Board of Social Services Minutes
November 17, 2014
Commissioners' Conference Room
Second Floor – County Administration Building
10 a.m. – 12 p.m.
In Attendance: Commissioner Lew Gaiter; Commissioner Steve Johnson; Commissioner Tom Donnelly; Linda Hoffmann; Neil Gluckman; Ginny Riley; Laura Walker; Marsha Ellis; Ed Rutherford; Laurie Stolen, Alternative Sentencing Director; Mariah Henkel; and Ann Marie Grobarek
A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm.
Introductions & Announcements
Commissioner Donnelly welcomed everyone and called the meeting to order.
Director Ginny Riley asked if there were any additions to the agenda. The Commissioners had no additional agenda items./p>
Human Services and Criminal Justice Collaboration Project
Ginny Riley introduced Marsha Ellis, Benefits Planning Division Manager, to speak about a special project we are doing in collaboration with the other departments. Marsha reported that an agency letter from the Colorado Department of Health Care Policy and Financing giving information on providing Medicaid for inmates initiated this project. The Affordable Care Act (ACA) expanded coverage to include additional populations including inmates who are in the hospital for 24 hours or longer. Coverage includes physical and mental health system costs. We formed a committee with staff from Alternative Sentencing, Community Corrections, Human Services and Touchstone to explore how to work with criminal justice populations to obtain coverage upon their release. The population is very diverse and includes families for these individuals who will benefit. There is a system in place to work with someone so they are covered when they are released. 70-90% of this population does not have medical insurance, so we want to be sure that everyone who is eligible is covered. This process will provide information about the health exchange to people who are not eligible, and provide an opportunity to assess applicants for food assistance or cash assistance programs. Hopefully having these benefits available will affect recidivism and we will track numbers to measure the impact of this project. Criminal Justice employees will do some of the initial screening for us regarding things like whether or not they have health insurance.
Commissioner Johnson asked if this expanded coverage will cover any costs for medical care while incarcerated. Marsha said no, and Laurie Stolen, Alternative Sentencing Director, added that it only is for hospital stays that are longer than 24 hours. Laurie continued by explaining that the ACA statute has not been as progressive as alternative sentencing efforts because of how the statute defines “offenders.” Work-release offenders are part of a community-based program, so they have to pay for their own medical coverage or the program has to pay for it. Once they are released, then they would be eligible. The goal is to get the applications completed and processed as quickly as possible so coverage begins the minute they are released to prevent gaps in medication and maintain provided treatments and health care providers.
Ginny Riley asked the Commissioners if we could suggest to Colorado legislature to change the definition of who is an offender in order to provide cost savings to the local community for those medical costs. Marsha Ellis added that Michael Wagner from HCPF has been working with the Centers for Medicaid and Medicare to try to get the statute changed. Ginny said she would follow up with them to see what they have done and if we can help.
Marsha explained that technicians have already expressed an interest in being located at all three facilities to assist people in completing applications, and we have posted positions so people can apply. We will be tracking recidivism and cross-reference those numbers with applications, and we plan to implement the program in January of 2015. Laurie said that ASD will pilot the program and explained how they will screen offenders and measure the effectiveness of the program with a monthly report. Working with Human Services provides additional benefits including helping those who frequently do not have access to their birth certificates and providing an incentive to go to the Workforce Center to look for employment. Commissioner Gaiter questioned how often we have offenders who have no identification, and Laurie explained that many offenders come in with no identification. An overview handout explained which people in the criminal justice system to determine which programs are eligible for Medicaid while they are in the facility. Commissioner Johnson asked clarifying questions about the handout and Laurie said the recidivism rates on the report were approximate guidelines for one year.
Marsha Ellis introduced Mariah Henkel, Income Maintenance Manager, who explained that two Technicians have been going twice a month to speak to groups of offenders about what programs they could be eligible for and what other options are available to them upon release. A representative from Child Support also went to speak about how to establish and modify a Child Support order. Groups attending these presentations grew from an average of eight people to an average of about twenty people per session.
Commissioner Donnelley asked about the budgetary impact of this program, specifically direct costs since we spend a significant amount of money on medical care for offenders. Any medical care that is not hospitalization for more than 24 hours is not covered, but offenders who have coverage for mental and physical health care can maintain stability better than before. Ginny said that we should have some good data later in 2015 we should be able to come back and talk about whether or not there has been an impact on recidivism.
Differential Response Conference Report
Ginny introduced Laura Walker, Deputy Director, who will talk about the Differential Response Conference. Jim Drendel, Child Youth and Family Division Manager is not here today because he is taking vacation after having been the keynote speaker at the conference. Commissioner Gaiter attended the conference, and Laura opened her remarks by thanking him for attending as it demonstrated interest from the Commissioners’ office that staff appreciates. We provided four different presentations at the conference, including Jim’s keynote address. Glory Magrum, from the House of Neighborly Services, and Jerri Schmitz, from the Matthews’ House, joined Jim for his presentation. They are looking at opening a second community life center within the next 12-18 months because demand is greater than the capacity. They each brought a client to tell the story of the impact of our work on their life. The lower level of intervention through Differential Response stabilized their families. Laura gained an appreciation for being a County administered program as opposed to a state-run program. This is a real advantage for us as it allows us to meet a family according to their needs through local control and the ability to adjust our program.
Vermont and South Carolina both implemented state Differential Response programs, but they are considering going back to their old system because they have had child fatalities. Laura felt that was an unfortunate decision because they may be blaming Differential Response when there may be a different cause. Laura was discouraged when attending two sessions led by researchers talking about data collected over time regarding Differential Response. She felt their conclusion that they did not see a statistical difference over time was misleading.
Commissioner Gaiter was impressed by seeing the staff in action, learned a lot and developed relationships. He told Laura that we have a great group of people who went to the conference.
Commissioner Johnson asked for clarification on what measures from the study were misleading. Laura explained an example of one of the studies and her assessment that their sample size was small, the cases were not a true cross-section of the severity of cases possible, and that the measures were customer satisfaction and not outcomes that are a more accurate measure of the safety of the children in the home. Ginny mentioned a study done by the Colorado State University that said Differential Response was very effective and provided more customer satisfaction. Studies across the country show a range of results for the effectiveness of Differential Response, but the CSU study’s fidelity to federal guidelines make it more reliable. We did provide outcomes from the CSU study, and had our After Hours supervisors talk about how we staff and use Differential Response with a 24x7 model.
Commissioner Johnson asked about net results from the conference. Laura said that people were at all stages for Differential Response. New York was very skeptical at first, but was encouraged by the end. People who are open-minded about it left with motivation to develop their programs further. Commissioner Johnson asked about 1451 programs to bring money in for community-based services because he feels that is so helpful in supporting Differential Response and allows us greater flexibility in providing services tailored the family’s needs. Laura responded that funding for the agencies are so different that it is hard to say, but Minnesota has 50% of their funding provided locally which means more ownership from the community because of investment in the programs.
It is part of the State Department’s legislative agenda to move Differential Response out of a pilot process into a permanent practice in counties throughout the state. Commissioner Johnson said he cannot see how a County could be forced to do it, but Ginny thought the intention is for it to go statewide once problems like how to do a red team with a small staff are resolved. Larimer County implemented Differential Response without using new money. Commissioner Donnelley said he thought it did not cost any more money. Ginny replied that it should be cost neutral and Laura said the Ohio study showed that Differential Response costs less. Ginny and Laura explained that the costs up-front are higher but that they reduce after time. Thad Paul, Child, Youth and Family Deputy Division Manager, provided some examples of up-front costs like utility costs and rent, in-home family therapies, and otherwise doing an identification of family needs right away and implementing them quickly instead of waiting for a judge to tell you what to do for the family.
In summary, Laura said that Jim’s theme at the conference was that you have to have a lot of courage to do Differential Response because of the critics. It did help our staff know how far we have come, to hear the feedback to presenters, and it provided a good opportunity for networking and asking questions.
Draft County Position on the State Child Welfare Workload Study
Ginny Riley provided the draft County position on the State Child Welfare Workload Study that said we need 700 new workers statewide to handle the caseloads we have now. There has not been a workload study since 1978. The proposed budget from the Governor’s office adds 130 new workers for the fiscal year 2015-2016, but the legislative process means we do not know what will happen to that proposal. Thad has been part of a work group of counties putting together recommendations on how to address issues raised by this study that includes seven of the big ten counties and several mid-size counties. At this time, there are no small counties, but they are hoping to add a representative at their next meeting.
Thad explained that they focused on numbers of workers, supervisors and managers because they wanted to stay away from the study’s conclusions on how much time to spend on different tasks in child protection. The study ended in February, which is not our busiest time or our slowest time. Our metrics were a bit higher than the State as a whole, showing 48 hours for workers and 53 hours for supervisors. Commissioner Johnson and Thad attended the Child Welfare audit last week, and Director Bicha used the workload study to show how we could improve outcomes for families by having enough staff.
Fifty-four counties participated in the workload study. All of the big ten counties except for Weld County participated in the study. Average number of hours worked per week is across the top of the report. Seven hundred additional employees are needed to “make the work whole”, so to speak. About 130 of those positions would be supervisory. The position statement recommends a supervisor ratio of 1 to 5, although we are currently at 1 to 6 in Larimer County. The position statement recognizes that it is not realistic to expect to hire 700 new people immediately, but it could be a long-term goal to reach that number. There are recommendations to look at it from two different ways: what would it take in increased funding to get to forty hours per week for staff, or from a caseload perspective because national workload studies use caseload basis. Larimer County would need approximately 20 more caseworkers and 8 more supervisors.
In the section discussing increased funding to meet national recommendations for caseloads, there is information discussing vacancies. There is a significant turnover rate (30-40%), which means new caseworkers with learning curves to complete. Even if we are approved to have all the new staff, there are vacancies due to turnover.
Commissioner Gaiter said he learned at the DR Conference about caseworkers who are fresh out of school who rapidly lose interest in the job and quit. Laura explained caseworkers who have just completed school have learned principles that are more in line with Differential Response, but they do not learn that the job has 60% paperwork, data entry, writing letters to Court or providers, etc.. They become disillusioned because of the reality of the job. An After Hours supervisor explained to Laura that documentation requirements have increased over time due to legislation requirements made in reaction to specific situations. In addition, the stress of the job takes a toll on the employee, and there is competition from partner agencies where contact is family-initiated and not initiated by the agency.
The third page of the report provides a caseload capacity recommendation based on reports pulled from Trails. Numbers on the table are state-wide assessments and ongoing cases per caseworker. The recommendation is that a caseworker should have eight new assessments a month, based the average assessment being open 45 days. This assumes that 2-4 assessments will carry over into the next month, giving a total of 10-12 assessments per worker. The recommendation for ongoing caseworkers is 10.5 cases per worker. Cases can include Differential Response cases moving from assessment to an ongoing case. Currently, the work group is gather data regarding how much Child Protection staff does each county have and how many approved positions do they have, trying to understand vacancy information.
The report provides research on workloads including studies from other states. The people who did Colorado’s workload study did the study for the State of Washington mentioned in the report. The Child Welfare intake and ongoing caseloads range from 10-12 cases per month based on those studies. The last page provides possible outcomes. The work group recommends that more staff would allow counties to provide improved outcomes and suggests standards for improvements in number of children re-abused, number of children that do not come back into the system, number of children that are reunified with their family within twelve months, number of children in foster care and number of children in congregate care. Director Bicha also believes increased staff will increase timeliness of initial response and timeliness of initial closure, so the work group will add those outcomes. Thad believes initial contact is very closely tied to better outcomes because if you can’t get eyes on the child how do you know they are safe. Additional staff will maximize the amount of face-to-face contact for discussion of their needs, and provide additional time for finding families to take in children when necessary. Caseworkers could also help supervise additional visitation to improve parenting time between the parent and the child.
Commissioner Johnson asked if the expectations listed in the report are dependent upon the increase of 700 employees. He had a concern about this as the Governor’s current proposed budget would address less than 20% of the proposed increase in staff, so that would mean lower outcomes. Thad confirmed this, and Ginny replied that the number of staff approved will depend upon decisions made by the legislature. It could be that they approve more - or less - than the Governor is going to propose. Neil asked if the County would have to pay 20% of those positions if the state does approve the budget, and Ginny replied that yes, they would. For 2015, we would be using fund balance to cover the County costs, but for 2016, we would look for the County to cover those costs.
Child Welfare Audit
In addition to the workload study, the legislature required an audit. The findings were released Wednesday. Ginny will do a summary and she will be available for a more extensive review of the results if the Commissioners would like it. The audit reviewed cases, 1451 projects, and the fatality review process. They made about 30 recommendations, and the State Department of Human Services did not agree with 10 of them. After the State makes their objections, the legislative audit committee has to direct the State specifically to follow the recommendation at the review if they want the State to take any action on them. The legislative audit committee allowed the objections for all 10 recommendations.
The State will send County Directors a draft work plan for how to implement the other recommendations in an effort led by a person at the State, with a lead for each recommendation. Many of these recommendations are things that the counties have already accomplished. This meant that one common reaction to the audit was that it was not fair for the audit to “ding” the State and counties for things that have already been addressed or corrected. The State lead staff for each recommendation will put together a team from different counties for each item and come up with an action plan. Director Reggie Bicha was very supportive of the counties and provided handouts to refute some of the audit findings. The auditors were not Child Protection professionals and had no Child Protection experience. They did not look at the entire case file, but only looked at the information in Trails.
This will be a big topic at CCI and Julie Crowe will do a presentation on the audit findings and the plans to move forward. Recommendations should be implemented in January. Linda Hoffman asked if there were any helpful recommendations from the audit. Ginny replied that there are some existing regulations or statutes where some people are not as compliant as they should be. There is a recommendation that there be an agreement with law enforcement on how to work together. Larimer County has agreements with law enforcement that are current, but some counties are not current or not in place. There are some legitimate recommendations but they are mostly technical issues based on statute issues. Some rule changes have already been made and it is just a matter of making sure the counties are compliant. Thad Paul also mentioned the flaws in Trails, specifically that you cannot upload anything into Trails. Being able to adapt Trails would be better than an entirely new computer system. Thad added that Director Bicha impressed him with his position that counties know counties best, and that the State needs to partner with the counties.
Neil Gluckman mentioned that he could understand how there might be some objections to support services costs that auditors do not understand. Ginny Riley asked if he meant the auditors’ questions about Larimer County buying a ski pass for a juvenile. Larimer County had only made the investment in this particular case because it was the best way to prevent him from getting in trouble. Commissioner Johnson responded that he believed the main concern of the audit committee was more the amount of the personal allowance, because it increased from $800 to $2,000. The audit focused on counties not following rules, but they have been re-worked recently. For example, there is a team called the Child Protection Team that is supposed to review each case. But Ginny had told Commissioner Johnson that if the team reviewed each case, they would have three minutes per case. This just demonstrated the auditors’ total ignorance of the realities of the system. The auditors even wanted the public to sit in on hearings, but there is no way for that to work and to maintain confidentiality. Director Bicha’s response was that the lesson has been for the State board to not be overly prescriptive with the rules.
Counties have come up with “Real Colorado” which explains that the priority is outcomes as opposed to checking all the boxes. Commissioner Johnson would like to hear if any of the cases in the audit were Larimer County cases. If so, to what extent are we not following those rules, and are they really important if we are not following a rule. The Board would be interested in seeing how the County responded to the audit, but perhaps it would be best to look at the audit after the work studies are done. Commissioner Johnson said that Director Bicha’s performance in the audit was phenomenal. Ginny explained that the question about whether or not state has authority to waive rules in a specific situation came up, and Commissioner Johnson said that the State now does have that authority. He provided an example of a child not being interviewed within the required timeframe because they were in intensive care, under treatment and safe.
Ginny said that many of the counties met with the auditors ahead of time in order to be prepared for the audit results. The main recommendation for 1451 programs was that the State office develop state-wide performance indicators for the 1451 program, but that is impossible because of the 1451 being structured to allow for tailoring to specific needs. The State objected to the recommendation, so there should not be any requirement to do this. Thad mentioned that the audit said that they did not see any outcomes for 1451 programs; but Director Bicha responded that there are 128 different measures across the State, and we have seen a number of outcomes including reduction in foster and congregate care.
Client Activity Report
Business Operations Coordinator Ann Marie Grobarek presented an overview of the department’s client activity. Ann Marie reviewed: monthly average caseloads, program activity, complaint totals, and results from the client follow-up survey regarding complaints from July 1, 2014 through September 30, 2014.
During the 3rd Quarter of 2014:
- The Food, Medical & Financial Assistance Program caseloads continue to increase. We currently have 54,481 cases.
- Child Support collected over $4.3 million.
- Children, Youth and Family received 1,604 referrals, and 97% of children with a case plan to remain home did.
- We received a total of 6 complaints during the 3rd quarter.
Ann Marie indicated that the Adult Protection caseload is 167 which is surprising because we thought we would see an increase in referrals with the mandatory referral requirements. Laura Walker added that we have seen an increase in referrals, 50-75% more, but to see the consistent number of cases indicates that our community was educated about where there is a legitimate need for intervention.
Commissioner Gaiter asked the reasons behind the complaint about communication and service delivery. The communication complaint was a result of someone not returning phone calls, and service delivery resulted from referrals not being made in a timely basis. Commissioner Gaiter asked what we know about people being afraid to make complaints. Ginny responded that family meetings allow an opportunity for people to bring complaints, but that we can’t address complaints if people don’t bring them to us. Laura added that there a lot of different avenues for people to address their complaints, at a number of different times during a case. As part of the County Strategic Plan we are looking for doors people can bring those concerns to our attention.
Ginny explained that the Department of Human Services has been working on Strategic Plan project over the past two and a half years. We have made several accomplishments for four focus areas. These projects are assigned to staff groups including managers and line staff who make recommendations back to the steering committee. One project is the group driving our partnership with Information Technology. We are negotiating a service design package with IT that will be completed by the end of this year. Ginny asked the Commissioners for their input on which projects they would like to hear about at our next Board of Social Services’ meeting in February. Commissioner Johnson asked about the People focus area. He has gathered our employees have requested more support for their needs. What is DHS doing about that? For example, Commissioner Johnson went to the presentation for the Child Protection employees with Jim Henry. Laura explained that the Building Resiliency project is working on secondary stress concerns for employees and we can make sure they are on the agenda for the February meeting.