New Provider Residential Services Orientation State Orientation of

New Provider Residential Services Orientation State. Orientation of Georgia 1

Am. Way The Miracle of Pyramid Marketing How to sale soap and rule the world. Orientation 2

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) Orientation – Department of Juvenile Justice (DJJ) 3

Who Should Attend Applicants 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. Orientation child homes 4

Who Should NOT Attend Foster Parent wantabe’s Adult Personal Care Home Applicants Psychiatric Hospital Applicants Maternity Homes Applicants Insect Exterminators Applicants Beauty Shop Operators Applicants Road Contractors Applicants Orientation 5

Overview Normer Adams Executive Director Georgia Association of Homes & Services for Children www. gahsc. org normer@gahsc. org Orientation 404 572 6170 6

Steps to Provision of Services 1. - Organizational Capacity and Needs Assessments 2. - Licensure 3. - Approval Process for Vendors 4. - Referrals and Payments Orientation 7

Steps to Provision of Services Step one - Organizational Capacity and Needs Assessments Orientation 8

FIRST PRIORITY Develop the “BUSINESS PLAN” The Plan vs. Good Intentions – Board – -Budgets – Constituency -Facilities -Policies & Procedures Needs Assessment. Organizational Capacity Assessement

FIRST PRIORITY THE BUSINESS PLAN (continued) • Research – The Need – The Competition • Interviews • Field Trips Needs Assessment Orientation 10

SECOND PRIORITY Develop “YOUR CONSTITUENCY” (Who Supports You) • Your Community Church, Civic Groups, Interested Parties • Your Supporters Give Time, Money, and Resources • Your Board Developed from your Constituency Organizational Capacity Assessment Orientation 11

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 Orientation 12

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 Orientation 13

Budgets and Budgeting Budget Development Expenses Income - State Fees Contributions Grants Endowments Organizational Capacity Assessment Orientation 14

Budgets and Budgeting Medical Care Covered by Medicaid - Nearly all children in residential care qualify for Medicaid. Organizational Capacity Assessment Orientation 15

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 Orientation 16

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 Orientation 17

Fundraising Grants for Startup All Foundations and Charities 1. 2. 3. Organizational Capacity Assessment Orientation 18

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 Orientation 19

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 Orientation 20

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 Orientation Organizational Capacity Assessment 21

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 Orientation 22

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 Orientation 23

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 Orientation 24 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 Orientation 25

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 Orientation 26

Working with the State • Some Steer The State is our partner in caring for children. Their role is regulatory and contractual. Respect it. • Others Row Our role is providing services to children. Together we work to provide the best care for children. Organizational Capacity Assessment Orientation 27

Departments & Divisions of State Agencies Orientation 28

Department of Family and Children Services (DFCS) Budgeting/Rate Setting Organizational Capacity Assessment Orientation 29

BUDGETING/RATE SETTING • Family Foster Care • Institutional Foster Care Organizational Capacity Assessment Orientation 30

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 Orientation 31

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 Orientation 32

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 Orientation 33

Unallowable Costs • Bad Debt • Contributions & Donations • Depreciation • Investments • Organizational Costs • • Contingencies Entertainment Fines & Penalties Prohibited Activities Organizational Capacity Assessment Orientation 34

Provider Reports Institutional Foster Care (IFC) • • Annual Group Facilities Cost Report Description of Treatment Program Independent Audit Report Typical Weekly Schedule Organizational Capacity Assessment Orientation 35

Steps to Provision of Services • Step Two - Licensure Orientation 36

DHR Office of Regulatory Services Child Care Licensing #2 Peachtree St. , 32 nd Floor 404 -657 -5562 Orientation 37

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 Orientation 38

How to Apply for Licensure (Handout # 2 - Steps To Licensure) • Purchase licensure application package Child Care Licensing Agency Department of Human Resources Office of Regulatory Services, Child Care Licensing Section Two Peachtree Street, NW 32 nd Floor, Room #458 Atlanta, GA 30303 -3142 Phone: 404 -657 -5562 Fax: 404 -657 -8936 Web site: http: //www 2. state. ga. us/Departments/DHR/ORS/orsccl. htm Licensure Orientation 39

How to Apply for Licensure (Handout # 2 - Steps To Licensure) • 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 Orientation 40

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 Orientation 41

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. Orientation 42 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 Orientation 43

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 Orientation 44

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 Orientation 45

Behavior Management (continued) • Chemical restraints or mechanical restraints • Denial of communication and visits unless restricted in treatment planning process • Corporal punishment Licensure Orientation 46

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 Orientation 47

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 Orientation 48

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 Orientation 49

Break Orientation 50

Steps to Provision of Services Step Three - State Approval Process of Vendors Orientation 51

Division of Family & Children’s Services DFCS Linda Ladd Program Consultant, Treatment Services Unit (MATCH) 404 -657 -3460 Rosalyn Williams Program Consultant, Treatment Services Unit (MATCH) 404 -657 -3574 Orientation 52

Services Purchased by DFCS Services purchased by DFCS for children in it’s custody are: – Institutional Foster Care (IFC) – Family Foster Care (FFC) Services Purchased Orientation 53

Services Purchased by DFCS (Handout 6 - Guidelines For Providers) • 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 Purchased Orientation 54

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 Orientation 55

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 7 a and 7 b for IFC Application and FFC Application) Approval Process of Vendors Orientation 56

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 Orientation 57

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 Orientation 58

Referral Process • Program will receive referrals directly from county DFCS offices. • County DFCS is responsible for reimbursement for services. Referrals and Payments Orientation 59

DMHDDAD Division of Mental Health Developmental Disabilities and Addictive Diseases Suzanne Lindsey C & A MH Program Specialist Department Of Human Resources Division Of Family and Children Services 404 -657 -2136 Orientation 60

DMHDDAD • Division of DHR • Made up of 7 Regional Boards http: //www 2. 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 Orientation 61

DMHDDAD Regions Orientation 62

Characteristics of Children in DMHDDAD Care • 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 Orientation 63

DMHDDAD Approval Process (Handout # 11 - DMHDDAD Guidelines for potential C&A Residential Services Providers) • 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 Orientation 64

SED Residential Treatment Services 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 Orientation 65

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 Orientation 66

DJJ Department of Juvenile Justice DIVISION OF COMMUNITY CORRECTIONS Gwen Skinner Deputy Commissioner, Community Corrections 404 -657 -2431 Orientation 67

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 Orientation 68

DJJ Approval Process (Handout 12 - DJJ Procedure for Approval) · 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 Orientation 69

State Outline of DJJ Districts (Handout # 13 - DJJ Community Corrections District Lines) Orientation 70

Residential Placement Specialists (Handout # 14 - Community Corrections) Regional Placement Specialists 13 Districts match DHR Districts 1. Wayne Reynolds 2. Kim Settles 3. Angela Parker 4. Carl Harrison 5. Sue Riner Approval Process of Vendors Orientation 71

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 Orientation 72

DJJ Contracts and Payments • Contract - referrals and payments are negotiated through contracts. Referrals and Payments Orientation 73

Characteristics of Children in DJJ’s Care • • • 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 Orientation 74

Services to 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 Orientation 75

Private Placements Normer Adams, GAHSC Orientation 76

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 Orientation 77

Characteristics of Children in Private Placement • 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 Orientation 78

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 Orientation 79

Private Placements Referrals 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 Orientation 80

MATCH Multi-Agency Team for Children Orientation 81

Characteristics of Child Served by MATCH • Children have severe mental, emotional and behavioral disturbances. Characteristics of Children Orientation 82

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 Orientation 83

MATCH Services Purchased • Intensive Residential Treatment Programs • Intermediate Residential Treatment Programs • Outdoor Therapeutic Programs • Therapeutic Foster Care (Levels I and II) Services Purchased Orientation 84

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 Orientation 85

MATCH Enrollment Process (continued) • Completed application is submitted to the Treatment Services Unit. • Application is reviewed by Treatment Services Unit. Approval Process of Vendors Orientation 86

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 Orientation 87

MATCH Enrollment Process (continued) • 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 Orientation 88

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 Orientation 89

MATCH Referrals and Payments • 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 Orientation 90

Steps to Provision of Services 1. - Organizational Capacity and Needs Assessments 2. - Licensure 3. - State Approval Process for Vendors 4. - Marketing to Referral Sources, DFCS, DJJ, Private Sector Orientation 91

WRAP-UP • Questions? ? ? ? • Evaluation Forms (Handout 16 - Evaluation) • Training Certificate Orientation 92

Large box Small box Orientation 93