marin's youth pilot project - Center for Social Services Research

Participants’ Case Studies • Class of 2004MARIN’S YOUTH PILOT PROJECT:IMPLICATIONS FOR A LARGE COUNTYNeely McElroy*E XECUTIVES UMMARYBACKGROUNDHistorically, foster care placement has been the mostvisible symbol of child welfare. As the State ofCalifornia embarks upon Child Welfare Redesign,California counties will be challenged to face thewell-being outcomes for its children and families. Inits discussion of its objectives, the Child WelfareServices Stakeholders Group, which developed muchof Redesign, addressed the issue of children in fostercare. In their instructions to the counties, the stakeholdersgive preference to prevention, family support,and less intrusive interventions than foster care.Most child welfare professionals would wholeheartedlyembrace this philosophical shift. Marin County’sYouth Pilot Project (YPP) not only embraces thisphilosophy, it addresses these very issues.Marin County Youth Pilot Project (YPP), whichbegan in 1996, serves the families of selected childrenwho are currently in placement or at imminentrisk of out-of-home placement.YPP has achieved at minimum an 85% success ratein keeping children in lower levels of out-of-homeplacement. Contra Costa County is also vested inidentifying innovative ways of achieving such agoal.SUMMARY OF FINDINGSThere are two key elements of YPP that make itsuccessful in keeping children safe in the leastrestrictive levels of care. First, once a child or familyis found eligible, families receive intensive,coordinated services through Family Network meetings.Family Network meetings are led by a trainedfacilitator and are comprised of the family, child oryouth (when appropriate), service providers, andmembers of the family’s support system.Family Network meetings are crucial in defining afamily’s success. Through collaboration and teamwork,parents are empowered to have a voice intheir family’s lives.The team approach encourages parental change. Nolonger is case plan “compliance” being measured.The parent is able to regularly demonstrate thecapacity and ability to make life changes to meetthe safety and emotional needs of his or her child.The second key element of the program is the abilityto pay for goods and services. As the teamforms, a service plan is developed. The service planincludes goals and action steps. Marin Countybegan YPP under the flexible funding stream ofAB1741and more recently is funded via a statewaiver. The project is able to pay for goods and servicesthat are identified in the service plan to supportthe goals and action steps. YPP can fundservices that traditional funding streams cannot.These services and goods include mentoring, therapy,psychological evaluations, and tutoring, extracurricularactivities.* Neely McElroy MSW, is the Family to Family System of Care Federal Grant Coordinator, Contra Costa County, Children &Family Services.43

Participants’ Case Studies • Class of 2004MARIN’S YOUTH PILOT PROJECT:IMPLICATIONS FOR A LARGE COUNTYNeely McElroyINTRODUCTIONCurrently, Contra Costa County is embarking onseveral innovative initiatives that have significantimplications for the way that child welfare is practiced.First, Family 2 Family Child WelfareRedesign was initiated in 2001 which is a bestpractice, grant-funded initiative that strives toimprove well-being outcomes for children. Second,in late 2003, Contra Costa was selected to be aCohort 1 State Child Welfare Redesign county. StateChild Welfare Redesign is a broad, system-wideinitiative by the state of California to improve outcomesfor children and families. And third, ContraCosta County was awarded a five-year, federalSystem of Care grant to provide wrap around andteam decision making services to youth in placement.These three initiatives have common goalswith each other and strive to improve the well-beingoutcomes for children and youth served by the childwelfare system.Since 1996, Marin County Social Services has provideda program, Youth Pilot Project (YPP), to servefamilies, and that also strives to improve the wellbeingoutcomes for children and youth. Youth PilotProject serves the families of selected children whoare currently in placement, or at imminent risk ofout-of-home placement in the county’s mentalhealth, juvenile probation and the social servicesystems. Through facilitated family decision-makingprocesses, intensive services are provided tothese families in order to safely maintain their childrenin the least restrictive, viable level of care.The Youth Pilot Project began under AB 1741 in1996. It has been a small program, which has successfullyserved children and families in MarinCounty. Recently Marin County filed for a statewavier and, with this waiver in place, the projecthas been able to expand its services significantly.Marin County is best categorized as a small county.Although geographically large, it has a small population(247,289) and currently has approximately90-95 children in out-of-home care at any giventime. On the flip side, Contra Costa County is alarge county geographically and in population.Population counts recently hit one million residentsin Contra Costa County, and the number of childrenin out-of- home care as of June 2003 was 2087children. By all accounts, the Youth Pilot Projecthas been a success for small Marin County andexample of best practice.This case study will examine how the Youth PilotProject maintains children and youth in the leastrestrictive level of out-of-home care and how itmight be implemented into a large county likeContra Costa County which is already embarkingupon several broad initiatives.HISTORY OFTHE YOUTH PILOT PROJECTThe Youth Pilot Project (YPP) was developed underthe auspices of AB1741 in 1996. YPP wasdesigned to serve families of selected children whoare in placement or at imminent risk of out-of-homeplacement. This is a collaborative project with thecentral partners being Marin County SocialServices, Community Mental Health, and JuvenileProbation. Each of these agencies makes directreferrals to YPP based upon referring criteria. Alva45

BASSC Executive Development Training ProgramJ. Ackley currently coordinates the program. Shereceives the referrals as well as authorizes expendituresfor enhanced services. The program is housedand managed in the Marin County Social ServicesDepartment.Since its inception, YPP has been a small programonly serving approximately 20-32 families per year.However, in 2003, the State of California grantedMarin County a waiver to allow for the flexible useof state funds previously available only to fund outof-homeplacement. As a result, the program isexpanding significantly and allowing more familiesto keep their children at home or in the least restrictivelevel of care. The goal is to double the size ofthe program. In a semi-annual report, which coveredJuly 1–December 31, 2003, the program was notedto have served 36 families with a total of 84 children.Of those families served, 10 were referred byMental Health, 17 by Social Services, and 9 byJuvenile Probation. As a result of the program, 96%of the children avoided more restrictive placements.KEY ELEMENTS OF THE PROGRAMThe Youth Pilot Project accepts referrals fromMarin County Social Services, Mental Health, andProbation. A referral generally begins with a phonecall to the program and then an intake form is completed.The requisite issue that must be addressedfor acceptance into the Youth Pilot Project is that ofmeeting the criteria for eligibility. A child must bedetermined to be in immediate need of placement.Once the referral is received and accepted, thefamily or child’s information is sent to theCoordinated Youth Services Council (CYSC). Thisis the entry into a key component of the program:the Family Network meetings.Family Network Teams are formed to work collaborativelywith a family to provide intensive services.Family Network meetings are led by a trained facilitatorand are recorded by a member of the team.Before a team is formed, CYSC holds a formal orientationwith the referred family. This meeting runsfor about 30-60 minutes and is used to both orientthe family to the model and solicit people that thefamily would like to be part of the team.With any team, there are logical participantsinvited to be on the team. For a mental health case,the team might include the child’s mental healthcase manager, therapists, and special educationteacher. The family could then identify others tojoin the team, such as extended family members orother community partners. As the team develops,and goals are identified and action begun, moreproviders usually join the team. This may includeadditional family therapists, mentors for the children,tutors, etc. After the orientation, the FamilyNetwork meetings are set up. The teams meet regularly,usually monthly.During the first meetings, a service plan is developed.The plan reflects the goals and services thatare discussed at the Family Network meeting. Theplan includes basic data such as the referringagency, family members, and child’s current livingsituation. It then includes a roster of individuals atthe team meeting. Goals are then developed andservice action steps identified to meet the goals.There may be a number of action steps to meet agoal. An example of a goal might be that “Andrewwill remain in the home (stay out of placement).”One action step might be “Andrew will have a consistent,dedicated mentor who will help him withsocialization and life skills.”46

Participants’ Case Studies • Class of 2004Then, at each meeting, the goals are addressed andprogress toward each action step is recorded anddocumented. Next steps are always addressed tocapture any follow-up that may be indicated. Aspart of the goal development, the group develops alist of “signs of success.” This helps the teamremain clear about, for example, how they willknow that Andrew is making progress toward hisgoal. In this example, one sign of success is that“Andrew will want to have a mentor.”Another key component of the YPP program is theability to pay for goods and services that help meetthe team’s goals. As the service plan is developed,some action-steps will require that a service is providedor good purchased. In Andrew’s case, a serviceaction goal that met the goal of staying in thehome was “Andrew will participate in a local basketballleague after school on Mondays andWednesdays.” The team then will request that YPPcover the enrollment fee for this basketball league.Because of its flexibility of funding, YPP is able topurchase a variety of goods and services. Some ofthese services include tutoring, mentoring, extracurricularactivities, respite, parent training, angermanagement, substance abuse treatment, and therapy.When the program began under AB1741, YPPwas not able to utilize the net savings that resultedwhen a higher level of care was avoided. Now, withthe waiver provided by the State of California,Marin County continues is able to redirect savedplacement costs into direct services to families andchildren.Alva Ackley, the program’s coordinator, authorizesservices on a service plan and negotiates paymentand billing with providers. However, initially, theprogram must determine in what out-of-home levelthe child would have been residing had he or shenot received enhanced services. The net savingsfrom projected placement level and current placementlevel determines the amount of money that thecounty receives for that case. For example, if achild would have been in a Level 12 residentialtreatment facility, but through the services of YPPis able to stabilize in a foster home, then the countywould receive those savings. The savings on eachcase can pay for the services designated andapproved in the service plan. In actuality, all thesavings from all the participants are pooled into oneaccount. The YPP coordinator has the discretion toutilize whatever amount of money is necessary tosupport a child in the least restrictive level of careup to an amount equal to the cost of the estimatedhigher level placement. In this way, all of the YPPparticipants help each other toward their goals.The semi-annual report dated July throughDecember 31, 2003, notes that of the 11 familieswho ended service, only two were placed out of thehome, one by Social Services and one by a family.Five of the families met its goals, one focus childmoved out of county, and three families did not followthrough with services. In the prior year-endreport of fiscal year July 2002 through June 2003,ten families ended service. Of those, six completedtheir goals, one child graduated high school withgoals partially completed, and three children wereplaced out-of-home. In that same report, MarinCounty reported that it served 32 families and 43children at risk of placement. Siblings are alsoserved in YPP, but not included in this number.)The cost of services for those participants was$347,178. The report estimated that had the 43children been placed out-of-home or at higher levelsof care, the cost of the placements for the 43children would have been $1,130,024.47

BASSC Executive Development Training ProgramMarin County Social Service social workers reportthat YPP cases move faster towards goals and, inessence, make their case management “easier.”They participate in a larger “brain trust” and feelthat even the most difficult cases are less adversarialand more successful. They also report that parentsare empowered through the process and have a“voice” where they did not have one before. Theyhave seen even their most resistant clients makechanges. They feel that the team meetings are flexible,dependable, responsible, resourceful and a“corrective experience” for families. Team memberswork together to remind and support each other oftheir agreed upon goals and, in essence, provides“transparent staffing” for each case. With theirbusy caseloads, social workers report that theyappreciate the accountability that the teamapproach demands. In social services, YPP hasbeen used to work with families in reunification orfamily maintenance, to support relative caregiversand foster parents, and even to help youth as theymove towards emancipation. The consensus is thatthe program is flexible enough to work with a multitudeof cases.SUCCESSES AND OBSTACLESFrom YPP there have been a number of great successesand, to a lesser degree, some ongoing barriers.As the program has been in existence since1996, there have been numerous programmatic andsystematic successes. First, at least 85% of participantchildren have remained in the least restrictivelevel of care due to the YPP services. Cases receivesuch intensive oversight and services that thosechildren are able to remain in their family homes orin lower levels of care.Second, but perhaps most exciting, is the successthat the program has made with parents. Unlikeconventional tracking of parental compliance in acase plan to determine if a child is safe or ready toreturn home, YPP cultivates “parental growth”. Theparent has been shown to change and improve inareas that were previously a concern. This area ofchange is perhaps the primary reason children areable to remain in lower levels of care through theservices of YPP.Finally, on a systemic note, there have been greatinroads into strengthening relationships with communitypartners, especially other county counterpartssuch as Mental Health and JuvenileProbation.To a lesser degree, there have been barriers that theprogram has had to face and, in some cases, continuesto face. First, while their partnerships withcommunity agencies have strengthened over theyears, this continues to be an area of growth anddevelopment. On an ongoing basis, communitypartners do not always understand each other’s populationsand mandates. YPP staff deals with thisarea by continually “putting issues on the table” toaddress and attempts to clear it up as soon as possible.Second, the success and amount of use that thisprogram gets is contingent on a philosophicalchange. Traditionally, the casework model is a medicalmodel where the agency diagnoses andassesses the “problem” and then gives a “prescription.”This model is process-oriented, and participantsmust believe that the client has the ability orcapacity to change. Many social workers who havecome to believe in this philosophical shift arewholeheartedly sold on the program. Other staffmembers think they have made the shift, but continueto operate as they did before, dictating servicesand encouraging dependence.48

Participants’ Case Studies • Class of 2004A third barrier is that of bilingual resources. Aswith many communities, there is often not enoughbilingual staff, in this case Spanish speaking, tomeet the needs of the population that it serves. Asthe program has expanded, YPP is challenged tocontinue to find and train facilitators and otherproviders who are Spanish speaking so that familiescan receive the most culturally competent servicepossible.IMPLICATIONSFOR CONTRA COSTA COUNTYAs mentioned earlier, Contra Costa County is managingthree separate, but interwoven initiatives:State Child Welfare Redesign, Family 2 FamilyRedesign, and System of Care. YPP has interestingimplications for the latter two initiatives.Family 2 Family Redesign is an initiative thatstrives to improve outcomes for children. One strategyof this initiative is to make decisions as a team.Family 2 Family utilizes Team Decision-Making(TDM) meetings as a vehicle to address the placementissues when a child is determined to at imminentrisk of removal from the birth family. In ContraCosta County, this strategy is currently limited inuse in the Emergency Response Program. Theintention of TDM meetings is to improve the qualityof decisions being made about children’s situations.Through collaboration, the family is viewed as the“expert” on himself or herself and is respectfullyincluded in the decision-making process.Additionally, Contra Costa County recently wasawarded a five-year grant to provide Child WelfareSystem of Care services to its families and children.Aptly named Family 2 Family System of Care, thisinitiative strives to address the special needs ofchildren and youth in out-of-home care for whichtraditional child welfare services have not succeeded.Although this program is in the planningphase of the grant, it has clearly identified threepopulations to focus its energies: children at riskfor multiple placements, high-need, multi-jurisdictional,youth, and transitional age youth for whomIndependent Living Skills Program (ILSP) has notbeen successful. The F2F System of Care programstrives to help children stabilize in placement andideally remain in the least restrictive level of care,as does YPP.So what can Contra Costa County acquire from theYouth Pilot Project as it moves forward with its initiatives?RECOMMENDATIONSBased on this case study, I recommend augmentingor expanding the services and programs that arecurrently in existence in Contra Costa County.1. Expand the use of Family 2 Family TeamDecision-Making (TDM) meetings.Currently in Contra Costa County, TDM meetingsare only used at the front end of the child welfaresystem to address children who are at imminentrisk of placement. In the program design, there is aplan to have follow-up TDM meetings, however, thishas only occurred on a limited basis. I would suggestthat Contra Costa County consider utilizingongoing TDM meetings to work with the familiesthat need ongoing care, either voluntarily or in thecourt arena.This expanded TDM model could address a multitudeof cases, from Voluntary Family Maintenanceto Family Reunification. The common TDM eligibilitycriteria would not change in that a child49

BASSC Executive Development Training Programwould be at imminent risk of placement, but thefamily could continue to meet with its team for support,case planning, and meeting goals.Currently the use of TDM meetings is beingexpanded geographically. I suggest that the proposedprogrammatic expansion take place over thenext 12 to 18 months as the System of Care programis developed. The System of Care GrantCoordinator should take lead in developing thismodel for expansion with input and direction beingsought from the Contra Costa County LeadershipTeam and TDM Debriefing Committee.2. Incorporate ongoing TDM meetings into thedesign of Family 2 Family System of Careprogram.Currently the System of Care (SOC) grant outlinesthe use of TDM meetings. However, it is not clearfrom the grant proposal how these meetings will beused. For the three populations identified childrenat-riskfor multiple placements, high-need, multijurisdictionalyouth, and transitional age youth forwhom ILSP has not been successful, I recommendthat the TDM be used in an ongoing basis for two ofthe populations.First, for the transitional age youth that are emancipating,the TDM could be used for case planningand then follow up. For example, a preliminarymeeting could be held with the youth and the identifiedteam members to develop an individualizedtransitional independent living plan. The groupwould identify the emancipation goals and how theywould be met. Then subsequent review meetingsmight be held at regular intervals, perhaps everythree months, to measure whether goals are beingmet and ensure accountability of the team andyouth.Second, TDM meetings could be used with themulti-jurisdictional youth. These are children andyouth who are often high-need, multi-problem childrenwho need more than what one social workercan provide. TDM can provide the team approachto working with these unique children. Partnersfrom mental health, public health, juvenile probation,and education would be natural partners onthis team. I would recommend that these meetingsbe held on a more frequent basis, such as monthlyor bi-monthly.The System of Care program is in the planningphase of development. The use of TDM meetings towork with the SOC target populations should beincorporated into the program design. I recommendthat this occur over the next 6-12 months. TheSystem of Care Grant Coordinator will take the leadin developing this program and will work closelywith the SOC Project Director, SOC Policy andPlanning Council and the Agency’s Permanencyand Youth Transition Workgroup.3. Develop a mechanism for accuratelyrecording TDM meetings.Family Network Meetings are recorded by an assistantand typed into a computer as the meeting isheld. The team meeting is accurately entered into aservice plan template. As a result, the service plansreflect the team’s discussion and accurately reflectprogress towards goals and ongoing concerns orproblem areas.One main component of YPP’s success is that ofaccountability. Interviewed social workers felt thatthis accountability was crucial and kept them, theteam members, and the client focused. Currently,TDM meetings in Contra Costa County are recordedon flip chart paper during the meeting and then50

Participants’ Case Studies • Class of 2004after the meeting, the facilitator must transcribe byhand the meeting notes onto a five page TDM summarydocument. Although this summary includesfamily strengths, recommendations, and actionsteps, the document is not distributed to the membersof the meeting, nor is it kept in a case file. Thefacilitator keeps the summary document.I would recommend researching the feasibility ofutilizing a computer during TDM meetings andidentifying a staff person(s) who would be able torecord the meeting into a service plan template.Additionally I would recommend distributing theservice plan to all team membersDetermining if it is feasible to better track TDMmeetings should be a priority over the next 3-6months. As the ability to maintain accurate recordsis crucial to team collaboration work, I recommendthat the System of Care Grant Coordinator, ChildWelfare Redesign Policy Analyst, and Court PolicyAnalyst take lead in determining how this might beaccomplished in the county’s current climate.4. Research and identify how a state waiveror other flexible funding source might beused to augment the services providedthrough the TDM model.It is clear that being able to spend money on goodsand services has helped in the “buy-in” to the YPPprogram and also the procurement of services thatare not ordinarily available through traditional childwelfare spending models. Currently there are fewdiscretionary funds available to augment servicedelivery to children and families. The funds that areavailable are often limited and not often widelyknown to social workers and supervisors. In MarinCounty’s case, its negotiated state waiver is tied toYPP. As the county’s AB 1741 funding sunsets, ithas been able to tap into this flexible-spendingvehicle and continue its program and actually procuremore monies to expand the program. Currentlythe System of Care program is federally funded forfive years, so it does not appear that this is a logicalprogram to look for a state waiver, however, perhapsas the five-year grant ends, this would be a differentcase. The Family 2 Family program is currentlyfunded by private grants and perhaps also does notcurrently need a state waiver option. However,again, I would recommend researching if a statewaiver might be able to be incorporated when thesegrants come to a close in the future.Contra Costa County’s System of Care Planning andPolicy Council has convened a sustainability subcommitteeon which the Children and FamilyServices Director participates. I recommend thatthe Director bring this issue to the committee fordiscussion and research.5. Identify flexible monies to support servicedelivery.Insofar as a state waiver is not necessary at thispoint, I would still recommend that Contra CostaCounty identify ways to utilize other flexiblesources of money to augment service delivery.Perhaps the most practical might be in the Family 2Family SOC federal grant. I recommend reviewingthe SOC budget and identifying discretionary fundsfor service delivery. If not currently identified, Irecommend considering renegotiating the budget toallow for having flexible money to use towardsgoods and services. I suggest that the SOC GrantCoordinator and Project Director consult with thefederal grantor and the Agency’s Finance Divisionto determine if renegotiating the budget is neededand/or possible. This should be accomplished bythe end of September 2004.51

BASSC Executive Development Training ProgramIn the Family 2 Family model, I would recommendaugmenting future grant proposals to include moneyfor goods and services to utilize in the expandeduse of the TDM meeting. All of these goods andservices would be tied to the service/case plan thatis developed in the TDM meetings. The ChildWelfare Redesign Policy Analyst and AgencyDirector should take the lead in researching futuregrants that may provide additional resources to theprogram.CONCLUSIONIn summary, it is clear that many aspects of MarinCounty’s Youth Pilot Project can be implementedinto a large county like Contra Costa County.Although it would not make sense to incorporatethe program as a whole, key elements of the programcan be incorporated into the initiatives thatContra Costa County is already embarking upon. AsChild Welfare Redesign takes hold at the countylevel, counties will be accountable for the wellbeingoutcomes of their children and families.Programs like Youth Pilot Project are already outcome-drivenand a proven success. Contra CostaCounty is a more complex county than MarinCounty due to its size and scale, but now has threeinitiatives that can help address outcomes.Incorporating some or all of the recommendations ofthis study may help move Contra Costa County onestep closer to brighter futures for its children andfamilies.ACKNOWLEDGEMENTSI would like to thank the staff at Marin CountyDepartment of Health and Human Services forbeing so welcoming and helpful during this project.I especially want to thank Alva Ackley, Youth PilotProgram Coordinator, for her time and assistance inlearning about this program. I want to thankHeather Ravani, Program Manager II for theServices Branch of the Division of Social Servicesfor freeing up Alva Ackley’s time and providinginspirational words at the beginning of this project.I also want to express my gratitude to MarcusSmall, CYSC Clinical Director, and Ryan Pickrell,Program Coordinator, for allowing me to view aFamily Network Meeting and learn more about thisinnovative program. Finally, I especially enjoyedmeeting with the social workers in Marin CountySocial Services who shared their time and greatenthusiasm for YPP.52