New Provider Residential Services Orientation

New ProviderResidential Services

Orientation

State of Georgia

AmWayThe Miracle of Pyramid

Marketing

How to sale soap and rule the world.

Introduction• What We Will Do - Educate • Presented By

– Georgia Association of Homes and Services for Children (GAHSC)

– Department of Human Resources (DHR)• Office of Regulatory Services (ORS)• Division of Family and Children Services (DFCS) • Division of Mental Health, Developmental Disabilities

and Addictive Diseases (DMHDDAD)

– Department of Juvenile Justice (DJJ)

Who Should AttendApplicants for the Licensing of:

•Children Group Home •Child Placing Agencies •Therapeutic Group Homes•Outdoor Therapeutic Centers•Emergency Shelters•Foster Care Placing Agencies•Second Chance Homes•Teen Mothers with child homes

Who Should NOT AttendFoster Parent wantabe’s

Adult Personal Care Home Applicants

Psychiatric Hospital Applicants

Maternity Homes ApplicantsInsect Exterminators Applicants

Beauty Shop Operators Applicants

Road Contractors Applicants

OverviewNormer Adams

Executive DirectorGeorgia Association of Homes

& Services for Children

www.gahsc.org

normer@gahsc.org

404 572 6170

1. - Organizational Capacity and Needs Assessments

2. - Licensure

3. - Approval Process for Vendors

4. - Referrals and Payments

Steps to Provision of Services

Step one - Organizational Capacity and Needs

Assessments

Steps to Provision of Services

FIRST PRIORITY

Develop the

“BUSINESS PLAN”

The Plan vs. Good Intentions– Board -Facilities – -Budgets– Constituency -Policies & Procedures

Needs Assessment

FIRST PRIORITY

THE BUSINESS PLAN (continued)

• Research– The Need– The Competition

• Interviews• Field Trips

Needs Assessment

SECOND PRIORITY

Develop “YOUR CONSTITUENCY” (Who Supports You)

• Your CommunityChurch, Civic Groups, Interested Parties

• Your SupportersGive Time, Money, and Resources

• Your BoardDeveloped from your Constituency

Organizational Capacity Assessment

Board Development(Those who are accountable for the

organization)

• Truism - An organization is as strong as its Board.

• Choose people who can help you

• Go beyond friends and family

• Movers and Shakers of community make good Board Members

Organizational Capacity Assessment

Executive Director(He/She who manages the organization)

• Choose person of experience, integrity, responsibility and history

• He/She will represent your organization

• He/She will carry out your policies and procedures

Organizational Capacity Assessment

Budgets and Budgeting

Budget Development

Expenses

Income- State Fees- Contributions- Grants- Endowments

Organizational Capacity Assessment

Budgets and Budgeting

Medical Care

Covered by Medicaid - Nearly all children in residential care qualify for Medicaid.Organizational Capacity Assessment

Budgets and Budgeting(See Handout # 1 – Sample Start-Up Budget)

• Staff--Base Pay

• Benefits

• Insurance--Property, Casualty, & Liability

• Other, including: Food, office supplies, clothing, travel & recreation, medical expenses,

school supplies & activities, gifts, allowances, conference expenses,vehicle repair, fuel, maintenance, grounds, promotions, postage, utilities,telephone, moving expenses of staff, GAHSC membership dues, and legal and professional

Organizational Capacity Assessment

Fundraising

Grants for Startup

List of all the Foundations and Charities that give to new organizations starting children homes and group homes.

Organizational Capacity Assessment

Organizational Capacity Assessment

FundraisingGrants for StartupAll Foundations and Charities 1.2.3.

Fundraising

Grants for Startup

• Very Few

• Only to Existing Groups

• Need 501(c)(3) status – Not-for-Profit

• Anticipate 18 months for startup support

• Build constituency

Organizational Capacity Assessment

Not-for-profit Organization(Nearly all are 501(c)3)

• Internal Revenue Service (IRS) Regulations for securing tax deductible contributions

• Takes at least 1 year to secure

• A knowledgeable person can do it without lawyer

Organizational Capacity Assessment

Your Facilities

• Fire Inspection - # 1 Problem Area– Most Expensive to Correct– State Regulations, County Interpretations

and enforcement

• Community - # 2 Problem Area– Build Support Carefully– If negative, hard to overcome– Use community leaders to lead

Organizational Capacity Assessment

Your Facilities

Zoning - # 3 Problem Area-- Required before Licensing-- Zone for “a licensed childcare institution for six or more unrelated children”-- Movers and Shakers of community can help with this

Organizational Capacity Assessment

Policies & Procedures(Provides the why and how of the organization)

• Get a person who has done residential child care to prepare your policies and procedures

• These are your rule books for operations

• You will live and die by them

• They become your Bible for operation

Organizational Capacity Assessment

Technical & Clinical Assistance

(Gut instinct is not enough.)

Truism - Experience is more valuable than gut instinct.

• A compliant child may be a depressed child.• An attentive, indulgent staff may be a

pedophile.• Money in your pocket may not mean money in

the bank.• Your High School Joe might like your facility as

coed, but you won’t.

Staff & Personnel Issues(They make or break your organization)

• Truism - Your program is as good as your worst staff.

• A thorough background check is essential.

• “Would you let these folks care for your child?”

Organizational Capacity Assessment

Reporting Requirements

• Child Abuse Reporting Requirements

• Stuff will happen! Self Report.

• The law requires you to report abuse

and neglect.

• Do not even THINK of not reporting.

Organizational Capacity Assessment

Working with the State• Some Steer

The State is our partner in caring for children. Their role is regulatory and contractual. Respect it.

• Others RowOur role is providing services to children. Together we work to provide the best care for children.

Organizational Capacity Assessment

Departments & Divisions of State Agencies

Department of Family and Children Services (DFCS)

Budgeting/Rate Setting

Organizational Capacity Assessment

BUDGETING/RATE SETTING

• Family Foster Care

• Institutional Foster Care

Organizational Capacity Assessment

Family Foster Care

DFCS Family Foster Homes Per Diem Rate – $33.30 Per Day – Provider Rate– Level of Care Family Foster Homes (Daily

Per Diem Calculated) for SED children

Organizational Capacity Assessment

Institutional Foster Care(group homes)

PER DIEM RATE

• Currently $44.22 /day/child for new providers.

• After first year reimbursement Rate Calculated at 62% of Total Allowable Costs.

Organizational Capacity Assessment

Allowable Costs (See Handout # 1 – Sample Start-Up Budget)

• Salaries

• Consultation Fees

• Occupancy Costs

• Insurance Costs

• Maintenance & Repair

• Depreciated Equipment

• Consumer Supplies

• Payroll Related Expenses

• Travel• Utilities• Leased Equipment• Purchased

Equipment• Lease Purchase

Organizational Capacity Assessment

Unallowable Costs

• Bad Debt• Contributions &

Donations• Depreciation• Investments• Organizational

Costs

• Contingencies• Entertainment• Fines & Penalties• Prohibited Activities

Organizational Capacity Assessment

Provider ReportsInstitutional Foster Care (IFC)

• Annual Group Facilities Cost Report

• Description of Treatment Program

• Independent Audit Report

• Typical Weekly Schedule

Organizational Capacity Assessment

• Step Two - Licensure

Steps to Provision of Services

DHR Office of Regulatory Services

Child Care Licensing

#2 Peachtree St., 32nd Floor

404-657-5562

DHR Office of Regulatory Services

Child Care Licensing• License Category:

-- CCI-Child Caring Institutions includes emergency shelters, group homes, and children's homes. (6 or more residents in (24 hour care)

• Application Process -- How to apply, temporary licensing, license

Licensure

How to Apply for Licensure(Handout # 2- Steps To Licensure)

• Purchase licensure application package

• Familiarize yourself with ORS rules and regulations--develop a working knowledge of the meaning and intent of these rules and regulations

• Prepare your agency for compliance with the regulations

Licensure

Staff Qualifications

• Director: Masters/2 years experience or Bachelors/4 Years experience

• Human Services Professional (Social Services): Bachelors/2 Years Experience or supervised by Masters

• Child Care Worker: 21 Years Old/ High School or GED

• Satisfactory criminal records check

Licensure

Staff Qualifications (continued)

• Human Services Professional--Master’s Degree in social work, psychology, childhood education, education counseling and psychology, or related field ,

• OR a bachelor’s degree in one of these fields and two years experience, or under the supervision of another HSP with a Master’s degree.

Licensure

New Criminal Records Check Law----July 1, 1999

• Satisfactory state fingerprint result on Director, with FBI results pending

• Satisfactory preliminary results--employees

• Employee checks can be done by local law enforcement with results on file

• If employee’s check reveals any crime, person cannot be hired until resolved.

Licensure

Physical Plant(Handout #3- Child Caring Institution Self Assessment for Physical Plant)

• Water/Sewage• Bedrooms: 63 Square Feet per resident

Single: 75 Square Feet

• Bathrooms - one sink /toilet per 8 kids, 1 shower per 10 kids

• Proper Storage for Hazardous Items• SAFETY FIRST--Inside and Outside

Licensure

Behavior Management(Handout #4- Discipline and Behavior Management )

• Forms of discipline which are not allowed

• Excessive or unreasonable work tasks• Denial of meals and hydration• Denial of sleep• Denial of shelter, clothing, or essential

personal needs• Verbal abuse, ridicule, or humiliation

Licensure

Behavior Management (continued)

• Chemical restraints or mechanical restraints

• Denial of communication and visits unless restricted in treatment planning process

• Corporal punishment

Licensure

Specifics on Behavior Management

• Regulations on the use of isolation rooms

• Regulations on the use of physical control techniques--ONLY by staff trained by a certified trainer and documented in personnel record

• Discipline/behavior management methods MUST be documented in the treatment plan

Licensure

Management of Medications(Handout # 5- Medications)

• System for Proper Storage, Administration and Documentation

• Monitoring for Side Effects/Complications

• Expired Medications• Accurate Medication Logs• Method of Managing Medication Errors• Documentation in Treatment Plan

Licensure

Regulatory Process

• Submit Application with local approvals• Self-Assess for Rule Compliance and

Completed Application Materials • Initial On-Site Inspection: Temporary

License (6 Months)• Annual Re-Licensing Inspections• Follow-Up Inspections• Complaints/Self-Reported Incidents

Licensure

Break

Step Three - State Approval Process of Vendors

Steps to Provision of Services

Division of Family

& Children’s Services

DFCSLinda Ladd

Program Consultant,

Treatment Services Unit (MATCH)

404-657-3460

Rosalyn Williams

Program Consultant,

Treatment Services Unit (MATCH)

404-657-3574

Services purchased by DFCS for children in it’s custody are:– Institutional Foster Care (IFC)

– Family Foster Care (FFC)

Services Purchased

Services Purchased by DFCS

• Institutional Foster (IFC) requires license by the Office of Regulatory Services (ORS)

• IFC includes group homes, emergency shelters, child care institutions, and therapeutic camps.

• Family Foster Care (FFC) requires license as Child Placing Agency or Child Caring Institution with Foster Care Services.

Services Purchased by DFCS(Handout 6- Guidelines For Providers)

Services Purchased

54Orientation

Characteristics of Children in DFCS Custody

• Age– Birth to 18 years old

• Mental/Emotional/Behavioral Difficulties• Medical/Physical Difficulties Deprivation

determined by the court• Abused, neglected, or abandoned• Committed status

Characteristics of Children

DFCS Approval Process

(Handout # 7- FCC IFC Provider Approval Memo)

• Potential Provider requests application package from the Treatment Services Unit.

• Completed Application is submitted to the Treatment Services Unit.

• Application is reviewed by Treatment Services Unit.

(Refer To Handout 7a and 7b for IFC Application and FFC Application)

Approval Process of Vendors

Approval Process (continued)

Three Possible Outcomes:

(A) Application accepted--will conduct an on-site visit and review the program

(B) Application incomplete--will include an explanation of application items for which more information is needed

(C) Application denied--will include an explanation of the basis for denial

Approval Process of Vendors

Approval Process (continued)

• If approved to serve children who are in the custody of DFCS, a notification letter will be sent to the provider.

• DFCS Treatment Services Unit notifies all county DFCS offices of the approval status.

Approval Process of Vendors

Referral Process

• Program will receive referrals directly from county DFCS offices.

• County DFCS is responsible for reimbursement for services.

Referrals and Payments

DMHDDADDivision of

Mental Health Developmental Disabilities

and Addictive Diseases

Suzanne LindseyC & A MH Program Specialist

Department Of Human ResourcesDivision Of Family and Children Services

404-657-2136

DMHDDAD

•Division of DHR •Made up of 7 Regional Boards http://www2.state.ga.us/departments/dhr/mhmrsa/regbomp.html

(Handout 8- Regional Executive Directors )

•Contract with 27 Community Services Boards (CSBs) and other private providers

(Handout 9- Community Service Boards)

•CSBs also sub contract with providers

Approval Process of Vendors

DMHDDAD Regions

• SED (Severely Emotionally Disturbed)• Under age of 18• Major mental illness diagnosis, such as

Major Depression, bi-polar disorder, anxiety disorder, PTSD, ADHD, oppositional defiant disorder, and substance abuse disorders

• Many are multi-agency involved

Characteristics of Children

Characteristics of Children in DMHDDAD Care

• Following appropriate licensing from ORS, contact the Regional Board or the Community Service Board (CSB) in your area (see handout material).

• If chosen as an eligible provider, you must comply with all Division standards and provider manual requirements (Regional Boards have this information).

Approval Process of Vendors

DMHDDAD Approval Process

(Handout # 11- DMHDDAD Guidelines for potential C&A Residential Services Providers)

SED Residential TreatmentServices of DMHDDAD

• Highly structured and supervised home• Individual, family, group and activity

therapy services• Psychiatric services, including

medication monitoring by an M.D. (psychiatrist)

• Community Re-integration Services, including identification of natural support systems

Services Purchased

DMHDDAD Referral Process

• Contracts are made directly with Regional Boards or Community Service Boards.

• The Regional Boards or Community Service Boards are responsible for reimbursement for services.

Referrals and Payments

DJJDepartment of Juvenile Justice

DIVISION OF COMMUNITY CORRECTIONS

Gwen Skinner

Deputy Commissioner,

Community Corrections

404-657-2431

Department of Juvenile Justice

Division of Community Programs

Serves to Protect the Citizens of Georgia by Providing Prevention Services, Court Services

and Supervision, Treatment and Rehabilitation of Youthful Offenders.

Approval Process of Vendors

No Formal, Written Application

Upon Obtaining Licensure, Contact the Residential Placement Specialist (RPS) in the District in which Your Facility is Located

Approval Process of Vendors

DJJ Approval Process (Handout 12- DJJ Procedure for Approval)

State Outline of DJJ Districts

(Handout # 13- DJJ Community Corrections District Lines)

Residential Placement Specialists

(Handout # 14- Community Corrections)

13 Districts

match DHR Districts

Regional Placement Specialists

1. Wayne Reynolds

2. Kim Settles

3. Angela Parker

4. Carl Harrison

5. Sue Riner

Approval Process of Vendors

DJJ Approval Process

• Residential Placement Specialist (RPS) Conducts Site Visit

• Assesses Willingness and Ability to Service Delinquent Youth– School Issues– Supervision

• Contract

Approval Process of Vendors

DJJ Contracts and Payments

• Contract - referrals and payments are negotiated through contracts.

Referrals and Payments

• Average Age - 15 (range is from 8-17)

• 82% Males - 18% Females• Most Common Offenses - Property & Status• Oppositional - Lack Impulse Control• Common Mental Health Diagnoses - Conduct

Disorder, Depression, PTSD• Substance Abuse Issues

Characteristics of Children

Characteristics of Children in DJJ’s Care

• During FY 1998, 789 youth were served in the Contract Home Program.

• Youth were served in either– Group Homes– Private Family Placements

Services Purchased

Services to Children in DJJ’s Care

Private Placements

Normer Adams, GAHSC

Private Placements

Agency determines what services to sell (or give away) to the private individual. The nature of these services are determined on the ability to provide those services within the Licensing framework

Services Purchased

• Characteristics of the children -- Determined by agency according to their mission and ability to care for the child.

• And by ability to serve.

Characteristics of Children

Characteristics of Children in Private Placement

Private Placements

• Application Process-- Licensing allows an agency to provide out of homes services. Within the rules of Licensing, each agency develops their own application process.

• Approval Process -- There is no approval process save Licensure.

Approval Process of Vendors and Marketing

Private PlacementsReferrals and Payments

• Referrals - Referrals are made by private individuals or agencies. This referral network is determined by the agency.

• Payments - Payments are negotiated with each referring party.

Referrals and Payments

MATCH

Multi-Agency Team for Children

• Children have severe mental, emotional and behavioral disturbances.

Characteristics of Children

Characteristics of Child Served by MATCH

MATCH(Multi-Agency Team for Children)

• Includes DFCS, DJJ, DOE, ORS, and DDMHDDAD

• MATCH is responsible for arranging and purchasing residential treatment services for children with mental, emotional and behavioral disturbances.

Approval Process of Vendors

• Intensive Residential Treatment Programs

• Intermediate Residential Treatment Programs

• Outdoor Therapeutic Programs

• Therapeutic Foster Care (Levels I and II)

Services Purchased

MATCH Services Purchased

MATCH Enrollment Process

(Handout 15- MATCH Provider Enrollment Application Memo)

• Potential provider requests application package from the Treatment Services Unit.

• Potential provider must have the appropriate license from ORS.

• The agency must be in compliance with the “Certification Standards for Enrollment as a Provider of Therapeutic Residential Child Care Services” prior to the submission of the completed application to the Treatment Services Unit.

Approval Process of Vendors

MATCH Enrollment Process (continued)

• Completed application is submitted to the Treatment Services Unit.

• Application is reviewed by Treatment Services Unit.

Approval Process of Vendors

MATCH Enrollment Process (continued)

Three Possible Outcomes:

(A) Application accepted--Treatment Services Unit and ORS will conduct an on-site visit and review the program

(B) Application incomplete--will include an explanation of application items for which more information is needed

(C) Application denied--will include an explanation of the basis for denial

Approval Process of Vendors

• If enrolled as a MATCH provider, appropriate paper work, including rate notification and contract with DHR will be sent.

• Program is added to the list of approved MATCH providers.

Referrals and Payments

MATCH Enrollment Process (continued)

MATCH Outcome Project

• A system designed to measure and track the effectiveness and results of residential treatment services provided to children and adolescents with severe emotional disturbance.

• All providers are required to participate.Services Purchased

MATCH Enrollment Process (continued)

• Provider will receive referrals from County DFCS or Community Mental Health after the child has been approved for funding by the State MATCH Committee.

• Approval letter is sent to the MATCH provider.

• The State Office of DHR is responsible for reimbursement for service.

Referrals and Payments

MATCH Referrals and Payments

1. - Organizational Capacity and Needs Assessments

2. - Licensure

3. - State Approval Process for Vendors

4. - Marketing to Referral Sources, DFCS, DJJ, Private Sector

Steps to Provision of Services

WRAP-UP

• Questions????????

• Evaluation Forms (Handout 16- Evaluation)

• Training Certificate

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