Family Foundation has provided a small grant to allow WHB to hire a person
to mine the EHSD database.
ONCE THE DATA ARCHIVE is DEEMED COMPLETELY OPERATIONAL CCFuTuRE
WILL SEEK OUT THE FINANCIAL RESOURCES FROM MEMBER DEPARTMENTS TO
INSTALL THE DATA ARCHIVE(OUTPUT COMPONENT)IN THEIR AGENCIES AND
TO FUND THE SYSTEM'S CONTINUED UPKEEP.
Challenges: CCFuture cannot input data from Employment and Human Services
(EHSD)CAL WORKS Data Base into the Data Archive. This database has severe
fundamental limitations' that make it impossible to link its information to information
gained from other sources. There have also been difficulties in programming the Child
Welfare data, but we are optimistic that these problems will be solved with additional
assistance from EHSD personnel. Overall, the most persistent difficulties facing
' The CalWORKs database was designed over 20 years ago and was never meant to provide a historical
record of client interactions.Each time a worker enters new information on a client the system over-writes
the previous information,leaving no historical record in place.
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CCFuture is coping with the slow pace of obtaining data from member agencies, cleaning
and inputting data into the Data Archive, programming each unique data set into the Data
Archive, incomplete and missing data in the original source data sets, and frequent staff
changes in county agencies that lead to pour coordination with our contractor.
Perhaps, the greatest challenge will be full "buy-in" from the participating agencies in
terms of repeatedly providing refreshed data in a timely fashion, funding of basic
maintenance and upkeep along with any additions, changes„ expansions, and agreement
on how to allow data to be used. Obviously, the will to overcome these challenges will
be much greater if the system proves to be highly valuable as a tool for examining
populations and services.
2). WHR and SOC:will gjdn increased, unprecedented access to all
children and airily related categorical dollars and private resources:
Progress to Date: The Fiscal Work Group has assisted the Health Services Department
(HSD)and the Employment and Human Services Department(EHSD)to better
understand how each department's funding streams constitute sustainable funding
sources required by the other department's programs.
HSD has nearly completed the inter-department agreement with EHSD to allow WHB to
bill Medicaid's Targeted Case Management for reimbursing paraprofessionals' home
visits to families and Medicaid Administrative Activities claiming for all outreach and
project efforts to enroll and support families use of Medi-Cal. "VVI expects to begin
billing Targeted Case Management funds this fall and will be able to bill Medicaid
Administrative Activities next year.
SOC is funded with a six-year federal grant,which Children's Mental Health has
successfully leveraged to maximize EPDST Mental Health dollars and public school
funding. To date no progress has been made in gaining EHSD' permission to submit a
SB 163 waiver request to the State. It is hoped that as SOC documents strong positive
outcomes for children and families achieved through its wraparound service methodology
it will be able to allay EHSD' concern about the waiver's fiscal risk in permitting the
waiver. If Children's Mental Health could access SB163 funding for wraparound services
through EHSD,these State dollars could sustain the SOC programs and services that are
currently supported by the federal,grant.
Challenges: Due to extreme budget cuts,the County has not hired a Management
Analyst to replace Jason Crapo, staff to the Fiscal Work Group. The Fiscal Work Croup
has not met since Jason's departure. Despite this setback,the work undertaken before
Jason's departure is bearing fruit. Due to the Fiscal Work Group's previous efforts WHB
is now in the final stages of obtaining Health Services permission to access Medicaid
categorical funding sources, Targeted Case Management and Medicaid Administrative
Activities, previously not available to it.
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Foch pilot is locating, rtdttptittg and implementing Progrnttt
Pe�fortnottceSofiwrtre into dlnili operations.
Progress to Date: Both WB and SOC have obtained and installed Program
Performance Software able to document:
✓ Who is served(demographics, severity, and,geographical location),
✓ What services are provided and what intensity of services are provided,
✓ Outcomes of services provided, and
✓ Cost of serving families to achieve the outcomes.
In December 2002, SOC/Children's Mental Health staff installed the Clinical.Manager
program performance software, developed by Terry Harte, Clinical Data Solutions,
Madison, Wisconsin. Modifications and updates to the program software are nearly
finished. It is expected that the program performance software will be fully functional by
late spring. During spring and summer all staff will be trained and data inputting begun.
SOC expects to have data available to track program performance by fall, 2003. Among
many other benefits,the system will be especially useful in tracking the use and costs of
the non-traditional services that are fundamental components supporting the wraparound
philosophy and approach.
The Clinical Manger is located on the County's mental health server. Staff located in
each regional clinic will have their own unique clearance and access. It is still unclear
when data on past clients will be input into the Clinical Manager. Although the evaluators
would like to have historical data on all clients served by the program since its inception,
much depends upon staff time and resources.
WHB has fully implemented the CS&O Program Performance Software and is using the
data to monitor and inform improvements in program performance. WHB recently
provided a demonstration of CS&O to Supervisor Mark DeSaulnier, Chairman of the
Board of Supervisors, on its capacity to track the duality of services being provided to
each family. This data collected by CS&O will help WHB gather the needed
documentation for claiming both Medi-Cal Targeted Case.Management(TCM)and
Medicaid Administrative Activities(MAA).
The CS&O software provides aggregated data on demographics, individual family
outcomes, and casts associated with serving each family. The data can be extensively
manipulated in an Excel format to provide real time pivot table reports for funders and
collaborating agencies. This program data as mentioned before allows WHB management
to maintain high standards of accountability. Supervisors now have the ability to monitor
the results of each home visit and to track the progress of individual families as well as
home visitors individual caseloads. CS&O program is internet-based and therefore is not
constrained by the available memory in a desktop computer or laptop carried into the
home. Currently WHB has entered information on 1,000 families and is able to use
program data for planning on where and how to provide services to families with young
children.
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4). The Cnt nni will reinvest as significant portion of'iclentffiled c oullty
dollars saved through the Welcome Home Baakv and Spirit of C raring
programs into the expansion ref each progrrarra.
Progress to Date: CC Future has a two-pronged fiscal strategy:
I. Leverage every discretionary dollar to maximize collection of all eligible
categorical funds.
2. Demonstrate a cost reduction in the expenditure of county general fund dollars
as a direct result of specifically identified program achievements. Persuade
decision makers to sustain programs based upon documented cost reductions.
Much progress has been achieved on leveraging discretionary dollars. WHB entered into
an agreement with the Health Services Department, (ISD),which provided the means to
access both TCM(Targeted Case Management)and MAA(Medi-Cal Administrative
Activities) funding. WHB Preposition 10 funds provide the match needed for both
funding sources. It is estimated that WHB will earn approximately $500,000 a year from
bothcategorical funding sources once HSD completes the administrative process required
to allow WHB to claim TCM and MAA..
SOC hopes to demonstrate its effectiveness in helping the County avoid high costs
associated with residential placement of youth with severe emotional problems to the
Employment and Human Services Department(EHSD)and receive approval to seek a
SB 163 Child Welfare Waiver. If SOC obtains a SB 163 Waiver, it will have tapped into
every categorical dollar for which they are currently eligible.
Tables B and C present a summary of WHB and SOC reinvestment strategies, each of
which is designed to demonstrate that as a direct result of SOC/WHB's achievement of
their children and Family outcomes, the County will realize a significant reduction in
costs associated with negative outcomes, thereby avoiding a substantial drain on county
general funds.
Each program reinvestment plan relies upon historical trend data to project possible
placement rates absent the two programs. The historical trend projections will be
compared to the actual rate ofplacement of children 0-5 and adolescents with severe
emotional problems placed in out-of-home placements since the two programs have been
fully operational.
V4M will make every effort to use a similar methodology to show that its program
reduced inappropriate use of emergency room and the number of teens having second
babies.
Current status of state and county budgets creates a climate of uncertainty regarding
ongoing funding of county programs. Each County Department has been asked to absorb
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their share of the local revenue shortfall as well as any reductions due to state actions.
Most believe that County dollars will be required to match existing categorical funding
sources for mandated services.This will significantly reduce the amount of discretionary
dollars available for reinvestment opportunities.
In light of the budget uncertainty,CCFuture's strategy is to pursue all appropriate
categorical funding sources--Medicaid Targeted Case Management,Medicaid
Administrative Claiming,EPS'DT,and a SB163 Waiver--to help sustain the two pilot
programs as current funding sources decline. Every effort will be made to ensure all
eligible families are enrolled in Medi-Cal and/or Healthy Families.
On January 28,2003,the Contra Costa County Board of Supervisors approved a board
order establishing in concept The Future Fiend,a pool of discretionary dollars to be set
aside for supporting effective prevention programs serving children and families, it reads:
If the Future Fund is included in the FY 2003-04 Budget, the County
Administrator is directed to focus prevention efforts initially in the Monument
Corridor area of the City of Concord earmarking annual Transient Occupancy
Tax(TOT) to be received from the Renaissance,Suites Hotel in the County's
Pleasant.Hill BART Redevelopment Project
With this direction,the County Administrator included$100,000 from anticipated TOT
revenues in the 03-04 Recommended Budget,which will be considered by the Board of
Supervisors on June 24,2003. The fust priority for use of these revenues will be County
programs in the Monument Corridor.
With the Board of Supervisors approval of the concept of The Future Fund and allocation
of revenues,a structure needs to be put into place for implementation of The Future
Fund. This would include a criteria for allocation of funds and a grant-making structure,
including a process for submittal of applications,their review and monitoring of allocated
funds.
Additional funding options could be explored that would expand The Future Fund's
capacity to fund effective prevention programs located throughout the County,such as an
amendment of the Master Tax Sharing Agreement between the County and cities,which
governs the distribution of future property taxes,sales taxes and other revenues from
properties annexed by a city. Usually,the property is undeveloped or newly developed
and so neither the city nor the County depends upon those revenues to meet current
operating requirements. Any changes to the Master Tax Sharing Agreement would
require approval of both the County and City involved in the annexation. Consequently,
the use of such revenue may be subject to differing terms and conditions.
There are also many challenges involved in proving the accomplishments of WHB and
SOC.It is still not clear that the data required to document and substantiate the
reinvestment will be available. Further,because documenting avoided costs is
impossible,we must rely on"logical inference"to make our case,but as we all know
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there are severe limitations on the evidence available. In scouring the literature we Bund
only two related cost effectiveness or cost benefit studies relevant to our two pilot
programs. We will continue our search, but it appears that up until now, most studies on
program effectiveness have failed to incorporate a cost-effectiveness capability.
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TABLE B: SOC REINVESTMENT STRATEGY
Plan for Demonstrating Cost Reduction in County General Funds'
A. SOC Cost Reduction Plan will provide answers to the following 4 questions:
1. Did SOC demonstrate a reduction in the length of stay of 15 youth by"(from 24
months to 16 months)that would;without SOC inkwention,remain placed in out-of-
home care in levels 13,14,15 residential facMes?
2. What evidence does SOC provide that shows that the length of stay was reduced directly
as a result of OC activities?
3.How much did SOC spend on efforts related to reducing length of placement in levels
13,14,15 facilities by 113?
4. What county costs were avoided as a direct result of SOC activities mentioned above?
Given limited resources,it is not possible to conduct"a state of the art cost-benefit analysis"
because neither a matched comparison nor random assignment to intervention and control
group could be accomplished with current funding.Even if we could convince the county to
do random assignment,the resources do not exist to perform the painstaking data collection
necessary to document cost-benefit results.Further,for many preventable poor outcomes
there are no well-established monetary values assigned to all the dimensions of achieving
positive outcomes.2
B. Spirit of Caring(SOC)will undertake the following activities to document its case of
reducing county costs for placement of youth in high end residential treatment
placements:
1.TM&t Pomlation•
SOC will identify those severely emotionally disturbed(SED)children who are currently in
expensive residential/group home placement. Criteria for eligible children/youth include:
4 Enrolled into the system of care by an interagency case management team
• Child/youth is placed out-of-home,hospitalized,incarcerated or not
attending school,or is at risk of any of these adverse outcomes
0 Enrolled child/youth is the focus of interventions funded through
the'interagency enrollee based program►"allocation
• Under the age of 18
* Shows a mental health disorder(other than primary substance abuse or
developmental disorders)that results in behavior inappropriate to the child's age
Shaff meet one or more of the following criteria:
0 Substantial impairatent in at least two areas;self-care,school functioning,family
relationships,or the ability to function in the community;
* Impairments have been present for six months or likely to continue for more than
one year without treatment
• Child shows psychotic features,risk of suicide or violence
* Child meets special education criteria due to a"Serious Emotional
2 Analyzing the Costs and Benefits of Early Childhood Interventions.
http://wvvw.rand.orgtMblications/RB/RB5051. Credible measures of benefits and costs require a
comparison group.A group of children who are tracked along with the program participants and who are
as similar as passible to the latter except that they do not participate. With no comparison groupsyou will
be unable to prove that the benefffsjwu measured would not have been realized without the program. (See
#2 footnote reference)Also,relied on:Using Cost Analysis in Evaluation.Meg Sewell and Mary
Marczak.bt!p://ap,.anzona.edu/fcr�/ff§Lcyfar/Costben2.htin
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Disorder"(defined by Chapter 26.5 of the Government Code)
2 Iletermine cost of service Mudd cog.of avoidance:
SOC plans to gather baseline data(12 months historical data)on the total costs for placement
and mental health services for these children.This population,once identified,would receive
the specialized Wraparound Services in order to facilitate a return to home(when possible
and appropriate.)This follows the basic principles of system of care which state one should
attempt to provide treatment within the community in the least restrictive setting that is
clinically appropriate to the child's needs.
SOC will do periodic assessments(every 6 months post-enrollment)in order to calculate
changes in total costs.Baseline costs will be compared(weighted to allow comparison)to
past-enrollment costs. Cost savings will be examined statistically by having individual level
data on each child and then using a paired t-test as the statistical test to examine significance.
3 Determine amount of cost of avoided throu�SOC's efforts:
SOC predicts a significant savings in the placement costs(which average$6,004/month for
group homes)that would occur if a child can be moved from a high level placement back
into the family's home,or into a lower level of treatment.
Current estimates of length of stay in-group homes/residential treatment are between 18 and
24 months. We think it is realistic to decrease that amount by 1/3.if we take 21 months as a
reasonable midpoint for estimation purposes,decreasing group home placement by 1/3,
would amount to$42,000(?months X$6,000.00_$42,000.)SOC's current plans calls for a
cohort of 15 clients to be identified and enrolled in this plan by January 1, 2003. We hope to
have up to 45 clients entered by the end of 2003.
This plan is a bold initiative to combine innovative treatment programs with cost savings
from the"top down." SOC is targeting the most severely disabled children,who are also
costing the most,and trying to maximize both treatment outcomes and cost effectiveness. In
addition,the program has a solid methodology to demonstrate cost savings(i.e.,baseline
compared to post-enrollment data).
4.Present plan to the Egn1 lv,and Human Services Committee,of the Board of
Supervisors on June ltd,2003 to determine if the plan is acceptable as documentation of cost
reduction. SOC will also present this plan to the Employment and Human Services
Department to determine if this documentation will be sufficient to gain support for the SB
153 Child Welfare Waiver to allow the County to receive the State share of avoided
residential costs.
5. C$llect County hiporical placement data to provide evidence that SOC reduced
countywide We for length of stay in out-of-home placement for youth suffering from severe
emotional illness by projecting the length of stay expected based on historical data.
Comparing historical trend data with the data collected on numbers and costs of serving
youth during program intervention period will provide some indication of the extent to which
SOC reduced county costs below the level it would have been without the wrap around
services program.
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............................................................................................. .........1.11,..................................................
TABLE C: WFIB REINVESTMENT STRATEGY
Plan for I3emonutrating Cost Reduction in County General I+Sunds:
A. OUTCOMES TO BE ACHIEVED:WHB will document its efforts to reduce those
county costs associated by achieving the outcomes listed below:
1) Reduced number of substantiated cases of child abuse and neglect in children ages,
0-5,living in selected zip codes;
2) Reduced number of hospitalizations for unintentional injuries by of children ages 0-
5,living
in selected zip codes;
3) Reduced number of out-of-home placements by children,ages 0-5,in selected zip
codes.
Analysis of data will answer the following questions:
1. Did WHB demonstrate achievement of the three outcomes?3
2. Dose the data strongly indicate that the three cost avoidance outcomes were
achieved due to
WHB activities?
3. How much did WHB spend on efforts related to achieving the three outcomes?
4. "at costs were avoided as a direct result of WHB activities mentioned above?
Given limited resources,it is not possible to conduct"a true cost-benefit evaluation"because
neither a matched comparison nor random assignment to intervention and control group
could be accomplished with current funding.
B. WORKPLAN:The following data will be collected to document WHB's efforts to
reduce those county costs associated with achieving its four outcomes:
1. Calculate WHB costs for the typical service package received by participants,
2. Calculate the average county cost of serving a child,0-5 for hospitalization of
unintentional injuries.
3. Calculate Employment and Human Services'(EHSD's)average cost of providing
supervision to a family of a child,ages 0-5,with a substantiated report of child
abuse and neglect,for specific periods of time and document average cost of related
court involvement;
4. Calculate the average cost of serving a child,ages 0-5,in foster care,including costs
for supervision,foster care and associated court costs.
5. Collect historical data related to WHB's three cost avoidance outcomes to estimate
past and future trends for each outcome.
3 WHB's program performance software,CS&O and data collected by County Hospital Staff will be required to track
the number of children,ages 0-5,saved by VaM,hospitalized for unintentional injuries at the County Hospital;with
assistance of EHSD it will track the number of WHB children who become known to Child Protective Services;and
document the number of fmmhes they have enrolled in Medi-Cal and Healthy Families.
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III. Specific Objectives, Activities and Work Plan For 2043-04
By December 2004 WHB and SOC will have documented achievements of the specific
children/family and community objectives listed earlier in this report.
CCFuture is proposing the fallowing program objectives to be undertaken in the
next 18 months:
1. Complete transition of the Children and Family Data Archive to Children's
Mental Health;update the Data Archive; and provide access to the Data Archive
by member County Agencies for program planning,development, and evaluation
purposes.
2. Successfully document the effectiveness of WHB and SOC reinvestment
strategies by collecting data on program performance and cost avoidance to the
County.
3. Investigate the feasibility of augmenting The Future Fund with additional
sources of discretionary revenue to support effective prevention programs.
CCFuture's Work Plan includes the following activities to achieve each of the three
programmatic objectives:
1. CCFuWm will maintain and update the Children and Family Data Archive and make it
available to all County Agencies for program planning,development,and evaluation
purposes by:
• Once fully installed in Children's Mental Health we will demonstrate the Data
Archive's capabilities to SOC Policy and Planning Council and Children's Policy
Forum Executive Committee;
• Update the Data Archive with data from all sources through 2002;
• Seek Health Services Department's permission to install County birth certificate
data;
• Program and input data on child care from Community Services, 1995-2003;
• Use the Data Archive to map community status on WHB and SOC outcome
objectives from 1995-2003;
• Provide demonstration of Data Archive to all interested County Departments
serving children.
• Explore all available funding sources to maintain and expand the Data Archive.
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2. SuccessMy document the effectiveness of WHB and SOC reinvestment strategies by
collecting data on program performance and cast avoidance to the County.
• WHB and SOC will seek support for the reinvestment strategies from the
Family and Human Services Committee on June 16,2003.
• WHB and SOC will document,relying upon program performance software
and Data Archive,achievement of children and family outcomes as well as
community outcomes;
• WHB and SOC will gather historical data related to each outcome;
• WHB and SOC will develop cost estimates of the services provided;
• WHB and SOC will document the value of avoided costs to the County
General.Fund.
• Prepare reports describing program achievements,cost of providing services,
and tally of estimates of general fund dollars saved through WHB and SOC
program activities.
3. Initiate The Future Fund,a sustainable funding resource for effective prevention
programs,and investigate the feasibility of augmenting it with additional revenue
sources:
• Initiate a process to implement The.Future Fund, as directed by the
Board of Supervisors,including criteria for fund allocation,process for
applications,review of proposals and monitoring of grants;
• Develop a concept paper on The Future.Fund outlining the purpose,
value,funding alternatives and stakeholders;
• Engage other stakeholders in a dialogue on the concept paper; and
• Explore additional possible funding alternatives,identify their
potential revenue stream.;necessary actions to capture those revenue
streams;necessary governing body approvals; and next steps.
IV. Fiscal Information CCFuture Project
CCFuture funds are used to:
1)Develop and then support the application of CCFuture reinvestment tools into
the daily operation of two pilots--WHB and SOC pilots;
2)Coordinate the two pilots' reinvestment strategy activities;
3)Analyze data from both pilots and create a report to the Stuart Foundation,East
Bay Community Foundation,and Centra Costa County Board of Supervisors on
achievement of the pilots' reinvestment strategies;
4)Help to explore discretionary revenue sources to expand The Future.Fund's
ability to support effective prevention programs.
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THE STUART FOUNDATION GRANT WAS USED TO PURCHASE,MODIFY, INSTALL, AND TRAIN
SOC STAFF ON THE CLINICAL MANAGER, ITS NEW PROGRAM PERFORMANCE SOFTWARE
AND PROVIDE TECHNICAL ASSISTANCE TO PILOT PROJECTS AND COORDINATION AMONG ALL
PARTICIPANTS IN THE DEVELOPMENT OF THE THREE CCFUTURE INVESTMENT TOOLS.
CCFUTURE PROJECTS A$25,144 FUND BALANCE FROM THE FIRST GRANT INSTALLMENT
BECAUSE LESS TIME WAS SPENT ON TECHNICAL ASSISTANCE THAN WAS ORIGINALLY
ESTIMATED AND FINAL PAYMENT OF RDA's CONTRACT THAT HAS NOT BEEN MADE(DUE
UPON INSTALLATION AND DEMONSTRATION OF AN OPERATING DATA ARCHIVE BY
CHILDREN'S MENTAL HEALTH).
CCFUTURE HAS ASKED THE STUART FOUNDATION TO GRANT PERMISSION TO CARRY
FORWARD THE$25,144 INTO THE SECOND GRANT PERIOD. THESE FUNDS WILL BE
COMBINED WITH THE SECOND GRANT PAYMENT OF$125,000 TO SUPPORT 18 MONTHS OF
WEB'S PROGRAM PERFORMANCE SOFTWARE MAINTENANCE COSTS, SOC PROGRAM
PERFORMANCE SOFTWARE MAINTENANCE COSTS, TECHNICAL ASSISTANCE AND
COORDINATION SERVICES BY THE EXTERNAL CONSULTANT, AND MAINTENANCE OF THE
DATA ARCHIVE. TABLE D PROVIDES THE BUDGET FOR PERIOD ONE AND PROPOSED BUDGET
FOR PERIOD TWO OF THE CCFU'TuRE GRANT.
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TABLE D: STUART GRANT BUDGET REPORT ---JANUARY 2002 THROUGH,JUNE 30, 2003
FIRST GRANT PERIOD FUND BALANCE, AND PROPOSED BUDGET FOR SECOND GRANT
PERIOD --,JULY 2003 THROUGH DECEMBER 31 , 2004
Expenditures Items Planned Actual Fund Proposed
Stuart Grant Expenditure Balance from Stuart Budget
Expenditures Of Stuart i'`grant for 2°d
1/02-6/03 Grant, Period Grant 7/01/2003
1/02--6/03 01/02 through
through 12/31/04
6/03
1.Data Archive: $ 15,000 $0 $15,000 $45,000
2. Program Performance Software: $75,000 $75,000 0 $15,000
SOC:--$511,000 purchase
---$14,000 customization of
the software
--- $8,000 annual
maintenance 8s staff tr
3.Program Performance Software: $0 $0 0 $75,000
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4.Technical $35,000 $24,856 $10,144 $15,144
Assistance/Coordination of
CCFuture Project
S.Total. C'CFuture Expenditure $125,000 $99,856 $25,144 $150,144
of Stuart Grant
In Kind Contribution
County Administrator Office $45,490 $45,490
Support and Oversight
Welcome Home Baby(W BB) $1.5 million $1.5 million plus
Program Budget plus$200,000 $200,000 in kind
in kind office office space and
space and supplies
suppiies
Spirit of Caring(SOC)Program $1.3 million $1.3 million
Budget federal dollars federal dollars
plus$1.3 plus
million in local $1.3 million in
match; local match;
Total vi Vind Contribution $639,136 54,345,000 f$4,345,000
BUDGET JUSTIFICATION':
1. Data Archive: These funds will support the following activities:
(1)Final modifications to Archive programming by RDA including inputting up-
to-date information from each agency;
(2)Updating Archive from an Access database to a Sequel database, which
requires reprogramming;and
(3) Adding new data from additional school districts and Community Services'
early childhood programs.
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Health Services Information Services is making a significant in kind contributions to the
maintenance of the Data Archive, but at this time it is difficult to estimate the dollar value
of the internal services. For example, IS has hired a new programmer who will direct
some of his time to this project, along with a portion of a senior manager,who already
conducts a monthly 2-hour meeting with SOC to discuss both the Data Archive and The
Clinical Manager Program Software interface with the Health Services Department.
2. Consultant Fees will reimburse time needed to assist both SOC and WI-IB in
implementing their reinvestment strategies, provide coordination services among SOC,
WHB, and County Administrator's office, staff the effort to establish the Future Fund and
draft reports to funders and County Board of Supervisors.
3. Program Performance: funds will be used for maintenance costs of software,
training of staff, and making modification in software design as needed.
4. In Kind Contribution: County, State,and Federal funding provide the actual
financial support for daily operation of the two pilots. WHB's annual budget is $1.7
million, which includes$200,000 of in kind,contribution from EHSD of space, program
manager and EHSD liaison, and supplies.
SOC has a federal grant of$ 1.3 million that pays for program operation; the County
contributes a$1.3 million in in-kind match of local program support. In addition the
County Administrator's office contributes time and county dollars to support the
CCFuture Consultant working with project.
CCFtture Direct Revenue Sources To Date. Amount
S.H. Cowell Foundation $235,000
East$a. Community Foundation $25,425
Safe Futures Grant $18,000
Contra Costa County rant $50,000
Contra Costa County Administrator's Office $5,000
(contract with Dine Fisher)
Propositivn 10 for WHB $604,500
Employment and Human Services, (New dollars, $200,868
Welcome Home Baby Pro Performance Software)
Stuart Foundation Grant(Grant awarded was$250,000, $125,000
first 18 month rant was$125,000
TOTAL REVENUE $1,263,793.
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