Family First Prevention Services Act (FFPSA): Maine’s ...

Family First Prevention Services Act (FFPSA):

Maine’s Proposed Prevention State Plan

December 3, 2020

Christine Theriault, LMSW

Office of Child and Family Services

FFPSA Program Manager

Maine Department of Health and Human Services 2

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Maine Department of Health and Human Services 3

Objectives

To recap the Family First Prevention Services Act.

To provide information on Maine’s proposed approach for implementation of FFPSA.

To gather thoughts and suggestions on initial program ideas.

Prevention Services

for Children and

Families

Increased Quality &

Appropriateness of

Residential Care

IV-E

Maine Department of Health and Human Services 4

Family First Prevention

Services Act Focus Areas

Prevention of foster care placements

through:

• Trauma informed and evidenced

based services including: mental

health & substance abuse prevention

and treatment services, in-home

parent skill-based programs, and

kinship navigator services

Improving the well-being of children

already in foster care by reducing

placement of children in group care

settings and enhancing quality of care for

residential treatment programs.

Establishment of Qualified Residential

Treatment Programs (QRTP)

Maine Department of Health and Human Services

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FFPSA State Plan

Parents, Youth,

Resource Parents

State Agency

Partners

Community Providers

Other States Resources Consultants

OCFS Staff:

CW, CBHS, Operations

FFPSA Stakeholder Workgroups

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Working together to support families in Maine….

FFPSA Theory of Change and Logic Model Development

Prevention Services Eligibility Services Prevention Plan

Services and supports to prevent removal from the home

• In SFY 2019

– 1,322 children entered State custody (a 42% increase over the 928

children that entered in the prior state fiscal year. Nationally, the rate of

children entering care per 1,000 children is 4 (based on 2017 data) and

Maine is slightly higher at 5 entries per 1,000 children.

– Over half of all child welfare removals involved parental substance use

as a contributing factor.

– 1 in 5 infants entered state custody following a drug affected

baby/substance exposed newborn report (may have been from multiple

contributing factors.)

– Over half of the children entering state custody were under the age of 5.

– In the last two federal fiscal years the data on outcomes for youth

exiting custody reflects a significant increase in the number of children

exiting to reunification.

Maine Department of Health and Human Services 9

Prevention Services Planning: The Data

• Qualitative data gathered: parents, youth, providers, school staff, state

partners, community providers, OCFS staff, resource parents

• Themes:

– Need to increase access and availability of services (especially rural

Maine)

– Need to increase knowledge of services (for parents, providers, other

state agencies)

– Workforce needs (recruitment, retention, wages, career ladders)

– Behavioral health and in home support needs.

– Substance Use services for families are needed.

– Cultural and racial sensitivity is necessary in service provision and case

management.

Maine Department of Health and Human Services 10

Prevention Services Planning: The Data

• Federal Guidelines:

– A child who is a “candidate for foster care”

• Imminent risk of entry into foster care, has a child specific plan, but can

remain safely at home with services.

• A candidate for foster care cannot be a child who is already under the

placement and care responsibility of the Office of Child and Family

Services (i.e., in foster care).

• Maine Definition of Candidacy:

– A child who is a victim of maltreatment in which safety and risk factors can

be mitigated by the provision of in-home services and is able to safely

remain at home with a child-specific Prevention Plan.

– Pregnant and parenting youth in foster care.

– Children who have exited foster care through reunification, guardianship, or

adoptions and may be at risk of re-entry.

Maine Department of Health and Human Services 11

Eligibility for Prevention Services

Maine Department of Health and Human Services

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• Post investigation, casework staff will use Structured Decision

Making (SDM) to determine if a child meets the definition of

candidacy for prevention services.

• SDM uses defined and consistent decision-making criteria and tools

for the following areas:

Maine Department of Health and Human Services 13

Determining Candidacy

Prevention Services

• FFPSA IV-E Guidelines:

– 12 month per candidate episode, Evidenced Based Practices (EBP), not already covered by MaineCare.

• FFPSA partnership with CBHS EBP initiatives

• OCFS Proposed Approach:

– Expand existing EBP that are on the Title IV-E Clearinghouse and covered by MaineCare

• Parent Child Interaction Therapy (PCIT), Incredible Years, Triple P

• Training opportunities in the spring/summer 2020

– Expand Parents as Teachers to cover families w/children 0-5

– Develop Homebuilders Family Preservation and Reunification Program

Maine Department of Health and Human Services

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Prevention Services

• OCFS Proposed Approach Continued:

– Increase knowledge and utilization of other services available to families in Maine

• Work across state systems to leverage resources and initiatives to build a system array improving access, availability, knowledge of services.

• Conduct a gap analysis to determine where service needs are to match population needs.

• Utilize State Agency Partnership for Prevention to develop inventory.

• Development and distribution of a Family Services Resource Guide.

• FFPSA Toolkit to assist with candidacy determination and service identification.

Maine Department of Health and Human Services

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Parents As Teachers (PAT)

PAT is a well supported, evidenced based home-visiting parent education program

Aims Components

-increase parent knowledge of early

childhood development & parenting practices,

-promote early detection of developmental

delays and health issues,

-prevent child abuse and neglect,

increase school readiness

-personal home visits,

-supportive group connection events,

-child health and developmental screenings,

-community resource networks

Currently implemented by Maine Families Home Visitors (0-3) Expansion opportunities:

– 0-5 to serve families for longer

– More referrals from OCFS for those cases meeting candidacy

– Increase in staffing to serve more families

– Assess geography of services to ensure more rural areas are covered

• Well-supported, evidenced based, Family Preservation/Family Reunification Program, not covered by Mainecare.

• Serves children 0-17 and their families.

• Work with high-risk families involved with the child protective services system to:

– remove the risk of harm to the child instead of removing the child.

– give families the chance to learn new behaviors, and help them make better choices for their children.

– Child safety is ensured through small caseloads, program intensity, and 24-hour a day service availability.

• Utilizes Motivational Interviewing, Cognitive Behavioral Approaches

• Outcomes: 6 months post-service, 86% of children have remained safely in their homes.

Maine Department of Health and Human Services

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HOMEBUILDERS

Maine Department of Health and Human Services

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Evidence Based Service Target Age Title IV-E Rating Funding Details

Substance Use Treatment Programs

Methadone Maintenance Therapy Age 18+

Under 18

w/consent

Promising -MaineCare funds service delivery.

-Funded by Federal Grant Funds and State

Funds for uninsured.

Multisystemic Therapy (MST) 12-17 years old Well-Supported -MaineCare funds service delivery.

-Future consideration of Title IV-E and SGF

Mental Health Services

Functional Family Therapy

(FFT)

11-18 years old Well-Supported -MaineCare funds service delivery.

-Future consideration of Title IV-E and SGF

Multisystemic Therapy (MST) 12-17 years old Well-Supported -MaineCare funds service delivery.

-Future consideration of Title IV-E and SGF

Trauma Focused Cognitive

Behavioral Therapy (TF-CBT)

5-17 years old Promising -MaineCare funds service delivery.

-State funds supported training.

The Incredible Years 4-8 years old School Aged/Toddler

Basic: Promising

-MaineCare funds service delivery.

-IV-E and State General Funds- to fund training

Parent Child Interaction Therapy

(PCIT)

2-7 years old Well-Supported -MaineCare funds service delivery.

-IV-E and State General Funds- to fund training

Triple P- Positive Parenting

Program

0-16 years old Promising (some

models)

-MaineCare funds service delivery.

-IV-E and State General Funds- to fund training

In Home Skill Based Parenting Supports

Parents as Teachers (PAT) 0-5 years old Well-Supported -Title IV-E and State General Funds

Homebuilders 0-18 years old Well-Supported -Title IV-E and State General Funds

Attachment Biobehavioral

Catchup (ABC)

6-24 mos.

24-48 mos.

Under Review -Maine Care exploration and/or possible Title

IV-E in the future

Kinship Navigator Programs

No programs are proposed N/A None -Use of IV-E and State General Funds in future

Mission: To establish partnerships across state agencies that will result in the

provision of a continuum of primary, secondary, and tertiary prevention services to

families in Maine that will result in safe, healthy, and successful families in Maine.

• State Agency Partnership for Prevention (SAPP) was created and includes:

• Office of Child and Family Services (OCFS)

• Department of Education (DOE)

• Department of Corrections (DOC)

• Maine Center for Disease Control and Prevention (MCDC)

• Department of Labor (DOL)

• Office of MaineCare Services (OMS)

• Office of Family Independence (OFI)

• Office of Behavioral Health (OBH)

• Tasks:

• Inventory of prevention services already being funded or provided

• Identifying gaps in programs and service delivery

• Cross program collaboration to increase access, availability, and knowledge of

services.

Cross Program Collaboration

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State Agency Partnership for Prevention

• FFPSA requires all services (Prevention and QRTP) to be trauma

informed

• QRTP subcommittee on Trauma Informed Care:

– Drafted a preliminary menu of Trauma Informed Care

practices that agencies could select from for implementation.

• A Trauma Informed Care Agency Assessment will be

recommended for implementation for all agencies receiving IV-E

dollars and more.

• Trauma Informed Care Resource Guide will be created that will

encompass resources for all providers.

Cultural and Racial Diversity and Inclusion

20Maine Department of Health and Human Services

Trauma Informed Care

• Training and support (for new EBP models) spring/summer

2021

• Logic Model Development through subcommittee of

Workforce stakeholder workgroup.– Addressing workforce needs in Maine goes beyond OCFS and will

require multiple programs/offices/stakeholders to improve

workforce issues.

– Convening of a Behavioral Health/Supportive Services Workforce

Collaborative

– Data gathering, rate studies, etc. were identified activities as well

• Ongoing work will continue to address Workforce post state

plan submission.

Cultural and Racial Diversity and Inclusion

21Maine Department of Health and Human Services

Behavioral Health Workforce

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• Intake: Current practice using SDM to assign case.

• Investigation: Current practice using SDM tools.

• Decision making:

– Does an investigation become a Prevention Services Case?

– Does the child/children meet the criteria for candidacy?

• If investigation results in a Prevention Services case, a Family Team

Meeting is conducted that will inform the development of a Prevention

Services Family Plan.

• The Prevention Services Family Plan is developed with the family and

signed by the parties.

• Referral to Services: Using Family Services Resource Guide

• Case Monitoring for safety, risk, and progress on goals.

• Prevention Services Family Plan is reviewed every 90 days.

• Monitoring of timeframes: 12 month limit per candidate episode

Prevention Planning with Families

• Training for staff on FFPSA– Candidacy Determination

– What is the right service to select for families?

– Completion of the Prevention Services Family Plan

– Monitoring safety and risk reduction for case closure

– Ongoing SDM trainings

• Monitoring of Caseloads– To be done by supervisors/management utilizing the workload analytic

tool.

• Trauma Informed Care: – Staff are trained using the National Child Traumatic Stress Network

(NCTSN) Child Welfare Trauma Training toolkit. (required after 6

months)

Cultural and Racial Diversity and Inclusion

23Maine Department of Health and Human Services

Child Welfare Workforce

• Evaluation of outcomes of prevention services: ensuring

service array is working to reduce entry into care

• OCFS Quality Assurance Processes will be utilized to

review cases

– Random selection of cases

– At least 50 cases reviewed annually

• New data management system being built, Comprehensive

Child Welfare Information System (CCWIS), to replace the

historical MACWIS (Maine Automated Child Welfare

Information System) system.

• Policy changes will be made after approval of FFPSA

Prevention State Plan.

Cultural and Racial Diversity and Inclusion

24Maine Department of Health and Human Services

Evaluation/Quality Assurance/Reporting

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The FFPSA Transition Grant was released in December 2019 and was automatically awarded to Maine in April 2020 with no application.

FFPSA Transition Grant:

Planning and Implementation

OCFS Plan Grant Funds: 5 year spend ($1,869,714)

QRTP Readiness Support: Accreditation/Fingerprinting/Background

Checks

QRTP Qualified Individual and Assessment Process Support

HOMEBUILDERS

Child Welfare Training

New Evidenced Based Practice Capacity Building

Maine Department of Health and Human Services

Qualified Residential Treatment Programs

Starting October 1, 2021, Children’s residential treatment programs must meet QRTP standards in order for states to receive Title IV-E funds for room and board for child welfare placements

QRTP Requirements Include:

• Placement assessment within 30 days by a “Qualified Individual”

• Heavy family engagement/involvement including siblings.

• Have registered or nursing staff and other licensed clinical staff available 24/7.

• Provide discharge planning and family-based aftercare support for at least 6 months post-discharge.

• Use trauma-informed treatment model.

• Program must be licensed and accredited.

Maine Department of Health and Human Services

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New Standards for Residential Treatment:

Qualified Residential Treatment Programs(QRTP)

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• An assessment will be completed within 30 days of QRTP

placement by KEPRO.

– Utilizing the Child and Adolescent Service Intensity Instrument

(CASII)

• Criminal background/Fingerprint checks for adults working in

QRTPs and other group settings.

• Accreditation preparations (reimbursement/applications/etc.)

• Draft Aftercare recommendations

• Draft Trauma Informed Care recommendations

(assessment/resources)

• Judicial Review requirement (working with AG’s office)

• More information on QRTP planning will come in early Spring

2021.

QRTP Planning To Date

Maine Department of Health and Human Services

• The Department supports racial, ethnic and cultural

diversity and inclusion.

• With global communication, specific outreach has occurred

with the tribes and New Mainer populations.

– Presentations at meetings to provide overview of FFPSA

– Active recruitment for Stakeholder workgroups

– Meetings with New Mainer representatives: feedback from families

– Ongoing communication with tribal representatives

• Needs Identified:

– To ensure child welfare and community service providers are

culturally and racially knowledgeable and sensitive in working with

each family.

– A mechanism for families to provide feedback and input into state

initiatives.

Cultural and Racial Diversity and Inclusion

29Maine Department of Health and Human Services

Cultural and Racial Diversity and Inclusion

• OCFS intends to have Maine’s FFPSA State Prevention plan

completed by December 31, 2020 and plan to be submitted in

early January 2021. Approval expected Spring 2021.

• QRTP planning will continue and QRTP IV-E plan submitted in

Spring 2021

• Prevention implementation is expected in the Fall 2021 with

infrastructure building, pilots, training to begin in Spring and

Summer 2021.

• Continued internal meetings to review polices and practice to

meet FFPSA requirements.

• Stakeholder workgroups (except QRTP) have completed their

work. Smaller implementation stakeholder group convening after

state plan submission.

What is to come….

30Maine Department of Health and Human Services

Family First Prevention Services Act: What’s next…

• Maine OCFS Family First Prevention Services Act Website

• Federal Family First Prevention Services Act Website

• FFPSA Program Fact Sheet

• FFPSA Overview Webinar

• FFPSA Update Webinar

• Child Welfare and Children’s Behavioral Health Annual Reports

What is to come….

31Maine Department of Health and Human Services

FFPSA Resources Available

Questions, Suggestions, or Feedback?

What is to come….

32Maine Department of Health and Human Services

Family First Prevention Services Act Discussion

Thank you !!

Maine Department of Health and Human Services 33

QUESTIONS??

Christine Theriault

Family First Prevention Services Program Manager

[email protected] or 624-7914

Websites:

• https://www.maine.gov/dhhs/ocfs/family-first-act.shtml

• www.familyfirstact.org

Maine Department of Health and Human Services

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