Mental health services

Housing and Disability Advocacy Program guidance

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The California Department of Social Services (CDSS) has issued updated program guidance regarding the Housing and Disability Advocacy Program (HDAP).  HDAP offers funding to county agencies or tribal governments to assist homeless disabled individuals with applying for disability benefits programs while providing housing assistance.  39 counties currently have HDAP programs.  HDAP requires grantees to offer outreach, case management, advocacy and housing assistance concurrently.

Assistance should be provided until disability benefits are granted and the participant is stabilized in permanent housing. A dollar-for-dollar grantee match is also required.

There are several changes to the program because of legislation in 2019.  These changes include: 1) Funding is now available for federally recognized tribal governments; 2) Priority for assistance is for chronically homeless individuals or homeless persons who rely most heavily on government-funded services; 3) Programs can consider providing housing assistance after disability benefits are granted until housing placement is stable and affordable; 4) Case management staff must assist in developing a transition plan for housing support when disability benefits are granted or denied.

HDAP continues its principles of housing first, collaboration among programs and prioritizing assistance is for chronically homeless individuals or homeless persons who rely most heavily on government-funded services.  Providing services on first-come, first-served basis or by most likely to find housing is improper.

Required program components continue to be outreach, case management, benefits advocacy and housing assistance.  Limiting outreach to General Assistance/General Relief applicants or recipients is insufficient.

Additional program components include transition planning, workforce development for participants not likely to be eligible for disability benefits, interim assistance reimbursement, and data gathering.  (ACL 19-104, November 1, 2019.)

Presumptive transfer of children in STRTPs

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The California Department of Social Services (CDSS) has issued guidance on the presumptive transfer process for foster children and youth placed outside of the their counties of original jurisdiction in Short-Term Residential Therapeutic Programs (STRTPs).

Presumptive transfer is a prompt transfer of the responsibility for providing or arranging and paying for specialty mental health services from the county of original jurisdiction to the county in which the foster child or youth resides.  Presumptive transfer is intended to provide foster children and youth who are placed outside of their counties of original jurisdiction with timely access to specialty mental health services.

STRTP placements are intended to be short term.  Considering that placements are supposed to be short term and that there is an exception for placements of less than six months, it is often appropriate and in the best interest of the child to waive presumptive transfer.  For a waiver, the county mental health plan in the county of original jurisdiction must have an existing contract with a specialty mental health services provider, or the ability to enter into a contract within 30 days of the waiver decision and the ability to deliver timely specialty mental health services to the foster child or youth.

Counties should work together so that placement agencies have the information they need to make informed and appropriate waiver decisions.  County mental health plans should be able to enter into a contracts with an out-of-county STRTP when presumptive transfer is waived.  County mental health plans are required to ensure timely access to federally entitled EPSDT Specialty Mental Health Services for foster children and youth placed in STRTPs.   To facilitate this, county single points of contact are posted on the CDSS website.

Presumptive transfer can be waived if: 1) transfer would disrupt continuity of mental health care or delay access to services; 2) transfer would interfere with family reunification efforts; 3) placement in a county other than the county of original jurisdiction is expected to last more than 6 months or 4) the child or youth’s residence is within 30 minutes travel time to the established Specialty Mental Health Services provider in the county of original jurisdiction.

If presumptive transfer is waived, the placing county must work with the mental health plan in the placing county to address the child’s needs and the mental health plan in the placing county must ensure that the child receives Specialty Mental Health Services.

If a presumptive transfer waiver is denied, the placing county must notify the mental health plan in the receiving county and work to ensure coordination of care for Specialty Mental Health Services by immediately sending required paperwork to the mental health plan in the receiving county.  The mental health plan in the receiving county must ensure access to Specialty Mental Health Services.

In making a waiver decision, the placing county should consider: 1) The child’s service needs including family friends and close relationship, the Specialty Mental Health Services needs, Regional Center services, educational issues, physical health needs and transition or permanent planning and goals; 2) the provider’s STRTP profile.

When there is a discharge from STRTP who a child who has a presumptive transfer waiver, there must be a child and family team meeting, the placing county must identify a placement in which to step the child down, the placing county must provide transition services and the placing county notifies the mental health plan in the placing county if the child returns to the county of jurisdiction or moves to another county.  The discharge process is the same if a waiver is denied except that the mental health plan in the receiving county must work the with the mental health plan in the placing county for a smooth transition of Specialty Mental Health Services.  (ACL 19-94, September 18, 2019.)

Requirements and guidelines for participation in the ASIST program

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The California Department of Social Services (CDSS) has issued guidance to counties participating in the Active Supportive Intervention Services for Transition (ASIST) program.  The ASIST program is a short-term resource to aid the transition of children, youth and Non-Minor Dependants currently residing residential placements, with priority for children who are not transitioning to a Short-Term Residential Therapeutic Program (STRTP).  ASIST will provide additional funding to counties to support extensive family finding, engagement, specialized permanency services, youth and caregiver coaching, and in-home support services.  ASIST program funding does not change existing county case planning and services obligations.

ASIST program funding is limited to the 2019/2020 fiscal year.  ASIST program funding will augment existing Wraparound services or other intensive support transition programs.  Counties must ensure that their contracted providers deliver services which meet the California Wraparound Standards.  Counties must also ensure that specialized permanency services are provided for youth whose case plan indicates permanent planning or supportive transition.

For ASIST program funding, counties must prioritize youth residing in residential placements with priority for youth not transitioning to a STRTP, youth who have been identified in the Child Specific Transition Plan, and youth who are in need of permanency.

All youth being served through the ASIST program must receive Wraparound services or other intensive support transition services, even if they do not meet the local criteria for eligibility.  This includes development of a short-term intensive transition plan.  In-home, individualized youth and caregiver services must available 24/7 as needed.

Participating counties must ensure that 21 requirements are met in partnership with contract providers or community partners.  (ACL 19-53, June 28, 2019.)

Short Term Residential Therapeutic Programs Placement Criteria, Interagency Placement Committees, Second Level Review for Ongoing Placements

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The California Department of Social Services (CDSS) has recently provided guidance and instructions regarding Interagency Placement Committees (IPCs), Short-Term Residential Therapeutic Programs Placement (STRTP) Criteria, Child and Family Teams (CFTs), and Second Level Review requirements for children and nonminor dependents placed in STRTPs and group homes.

Assembly Bill 403 established new licensed children’s residential facilities called STRTPs, which are public agencies or private organizations licensed with CDSS to provide integrated, high-quality, therapeutic programs. The programs are intended for children whose behavioral and therapeutic need are not met by a home-based family setting, even with supportive services. The goal of the program is to provide trauma-informed therapeutic interventions and integrated programming to address barriers to the child’s ability to safely reside and transition into a home-based family setting. The county placing agency, the STRTP, the caregiver, and the child and their support system must work together to identify and coordinate necessary services.

STRTP homes must be cleared by IPCs and a second level of review which takes into account CFT’s opinions.

The IPC is made up of representatives from county placing agencies and the county Mental Health Plan (MHP). The IPC may work together with other jurisdictions to act as a multi-disciplinary committee for child care and treatment. The IPC must also review and approve placements for STRTPs, group homes with a level of care assessed at Rate Classification Level 13/14 and that have been granted extensions (as determined by ACL 16-65), as well as out-of-state residential programs. The IPC decision is to be made by reviewing all available assessments. To support partner agency compliance, county placing agencies must notify and coordinate needed services with the school of origin regarding educational stability and the case plan, the MHP, and the Regional Center currently serving the child immediately upon the child’s placement.

The child may be placed in a STRTP if the child does not require inpatient care in a licensed health facility and the child’s needs have been assessed and can be provided in a STRTP to maintain the health and well-being of the child. One of the following criteria must also be met:

  • the child meets medical necessity criteria as determined by a mental health professional
  • the child is assessed as Seriously Emotionally Disturbed
  • the child is assessed as requiring the level of services provided by the STRTP
  • OR the child meets the criteria for emergency placement into a STRTP.

Emergency placement determinations may be made prior to the IPC determination if:

  • A mental health professional has made a written determination that the child requires the level of care that STRTP services offer
  • The IPC makes a similar determination within thirty days of an emergency placement (or transmits their disapproval to the STRTP)
  • AND the STRTP is not acting as a temporary placement in the event that a home-based family setting cannot be found. The county placing agency must ensure there is commonality of need with the other children in the placement setting.

If counties decide to integrate the CFT and IPC into single meetings, they should do so via an Interagency Memorandum of Understanding.

STRTP providers are not required to accept any specific child for placement, though they are expected to have the capacity to serve individual children with complex needs. The intake process should be coordinated with the IPC to avoid non-admissions and 7-day notices of denial from an STRTP provider, and information should be conveyed to county placing agencies to allow for CFT meetings pending placement. If STRTP providers demonstrate a pattern of not accepting placements, a review may be conducted by CDSS to assess the technical assistance level of the STRTP in order to prevent unnecessary disruption.

Assembly Bill 1997 provided added requirements, and also requires that the Department of Health Care Services and CDSS develop a dispute resolution process in order to track the number of reported and resolved disputes. While this is developed, county placing agencies should inform the CDSS if there is an unresolved IPC dispute by emailing CDSS.

The Continuum of Care Reform (CCR) uses residential care as a short-term, therapeutic intervention until the child is able to transition into a home-based family setting.  The CCR includes additional requirements on case plan documentation and second level review. The former requires that the case plan for a child placed in a STRTP document that the placement is for the purposes of short-term, specialized and intensive treatment, the need for the placement, the plan for transitioning the child, and the projected timeline for future action. If the child is under 12 years of age of younger, prior approval from the director of the child welfare agency is needed.

The Placement Timeframes for Second Level Reviews are age-specific. For children ages 0-6, STRTP placements are extremely rare and not to exceed 120 days. For children ages 6-12, STRTP placements shall not exceed 6 months unless the county made progress toward implementation of the case plan (including the child’s future transition), circumstances beyond the county’s control have impeded the county from obtaining those services, and the need for additional time is documented by a caseworker and approved by the Child Welfare Deputy Director.  For children older than age 13 under the supervision of the dependency court, the placement shall not exceed 6 months unless the Child Welfare Deputy Director or Director has approved the case plan. For children older than age 13 under the supervision of the delinquency court, the placement shall not exceed 12 months unless the Chief Probation Officer of the county has approved the continued placement no less frequently than every 12 months thereafter.

County placing agencies should have established processed to ensure that these processes are followed immediately for children placed in STRTPs or group homes.  (ACL 17-122, January 9, 2018.)

 

Presumptive transfer of specialty mental health services for children, youth, and non-minor dependents in foster care

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The California Department of Social Services (CDSS) has issued instructions regarding the implementation of AB 1299 regarding presumptive transfer of specialty mental health services (SMHS) for children, youth, and non-minor dependents in foster care.

In the event that a child, youth, or non-minor dependent is taken into foster care and moved to a different county, the responsibility for arranging and paying for adequate SMHS is transferred to the new county of residence.

For expedited transfers, the county must provide, arrange, and pay for SMHS within forty-eight hours of when the child is placed. If the child is in imminent danger or an emergency psychiatric condition arises, SMHS must be provided immediately without prior authorization. If a child is moved and a Child and Family Team (CFT) cannot meet, the county-placing agency is to alert the Mental Health Plan in the new county of residence to the need to provide, arrange, and pay for SMHS.

For foster children or youths who reside in counties other than the county of original jurisdiction after June 30, 2017, who continue to reside outside of the county of original jurisdiction after December 31, 2017, and/or for whom the responsibility to provide, arrange, and pay for SMHS has not been transferred to the new county of residence, placing agencies must complete all duties to notify conditions of presumptive transfer, waiver requests, and waiver decisions ten days before the child’s next status review after December 31, 2017.

Placing agencies must provide information about presumptive transfer requirements, the exceptions, and the right to request a waiver to: the foster child and their attorney, the agency responsible for making mental health care decisions for the foster child, and the social worker and/or juvenile probation officer. These details should also be added to the child’s case file.

Counties must give fourteen days notice of a child’s out-of-county placement to the child’s parent/legal guardian, the child, and their attorney, unless the child’s safety would be endangered by delay or prior notice. In the event that a child is not receiving SMHS, placing agencies are still required to notify the MHP in the new county of residence.

If a child’s placement status changes and the child is moved back into their original county of residence, the placing agency in the original county must notify the MHP in the former county of residence and the county of original jurisdiction.

CDSS also mandates the creation of a Child and Family Team (CFT), which integrates the child with providers, caregivers, and other support structures. Recent instructions encourage that case planning and the CFT process include MHPs and county placing agencies, especially when the case involves an out of county placement. The county of original residence must continue to collaborate with the county of placement to establish and maintain a single CFT for each child.

The presumption of transfer may be waived on a case by case basis, which places a “hold” on the transfer of responsibility. Exceptions are determined by the placing agency in the county of original jurisdiction in coordination with the CFT. A waiver request must be made within seven  days of the placing agency’s decision to move the child out of their original county of residence. If granted, exceptions mandate that responsibility for providing SMHS remains in the county of original jurisdiction if that county can demonstrate the existence of, or ability to establish within thirty (30) days, a contract with SMHS providers.

A Short-Term Residential Therapeutic Program (STRTP) is a congregate care facility, which includes SMHS services. Placement into a STRTP is considered a temporary exception to presumptive transfer, as it is expected to be last less than six months with the child returning home after treatment.

In the event that a waiver request is denied or otherwise contested, the individual who requested the waiver can request judicial review within seven days of the initial denial of the waiver. The court will then have five days to set a hearing on the matter, and during that time, a hold is placed on the presumptive transfer.

Additionally, children who are covered under the Kinship Guardianship Assistance Program (Kin-GAP) are no longer considered dependents of the court so the county of original jurisdiction retains responsibility for SMHS.

Children whose adoptions are finalized and who receive assistance under the Adoption Assistance Program are also not covered by presumptive transfer. The MHP in the county of residence of the youth’s adoptive parents retain responsibility for authorizing and re-authorizing SMHS.

When a foster child is presumptively transferred, it is not intended that the child be covered by multiple MHP’s. Under certain circumstances, however, counties may simultaneous provide SMHS if, for example, the county of original jurisdiction has an established relationship with the child and will continue paying for MHP during the child’s transition. If the county has an established relationship with the child’s substantial support system, and the providers will continue to be involved in the child’s life after the out-of-county placement, the original county of jurisdiction will continue to arrange and provide for the child’s SMHS.

CDSS does not, in existing presumptive transfer law, distinguish between inpatient and outpatient SMHS. Specific conditions apply to psychiatric inpatient services, depending on the circumstance. Because psychiatric inpatient services are not considered foster care placements, children are to be returned to the county of original residence following inpatient hospital stays.

Responsibility for drug Medi-Cal benefits remains with the county of original jurisdiction, even under conditions of presumptive transfer. Counties are expected to collaborate on the provision of necessary substance use disorder services for foster children placed outside the county of original jurisdiction.  (ACL 18-60, June 22, 2018.)