What’s in it for kids?

Outstanding issues related to the proposed FY 2010

Child and Family Services Agency (CFSA) budget

Introduction
The community and the Committee on Human Services identified a number of issues related to the FY
2010 CFSA budget and the programs and services it is proposed to support. This document identifies the
issues/concerns raised at the April 3 CFSA public hearing, at the DC ACT-sponsored CFSA briefing and
since both events. Included is additional information to the extent DC ACT has been able to get it relying
largely on communications with CFSA staff, the testimony of Dr. Gerald at the Committee on Human Ser-
vices CFSA budget hearing, and the CHS/CFSA Q&A.

Agency operations
Group home rates
Question: When was the last time congregate care providers received an increase? Is it a problem that
they are not in this budget?
CFSA response: There is no planned increase for overall spending on congregate care.

Question: There is a significant overall decrease in 50 (subsidies and transfers). Given that foster parent
and placement contract per diems are not declining, is this realistic?
CFSA response: The incorrect budget amt was printed in budget book and Justin Kopca
responded to this at the hearing.

Recruitment travel
Question: There is a $50,000 reduction in recruitment travel shown in AMP, which is agency manage-
ment. What is this for?
CFSA response: This is social work recruitment travel.

Personnel services
Question: The overall budget shows an increase in baseline costs due to salary step and other changes.
But in Dr. Gerald’s presentation at the pre-hearing meeting, he said that most of the $2.4 million in-
crease for intake and investigations was due to salary increases. By the numbers, this suggests that only
intake will experience salary increases; clearly that is not possible.
CFSA response: CFSA budgets staff to the lowest step and then has to correct for step increases.
This is a government-wide practice, not just a CFSA one.

Question: Information about changes to personnel services contracts is confusing. Reductions are listed
three times under cost savings for a total of $686k; there is also a decrease in temporary staffing of
$234,000. Combined, those total a reduction of $920,000. The overall reduction in contract services is
$777,000, which implies an increase somewhere else of $143k. Is this for nurses to do the after-hours
screenings? If not, what is it for?
CFSA response: There is not increase in PSC funding.

DC Action for Children

1616 P Street, NW * Suite 420 * Washington, DC 20036
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What’s in it for kids? Outstanding issues related to proposed FY 2010 CFSA budget

Question: What is included in 012 “regular pay – other”? (comp time?) and why are the 012 amounts
being completely eliminated? And what is in 013 “additional gross pay?”
CFSA response: This is all OT – 012 was combined with 013.

Medicaid/Title IV-E billing

Question: Do the projections make sense?
CFSA response: CFSA worked with DHCF on the assumptions and taking the necessary steps to
identify staffing, policy and practice changes needed. There are risks involved but CFSA and
DHCF are committed to making the changes work.

And from the CFSA response to Committee on Human Services’ questions:

Q10. What was the impetus behind the decision to eliminate Targeted Case Management (TCM)
services through Medicaid? How will these services be provided if not through Medicaid? Will there
be services that will not longer be available? Is it the expectation that local funding will be used
to pay for TCM services and or other services that will no longer be provided under Medicaid? Pro-
vide a timeline for this transition.

A10. Recent internal audits of the CFSA’s Medicaid claiming resulted in significant disallowances
for claims made under the Medicaid Targeted Case Management (TCM) and the Rehabilitative Op-
tion programs. Given these results and an examination of the Agency’s current Medicaid claiming
practices, it became apparent that future disallowances would more than likely occur unless there
was a substantial change in these practices. Therefore, CFSA has stopped claiming (as of January
31, 2009) for these services.

These changes will not impact services to children. In addition to the increase in local funds
($19,415,079) in the proposed FY 2010 budget, we are now claiming eligible costs under Title
IV-E. Finally, we are also working with the Department of Health Care Finance (DHCF) to restruc-
ture how we deliver and claim for services under the Rehabilitative Option. This work is slated to
be complete in FY 2009 and we anticipate restarting claiming for these services by the second
quarter of FY 2010.

Q11. Can you identify what services were previously eligible under Targeted Case Management
and how these services will be delivered?

A11. Services that were claimed under TCM will continue to be delivered in the same fashion.
The categories of services that may be claimed under TCM are:
a) Client Intake
b) Assessment
c) Case Planning
d) Service Coordination and Monitoring
e) Case Plan Reassessments

Q12. What are the documentation requirements for Medicaid? What are the documentation re-
quirements for Title IV-E? What benefits do you expect to gain from making this transition?

A12. For Medicaid, the following must be documented:

a) Eligibility of child;
b) Provision of a CMS-approved service;
c) Description of the service;
d) Date of service;
e) Location of service provider;
f) Qualifications of service provider; and
g) Signed case plan with service recommendation.
What’s in it for kids? Outstanding issues related to proposed FY 2010 CFSA budget

To claim Title IV-E, the following must be documented:

a) Eligibility of child;
b) Valid court ordered removal;
c) AFDC eligibility;
d) Judicial determination regarding permanency; and
e) Licensed placement.

FTE changes
Question: What non-social work positions are proposed to be eliminated and whether they will have
impact on agency operations?
CFSA response: From the CFSA response to Committee on Human Services’ questions:
Q1. What is the total number of currently filled FTE positions identified for elimination? Please
provide the title of each position and which program each position is in? Identify which posi-
tions are subject to collective bargaining? How will the loss of these staff impact service deliv-
ery? Is early retirement being offered to those individuals who are eligible? What was the impe-
tus for the elimination of these positions?

A1. Some filled positions will be eliminated in FY 2010 however the exact number of positions
has not yet been determined. Restructuring will occur as part of an effort to better align CFSA
resources with its core services.

Issues for which DC ACT did not obtain additional information

 Contracting, performance-based contracting
 Overtime
 Intake, particularly whether CFSA has resolved those with no fixed address
 Maximization of Federal funds

Services
Community-based Services Program
Question: What is the explanation for the negative budget of $1,877,000 in the Community-based Ser-
vices Program?
CFSA response: This is a mistake and it will be corrected in the final budget. The correct
amount is $544,000.

Youth Transition Center and the role of the private sector, particularly Progressive Life
Question: Why have funds have been committed to YTC construction without any apparent plan yet as
to programming at the YTC or how that will be funded.
CFSA response: CFSA has made a concerted effort for seven years on the concept and model
for the District’s Center. CFSA response: CFSA has made a concerted effort for seven years on
the concept and model for the District’s Center. While the build-out of the site is being com-
pleted, CFSA will engage in a planning process with the other government agencies (DOES and
DYRS) that will be located at the YTC and stakeholders (including youth) to ensure the success-
ful implementation of the model.

And this from Dr. Gerald’s April 3 testimony before the Committee on Human Services’ budget
hearing:
Establishment of the Youth Transition Center--$818,959
For older youth in foster care, transition centers are a best practice for supporting successful
transitions to adulthood. Establishment of the Youth Transition Center is a key initiative in
What’s in it for kids? Outstanding issues related to proposed FY 2010 CFSA budget

CFSA’s overall efforts to strengthen services for older youth and in ensuring all youth in care
achieve permanence. In FY 2010, CFSA, other youth-serving District agencies, and community-
based organizations will move into the former Merritt School. This facility is being re-purposed
into a one-stop service that will provide life skills training, employment services, and a range of
supports for older District youth. The proposed budget includes $818,959 in one-time funds for
moving and build-out costs. (Testimony is online at http://www.scribd.com/doc/13967218/
FinalCFSAFY10budgettestimony)

Question: Why are build-out costs for the Youth Transition Center in CFSA’s operating budget?
OCA response: There was no capital budget for the Merritt School. Further, the costs are
categorized as Fixtures, Furniture & Equipment (FFE), which are sometimes not eligible for
bond financing because of the covenants on our General Obligation bond issuances. A real ex-
ample: If the city is financing bookshelves in a library, it’s ok to use GO financing only if the
shelves are “part of the building”—either built-in to the wall or bolted to the floor. Standard,
moveable shelves that you can theoretically pick up and carry out of the building should be
paid for with operating funds.

Safe Shores – The DC Children’s Advocacy Center

Question: Why are construction costs for the Child Advocacy Center in CFSA’s operating budget?
OCA response: The funding is not for construction but for moving the special abuse unit staff
to the new space and equipping their office space with the necessary furniture, technology,
telecommunications and office equipment. Like is the case with the Youth Transition Center,
the funds are categorized as Fixtures, Furniture & Equipment (FFE).

Question: It is still unclear how the operating funds for Safe Shores will be used.
CFSA response: From Dr. Gerald’s April 3 testimony before the Committee on Human Services’
budget hearing:
Co-location with Safe Shores/DC Children’s Advocacy Center (CAC)--$596,073
The CAC is a key partner in providing services to child victims of physical and sexual abuse. In
early FY 2010 when the new CAC opens at the former Bundy School, CFSA will collocate two
special abuse units with the Multi Disciplinary Team (MDT). The co-location of the MDT staff to
a central site will strengthen the quality and increase the capacity for joint investigations of
child abuse cases.

In addition to $500,000 of baseline operating funding to the CAC, the proposed FY 2010 budget
includes one-time funding of $246,073 for moving and build-out costs and an additional
$350,000 in operating funds. These additional funds will support additional child abuse preven-
tion education and outreach and increase the length, depth and breadth of service to each child
victim of abuse referred to Safe Shores/CAC by the MDT through the expansion of existing pro-
grams (i.e., therapy, victim services, and forensic services).

And from the CFSA response to Committee on Human Services’ questions:

Q15. Under Policy Initiatives, $246,073 in one-time funding is allocated for build-out of the
Special Abuse Unit of CFSA’s Child Protective Services program to co-locate at the new DC Chil-
dren’s Advocacy Center (CAC). How many CFSA staff will be co-located to the new CAC? Will
staff from other District government agencies be included in the co-location? If yes, provide
which agencies and the number of staff from each. When will the co-location be completed?

A15. The CAC is a key partner in providing services to children who are the victims of physical
and sexual abuse. In early 2011 when the new CACs opens at the former Bundy School, CFSA
will co-locate two special abuse (19 FTE’s) units with the Multi Disciplinary Team (MDT). In ad-
dition to CFSA and the CAC, the MDT includes:
What’s in it for kids? Outstanding issues related to proposed FY 2010 CFSA budget

* Children’s National Medical Center (The Freddie Mac Child and Adolescent Protec-
tion Center);
* Metropolitan Police Department (Youth Investigations Branch and Special Victims
Unit);
* Office of the Attorney General (Child Protection Section, Juvenile Section and
Neighborhood Victim Services); and
* United States Attorney’s Office for the District of Columbia (Sex Offense and Do-
mestic Violence Unit and the Victim/Witness Assistance Unit)

In-house medical screens at intake

Question: How was the figure of $492,000 in savings related to doing screenings in-house arrived at?
What has CFSA spent on these screenings in the past? Can this change be made without renegotiating
the contract (or whatever agreement is in place) with Children’s? (and how much have contract ser-
vices been increased to pay for the nurses who would do the screenings after hours?)
CFSA response: CFSA has a Certificate of Need and will be a Medicaid provider. As such, CFSA
will be claiming for services where they were not before. The amount of savings was deter-
mined by CFSA in collaboration with the Department of Health Care Finance. The dollar savings
are actually conservative and thus could be greater.

And from the CFSA response to Committee on Human Services’ questions:

Q24. In the Transfers Out section of the proposed budget CFSA will transition services for
medical screening from hospital-based services to agency-based clinic services. Agency-based
medical professional will provide immediate medical screenings. Please provide detailed infor-
mation about the transition and how it will work to ensure timely medical screenings. Do you
anticipate a budget impact as a result of this transition? Please walk through a case?

A24. In FY 2010, consistent with CFSA’s commitment to ensuring the well-being, we will move
forward in implementing an innovative model medical care management model for medical,
dental, and mental health services for children within the foster care system. The model will be
supported by both local funds and Medicaid reimbursement. This new approach will not only im-
prove children’s access to these critical services but help to address the well-being issues which
are often a barrier to permanency.

The on-site screening for the pre-placement evaluations will significantly streamline the process
where children are removed, medically screened and placed. Currently, children receive medical
pre- and replacement screens at THEARC, or at the Children’s National Medical Center. THEARC
screenings are available Monday to
Friday 7:30am to 7:30pm. CNMC screenings are available evenings, weekends and holidays.
Medical legal and acute psychiatric evaluations are seen in the CNMC Emergency Department.

When a child is removed from their home, she is transported to THEARC or to CNMC – depend-
ing on the day and time; neither site is designed exclusively to provide pre-placement screen-
ing evaluations for children coming into care initially or being replaced into another home there-
fore wait times are extensive, averaging 2-3 hours but can be longer depending on the existing
patient load at either site.

The process of being removed from families and enduring long wait times in unfamiliar environ-
ments with strangers compounds stress and serves to further traumatize children.

Under the proposed model, when a child is removed, she will be brought to the CFSA On-Site
Prescreening Health Project and be seen immediately by an experienced clinician sensitive to
child welfare concerns. Additional benefits will include:
* Early and up close engagement of social workers regarding immediate health
care needs of the child;
What’s in it for kids? Outstanding issues related to proposed FY 2010 CFSA budget

* Ability for clinicians to communicate with foster parent prior to and following
placement of child as needed;
* Early engagement of biological family for medical information.

Grandparent Subsidy Program (formerly known as the Grandparent Caregiver Pilot Pro-
gram), Adoption Subsidy and Guardianship Subsidy
Question: Further explanation is needed regarding the grandparent program along with other subsi-
dies.
CFSA response: As to the question of how the adoption funding was calculated, CFSA ac-
counted for the number of youth adopted who are still receiving subsidies, those who will age
out in FY 2010, and the number of young people “in the pipeline” to adoption and guardian-
ship. As stated before, the proposed budget is adequate based on these projections.

The FY 2009 budget book included the wrong budget number for Program 5000 (adoption,
guardianship, grandparent subsidy). The correct difference between FY 2009 and FY 2010,
then, is $1 million.

There are currently 198 children on the waiting list for the Grandparent Program. The average
annual subsidy is $9,000; therefore approximately $1.6 million would be needed to fund the
children currently on the waiting list. (This factors in the already proposed $185,000 increase
in funding for FY 2010.) CFSA expects to serve at least 20 more children with the additional
funding in FY 2010; this assumes the average subsidy.

Issues for which we obtained no additional information

 Rapid housing funding
 Congregate care for young children
 Permanency, especially for older youth; services for older youth such as those of KidSave
 Truancy and educational neglect, CFSA memorandum of understanding (MOU) with DCPS;
responsibilities of charter schools
 Child abuse and neglect prevention
 Mandated reporting
 Refugee minors, program moving to the Department of Human Services
 Case management vis a vis the budget
 Contracting for special services to youth such as mentoring
 Nurse Family Partnership (NFP)
 CFSA relationship with Department of Human Services (DHS), particularly homeless services
 Transportation for special ed kids

Sources:
1. Communications with CFSA staff.
2. CFSA FY 2010 budget testimony — online at http://susiecambria.blogspot.com/2009/04/cfsa-fy-
2010-proposed-budget-info.html
3. CFSA/CHS questions and answers related to FY 2010 proposed budget — online at http://
susiecambria.blogspot.com/2009/04/more-info-about-cfsas-proposed-budget.html

Additional Resources:
1. Budget.dc.gov — http://grc.dc.gov/grc/cwp/view,A,1246,Q,461527.asp
2. CFSA Web site — http://www.cfsa.dc.gov/cfsa/site/default.asp

April 16, 2009