HomeMy WebLinkAboutMINUTES - 05041993 - IO.5 TO: BOARD OF SUPERVISORS Contra
). +
FROM:. + INTERNAL OPERATIONS COMMITTEE `.'` f Costa
County
DATE: April 26 , 1993
SUBJECT: RESTRUCTURING THE DELIVERY OF HUMAN SERVICES IN
CONTRA COSTA COUNTY
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1 . ACCEPT the attached status report on Service Integration and
ENDORSE the directions being taken.
2 . DIRECT the County Administrator to report back to our
Committee on June 14, 1993 identifying those federal and/or
state waivers which would be needed in order to implement the
type of service integration which is anticipated in the
attached report.
3 . AUTHORIZE the County Administrator and the staff of our
various human services departments to discuss with the
Zellerbach Foundation, Northern California Grantmakers and
other foundations their interest in providing funding to
assist in the transition from the present way of delivering
services to that outlined in the attached report, particularly
if we were to undertake this as a three or four county project
with Sacramento, Alameda and/or Solano counties .
4 . DIRECT the County Administrator to work with the staff from
the various human services departments on ways in which the -
schools can be made a more central part of the service
integration model, using a school site as the point from which
other human services would be delivered and recognizing that
the classroom is often the most reliable early warning system
of problems within the family unit.
5 . REQUEST the County Administrator to . provide the Board of
Supervisors with an analysis and recommendation for a position
on AB 1741 (Bates) which may be a vehicle for obtaining the
necessary waivers needed for this type of a project.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD CO T
_.APPROVE OTHER
SIGNATURE S
4SUNNE WRIGHT -Mc: SMITH
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
1 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
Contact: PHIL BATCHELOR. LERK OF THE BOARD OF
CC., See Page 2 SUPERVISORS AND COUNTY ADMINISTRATOR
BY DEPUTY
f
I.O.-5
r •
-2-
BACKGROUND:
In October, 1992 the Board of Supervisors directed that certain
actions be taken in support of an effort to find new and different
ways in which to deliver human services in Contra Costa County
which would integrate services regardless of arbitrary departmental
lines . This effort was to propose ways in which to increase the
effectiveness of the current service delivery system in specified
areas of the County.
On January 5, 1993 this matter was referred to our Committee. On
January 19, 1993 this referral was expanded to include the District
Attorney's Family Support Division's services . On April 26, 1993
we met with staff from the County Administrator' s Office, Community
Services Department, Health Services Department, District
Attorney' s Office, and the Juvenile Justice & Delinquency
Prevention Commission.
We reviewed the attached report with staff, noting particularly the
Services Wheel on page 10 which shows the relationship among the
various services which are available and the level of problems
displayed by families, the Client Flow Diagram on page 15, and the
Time Frame for Operational Teams on page 18 . It is staff 's hope
that services can begin in the communities of West Pittsburg and
North Richmond in September, 1993 .
It was suggested by our Committee that discussions be continued
with various foundations and funding sources to provide grants for
the transition from the current delivery system to that
contemplated in the Service Integration concept embodied in the
attached report. Our Committee believes that Sacramento County,
which is moving in much the same directions we are might be
interested in cooperating in some pilot projects with one or more
foundations and that Alameda County might also be interested.
Staff noted that Solano County was also expressing interest in this
concept.
One barrier which has been noted repeatedly in the need for various
federal and state waivers in order for Service Integration to work
effectively. We want staff to identify and report back to us on
June 14 exactly what waivers are required in order to allow this
project to move forward and be operated as effectively as has been
conceptualized.
We will continue to stay in close contact with this effort and will
report back to the Board following our June 14, 1993 meeting.
cc: County Administrator
Sara Hoffman, CAO's Office
Social Services Director
Health Services Director
Community Services -Director
County Probation Officer
Executive Director; PIC
District Attorney
r
CONTRA COSTA COUNTY
OFFICE OF THE COUNTY ADMINISTRATOR
651 Pine Street, 10th Floor
Martinez, California 94553
Telephone: 646-1390
DATE: April 26, 1993
TO: Supervisor Jeff Smith
Supervisor Sunne McPeak
Internal Operations Committee
FROM: Youth Services Board 5-r
Phil Batchelor, Chair
SUBJECT: Status Report on Service Integration
Recommendations:
Recommend that the Board of Supervisors ACCEPT the status report on Service
Integration.
Background/Reasons for Recommendation
On December 15, 1992, the Board of Supervisors authorized and directed the Youth
Services Board, Social Service Department, Health Services Department and Probation
Department to proceed with the development of integrated service delivery in selected
communities. In doing so, the Board requested that the 10 Committee monitor the
progress of the Service Integration effort.
Attached is the implementation plan for Service Integration. The plan provides details on:
actions to date
levels of service
• expectation of service integration teams
team approach
team membership/management
client flow
technology
financing mechanisms
time frames for operational teams
evaluation of outcomes.
h30:iocomm.mem
1
1
i
HEALTHY FAMILIES 2000:
PLAN TO IMPROVE THE HEALTH OF
CHILDREN, YOUTH AND FAMILIES
IN CONTRA COSTA COUNTY
April 26, 1993
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 that 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 the families
that they serve 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 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.
VALUES
Children are Society's most valuable resource. Society is responsible for protecting 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 service delivery
systems of the agencies that serve them, including the allocation of resources for services.
2
Family centered services address the broad concerns and responsibilities for children,
families, neighbors, and their social and economic environment. 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.
. . . 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 and other complicated bureaucratic
procedures.
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.
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 costly treatment and care.
3
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 its 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.
Family Centered Service Integration
Contra Costa County is in the process of replacing its current fragmented service delivery
system, which 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
"A" and "B" Families.
The expected outcomes are:
'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,and/or 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
1. An increase in the number of "A" Families by increasing the movement from "C"
Crisis to "B" At-Risk to "A" Self-Sufficiency and prevention of movement toward
,.0.11
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.
COLLABORATIVE PLANNING TO DATE:
The Service Integration effort began in June 1991. Following extensive coordination with
the departments represented on the YSB, as well as the County Office of Education, the
"Healthy Family 2000" strategic plan was adopted January 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,
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 initiation of several inter-related needs
assessment activities including 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 both the North Richmond and West Pittsburg neighborhoods that had efforts
underway which could be leveraged to support service integration:
2I addition, 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
The North Richmond and West Pittsburg Advisory Boards sponsored the 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 that 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) is incorporated into the program
design. By May 15, 1993 we will learn if these grants have been funded. (The
implementation plan assumes that the operational grants will be funded.)
Time Line of Actions to Date:
Hired YSB consultant to develop June 1991
Strategic Plan for Implementing
Comprehensive Integrated, Community
Based, Family Centered Service system
in Contra Costa County.
Initial draft of YSB
Healthy Families 2000: Strategic Plan September 1991
Plan reviewed and approved by Expanded
Youth Services Board January 1992
Applied for Healthy Start Planning
grants to help support Strategic
Plan--North Richmond, West Pittsburg November—March 1992
and Probation/County Office of Education
in West County
YSB adopted Healthy Families 2000 after
extensive input from Departments June 1992
Healthy Start Grants awarded to North
Richmond/Verde School and West Pittsburg/
Mount Diablo Unified School District
and County Office of Education/Probation
in West County June 1992
6
Began Community Planning September 1992
Conducted Needs Assessment, Data Match,
Resource Mapping and visited program models November 1992-January 1993
Youth Services Board began planning
Service Integration Teams and how they
will work with each of the Healthy Start
Communities October 1992
Began PATHS Project/ Pittsburg November 1992
Board of Supervisors adopted Order
authorizing pilot Service Integration
Teams in North Richmond, West
Pittsburg, Pittsburg, San Pablo
and Concord. December 15, 1992
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 on a Healthy
Start Planning Grant proposal to CA Dept.
of Education. January-March 1993
Submitted Healthy Start Operational Proposals
for North Richmond, West Pittsburg
(and West County Youth Transition project) March 15, 1993.
Conducted intensive planning for service integration
team implementation January-April 1993
Presented implementation plan and status report
to 10 Committee April 26, 1993
IMPLEMENTATION OF SERVICE INTEGRATION
Pilots for family-centered services are scheduled to begin in the North Richmond and
West Pittsburg communities in September 1993, in conjunction with the anticipated start
of the Healthy Start Operations Grants and the opening of school. Implementation in
7
Pittsburg will follow in approximately 6 months, in close coordination with PATHS3 and the
Parkside Healthy Start project (assuming funding for the Parkside Elementary, Pittsburg
Unified School District Healthy Start Planning Grant applications.)
The Service Integration Teams are one facet of the full implementation of this plan. The
success of the effort in the 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, one at a time, along with the bricks existing
within the community based organizations and the residents; bricks which have been
mostly ignored by public agencies. We will be living in the old structure, but slowly moving
into the new structure, during a time of major budget cuts.
The discussions and planning for the new systems have been extensive and are detailed
by section:
Levels of Service
Expectations of Teams
Team Approach
Team Membership/Management
Client Flow
Technology
Financing Mechanisms
Time Frames for Operational Teams
Evaluation and Outcomes
Despite the time and effort of both the Advisory Boards and Youth Services Board, not all
questions have not been answered nor all issues resolved. In some cases, it will be
necessary to make adjustments based upon actual experience. In others, program
refinements are still being worked on by the involved parties.
3 PATHS is a three year federally funded grant to prevent homelessness for At Risk Families and to develop an automated
network for public and private agencies to provide clients a uniform eligibility system, risk assessment, tracking of services, and
monitoring of outcomes. It is this project which will be primarily responsible for developing the technological support system for each
of the neighborhood pilots.
8
Levels of Service
In each pilot, three levels of services must be integrated, coordinated, and made available
in the community:
1. Service Integration Team Services-- Each community service integration team will
provide intense 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.
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.
These three levels of services are best represented in a Services Wheel:
9
i SERVICES WHEEL
,A.. --
Resources Pool
Homeless Services
Geriatric Services - -
___. Community-Based Network
of Services for All Families
Senior Services Nutrition for the Elderly ; P.
Ch%/ ALL Families �5Vol
-
dCar - =- IHSS
eiyead Stat., 5�r
School
Healthy Start Program-.•
Service Integration Team ',Volunteer Services
1)Community HS. Family Resource Council Employment
Community Prevention'
-- ---, Child Welfare Service ' _ _ _ ... EBCEAp
Programs in ! Probation
• Nutrition' Recreation&After;
• Chronic! School Activities: Health-Clinical Generalist
_-
Disease
(PHN Type)-_ -- ----....--- -- -- -- ,
• Injury&\ Case management S@NIC@S Head Start,
Violence`, through HS grant
_... — United Way
_ ...-- 2)Families in crisis, at risk of crisis -- -
Preventative Dental :Delta 2000
Education in Schools - ---- -- Opportunity Wes
Housing Authority, --..... _-
Community Services et�� i Medical Services
Block Grant- th
Weatherization..- " Community Org. in! S�O�
Neighborhood -----
1 Qj . On-Site Mental Health Ces
a� Consultation' A_x I
MAC`, - ---
Public Health Clinic Services
-- - 5 On-Site
Business Round , Benefit Services/Single
Table Substance Abuse
� Eligibility Application
Community Partnerships
Substance Abuse
Treatment Programs .
Area Agency on Aging
Mental Health Services,
10
Expectations of the Service Integration Teams
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 selecting these program outcomes must 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, and Health Services Department. The SIT will provide services and support
primarily to Crisis Families. At this time, it is anticipated that at least 80% of SIT time will
be spent on these activities. Up to 20% of SIT time will be spent on helping all families
by working with the Healthy Start Coordinator, the MAC coordinator, the greater
community planning and advisory bodies on the community-based network of services.
The teams will develop a case management method for working with Crisis Families. The
teams will figure out how to serve these families by determining the commonalities among
each of the departments, the interdependence that exists between the departments that
service the same families, and the specialized expertise that each department brings to
the service mix capacity.
There will also be dialogue between the community and the SIT in serving Crisis and at-
Risk Families through the Family Resource Council made up of the SIT and the Healthy
Start Project case management staff as well as school staff. This Family Council will
meet once a week, to review and conference all families being helped through service
integration, to ensure team coverage, lead responsibilities and to avoid duplication.
The SIT members will be primarily responsible for all mandated families, the Healthy Start
Project case management staff will provide services to the un-mandated families, referred
by the schools/community/parents.
11
,
The Council will use the family preservation model of serving families, assessment, joint
service planning,develop family strength, insure access, and 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.
Further Needed Refinements:
1) define referral procedures between the SIT, Healthy Start Program, community
groups and mother agencies.
2) identify barriers and obstacles to integration and obtain changes to policy, rules
and regulations, including those which require state and federal waivers.
3) develop an early warning mechanism for identifying pending family crisis since our
ultimate purpose is to intervene before a crisis is unmanageable.
Team Membership and Management
The number of team members from each department and their specialty will be
determined by each Department, based upon community characteristics. The YSB will
announce the positions available for each of the pilot teams. The departments will seek
volunteers, and select applicants who meet the criteria of the service integration team.
Members of the Healthy Start Advisory Boards will be invited to review the final
candidates.
A team leader will lead each of the pilot teams. The team leader's role is to facilitate team
self-management, ensure coordination with the Healthy Start Community-Based Project
MACs and YSB, and to identify issues preventing family centered services.
After each department has assigned their staff to work on the team, the team will work
with the Healthy Start Project Coordinators 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. This is not a co-location of
staff but a re-design of the service delivery to families. The goal is for the team to assist
families through an integrated and multi-disciplinary approach. 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.
The team members will relate to their own departments, seeking clinical consultation on
cases, and presenting reports to their peers and colleagues during regularly scheduled
meetings. They will stay well informed about the regulations and administrative issues
under which they must practice. The team leaders and teams will periodically provide
reports on the status of service integration.
12
The team leader and team members will closely align their work with the Healthy Start
Advisory Board and Coordinator, to ensure that the SIT is responsive, accessible and
accountable to the community.
The team will eventually 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.
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 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 and career enhancement opportunities.
Client Flow
The Healthy Start Family Resource Council in each of the Healthy Start Communities will
oversee the management of individual service delivery in the community. The Council will
consist of the SIT Team, the Healthy Start case manager/coordinator, and school student
support staff.
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 is intention to
eventually provide this function through a Customer User Friendly Work Station,
13
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 Family Resource Council 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 Healthy Start programs as well as
services available in the community and the greater County region.
14
CLIENT FLOW DIAGRAM
IEnformation & Refer to Community-
Assistance Based Network &
I
Resource Pool
Referral in
Social Services Referral in
Probation Com_ munity-Based Community
Health II School
Community Services Family Resource Walk-in
Council Self Referral
--' Screening - check in to
determine if family
known & assign worker
to complete
III Team Involvement
with Family. Assessment
Develop Family Plan
Assist in Achieving Plan
I Consult Schools
Recreation 40 Follow Family 1, ;o Benefit Programs
Parent Education:; !` I Insure Referrals 11 Employment
Drug/Alcohol Treatment Services Received I Housing
y
Terminate to
IV Community-Based
/
System of Services
Recreation Employment
15
Technology
The PATHS Project in Pittsburg was awarded a federal grant to develop a
comprehensive case management system that can be utilized for health, welfare, housing
and other services. They are pursuing additional funds to complete this task. Through this
effort the County could have the technological support needed to help the pilot
communities provide effective integrated services. There are four primary components
of the technological support:
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.
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 the Teams, Healthy Start Advisory
Boards, MAC and other 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.
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.
16
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 lists each department's
resources allocated to the pilot. 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.
17
• 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).
Time Frame for Operational Teams
Task Date
Determine the number and types of team staff
needed from each department needed for teams. April 1993
Follow up with unions as appropriate to secure
necessary agreement May 1993
Develop job announcements, announce available
positions and recruit team members for North
Richmond and West Pittsburg. May 1993
Select staff and begin process to re—assign cases,
bill existing categorical accounts, work out
procedures for team management and
relationships with home organization, Healthy
Start Advisory Board and the Youth Services Board June 1993
Finalize client flow, referral processes, linkages
between Team, Healthy Start and Community.
Orient and cross train team members
and home organizations. July 1993
Reassign cases, refine team approach to working
with Healthy Start Family Council and serving clients. August 1993
Begin services in the communities. September 1993
18
Evaluation and Outcomes:
The fiscal and organizational model for Service Integration will be judged on a variety of
factors relating to quality and comprehensiveness of services, efficiency of program
administration and, most importantly, outcomes for families and overall improvement in
quality of life within the two target communities.
Process evaluation will examine the ability of the pilot to meet the full-range of service
needs of community members either through direct provision of services, contracting of
services, or linkage with other providers. Such a evaluation will be a regular part of
organizational operations.
Outcome evaluation will focus on the pilot's ability to produce specific outcomes. While
specific percentages for outcome goals can only be determined following actual program
experience, some possible outcome objectives are outlined below. The objectives are
taken from the Healthy Families Strategic Plan.
Group A -- All Families in the Target Area by Year 2000
A.1 Increase significantly the number of parents moving off AFDC due to meaningful
employment.
A.2 Increase the average number of wellness care visits received by infants.
A.3 Increase access to health care and dental services for low income children by
increasing by the number of providers accepting new low income children for care.
AA Decrease the number of intentional and unintentional injuries occurring to children
(0-19 years old)
A.5 Increase the number of community initiated activities that support families and
community.
A.6 Increase the number of residents from each of the communities who participate in
the activities provided.
a
Group B -- Families at Risk by Year 2000
B.1 Reduce.the percentage of low birth weight (LBW) infants born in the target areas.
Baseline: West County high risk census tracts= 11.86% of births are LBW
(1981-85)
East County high risk census tracts = 11.75% of births are LBW
(1981-85)
19
a ,
B.2 Reduce the rates of intentional and unintentional injuries and death due to violence.
B.3 Reduce the percentage of births to young women less than 18 years old.
Baseline: West County high risk census tracts = 10% of births are to teens.
(1981-85)
East County high risk census tracts = 9.3% of births are to teens.
(1981-85)
B.4 Improve school attendance by children in the target communities.
o Provide day care for younger children so that older children do not
miss school to take care of them.
o provide special day care for sick children so that older children do
not miss school to care for them.
o Provide in-school and after-school support activities --tutoring,
recreation, mentoring--for grades 2-6 to prevent failure (turning off
to school begins in grade 3)
B.5 Improve the health status of children and youth by exploring partnerships with
schools to provide and /or facilitate access to health promotion, health education
and health care services. Topics for attention include nutrition, weight
management, mental health, tobacco, drug and alcohol prevention/intervention,
violence prevention, sexual responsibility, etc.
Group C -- Families in Crisis Year 2000
C.1 Reduce the average length of stay for children in out-of-home care through
enhanced Family Preservation/Reunification services.
C.2 Reduce the number of children at eminent risk of out-of-home placement by
increasing number of children served in the Family Preservation Project.
C.3 Decrease the number of juveniles under the supervision of Probation that are
placed out-of-home.
CA Increase the number of youth who emancipate from out-of-home placements as
evidenced by success in the following areas:
% who have GED/Diploma
% who are employed
% enrolled in higher education/vocational training
% with stable housing
20
lb
a • i
C.5 Increase the number of pregnant women and women with young children who
participate in intensive substance abuse treatment and recovery programs.
C.6 Increase the number of families that move from C to B to A after being served by
the SIT and community based programs as determined at three month, six month,
and 12 month follow up with families.
21
Attachment: 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; YIACT; 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.
Community 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
22