This is an exchange I had with an apparent big-wig at the agency (who I didn't realize who he was, oh no! ::eye roll::) that they want to have a special meeting with me to talk about our "core values" about. A law changed or new protocol for who we're paying to "service" our families is going to be implemented, and they encouraged questions about what a 15 minute primer video was telling us. My direct supervisor thought nothing of it and just said she hopes I don't lose my shit and go out on bad terms. Bold is me.
How much are we going to paying in "per diem" verses what we are paying in billable hours today?
That depends on several variables. The idea with Family Pres is that we’re moving to a more intensive approach to service delivery for these families to not only prevent removals when we can, but more quickly and efficiently move the case to closure and the family to life after DCS.
I know what the idea is, but I don't know to the degree it's an informed idea, and unfortunately this doesn't answer the question.
What happens to individual therapists or smaller outfits that DCS trusts and works with that might not have the ability to address every concern a family may have even while they are really good at doing what it is they are currently doing?
All of our community-based providers are still available for other case types. For IA’s and in-home CHINS cases, you will need to select one of the contracted Family Pres providers. For existing cases, they can continue with their current services but after June 1 the law requires us to utilize this new service.
So a case worker retains their small outlet, puts in a FPS person anyway, and that doesn't immediately conflict with one of the opening training slides that it's supposed to simplify a seemingly complicated process? I got feedback from a small therapist who said she would not even be able to bid to be allowed to be a vendor unless she hired an unsustainable amount of people to provide for services she currently doesn't.
How do you construct "better measure the impact" of each provider's work? Are there surveys? Are they self-reporting? Are we starting an auditing leg? What are we comparing their metrics to to denote that it is "better?"
We’ll be able to gather a number of different data points such as intensity, model effectiveness, etc. More importantly we’ll be able to see which providers are investing the time and resources in each case and track the outcomes of those cases (removal/closure/extension).
I don't understand this. What constitutes "intensity" and "model effectiveness?" I'm still confused as to what makes an FPS referral a better equipped to track what we're doing. Do they have better software? Training in data collection? We don't know already when we're removing, closing, or extending a case? If we can't open a case unless their is a substantiation of abuse or neglect, what is meant by a referral must be made to FPS in any in-home CHINS or IA even if there is not a substantiation?
If a case exists that is either a in-home CHINS or IA, a FPS referral is required to be issued according to the new law.
I understand there is a new law. I think the slide was confused in its phrasing, because a case is predicated on a substantiation. Unless the law has changed something to do with the circumstances and an FPS referral is to be put in anyway.
How do we ensure providers are documenting their evidence-based model any better than we currently are? Is there a roadmap for each model that we can follow along? Is it predicated on individual perception of progress or perhaps family testimony?
Central Office will help monitor the delivery of EBM’s through regular audits but providers are also required to document required fidelity measures in their monthly report as well as maintaining their certifications to provide those models with the model owners themselves.
This is the "who," but not the "how." The company I was working for was required to document as well, and whatever they were documenting was not accurately reflecting what they provided. Them being pressed on how to justify their billing would have gone a long way to help families and kept money out of bilking hands.
Concrete assistance must be paid by the provider "when necessary" like a heat bill in the winter to prevent removal. Who's determining when it is necessary?
You, your supervisor and the Family Team.
The video says the team decides, otherwise a removal would be necessary. If the provider controls the purse, is it hard to imagine they'll get creative in arguing for how the child doesn't need removed? How does this not incentivize providers to hang on to cash by insisting families move, access shelters, or under and falsely report?
Many of our partner agencies have long-standing relationships with the State and for their agencies to remain solvent, most wish to continue those relationships. Again, we will be able track a variety of data points, including when and how concrete assistance is being utilized.
Why would DCS cede that decision making process with the allocation of funds for families they likely have more familiarity and history with and no financial incentive to downplay?
If you or your supervisor identify a need that requires the use of concrete assistance funds, it is the expectation that (within reason) would occur. You are still the manager of the case and if you run into concerns like these, please report them to me immediately.
I suppose the practical reality of this will play out one way or another. Some of our long-standing agencies do a consistently "meh" to "terrible" job as it is and still get paid. I don't know what they've done, nor gather from the collective coworker conscience that they deserve even more money.
A good portion of this video describes our job. If we're asking providers to identify safety concerns more comprehensively than we are currently, and to call the hotline if they are unable to get a hold of someone at the office, are we not just adding an unnecessary barrier to addressing the concern ourselves and acting in a timely and organized manner with regard to our caseloads?
Well, we’re not. Providers understand their mandate and responsibility to report any concerns. If a safety concern is identified by the provider, they are required to report that immediately by phone. This does not necessarily mean that a new report will be generated, but rather the information was communicated to someone at the county immediately.
Why are we shifting the burden and removing the impetus to develop ongoing relationships with our families?
I’m unsure how you arrived at this conclusion.
If we're not understanding our mandate to ensure the safety of children, why are we believing providers are doing any better or trusting we have the capacity to recognize when they are doing so? As an assessor, the amount of new reports that get generated because we fumble around with pretty straight-forward means of accounting for what we already know does not give me reason to believe new reports won't get generated. I arrive at the conclusion that we are shifting the burden because instead of paying case managers to case manage, it sounds like we're mandating fledgling to tolerable service providers get paid more to do what were explicit descriptions of my/our job.
Is there anything consolidating providers speaks to that could not be better accounted for by better organizing and distributing work loads at the individual county level?
I’m not really sure about you mean by this question, but one of the ideas behind Family Preservation is streamlining service delivery. We know from years of feedback from families that multiple providers increases confusion and duplication of those services.
Things I've proposed are the making of unannounced home visits by assessors with less on their active case load, the distribution of menial paperwork tasks to designated people, the auto-filling of paperwork ready to print, and concurrent database search-ability to free up hours that can be spent with families or traveling.
Ok
Feedback from families will tell you perfectly inadequate case managers were their favorite or that someone who worked tirelessly to keep a family together hates them and did a terrible job. If you're going to solicit feedback, you need to ensure that those families weren't just being handled by a disorganized case manager, aren't reporting from areas with a lack of services to begin with, aren't experiences a mental or practical barrier that would keep them communicating with those providers, and were being properly referred in the first place. If you're basing the idea of changing the law solely on "families thought this was confusing," that seems incredibly short in its analysis of why they may say that. My questions suggests that if you better train and equip case managers, by actually organizing what the expectations are, better oversight, and things we apparently can't take for granted and have lost even the conception of, you don't need to redirect money to someone else to do a worse job.
As someone who has filled out "monthly reports" as a visit supervisor, I can tell you I was encouraged to use catch-all language that suggested they had trained me to do this comprehensive level of engagement I was in no way trained to do. As well, it was never expected I should learn or ask how to get to the level required to properly address the needs, and I was reprimanded for raising my concern for our inadequate standards. We still contract with that agency, leading me to believe our oversight is exactly zero, yet we plan to shift the responsibility even further to service providers?
I’ve attached a helpful document that we utilize to help FCM’s understand what they should be seeing in monthly reports as well as what we should be including in our referrals to providers. It’s unfortunate that you have this perception, but I’m hopeful when you review monthly reports submitted to you on your cases that you are mindful that case plan goals are being addressed and examples of progress/lack there of are being documented.
I'm in assessment, I'm just relaying my first-hand, albeit anecdotal, knowledge of a company that bragged about its increasing access to drug-riddled families and their willingness to hire anyone to send into anyone’s home to collect.
Cases should be referred for 6 months, ensuring the provider a paycheck even if the family only needs 3 months of an I.A. or something as specific as a payment one month in times of crisis?
We will rely on our Child and Family Teams in concert of course with our partner agencies and relevant participants to be familiar enough with the clients and their progress to understand when decisions about the direction of each case need to be made.
It said 6 months was required. Maybe it is, maybe it isn't. If that 6 month period conflicts with the wisdom of the team, who wins?
Parent enters detox, kid is with healthy grandma environment, but don't close the referral, because provider is now incentivized to tell grandma kid needs their lowest cost already hourly-budgeted service or some broad family planning and monitoring. As long as there's a kid anywhere at any level of DCS, I bet they're going to have an identified need, real or otherwise, that keeps the referral open, no?
I would point you to a few of the answers above. If partner agencies “game” the system that would negatively affect their ability to receive future referrals and contracts with the State.
In theory it would, but I don't know how it does currently, and I certainly don't know how it would when they squeeze out smaller outlets and we become dependent on them to an even further degree.
Make sure new kids are added to the referral, because who knows the kind of expensive baby-specific specialists it will need that the per diem needs to make sure it accounts for! Generational abuse means we can keep them on the hook for life!
I’m not sure this really needs a response, I would direct you to our Practice Model and your supervisor if concerns like this become an issue. I hope this is helpful!
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