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HomeMy WebLinkAboutMINUTES - 11021993 - IO.2 * S TO!* BOARD OF SUPERVISORS 1 .0.-2 Contra r- FROM: INTERNAL OPERATIONS COMMITTEE Jl Costa . � . o•.. s County October 25, 1993 s,.. " DATE: r+CO VIAS SUBJECT: REPORT ON SERVICE INTEGRATION AND IMPLEMENTATION OF THE PROPOSED "HEALTHY FAMILIES 2000" PROGRAM SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . ACCEPT the .attaC ed:�^'status report on the Service Integration Project. 2 . ACKNOWLEDGE the cooperation of the General Services Department in facilitating the renovation of the buildings needed to make the Service Integration Project work smoothly. 3 . ACKNOWLEDGE the cooperation of the County Counsel ' s Office in attempting to resolve outstanding legal issues relating to confidentiality and inter-departmental sharing of records and data in a prompt and positive manner. 4 . DIRECT the County Administrator's Office to insure that a policy-level meeting is convened with all affected employee organizations and department management before the Personnel Department undertakes individual meet and confer meetings with the employee organizations to insure that all affected employee organizations are fully briefed on the goals and objectives of the Service Integration Project. 5 . REAFFIRM the Board's interest in insuring that the security which is provided at Service Integration Project sites involves a "gate-keeper" concept where an individual from the community, who knows and is in touch with the community, can keep employees advised of the climate in the community and can assist in defusing potential problem situations . CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOA COM ITT APPROVE OTHER SIGNATURES : ` ACTION OF BOARD ON Nn P.tuber 2 1993, APPROVED AS RECOMMENDED 4- OTHER y VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED LC •y�/ �, g f Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cc: See Page 3 SUPERVISORS AND COUNTY ADMINISTRATOR BY ,DEPUTY l., l I.O.-2 6 . URGE staff from the County Administrator's Office and the involved departments to focus their energy on insuring that the County is designated as an AB 1741 site, and also try to submit a response to the RFP from the Foundation Consortium for School-Linked Services for designation as one of the eight participating counties in the Policy Academy at the same time, recognizing that this may cause the proposed implementation schedule to slip by three or four weeks . 7 . REQUEST the County Administrator and affected department heads to provide our Committee with an oral status report on November 22, 1993 on the implementation of the Service Integration - "Healthy Families 2000" Project. BACKGROUND: On June 22, 1993, the Board of Supervisors approved our last report on this subject and directed that the County Administrator and affected department heads provide a further status report to our Committee on October 25, 1993 . On October 25, 1993, our Committee met with Jerry Buck, County Probation Officer; Perfecto Villarreal, Social Services Director; Bill Weidinger and Wilda Davisson, representing the Community Services Department; Damita Davis-Howard, representing SEIU Local 535; Jim Hicks, representing AFSCME Locals 512 and 2700; Kathy Armstrong, Consultant to the Service Integration Project; Judy Campbell, Personnel Officer for the Social Services Department; and Sara Hoffman, Senior Deputy County Administrator. Sara Hoffman summarized the attached report, including the activities which have been completed since last Spring, the implementation schedule for the two project sites, issues which are still outstanding, and contingency plans which may have to be considered if Proposition 172 fails to be approved by the voters . Ms . Hoffman noted the possible problems in keeping to the proposed implementation schedule, which calls for operations to be commenced at the new sites on February 1, 1994 . It was noted that extensive .discussions have been held with Local 535 . However, similar discussions have not taken place to date with AFSCME Locals 512/2700 nor with Local 1. It is essential that these discussions be undertaken immediately. However, rather than simply proceeding with required "meet and confer" discussions, we . believe that the affected employee organizations must first have a policy-level background briefing to place what is being proposed in context. Then, meet and confer discussions can proceed to address the details of staffing levels and working conditions . It was noted that the staff are relying heavily on designation pursuant to AB 1741-Bates (Chapter 951, Statutes of 1993) to gain the funding flexibility which will be required to make the Service Integration Project work as it was intended to work. At the same time, there is an opportunity to be designated by the Foundation Consortium for School-Linked Services as one of the eight participating counties which would then form a county-state Policy Academy. It is important that the County receive both designations and we are urging staff to complete the necessary applications for both AB 1741 and the Policy Academy. It was noted that the General Services Department has been most cooperative and supportive in attempting to get the necessary renovations to the building in West County accomplished as quickly and inexpensively as possible. Likewise, the County Counsel 's Office has been working closely with staff on the many complex legal issues which must be resolved. We want to recognize these efforts, which are going a long way toward making the Service Integration Project a reality. -2- I .O.-2 We also want to comment on the security issue, which is an understandable concern of the staff who will be working on the Service Integration Project. What we do not want to see, however, is simply another security guard with a gun in the lobby of the building. We believe it is far more appropriate and effective in the long term to bring an individual in from the community and have that individual serve as a link between the community and the staff. Knowing when a gang is forming, when tensions are growing and when problems are likely to arise so these situations can be addressed early on, is more what we are interested in seeing in the way of security. cc: County Administrator Social Services Director Health Services Director Community Services Director County Probation Officer Sara Hoffman, Senior Deputy County Administrator Kathy Armstrong, Consultant to the County Administrator Damita Davis-Howard, Local 535 Jim Hicks, AFSCME Locals 512/2700 Henry Clarke, Local 1 Eileen Bitten, Assistant Personnel Director -3- MEMORANDUM To: Supervisor Sunne McPeak Supervisor Jeff Smith Internal Operations Committee From: Youth Services BoardS�} Phil Batchelor, Chair Date: October 25, 1993 Subject: Status Report on Service Integration Recommendations: Recommend that the Board of Supervisors ACCEPT the status report on Service Integration. Background/Reasons for Recommendation This Youth Services Board status report on implementation of phase I of service integration addresses: I. Activities completed since the April 1993 report. II. Implementation schedule for North Richmond and West Pittsburg/Bay Point. III. Outstanding issues, and IV. Contingency plans - Proposition 172. The Youth Services Board has provided overall guidance for service integration consistent with the Board of Supervisors'directives,while detailed planning has been handled by the Service Integration Management Team (STMT). The SIMT is comprised of high level management representatives of Social Service; Health Services, including Substance Abuse, Mental Health and Public Health; Probation; Community Services; County Administrator's Office; West County Unified School District; Mount Diablo Unified School District; and the County Office of Education. Each SIMT representative has systematically involved the divisional management staff from his/her own department (Health, Probation, Social Service, Community Services, Schools) in reviewing drafts and in all decision making related to the proposed program infrastructure. Department divisional managers have been responsible for keeping their first line supervisors and staff well informed; there has been a systematic effort to solicit opinions and information from front line supervisors and staff on each of the issues under consideration. i 1. PROJECT ACTIVITIES: Since the last report to the 10 Committee on April 26, 1993,departmental consensus has been reached on program design and the infrastructure needed to support the service integration efforts. Significant achievements include: ♦ established agreed upon geographical boundaries for the two communities. ♦ identified the program make up of each service integration team and determined the number of program representatives by team. s defined the team management plan for overseeing program operations. o developed the job descriptions for each program. o drafted a confidentiality policy and a release of information form that is now circulating throughout the departments and will be submitted for discussion and review by County Counsel, Juvenile Court Judge, Juvenile Court Referees, legal advocates, and public defenders office. ♦ outlined the first year training program for team members and Department Supervisors. ♦ Outlined, with Data Processing, the technological support model to link the teams to data processing, the state and other teams. ♦ drafted a preliminary set of outcome measures that will be used to assess the team's performance on program, family, and community goals and which will become the basis for AB 1741 waiver requests. ♦ estimated budgets for start up and first year operation for each team. ♦ conducted extensive informational meetings with department staff, supervisors and Local 535; County Personnel has begun coordination of negotiations with Local 1, 2700, 512 and 535. ♦ established working relationships with North Richmond and West Pittsburg/Bay Point MAC's. ♦ worked with foundations to secure funding for both MAC's (approximately $50,000 for West Pittsburg/Bay Point and $300,000 for North Richmond). ♦ worked with other counties to share information and visited 3 sites. 2 i . In addition, Healthy Families 2000 Report has been revised and updated to reflect the decisions made and the new inter-departmental agreements achieved. (Report attached) The major revisions are contained in the sections on: ► Confidentiality (pg 15 ) ► Program Representation and Team Membership (pg 16) ► Management Plan (pg 19) ► Job Description (pg 21) ► SIT Training Outline (pg 23) ► Technology (pg 24) ► Outcome and Performance Measures (pg 25) ► Financing Mechanisms (pg 25) ► Budget (pg 27) 11. IMPLEMENTATION SCHEDULE: The current schedule calls for service delivery in North Richmond and West Pittsburg/Bay Point by February 1, 1994 (See Appendix A). Achievement of this time line requires: ♦ Employee organization negotiations completed by October 30, 1993; ♦ Bid staff positions by November 3, 1993 and select all staff by November 30, 19931- Financial 993;Financial resources for start up costs allocated by November 2, 1993; ♦ Begin building renovations November 3, 1993; ♦ Install all wiring improvements needed to connect pilots to data processing by January 30, 1994; ♦ By November 3, 1993, begin programming the information systems to link community sites with central data processing and departmental data processing units and for developing the community index of clients with completion by December 15, 1993; ♦ Sort and consolidate caseloads by geographic area by December 15, 1993, ♦ Initiate family matching across departments for. the two communities by December 30, 1993; ♦ Notify clients of the community based service delivery and the location for receiving their services by December 20, 1993; 3 ♦ Submit proposal for Policy Academy to State by November 15, 1993 (if necessary); ♦ Training modules for the Orientation, Family Centered Care, Confidentiality, SnIf Managing Teams and Re-Engineering completed for review November 30, 1993; ♦ All parties agree to the use of a common confidentiality release form by December 15, 1993; ♦ Begin team training December 10, 1993; ♦ Teams consolidate forms and systems and create new working structure to serve families together in January 1994; ♦ Hold informational meetings in the community regarding the new service integration teams by January 15, 1994; ♦ Teams located in renovated building sites and operation begins by February 1, 1994; III. OUTSTANDING ISSUES The following issues are under discussion.- How iscussion:How will we proceed if negotiations with the employee organizations (Local 1, 535, 2700, and 512) reach an impasse? How will we finance the County share of costs for start up and first year operating budgets for the two communities? Should Contra Costa County respond to the Foundation Consortium for School- Linked Services RFP to establish an eight county-state Policy Academy? AB 1741 has been signed by the governor. Five county pilots will be chosen by 12/94 to begin working with the State on consolidating categorical funds. Should we focus on our current implementation efforts and apply to become an AB 1741 pilot in late 1994? Do we have any agreements with Assemblyman Bates regarding our County's participation as one of the five pilots? To what extent will current categorical funding requirements inhibit full achievement of service'integration because of the need to maintain parallel work systems? 4 IV. CONTINGENCY PLANS - PROPOSITION 172 Several contingencies have been discussed in case Proposition 172 does not pass: • Implement one pilot in this fiscal year, the second pilot in 1994-95. • Postpone operative date pending foundation support for implementation. • Co-locate all team members in an existing county building, eliminating start up costs and minimizing operating costs. Note: there are no county buildings in the two pilot communities. • Establish common geographical communities, select service integration team members, link the team members, who maintain their existing office, through the electronic network; establish weekly team meetings and provide as many services as possible in the school and community settings. Note: this approach may improve coordination, but does not achieve community- based, family centered services consistent with our vision and goals. • Postpone operative date for teams until waivers have been obtained for consolidating dollars and changing rules of operation. Note: no clear timeline for implementation for this alternative. Joreport 5 HEALTHY FAMILIES 2000: PLAN TO IMPROVE THE HEALTH OF CHILDREN, YOUTH AND FAMILIES IN CONTRA COSTA COUNTY OCTOBER 25, 1993 UPDATE Contra Costa County Board of Supervisors Tom Torlakson, Chair Tom Powers Jeff Smith Gayle Bishop Sunne McPeak As Contra Costa County's fiscal resources become more and more strained, it is becoming obvious that we will never have enough people or enough resources to meet the needs of children and families as long as we continue to segment services and, consequently, people's lives. There are neighborhoods in Contra Costa County where households receive up to nine services per household; services which are provided by three separate departments. Fragmentation of our delivery system also affects our staff. Individual staff members are specialized in income maintenance or child welfare services or mental health or probation, to name just a few. Each of our specialists is doing his or her best to help the family. But, because of State and Federal categorical grant aid and/or regulatory limitations on their efforts, they are not able to help the entire family or to focus on developing the capacity of communities to assist and help the families who reside in the high risk neighborhoods. Our workers need to be empowered with the ability to truly affect the lives of these families through increased communication and coordination; by mobilizing resources other than just their own; and by approaching the problem of families in crisis or families at-risk from a new perspective. A holistic approach with families will build upon the individual strengths of families, increasing the ability of these families to solve their own problems. FRAMEWORK FOR ACTION The Values, Mission and Goals of the Implementation Plan provide the framework to guide the development and implementation of service integration. VALVES Children are Society's most valuable resource. It is Society's responsibility as well as in its best interest, to provide for and protect its children, and to foster an environment that supports, encourages and challenges each child sufficiently that he/she has an opportunity to flourish and achieve his/her own unique potential. The best environment for most children is their family; and families need communities to support them in their efforts to provide opportunities for their children. Communities, families and public agencies have a shared responsibility for improving the health and well being of families. The needs and desires of families in the community should drive the allocation of resources, and the service delivery systems of the agencies that serve them. Family centered services address the broad concerns and responsibilities for children, families, neighbors, and the social and economic environment in which they live and interact. Family centered services . . . . . . view the whole family and not just the individual as the appropriate level for service intervention . . . have the flexibility to respond to individual differences with a comprehensive range of services. . . . recognize community and family strengths, capabilities and resources and mobilizes them in solving problems. . . . are responsive to cultural and ethnic diversity. . . . include the prevention of health, social and educational problems. . . . foster creativity and initiative of service providers, families and the community. . . . are accessible and delivered on a human scale by competent people who know, care about, and have established mutual, personal trust with the people they serve. . . . will employ democratic methods of decision-making so that providers and consumers of service collaborate in governing, operating and evaluating programs. . . . are simple in structure and management, with a minimum of red tape, costly interagency transactions, referrals and other complicated bureaucratic procedures. r MISSION Contra Costa County is committed to developing an effective interagency system that fosters healthy development and opportunity for children and youth in Contra Costa County by promoting, enhancing, and strengthening family life. This collaborative, community based system of services will serve families in a holistic manner, include families as partners, and respect the cultural and ethnic diversity of families. 3 t Children who fall within the purview of Contra-Costa County's social, health, and justice agencies are a broad group whose needs.-range from severe, requiring placement, to those signaling minor difficulties and for whom early intervention and support could avert more serious problems and c;,Istly treatment and care.. Goals The three major goals of"Healthy Families 2000," are directed at serving the three broad groups of families,' who represent the full spectrum of family needs. A. Promote the health and well being of all family members in Contra Costa County. Help families insure that their children flourish. B. Reduce the number of children at risk of poor health, out-of-home care and potential school failure by increasing the number of prevention programs directed at strengthening a family's ability to improve the health and well being of their children. C. Improve the quality and kinds of services and protection available to families whose children are experiencing significant problems and crisis so that the number of children who will require placement outside of their home will be significantly reduced. 'These groups of families are: A. "Self-Sufficient' Families ("A". Families) - The largest group is currently self-sufficient families in which economic pressures, family arrangements, andfor dual job and child rearing responsibilities create potential stresses which could result in a need for support, encouragement, information and assistance to insure that the children grow up healthy, competent, and emotionally able and self-sufficient members of society. B. "At Risk"Families("B"Families)-The second largest group is families with serious needs which,unserved, could develop into multi-problem crises, putting the children at risk or imminent risk of out-of-home placement, poor health or potential school failure. C. "Crisis" Families ("C" Families)-The smallest, but most critical, group is families in which members are already in the charge of the County because they have been placed out of their homes or are in imminent danger of being removed from their home. 4 Family Centered Service Integration Contra Costa County is in the process of replacing its current fragmented service delivery system, which now focuses primarily on crisis. The service delivery system will consolidate services of three departments, Health Services, Probation and Social Service, within selected neighborhoods. Teams from these departments will work closely together to continue to provide services to Crisis families, but in a coordinated, comprehensive manner. The effort will tap the resources of families, the community and public and private agencies. The Service Integration Teams (SIT) will also expand their purview to providing assistance to families at risk and work with the community to insure all families receive support in maintaining their self sufficiency and well being. The expected outcomes are: 1. An increase in the number of "families who are self sufficient"; and a reduction in the number of "families at risk" and "families in crisis"; 2. An increase in the overall functioning of the community/neighborhood as demonstrated by the existence of mutual support and self help activities within the community that support families. COLLABORATIVE PLANNING TO DATE: The Service Integration effort began in June, 1991. Following extensive coordination with the West Pittsburg and North Richmond communities, the"Healthy Family 2000"strategic plan was adopted July, 1992. Concurrent with the development of the strategic plan, the Youth Services Board (YSB) worked closely with the Richmond Unified School District, Mount Diablo Unified School District, and County Office of Education to write Healthy Start Planning Grants for North Richmond and West Pittsburg.2 These grants have provided financial assistance for community involvement in planning service integration. The result was a close partnership between the County, Schools, Community Agencies, Parents and Residents in each of the two communities. Both North Richmond and West Pittsburg created Advisory Boards with broad-based participation, including representation from community based organizations, parents, residents, the Social Service Department, 2I addition,a Healthy Start Planning Grant was obtained for West County Transition of Youth from Byron Boys Ranch, to serve youth from San Pablo, North Richmond and the Iron Triangle. The program's objective is to reduce out-of-home placement and will be a resource to the service integration teams. 5 Health Services Department, Community Services Department, Youth Services Board, Housing Authority, MAC, and Schools, usually the principal, teachers, aides. The groups met several times every month to oversee the planning process and Healthy Start Grant expenditures. The next step occurred in fall, 1992 with the completion of a needs assessment. The needs assessment consisted of a match of public agency data, household surveys, focus group discussions and individual interviews. The County Data Match Project matched the data files from Probation, Social Service and Health Services by address. The match identified ten census tracts that house the highest number of households that receive services from all three departments. These included three neighborhoods which had efforts underway which could be leveraged to support service integration: • West Pittsburg-community-school partnership program is currently underway with strong participation by the Mt. Diablo Unified School District, Community residents and the Municipal Advisory Council. • North Richmond -currently has the Neighborhood Services Mall project and strong community groups including the school/community partnership at the Verde School and the newly formed North Richmond Municipal Advisory Council. To better understand the needs of families within these neighborhoods, the North Richmond and West Pittsburg Advisory Boards sponsored household surveys, focus group discussions and individual interviews. People were asked what services they needed and wanted; what were their priorities and preferences. The survey found that families wanted a means to help themselves, opportunities for good education, training job preparation, job placement, a decent wage. Parents wanted their children to have access to fun, constructive, helpful activities within safe neighborhoods. The study also found tremendous resources within these neighborhoods which could be tapped to support children and families. On April 15, 1993, West Pittsburg and North Richmond Advisory Boards submitted proposals to California Department of Education for full operation of the community based, family centered approach to achieve the needs and wishes articulated by the community. In each proposal, the Service Integration Team (SIT) approach was incorporated into the program design. Unfortunately the Healthy Start operation proposals were not funded. The County had to work with the North Richmond and West Pittsburg communities to revise and adjust implementation plans since all plans were developed on the assumption that the extra funds would be made available. 6 C.- t Time Line of Actions to Date: June 1991 Hired YSB consultant to develop Strategic Plan for implementing Comprehensive Integrated, Community Based, Family Centered Service system in Contra Costa County. September 1991 Wrote, reviewed and agreed upon Healthy Families 2000: Strategic Plan November - Applied for Healthy Start Planning grants to help support Strategic Plan--North Richmond, West Pittsburg, and Probation/County Office of Education in West County June 1992 Healthy Start Grants awarded to North Richmond/Verde School, West Pittsburg/Mount Diablo Unified School District County Office of Education/Probation in West County September 1992 Began Community Planning November 1992 - January 1993 conducted Needs Assessment, Data Match, Resource Mapping and visited program models October 1992 Youth Services Board began planning Service Integration Teams and how they will work with each of the Healthy Start Communities November 1992 Began PATHS Project/ Pittsburg December 15, 1992 Board of Supervisors adopted Order authorizing pilot Service Integration Teams in North Richmond, West Pittsburg, Pittsburg, San Pablo and Concord. January- March 1993 Determined community goals, objectives, program design for North Richmond and West Pittsburg (and West County Youth Transition project) January- March 1993 Worked with Parkside Elementary, Pittsburg Unified School District to write a Healthy Start Planning Grant March 1993 Submitted Healthy Start Operational Proposals for North Richmond, West Pittsburg and West County Youth Transition project. January- April 1993 Conducted intensive planning for service integration team implementation 7 7 _ 1 April 26, 1993 Presented implementation plan and status report to 10 Committee April- October 1993 Developed program infrastructures for implementing community based, family centered, service integration in two communities. October 25, 1993 Operation Plan presented to 10 Committee for implementing service integration teams in North Richmond and Bay Point. IMPLEMENTATION OF SERVICE INTEGRATION Pilots for family-centered services are scheduled to begin in the North Richmond and Bay Point/West Pittsburg communities in January 1994. See Appendix A for a complete schedule of activities to be accomplished before SIT can be implemented in the two communities. The geographical boundaries for the two pilots are North Richmond 3650.02 and West Pittsburg 3142 and 3141.01. These census tracts are consistent with the school district boundaries for West County Unified School District, Verde School and Mount Diablo Unified School District, four elementary schools, middle school, and continuing high school in West Pittsburg. The tentative census tracts selected for Pittsburg Community are: 3141.02, 3100, 3090, 3110, 3132. Full implementation of community based, .family center, service integration in the remaining eight communities will commence following receipt of the waivers necessary to consolidate categorical funds and permission to eliminate many of existing procedures and practices that deter effective service delivery and effective deployment of staff. The success of the effort in the first two pilot communities depends upon the Healthy Start Advisory Boards and community participation and ownership, as well as the improved access to the available resource pool of services provided in the greater County. Success will require a major upheaval in "status quo." Moving from a categorical, public agency focus in the provision of services to a comprehensive, inter-agency, family- centered, community-based delivery process requires re-thinking and restructuring our entire relationship to each other and our clients. But, perhaps more difficult than this paradigm shift, is the building of a new system out of the "bricks" of the existing programs. Each brick must be disassembled from our old structures one at a time and re-assembled with "bricks" added from existing community based organizations and the residents. We will be living in the old structure, but slowly moving into the new structure, during a time of major budget cuts. 8 -- T The discussions and planning for the new systems have been extensive and are detailed by section: Levels of Service Client Flow Expectations of the Service Integration Teams (SITs) Service Integration Team Approach Confidentiality Program Representation and Team Membership Management Plan Job Description SIT Training Outline Technology Outcome and Performance Measures Financing Mechanisms Budget Despite the time and effort invested to date by the STMT, Healthy Start Community Advisory Boards and Youth Services Board, many questions remain. Much more work is required to resolve the outstanding programmatic issues. Program development will continue to be the focus of effort throughout November, December, and January, as documented in the implementation time line. In some cases, it will be necessary to make adjustments after the SITs are in full operation. Levels of Service In each pilot, three levels of services must be integrated, coordinated, and made available in the community- 1. ommunity:1. Service Integration Team Services-- Each community service integration team will provideintense services which are family centered, holistic, and integrated across social services, health, and probation. The target of these services is primarily Crisis Families and then At-Risk Families (services to"C" and "B" families). See Attachment for the inventory of services. 2. Coordinated Community-Based Services-- The Healthy Start Advisory Board and the MAC leadership in North Richmond and West Pittsburg will have primary responsibility for coordinating and consolidating services of agencies that have been identified by the communities as high priority; eg: employment assistance, after-school activities, community protection and safety, housing assistance, Head Start/childcare, etc. There is considerable need to improve the coordination, access, and availability of services within this domain. All families will be targeted for these services. 9 3. Resource Pool -- Both the Service Teams and Healthy Start Advisory Boards will provide referral to services that are shared by more than one community or neighborhood and will work together to ensure interconnection of services as appropriate. 10 These three levels of services are best repre*sented in a Services Wheel: SERVICES WHEEL Resources Pool Homeless Services Geriatric Services Community—Based Network of Services for All Families Senior services Nutrition for the Elderly rade ch- ALL Families MCI�?rell., IHSS e-70f84wt school Healthy Start Program volunteer Services Service Integration Team Community Prevention I)Community HS. Family Resource Council Employment Child Welfare Service ESCEAP Programs in Probation • Nutrition Recreation&After - Chronic School Activities Health-Clihical Generalist Disease (PHN Type) - Injury& Case management services Head Start Violence through HS grant United Way Preventative Dental 2)Families in crisis, at risk of crisis Delta 200o Education in SChOOls Opportunity Wes Housing Authority Community services ai Medical services Block Grant- Weatherization Community Oro.in Neighborhood On-Site Mental Health Consultation MAC On-Site public Health Clinic Services Benefit Services/Single Substance Abuse Business Round able Eligibility Application Community Partne(W' ps Substance Abuse SON Treatment programs Area Agency on Aging Mental Health Services, Client Flow The SIT will oversee the management of individual service delivery in the community and provide the following scope of services: I. Information and Assistance Families will be referred to the Council by: 1. Departments who will assign cases from that neighborhood currently on their caseloads, and all new cases after intake and court work is completed. 2. Schools, families, community, walk-ins and self referrals. Many people who come to the SIT for services will be assisted to find services they need within the Community-Based Network and Resource Pool. It will be our intention to eventually provide this function through a Customer User Friendly Work Station, referred to in the Technology Section. II. intake and Assessment All families in crisis, at risk of crisis or referred by Public Agencies will be reviewed by the SIT to determine if the family is already known to the system. If so, the lead worker for the family will take on this new request, including any referral out to the community-based programs or resource pool. If not, a SIT member will be assigned the family to take the lead in assessment and service planning. III. Team Involvement with Family The SIT member completes an assessment with the family, develops a family plan, and works with the family to achieve the plan. (Team members will use the principles developed and tested through the family preservation program during this process.) IV. Completion of Team Responsibilities Termination of work with a family will be a joint decision. At termination, the worker will insure that the family is connected to the programs and services available in the community and the greater County region. 12 CLIENT FLOW DIAGRAM I Information & Refer to Community- Assistance Based Network & Resource Pool Referral in Social Services Referral in Probation Community-Based Community Health 11 School Community Services Family Resource Walk-in Council Self Referral Screening - check in to determine if family known & assign worker to complete Ili Team Involvement with Family Assessment Develop Family Pian Assist in Achieving Plan 1 1 I Consult Schools I Recreation Follow Family 1, jo Benefit Programs Parent Education Insure Referrals I Employment Drug/Alcohol Treatment Services Received I Housing Terminate to IV Community-Based System of Services Recreation Employment 13 1 • Expectations of the Service Integration Teams (SIT) The primary expectation of the teams is that their service integration efforts will provide and/or stimulate support for/between all families within the community: Crisis Families, At-Risk Families and Self-Sufficient Families. Within the framework, teams must be given clear direction and authority: • Teams will be self-managing and given latitude to take initiative in their approach. Team performance will be measured against a set of agreed upon outcomes. Baseline measures in each of the communities will be assessed at the beginning of SIT and changes in these indicators monitored over time. The communities baseline and changes will be compared to County as a whole on the same measures. After more experience, it should be possible to estimate the magnitude of change expected over time. Criteria for program outcomes include: 1) the perspectives of the community, and 2) state and federal program and funding requirements. • Service Integration Team Approach The SIT teams will consist of members from the Social Service Department, Probation Department, Health Services Department and in West Pittsburg from the School. In the initial phases of implementation, the SIT will provide services and support primarily to Crisis Families. We anticipate that within 6-12 months of operation, we will obtain the necessary waivers and regulation exemptions needed to free the Service Integration Teams to re-direct up to 20% of the team members time to prevention and early intervention activities. The 20% staff time available will be redirect into efforts to help families at risk and the community, coordinated closely with the Healthy Start Coordinator, the MAC coordinator, the greater community planning and advisory bodies and the community-based network of services. The teams will maintain a community index of all clients being served by the team in the individual community. A team member will assume responsibility for coordinating all services to a family that is known to more than one program or department. The SIT will use the family preservation model of serving families, i.e.. completing assessment, joint family planning, develop family strength, insure access to all services needed to help the family become more self-sufficient. The services will be time limited. We will seek to link every family into the community based network of services so upon graduation from the intense family services coverage they will have an ongoing support system. 14 Once the teams are operational they will define referral procedures between the SIT, other county agencies, the schools, community groups and mother agencies. As the teams encounter interagency barriers to service integration, they will inform the YSB of barriers and obstacles to integration and to recommend changes to policy, rules and regulations, including those which require state and federal waivers. • Confidentiality A single confidentiality release of information form has been developed that applies to all programs under service integration (Social Service, Health and Probation) This draft was developed after .a careful study of confidentiality rules and a review of existing confidentiality policies and release forms developed by the San Diego New Beginnings Program, Sacramento's Neighborhood Services Integration Pilots and other service integration projects throughout the country (See Appendix B). The confidentiality release form is being reviewed by Social Service, Health Service, and members of the juvenile legal system. Agreement on the release of information form is seen as a prerequisite to the family match of cases across departments. In addition to the confidentiality release form, it may be advisable to develop protocol and forms to maintain confidentiality of sensitive information. For example, service referrals may be given access to information that confirms eligibility to the specific program, rather than complete client data. The guiding principle for such protocol and forms will be based upon "need to know." 16 • Program Representation and Team Membership The Service Integration Management Team (SIMT) worked closely with each department to determine which of their programs would become more effective if delivered on a community level, within a specific geographical area. Programs that have centralized their services as a means of more effectively serving their clientele were not included in team membership. Several significant programs will not have team members assigned to the SIT; but, we have carefully defined appropriate linkage between these programs and the SIT. For example, the Special Refugee Income Maintenance Team in West County is very effective in serving new immigrants. The multi-lingual staff represents each of the new immigrant populations served, and has effectively personalized services to the entire West County new immigrant population. However, assignment of one of the members of the Refugee Unit to the North Richmond SIT did not appear to be an effective use of resources. A written agreement now exists defining how the Refugee Unit will work with the SIT in serving residents of the North Richmond Community. Other programs not included on the team are: Probation, Social Service, and Mental Health 'but of home placement units"; Permanency Planning Units within Social Service, Intake and Court Units within Probation and Social Service, Centralized intake for General Assistance and Income Maintenance. The Service Integration Teams(SIT)will include the following program representation and consist of the following team members.- WEST embers:WEST PITTSBURG PILOT: SOCIAL SERVICES: 7.5 FTE EW SPECIALIST (IM) 1.0 FTE SENIOR LEVEL CLERK (IM) 1.0 FTE SUPERVISOR (IM) 1.0 FTE GAIN WORKER 1.0 FTE GAIN PREP WORKER 1.5 FTE FAMILY MAINTENANCE AND RELATIVE CAREGIVER WORKER FOR Permanency Planning and Family Reunification families 1 FTE PROBATION OFFICER 1/2 FTE PUBLIC HEALTH NURSE .1/2 FTE SUBSTANCE ABUSE SPECIALIST 4 HOURS OF MENTAL HEALTH SERVICES 1/2 FTE CLERK FOR THE BUILDING SUPPORT 16 NORTH RICHMOND PILOT: SOCIAL SERVICE: 3.5 FTE EW SPECIALIST (IM) 0.5 FTE SENIOR. LEVEL CLERK (IM) 0.5 FTE SUPERVISOR (IM) 1.0 FTE GAIN WORKER 1.0 FTE GAIN PREP WORKER 0.7 FTE MAINTENANCE AND RELATIVE CARE GIVER WORKER FOR Permanency Planning and Family Reunification families 1 FTE PROBATION OFFICER 1/2 FTE PUBLIC HEALTH NURSE 1/2 SUBSTANCE ABUSE SPECIALIST 4 HOURS OF MENTAL HEALTH SERVICES 1/2 FTE CLERK FOR THE BUILDING SUPPORT • NUMBER OF CLIENTS BY PROGRAM IN EACH PILOT A formula was developed to determine how many workers would be assigned to each team: the number of clients living in each community in each program PLUS 12% to account for discontinued cases DIVIDED BY the approximate average caseload size for each program. For example: North Richmond AFDC 349,cases divided by 180 = 1.9 Medi-Cal 148 cases divided by 400 = .4 NA Foodstamps 87 cases divided by 225 = .4 GA 124 cases divided by 200 = _6 total workers 3.3 West Pittsburg AFDC 836 cases divided by 180 = 4.6 Medi-Cal 627 cases divided by 400 = 1.6 NA Food Stamps 142 cases divided by 225 = .6 GA 136 cases divided by 200 = _7 total workers 7.5 The typical span of control within the Income Maintenance Programs (IM) is one supervisor to 7 intake workers and one supervisor to 8 field workers. So .one IM supervisor will be appointed to West Pittsburg team and 1/2 IM supervisor to North Richmond Team. Based upon current practice the Income Maintenance Unit will assign one full time 17 clerk in West Pittsburg and a 1/2 time clerk assigned to North Richmond. The number of team members from each department and their specialty will be determined by each Department, based upon community characteristics. The YSB will bid the positions and seek volunteers for the SIT. SIMT has worked out a process with Local 535 for recruiting staff from Social Service Department. The job interviews will be conducted by a panel representing the SIMT, the department, school staff, and community leaders active on the local Healthy Start Advisory Boards. 18 • Management Plan SIT FLOW CHART (Revised#110/7/93). Stage II ECI I LI , { E N T S SIT TEAM Functional Sup - -SSD CBO'S -----HEALTH MAC ROBATION Community ----SCHOOLS Resources I � TEAM FACILITATOR SIT MANAGEMENT TEAM Q/ YSB BOS DIV. MGRS. OTHER SYSTEMS 19 SIT FLOW CHART (Revised#110/7/93) Stage I FL nIMN T S SIT TEAM Functional Sup SSD HEALTH Functional Sup Prob Schools " TEAM FACILITATOR SYSTEMS CHANGE AGENT 00, SIT MANAGEMENT TEAM YSB BOS DIV. MGRS. CBO'S MAC COMMUNITY RESOURCES 20 The proposed management structure was greatly influenced by the innovations in the private sector with "self managed teams." Self managed teams have been demonstrated to improve productivity and quality as well as employee morale. The object of service integration is not simply to move staff from each of the departments to a common location and have them perform services identical to those being provided back at the main office. However, many of the envisioned programmatic changes must await State and Federal waivers and administrative flexibility, before the County can actually create a service delivery system that is truly comprehensive, integrated, family centered and community based. Appendix B is a detailed description of the proposed management plan for overseeing the service integration teams. It seeks to address the difficulty of making a transition from the existing bureaucratic management approach and rigid administrative requirements imposed by state and federal regulations into the proposed community based, family centered, comprehensive, integrated system of care. The SIT will eventually operate as a self managed team. The proposed management plan describes the roles and responsibilities of all parties involved in promoting the SIT success. A team facilitator will: ♦ facilitate the day to day work of the SITs, ♦ promote team self-management, ♦ ensure coordination with the Healthy Start Community-Based Project, MAC and YSB, and ♦ help identify issues preventing family centered services. Team members will report to functional supervisors from their departments for assistance and coaching on the technical aspects of their work. The team members will continue to relate to their own departments, presenting reports to their peers and colleagues during regularly scheduled meetings. All team members will stay well informed about the regulations and administrative issues under which they must practice. The team will be trained in self management techniques and expected to establish agreements about how they will work, manage conflict, resolve problems, expend funds and oversee team performance. After the initial start up period the SITs will work with the SIMT, Healthy Start Project Coordinator and the YSB to re-engineer services currently being provided into a service delivery system that is family centered, community based, integrated, and accountable for improving family functioning. 21 The STMT will expand to include the functional supervisors from each department involved with coaching team members. The SIMT Will meet monthly and assist with training, insure effective communication between the teams and the departments and to work together to restructure services and document the various waivers required to improve the effective functioning of the community based, family service delivery system in each community. Team leader and team members will closely align their work with the North Richmond MAC and the West Pittsburg Healthy Start Advisory Board and Coordinator, to ensure that the SIT is responsive, accessible and accountable to the community. The teams will be supported by a telecommunications and automated data and information system. A more detailed description is provided in the Technology Section. The Team's performance will be measured by how well they achieve the expected objectives established for each team. A draft of the outcome performance measures is attached in Appendix . See Appendix B for a detailed description of the roles and responsibilities of the SIT, Team Facilitator, Functional Supervisors, Systems Change Agent, STMT, Youth Services Board and MAC. Further Needed Refinements: 1) The existing monitoring and assessment approach must be restructured. We must reassemble the existing data, from categorical, isolated pieces of information about "parts of people" into a family, community measure of well being and health, community status. This requires a geographical mapping system that has the capacity to demonstrate changes in health status by neighborhoods, schools, and communities as well as an integrated data system which collects the necessary information. 2) A system of team rewards must be developed that not only provides for periodic recognition of team accomplishments, but also monetary rewards. For example, a portion of any savings achieved could be kept in the community to develop community owned services focussed on improving the economic, social and health conditions in the neighborhoods. A portion of the savings could be used to increase staff training opportunities. • Job Descriptions Job descriptions congruent with the self managed team concept were developed for each team member. Detailed descriptions of the jobs are provided in Appendix C. The SIT job descriptions desci be three additional functions added to existing programmatic job requirements. These include: 22 o the tasks associated with managing and operating as a team; o the responsibility for insuring that services are integrated to all families known to more than one department or program and for assigning lead responsibility for family a.,sessments, family plans, and the insurance that all needed services are provided; ♦ activities related to re-engineering service provision, eg: identifying structural improvements that can be made to improve efficiency and effectiveness and assisting with the documentation required to obtain waivers needed to implement these systems improvements; 23 • SIT Training Outline Appendix D describes the one year training plan for preparing the SIT. The training consists of seven modules: I. An Orientation to the history and purpose for service integration in Contra Costa County; it will include an introduction in Self Managed Team Practices Lead responsibility: Rich Clark 11. Confidentiality and release of information rules plus record keeping and administrative expectations Lead responsibility: Sara Hoffman III. Family Centered Practice Lead responsibility: Bill Weidinger IV. Community Based Approaches to Service Delivery Lead responsibility: Kathy Armstrong V. Advanced practices in operating self managed teams Lead responsibility: Adanna Henry VI. Service Re-engineering and systems improvements and the Technological support and information systems necessary for successful service improvements Lead responsibility` Kathy Armstrong • Technology There are four primary components of the proposed SIT technological support system -that: 1) Provide information to community residents and clients about all of the services and resource available in the community and the resources pool. The purpose of providing complete information is to support self sufficiency and community self help. Examples of the types of systems under consideration are: Info/California information kiosk being piloted by State in shopping malls, DHHS/ODPH work station prototype under testing in Washington D.C. 2) An on-line telecommunication system, electronic mail for teleconferencing of cases, scheduling, information sharing and feedback on grant applications, shared report writing, etc. Examples: EcoNet, PeaceNet, HandsNet, Special Net, Senior Net, NCN, the Well, etc. PATHS project is looking into using CompuMentor for project communication. Northern California Family Therapy is testing a system with our Healthy Start West County Youth Transition Project by Probation and County Office of Education. 24 3) Client Centered information and data management system through uniform eligibility application, risk assessment, services tracking, outcome monitoring. This will help agencies simplify access to services, identify at risk families for intensive prevention services, increase the efficiency of administering programs and collect outcome information to evaluate the effectiveness of services. Front end systems like the Freedom System are expert systems able to determine eligibility for all programs with one entry of data. The remainder of the system would consist of a system integration effort linking the community based pilots with the various categorical data systems held in the various public agencies. 4) Report generation that provides documentation to decision makers about service performance, effects of existing policies, and provides direction for continuing improvement of services and policies. Data would be collected which would inform us of who is being served, what services are being received and the effect of the intervention. This effort could help in early identification of risk factors and prevention strategies. • DEVELOPMENT OF THE TECHNOLOGICAL INFRASTRUCTURE The existing information systems used by each department are designed to comply with state reporting requirements. The information needed to monitor services in the communities is not collected through these existing information systems. Extensive programming is required to create a system that meets the need of service integration, is not overly cumbersome, and also maintains the existing state system. Appendix F is a picture of the proposed system. SIMT has worked closely with Social Service, Health Service systems units/experts and with CCCo Data Processing to design the technological support system for service integration. During the next three months Data Processing will work with the STMT to implement the proposed model and its requirements: ♦ create a community specific client index for each of the two geographical areas by downloading client information from each department's centralized intake units; ♦ establish online linkage between the SIT and the mainframe, thereby maintaining the existing mandated state information and reporting systems; ♦ develop a community based information system that maintains records on families served by the SIT including the individual family assessments and plans, service tracking, and follow up after termination; ♦ provide linkage between the Health Service Information Systems, School Information Systems, and the Data Processing Mainframe; 25 r l Z • Outcome and Performance Measures: SIMT has-drafted a tentative. list of outcome measures that assess performance on family, community, and program service goals. (Appendix G) The proposed list of outcomes ate organized by Program, Family and Community Outcomes: 1. Program outcomes are those indicators that measure the extent to which services were provided, consistent with legal requirements, responsive to clients' needs, and respectful of cultural diversity and at a high level of quality and comprehensiveness; 2. Family outcomes are those indicators of the extent to which families served by the SITs had achieved their family goals and improved health and well being; 3. Community outcomes are those indicators that measure the extent to which the community population had improved health, economic, and social status; Listed for each outcome are: ♦ proposed measures ♦ necessary activities to achieve the outcome ♦ existing programs and agencies providing the needed activities, and ♦ lead responsible agency for insuring the availability of activities and programs needed to accomplish the outcome. Extensive review and refinement of these measures is still required. The SITs will be operational and involved with STMT in preparing for the transition from "monitoring of process and input activity" to "performance based management". To qualify as a pilot county under AB.1741, Contra Costa County must develop a performance based monitoring system that links achievements to financing so much of the work should be completed by summer, 1994. SIMT will be seeking University of California, Berkeley students and perhaps San Francisco State students to help us locate data sources for each measure, develop new data sources, and attempt to desegregate county level data for the two communities. • Financing Mechanism A new financing system must be created that gives the County the flexibility to serve families in new ways. With little new money available and existing programs shrinking, new approaches are necessary to maximize the effectiveness of existing funds. In addition, project specific grant funding is needed to help with long term organizational redesign. 26 Phase 1: Start up Financing Each department maintains responsibility for billing for the services, tracking staff time studies, and completing necessary paperwork, under existing categorical rules. During this phase each pilot will have a "budget" for their community which reflects the resources expended by each department. Each pilot will also receive budget information from each department about the revenue billed by the departments for the clients served in their community by the SIT. Phase 2: Continuing Financial Support At the same time that the pilot projects are redesigning the service delivery approach, the County will, be creating a new structure-for ongoing financing of the comprehensive, neighborhood-based, family-centered services. Categorical funding maintains fragmentation of service. Precious resources are wasted to maintain separate categorical reporting systems and relationships. . The County's goal is to create a financing mechanism which pools the resources from participating departments into one budget. The following steps will be necessary to create the combined budget: • Detailed analysis by department and program of funds currently being spent on crisis and at-risk families in the pilot communities. sources of funds (eg., federal, state, local) reporting requirements (eg., time studies, service reports) service requirements (eg., who is to be served) fiscal match requirements. • Combine sources and create annual cost estimate for crisis and at-risk families served currently. This is the initial pooled budget for each SIT. • Identify waivers needed to reduce burdensome reporting and funds tracking requirements. • Estimate savings anticipated from new service delivery approach and create formula for reinvesting savings into supports for earlier intervention and prevention of movement to crisis status. • Undertake a similar funds analysis process with funds expended in communities by schools non-profit organizations and others to define annual cost estimate for all families. Focus will be on services such as employment after-school recreation, overall community health, child care, Head Start, safety and protection. 27 .J • Combine current spending estimates to create a "community rating system" which uses such factors as population, demographics and existing-service history to create a capitated rate for all services in the pilot communities. • Prepare rationale for creating a global budget based on the capitated rate, blending funds and changing current reimbursement practices for each program. • Obtain necessary waivers and funding sources agreements to reinvest savings. This new approach builds.on the County's 20 year experience in managed care and five-plus years in family preservation. When the financial changes have been achieved, the County will have a fiscal structure that will provide the ongoing support for the expansion of service integration into a comprehensive Family Maintenance Organization in each pilot community (Currently, in conceptual development stage within YSB). :healfam.doc 28 • BUDGET The estimated cost for implementing (one-time and .ongoing costs) the two service integration communities is detailed in the line item budget: SERVICE INTEGRATION PILOTS: ONE TIME ONLY COSTS N.R. WP/BP TOTAL Upgrade Facility with Accessibility for People with $35,000 $35,000 Handicaps Renovation - Painting, Cosmetic Improvements to $2,825 $1,130 $3,955 Sites (Painting Supervisor $47.06/hr) assumes GA paint crew; paint costs not included BUILDING WIRING; INSTALL PHONES Probation ($270 @) $270 $ 270 $ 540 Social Service ($100 @) $800 $1300 $2100 Health ($270 @) $810 $ 810 $1610 Computers $1400 $2275 $3675 Drop Pole/Utility Pole $ 500 $ 500 FURNITURE FROM STORAGE Probation $3000 $3000 $6000 Social Service $ 825 $1650 $2475 Health $ 500 $ 500 $1000 DIVIDERS FROM STORAGE EQUIPMENT PURCHASES Probation laptops $ 3,200 $ 3,200 $ 6,400 Social Service Copier $17,140 $17,140 $34,280 Fax $ 1,000 $ 1,000 $ 2,000 Terminals - 5 @ $350 $ 750 $ 1,050 $ 1,800 Terminal Printers - 5 @ $900 $ 1,800 $ 2,700 $ 4,500 PC (with 3270) - 5 @$1,500 $ 3,000 $ 4,500 $ 7,500 MEDS Printer Safe for MEDS Stock $ 800 $ 800 $ 1,600 VCR/Monitor $ 100 $ 650 $ 750 Panic Buttons $ 1,500 $ 1,500 $ 3,000 Port Controllers - 2 @ $85 $ 680 $ 1,360 $10,000 Line Connections $ 1,000 $ 1,000 $ 2,040 Health $ 5,000 $ 5,000 $ 2,000 NR WP/BP TOTAL MOVING COSTS Probation Social Service $ 5C0 $ 500 $ 1,000 Health DATA PROCESSING PROGRAMMING COSTS TO LINK UP TO SIT TOTAL $82,500 $51,335 $133,835 SERVICE INTEGRATION COST ESTIMATES: ONGOING COSTS NR WP TOTAL Security Guards $65,000 $65,000 $130,000 ($251hour x 50 hours x 52 weeks) Rent. Operatinq Costs $30,000 $26,640 $ 56,640 (NR is .25/sq.ft x 10,000 sq.ft) (WP is .75/sq.ft. x 2960 sq.ft.) Shared Clerical Support $20,506 $20,506 $ 41,012 (per sit, 1/2 FTE, includes 31% fringe) Telephone Coverage Probation $1,200 $1,200 $2,400 Social Service $ 280 $ 455 $ 735 Health $1,080 $1,080 $2,160 Voice Mail ($9/month per phone) Probation $ 108 $ 108 $ 216 Social Service $ 864 $1,404 $2,268 Health $ 324 $ 324 $648 E-Mail $22/user/sign on/month Ongoingcomputer maintenance and linkage to mainframe Data Processing costs for systems design of MIS and ongoing improvements in technological support to the SITs. $55/hour for analyst; $45/hour, programmer $1,440 $2,160 $3,600 Equipment maintenance 5 terminals Q@ $6.50/month $ 156 $ 234 $ 390 2 controllers @ $8/month $ 77 $ 115 $ 192 5 PC's @ $15/month $ 360 $ 540 $ 900 5 printers @ $8.70/month $ 209 $ 313 $ 522 Staff costs for mileage, etc. Probation Social Service Health (30 miles/mo/@.28¢) $303 $303 $606 TOTAL $121,907 $106,862 $228,769 One Time Only Costs .$ 82;500 $ 51,335 $133,835 Estimate of Total/One Year $204,407 $158,197 $362,604 APPENDIX A SERVICE INTEGRATION MANAGEMENT TEAM SCHEDULE (Revised 10/14/93) ACTIVITIES TO BE ACCOMPLISHED Aug Sep Oct Nov Dec Jan Feb Team Members Selected X Caseloads Converted X Family Matching Among Team Members X Confidentiality, Release of Information X X X Form Locations Selected X Begin Preparing Sites for Renovation X Management of Team Decided X Clerical Support Resolved X Training X X X Technological Support Created X X Collaboration with Community by Team X X X Members Budget Created X Baseline Data Collected I I X Reimbursement for Services X Clients Notified of the New System and X Delivery Creation of Customer Service List X Union Issues Resolved I X Interface Between Teams and School X X X X X X X Building Ready for Occupancy X Stakeholder Meetings Held X X X YSB Briefing X X X X X X X Services Begin in 2 Pilot Sites X Client Feedback Regarding Services X Begun Begin Evaluation of Team Performance X f r ACTIVITIES TO BE ACCOMPLISHED Aug Sep Oct Nov Dec Jan Feb System for Service Improvement In X Place and Ongoing Expand Focus of Team Members to X Second Circle of Services, Begin Community Oriented Focus Prepare Waiver Requests to the State X Redesign Service to be More Effective, X Efficient and Less Costly H LL Q N Z oo _� cc Q O WJ OW aVi � � mVm +° U 0E c - v :L- N 16 ElAm Z E L 0' ov 00Qar0) 0 (D o M0 c0 < co co 0 co U = 2 co CO U) +. 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C E 3 II C � a .G d L CU CU m dr C > O O C M C O ++ fA 7 m N -p ca a) O U to EO U L E ILJ C o r- U ii m APPENDIX C ;;`� ;• Contra �; •+/il;aen ' :Costa o ; County Tq.4cf,, NORTH RICHMOND FAMILY SERVICE CENTER CONSENT TO PARTICIPATE AND AUTHORIZATION TO SHARE INFORMATION The Family Service Center is designed to improve services ; o :the families of North Richmond: increases serve acce181br staff from multiple disciplrnes in a single, krcal office. • tceduplicate effort rtequrted by boti staff and clients through sharing of mrrnation >> alvs mulfrdisciplinary approaches to developing family service/treatment plans and supporting family self sufficiency helps match family needs with available health, education, social and community services. In order for the Family Service Center to serve you and your family, Center staff (representatives of the Contra Costa County Social Service Department, Health Services Department, Probation Department and West Contra Costa Unified School District) must be able to communicate with each other on your behalf and to review the records of participating agencies. 10/25/93 Under state and federal law, your permission is a prerequisite to the sharing of information and records. Information and records will NOT be disclosed to anyone except staff of the Family Service Center and their supervisors (representatives of the Contra Costa County Social Service Department, Health Services Department, Probation Department and West Contra Costa Unified School District). If information or records disclose that drug or alcohol treatment services are/have been provided, such information and records cannot be used to criminally investigate or prosecute you, in accordance with federal law. Service Center staff have the legal obligation to keep all information and records confidential. If you and your family would like to pagleipate in"'the F" mily Set ice Center, please initial each of the statements'belvur �o acknowledge that you have read, understand and agree uuitft the .staterne�t� 1. I wish'..to.re.cei qi..st3t..V for myself and my minor child(ren) at the Family SerVli? Certfer I `a #horize< taff of`tile Family Service Center to share information and re(%Ws: eg fding me and my minor child(ren) with other staff of the Center (ani ir'supervisors, as necessary for quality control) for the purpose of planning, providing, and reviewing services and/or treatment, including information in the social service case record, juvenile court records, medical records, psychiatric/psychological evaluations, therapist/counseling reports, educational/vocational records, behavioral reports, treatment plans, drug/alcohol abuse records, records related to AIDS, HIV, tuberculosis and sexually transmitted . diseases, financial information, social history, rehabilitation/habilitation plans, summary of record, , and 2 10/25/93 I I i i Your consent to participate in the Family Service Center and authorize sharing of information is effective , 19_ and remains effective for one (1) year. You may cancel your consent at any time during the year; however, the revocation will not apply to any actions taken before you cancelled your consent. Your consent applies to you and your minor child(ren), including the child(ren) for whom you are the legal guardian. Please print the names and birth dates of your minor child(ren). Child's name: Birthdate Child's name: Birthdate Child's name: Birthdate Child's name: Birthdate Child's name: Birthdate If you have any questions regarding this form, please ask ;;The.4th' iichmond Family Service Center's purpose is to support families in their q est for stabil!t l self-sufficiency and happiness. Your participation is important Signature Date Name (please...p #nt} Birthdate Social Sec. # Address City Zip Code Witness: Signature Date Name (please print) Title This form is designed to comply Health&Safety Code 1795;welfare and Institutions Code 10850 and 5328;Education Code 49073; Civil Code 56 and 1796 and 42 CFR Part 2. All records governed by 42 CFR Part 2 shall include the statement"This.information has be disclosed to you from records whose confidentiality is protected by federal law. Federal regulations,42 CFR,Part 2,prohibit you from making any further disclosure of it without the specific written consent of the person to whom it pertains,or as otherwise permitted by such regulations.A general authorization for the release of medical or other information is NOT sufficient for this purpose." A copy of this consent form will be given to you upon request. 3 10/25/93 APPENDIX D SERVICE INTEGRATION JOB DESCRIPTION BACKGROUND On December 15, 1992 Contra Costa County Board of Supervisors launched the Healthy Families 2000 Initiative, declaring the County's commitment to improving its service delivery system to better serve the needs of its clients and to recognize the need to be more cost effective. Healthy Families 2000 directs the Health Services, Social Services and Probation Department to jointly develop and implement family centered, community based comprehensive service integration in specified neighborhoods of North Richmond and West Pittsburg. The values, mission and goals of the initiative are spelled out in the Healthy Families 2000 Framework available upon request from the Department's Personnel Office. The service delivery systems in the two pilot communities will consolidate services of three departments, Health Services, Probation and Social Services into service integration teams (SIT). The SIT will work in collaboration with the whole family, the schools, community agencies, other county agencies and the community residents to insure that services meet the needs of families and communities and promote and sustain healthy family life. Team member jobs will consist of three distinct areas of responsibilities in addition to required job assignments: • Shared team tasks related to managing and operating service integration teams; • Service Integration tasks related to serving common families and clients; • Re-engineering services to be more effective and efficient and developing documentation needed to obtain State and Federal waivers; PERSONS INTERESTED IN APPLY FOR THE SERVICE INTEGRATION TEAMS SHOULD BE-- �► COMFORTABLE WITH CHANGE AND AMBIGUITY, • ENJOY WORKING WITH TEAMS, • COMMITTED TO IMPROVING AND REDESIGNING THE WORK PROCESSES AND JOB ACTIVITIES, AND • COMFORTABLE WORKING IN COMMUNITY SETTINGS, HOMES, AND SCHOOLS. JOB DESCRIPTION PAGE TWO TEAM MEMBERS WILL BE ACCOUNTABLE TO THEIR OWN SERVICE INTEGRATION TEAM, LOCAL COMMUNITY GOVER.%,4ING BODIES AS WELa_ AS TO THEIR OWN AGENCY. Specifically, team members will be expected to fulfill SELF DIRECTED TEAM MANAGEMENT FUNCTIONS THAT RESULT IN EFFECTIVE SERVICE DELIVERY AND HIGH QUALITY SERVICES TO FAMILIES AND COMMUNITIES. ♦ Team Management Functions: Engage in team management functions--develop a joint team work plan, which may include identifying changes needed in work processes to enhance effective service delivery; create a mutual learning community which may include participating in training activities and educating one another on job duties and functions; ♦ Communication and team meetings: Participate actively in team meetings, share. responsibility for communication with team members, communicate with own department about team efforts, engage in conflict resolution with team members, community and clients as necessary; ♦ Community Collaboration and Accountability: Participate in meetings of community and school coalitions and other appropriate groups (residents, schools, community agencies, Municipal Advisory Councils) in order to build and sustain collaborative relationships. In collaboration with the Community-School Coalitions, MAC, and clients develop mutual accountability systems. ♦ Prevention: In collaboration with the community, contribute to improving the availability of prevention activities in the community, these activities may include the promotion of after school events and programs for youth and families, the development of mutual support and self help projects, assistance with economic development activity, health education, and other programs as needed by community; ♦ Client Feedback: Design systems that periodically assess client and community satisfaction with services as well as the accessibility, and acceptability of services received; ♦ Planning and System Improvements: Be responsible for the continuous refinement and improvement of services provided to the community and insure that services for specific target population groups are culturally and ethnically appropriate. Promote policy and system changes by communicating to the Youth Services Board information about gaps in treatment services and about regulatory waivers needed to improve services to families and the community. JOB DESCRIPTION PAGE THREE ♦ Responsibility for outcomes: The team will be responsible for fulfillment of their work plan and achievement of performance outcomes established by the Youth Services Board. SERVICE INTEGRATION RESPONSIBILITIES ARE THOSE COLLABORATIVE ACTIVITIES RELATED TO JOINTLY SERVING THE SAME CLIENT AND FAMILY AND INCLUDE-- IV Family matching across agencies: all members of the team will have clients sign a confidentiality release form that allows the team members to check each other's caseloads and match all families being served by more than one team member/agency. IV All families served by more than one worker/agency will receive an Family assessment; a lead worker will be assigned to develop the family plan and over see the delivery of services and insure that the services are monitored; at termination of services complete a termination plan to insure that the family is connected to relevant community activities and programs in the second circle of the Services Wheel V Co-Facilitation of groups, health education classes, parent education classes as the need is identified. V Provide consultation and training to other SIT members on one's area of expertise and professional field of knowledge in order to improve the comprehensive nature of service provided to families V Share and provide information about community agencies and assist with referrals and resource brokering V Facilitate the linkage and participation of home agency programs in serving families in the community V Assume lead responsibility on serving families assigned through team case planning IV Team members will be expected to deliver services at the Neighborhood Center, in the community, at the school, and in clients homes. JOB DESCRIPTION PAGE FOUR FULFILL ONE'S OWN UNIQUE JOB EXPECTATIONS: ATTACH JOB EXPECTATIONS FOR-- PUBLIC HEALTH NURSING PROBATION MENTAL HEALTH SUBSTANCE ABUSE SOCIAL SERVICES INCOME MAINTENANCE SOCIAL SERVICES CHILD PROTECTIVE SERVICES SCHOOL RESOURCE BROKER The Service Integration Teams will be located at community centers. In North Richmond at the Neighborhood Family Services Mall, 847 Brookside Drive and in West Pittsburg at the Ambrose Community Center located at 3105 Willow Pass Road, West Pittsburg. A TOUR OF THE COMMUNITY CENTERS WILL BE SCHEDULED IF APPLICANTS ARE INTERESTED IN SEEING THE CENTERS; CALL PERSONNEL TO REGISTER FOR THE TOUR. APPENDIX E SERVICE INTEGRATION TRAINING OUTLINE LEARNING OBJECTIVES: By the end of the first year of training the Service Integration team members will know: ♦ the project's purpose, background, operating principles, community needs assessment results,community characteristics,resources available,and the community needs and wants, as well as understand the team's relationship to the schools, community coalitions, MAC, and other community based agencies ♦ the roles and functions of all county agency members involved in the team and how to work with county units that have close liaison relationships to the team's community ♦ the confidentiality rules and procedures to be followed ♦ the key principles of a family centered practice ♦ the key components of a community based service delivery focus ♦ the key characteristics of a self management team approach to service delivery ♦ the steps to follow in using a job re-engineering process and the characteristics of an approach that improve services ♦ principles of promoting collaboration with schools, community leaders, and clients and families ♦ practices related to serving clients and community in a culturally responsive manner ♦ the steps and processes involved in program planning and development ♦ community resources available to support the pilot communities(Delta 2000 has a training approach we may want to use) ♦ the local community history, local governance and community activities, the evolution of county agencies activities in the community 1 ♦ how to operate the new community based management information system ♦ record keeping and administrative practices necessary to operate the program By the end of the first year of training the Service Integration team members will enhanced their skills in the following areas: �► listening, communicating, and collaborating skills conflict resolution and negotiation skills interpersonal skills needed to operate within a self managed team ability to perform job analysis and program development for improving services design and cost effectiveness �► ability to work effectively with families from different cultures �► planning and program development skills how to conduct productive meetings PROGRAM MODULES: I. Orientation will also include an introduction in Self Managed Team Practices Lead responsibility: Rich Clark II. Confidentiality and release of information rules plus record keeping and administrative expectations. Lead responsibility: Kathy Armstrong III. Family Centered Practice Lead responsibility: Bill Weidinger IV. Community Based Approaches to Service Delivery Lead responsibility: Kathy Armstrong V. Advanced practices in operating self managed teams Lead responsibility: Adanna Henry 2 Y I VI. Service Re-engineering and systems improvements and the Technological support and information systems necessary for successful service improvements Lead responsibility: Kathy Armstrong We may need to adapt several of the modules and provide training to the supervisors assigned from each department to work with their service integration team members. Specialized training will be important for several modules, eg: service re-engineering, self directed teams, family centered practice and community based approaches. Each module will consist of V Didactic Instruction: the specific information to be provided by presenters and special guests V Skills/Exercises: activities to teach skills and provide participants a chance to use the information provided V Materials needed for the training IV References and Articles to be provided to participants 3 (. .ORIENTATION MODULE Information to be provided: o Community Sketches--past, present and future trends for North Richmond and West Pittsburg. o Contra Costa County's historical context for service integration: --Board of Supervisors and County Administrator's Commitment to Service Integration,,board orders, board progress reports --Youth Services Board --Inter Agency Family Preservation demonstration --Local community governance and collaborative relationships --Healthy Start Planning Processes and Operational Proposals for the North Richmond and West. Pittsburg communities --Healthy Families 2000 Strategic Plan: Goals and Operating Principles o Legislative Framework for Services Integration (SB620,SB997,SB786, AB 1741 and AB 1765) o Youth Services Board performance expectations and community objectives and plans o Introduction to how each department functions, a survey of each department's programs and responsibilities in each community o Introduction to self regulated teams Skills/Exercises.- 0 kills/Exercises:o Members will be given an exercise which encourages them to express feelings of fears, concerns, hopes and dreams 4 o Members will be given an opportunity to state personal goals for participating in the project and to express their program priorities for their community O The team will be led through an exercise which helps each member to articulate personal expectations of the team and to stave their requirements for successfui�- team functioning. o An exercise which encourages each community team to list opinions regarding which current department practices must be changed and what program mandates must be waived if they are to succeed with family centered work and service integration. o Teams will be asked to analyze a situation in which a family has many different departments involved in their life; the team will be asked to illustrate how service integration, would improve the quality of services to the family and how the various team members from each department would effectively work together to meet the family's needs. O The team will develop a glossary of terms associated with working with families. (Gary Rutkin has a sample which can be used as a model for the training) O The team will review the job description together to make sure there is a shared understanding of what is expected of each team member. Materials: A. All relevant legislation B. Strategic Plan, Board Orders, background reports from Healthy Start planning and operational proposals. C. Healthy Start proposals for North Richmond and West Pittsburg D. Background materials on the North Richmond MAC and West Pittsburg MAC Articles: A. Service integration articles B. Program descriptions from similar community pilots--Sacramento, San Diego, St Louis C. Introduction article on self regulated teams 5 N SY$-��M A Np,X F o��► -V1O p,P�M�N'f SNF � MANpG oolD sk g, u rA low r W tip Data Link Health Services to DP , Public Health *PH Visits-Clinic-Batch System CH - FP *CCS-Being implemented -Batch System . Unix based system 486 *AVSS-Vital statistics-Batch System morbidity reporting *PH lab system-Batch System PDP 11 -tests performed *Immunization system-Stand Alone PC -immuno ation registry *AIDS(PC)OV positive residents-Stand Alone PC Drag Alcohol *Perinatal Substance Abuse options for recovery-online (UNM *PSP-substance abuse AIRS Clinic for Drunk Driving *PSP-Mental Health Contractors on system input micro vax,early childhood information only,no contractors *Drug Store-no real antomation Mental Heath Homeless *Elomeless Center-Monthly Information Download PC programs&laptops Medical Services *PHS-Medical Services-MV 20000 -Clinkmospital Demographic Data Treatment Services Dara Health Plan System "Eligibility Appointment Schedule *Global New System due to be up November 1993 Data General MV L"N Systems transfer We to PHS for billing *Phaim oy *Lab APPENDIX G MANAGEMENT PLAN OVERVIEW OF .ALL ROLES AND RESPONSIBILITIES SELF REGULATED TEAMS PURPOSE: THE SERVICE INTEGRATION TEAMS' PURPOSE IS TO DELIVER SERVICES TO A GEOGRAPHICALLY BOUNDED COMMUNITY/NEIGHBORHOOD. THESE SERVICES WILL BE FOCUSED ON THE ENTIRE FAMILY. AS A PART OF THEIR EFFORTS TO STRENGTHEN FAMILIES, THE TEAMS WILL INVEST TIME AND, ENERGY IN SUPPORTING COMMUNITY LIFE AND PROVIDING PREVENTION AND HEALTH PROMOTION PROGRAMS AND ENCOURAGING MUTUAL SUPPORT AND SELF HELP ACTIVITIES. THE TEAMS WILL BE EXPECTED TO IMPROVE CLIENT OUTCOMES AND ACHIEVE AGREED UPON PERFORMANCE EXPECTATIONS, IMPROVE SERVICE DELIVERY PROCESSES AND FULFILL CCCO'S OBLIGATIONS TO THE BOARD OF SUPERVISORS, STATE AND FEDERAL AGENCIES. MEMBERSHIP: North Richmond and West Pittsburg Teams include all members assigned to the pilots by the Departments of Social Services, Probation, and Health. AREAS OF RESPONSIBILITY INCLUDE: ♦ Provide direct service to clients as appropriate to classification; ♦ Coordinate with other team members in serving clients; ♦ Help resolve on-site issues related to serving families; ♦ Help resolve on-site issues related to team interactions and performance; ♦ Keep Functional Supervisors informed of team members performance in serving clients; ♦ Organize own work including scheduling time with clients; ♦ Initiate requests for time off, work schedule, etc ♦ Work with the Team Facilitator to help resolve crises in the work place; ♦ Make every effort to solve team performance issues; ♦ Relate to department regarding ongoing re-assignment of cases and team member replacements; TEAM FACILITATOR PURPOSE: Facilitate the day to day activities at the pilot sites. This person will insure that team time is constructively directed at service provision, services improvement, and service integration tasks. THE TEAM FACILITATOR WILL BE APPOINTED FROM AMONG THE SUPERVISORS ASSIGNED TO THE PROJECTS AND COULD BECOME A ROTATED POSITION. AREAS OF RESPONSIBILITIES INCLUDE: s Facilitate team relationships ♦ Insure that services are integrated to families that are known to more than one agency or programs ♦ Facilitate efforts to improve services to community and residents ♦ Oversee day to day activities at the site: eg: scheduling of staff time, signing time sheets, overseeing vacation and time off. For those staff only assigned to the team 1/2 time, the team facilitator will coordinate time schedules with the functional supervisor sharing oversight for the less than full time staff. o The team facilitator will give input to the functional supervisors on employee performance and expectations. They will use the STMT group as consultants on team relationship issues and training needs. ♦ Help with evaluation of the pilots'effectiveness by overseeing the necessary collection of data, tracking management information system, and reviewing client satisfaction surveys. FUNCTIONAL SUPERVISORS PURPOSE: will insure that their staff members on the pilot teams comply with department mandates and expectations. 2 THE FUNCTIONAL SUPERVISORS ARE: the individual department supervisors who have responsibility for overseeing department staff assigned to the pilots AREAS OF RESPONSIBILITY INCLUDE: ♦ The functional supervisors will on a systematic basis, review the quality of technical work done and will provide technical assistance on work performance. ♦ The functional supervisor will coordinate with the team facilitator day to day work schedules for staff who are assigned less full time to the teams. ♦ Completes the Department Team Member's performance evaluation, incorporating the Team Facilitator assessment of the team member regarding his/her performance in the following areas: communication skills, serving clients, interviewing, record keeping, work organization, adaptability to job and the team, relationship with others, including community leaders and residents. SYSTEMS CHANGE AGENT PURPOSE: ♦ is coach, facilitator and consultant to the team and team facilitator in fulfilling their tasks of service integration, service improvement, and maintaining good team relations. ♦ acts as a facilitator/bridge between the site teams and external relationships with community, schoois,a nd service integration management team. This person will help develop team capacity to fulfill these roles within the team. This is a transitional position that terminates within 6-12 months. SERVICE INTEGRATION MANAGEMENT TEAM (STMT) PURPOSE: is to act as.a catalyst and facilitate, consult, provide expertise to the Service Integration Teams in the fulfillment of their duties. 3 MEMBERSHIP: There may need to be two service integration management teams one in each region of the county overseeing the pilots. It is preferable to have one meeting and have a portion of the meeting divided into two regional breakout discussion groups. The team will include: • Youth Services Board designated representative (Mary Foran, Beverly Jacobs, Adanna Henry, Ruth Ormsby-HSD; Paul Zaro- PO; Bill Weidinger- SS & CSA; Sara Hoffman & Kathy Armstrong--CAO; Rich Clarke, Jennifer Jennings, and Gary Rutkin--Schools) • Functional Supervisors from each program • Team facilitator • System Change Agent AREAS OF RESPONSIBILITY INCLUDES: ♦ SIMT will plan and implement SIT ♦ The SIMT will provide technical assistance, consultation and oversee the training to the SIT in their region. ♦ The SIMT will help resolve any existing problems among team members that relate to department policies and practices. They will report to the YSB on all recommended policy changes, waivers and regulations requests. ♦ This group will meet once a month. The intention will be to promote strong partnerships among the supervisors from each Department and to give supervisors the time to focus on service improvement planning and service integration efforts. ♦ Training: help develop the orientation training sessions that help set the stage for the true focus of the teams on service integration and service improvements. Help develop scenarios that direct the teams to work out practical approaches to problems illustrating cross departmental issues, service integration treatment planning and service development issues. This SIMT may change over time in response to changing conditions of departments, eg: if all 10 pilots are implemented this management design would require significant changes. 4 DEPARTMENT DIVISION MANAGERS PURPOSE: insure that the Service Integration Teams's performance is consistent with Department requirements and be the final arbitrator of conflicts which can not be resolved by the Teams or the STMT. AREAS OF RESPONSIBILITY INCLUDE: ♦ Decide how much work is expected; ♦ Sets work load targets; ♦ Handles replacement of staff; ♦ Oversees all personnel performance conflicts and issues; ♦ Coordinates with all relevant activities related to monitoring performance; ♦ Insure employee complaints of harassment and discrimination by co workers and/or supervisors are addressed, 4 Determine caseload size assigned to the team;(footnote) ♦ Monitor performance and achievement of outcomes based upon data provided by the teams, ♦ Works with systems and finance to insure adequate coordination of pilots with department wide activities; footnote: A fundamental assumption of this management system design is that the team must have incentives to motivate and reward performance. A key reward for the team who reduces the number of people on their community caseload is to allow them to re- direct their time and efforts into prevention activities. They must be free to provide services that have the potential to further reduce the number of families relying upon the public income programs. This assumption is not now possible due to department wide work load equity policy and the need to obtain state and federal waivers regarding the reimbursement policies. But, we should make every effort not to give the team additional cases outside the geographical area, when and if, they successfully,reduce the number of families in the community on income maintenance and child welfare cases. 5 YOUTH SERVICES BOARD PURPOSE: to obtain necessary state and federal waivers and generally insure the implementation of policy changes needed to accomplish the community based, family centered approach to serving families. AREAS OF RESPONSIBILITY INCLUDE: ♦ Approve the SIT implementation plan; ♦ Insure funding available, o Monitor operation, o Pursue state waivers; ♦ Begin to consolidate budgets for a community, SOCIAL SERVICES MANAGEMENT AND SUPERVISION ISSUES DECIDED 8/10: Disposition Reviews: The workers in each of the pilots will perform the dispositional reviews exactly as is currently in practice. Supervision: The worker in each pilot will meet with SS supervisor to review cases every other week, consistent with existing schedule of supervision. The supervisor will be responsible for insuring that the department guidelines and standards for protecting the child are practiced within the pilot communities. The conflict resolution process for resolving differences of opinion between the team family plan and the supervisor's expert opinion about the safety of the child will be: If there is a difference of opinion regarding the team plan and the supervisor's judgement, the supervisor will meet with the team to discuss the decisions and review the facts together. If there is continued disagreement between the Social Services supervisor and the team about action to be taken on behalf of the child, the Social Services Division Manager will make the final decision regarding action to be taken with the child. 6 Case Coverage: The two workers assigned to each of the pilot communities will provide case coverage for each other during vacation periods and time off. The supervisors in each district will continue to be available for technical assistance on the cases in the respective communities. (eg: The West Pittsburg supervisor will provide assistance to the North Richmond worker when she/he is providing coveraga'on West Pittsburg cases) 7 -4 r } SIT FLOW CHART (Revised#110/7/93) Stage I LL �I N TIS SIT TEAM Functional Sup SSD HEALTH Functional Sup Prob Schools TEAM FACILITATOR of z SYSTEMS CHANGE AGENT SIT MANAGEMENT TEAM YSB BOS DIV. MGRS. ' gCBO'S MAC COMMUNITY RESOURCES SIT FLOW CHART (Revised#110/7/93). Stage 11 C L I , t N [1T S SIT TEAM Functional Sup —,—SSD CBO'S HEALTH MAC ROBATION Community - - SCHOOLS Resources t ! t TEAM FACILITATOR SIT MANAGEMENT TEAM YSB BOS DIV. MGRS. OTHER SYSTEMS 8 APPENDIX H The Services Consolidation Inventory Department of Social Services Child Welfare Services: Intake, court, family maintenance, family re-unification, permanency planning, adoptions, foster care, emancipation, family preservation, foster care licensing, lions gate Probation: Adult and juvenile supervision Out-of-home care Health Services: Medical care services at Health Centers and Merrithew Memorial hospital, Mental Health Services - adult and children and adolescents; YJACT; Substance Abuse treatment and recovery services; Substance Abuse prevention and community partnership activities; Geriatric services; Public Health prevention activities in nutrition, chronic disease, childhood injury and violence prevention; Health Care for the Homeless; Developmental Disabilities services; CCS; CHDP; WIC; Public Health Clinic Services (child health, family planning, immunizations, STD, etc.); Public Health Nursing visits; Acute and Communicable Disease Follow-Up (TB, STD, etc.); Prenatal Care outreach; HIV/AIDS outreach; Dental Disease Prevention in the schools; environmental health services. Communitv Services: Head Start, State funded Child care, Community Services Block grant services Housing Authority_ Section 8 vouchers, Housing Assistance, Operation Bootstrap, Pride, Homeless Program and Shelters Schools/Education: Community Colleges School District services provided to the community school Employment Services: West County Workforce Development Council CCC PIC GAIN Program, General Assistance Work Program ROP programs and adult education programs in East County Benefits and Eligibility Programs: AFDC, GA, Food stamps, Medi-Cal, FEMA, Section 8 Housing Vouchers, CHDP 200%, Head Start, Weatherization, Emergency Homeless, Rental Assistance, SSI and WIC