Commissioners’ Conference Room
Second Floor – County Administration Building
10:00 am – 12:00 am
In Attendance: Commissioner Tom Donnelly, Commissioner Steve Johnson, Commissioner Lew Gaiter, Linda Hoffman, Neil Gluckman, Ginny Riley, Jim Drendel, Marsha Ellis, Ed Rutherford, Ruth Long, John Gillies, Thad Paul, Deb DeLuca-Forzley, Shannon Reiff, Eileen Brittingham, Ann Marie Grobarek
A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm.
Introductions & Announcements
Commissioner Johnson welcomed everyone and called the meeting to order.
Everyone in attendance introduced themselves and stated their position for the listening audience.
Director Ginny Riley indicated that agenda items added by the Commissioners would be addressed within the agenda. Jim Drendel would cover the question about the IV-E Waiver Memorandum of Understanding in his presentation, and she would explain the mandatory local child fatality review required by Senate Bill 13-255 briefly at this time.
Senate Bill 13-255 requires a mandatory local child fatality review under the Department of Health and Environment. Although this is new, our county has done child fatality reviews on a voluntary basis for the past ten years as a result of a previous bill. We are one of about six counties that have a voluntary group that looks at any child fatality, not just child welfare-related, and makes recommendations to improve child safety. The new bill requires this process for all counties starting in 2015.
The State Department of Health and Environment is making rules and policies that will be issued sometime between October and December of this year. Those policies will include more reporting requirements than we currently have. In 2014 Health Departments will get a little bit of planning money to get a new team or fold the current team into their new one. We hope our team will continue as they are already experienced and committed. Reviews will start in 2015, looking at fatalities from 2013 forward.
Commissioner Johnson asked if our current team receives any funding from the State. Ginny Riley responded that our current members are voluntary, manage themselves, recruit their own members, have a chair that is elected and their agencies are covering their salaries. They are comprised of only one member from the Department of Human Services, and the rest include members of local law enforcement, the sheriff’s office, community agencies like the child advocacy center, and the coroner. Approximately $250,000 statewide will go to Health Departments to cover reporting to the state Health Department. It has not been determined how much money will go to each county, but the money is intended to cover administrative costs for managing the team, notifying them of meetings, etc. Commissioner Johnson explained that he wanted to know how much funding was available because the Commissioners had been told at CCI that if there was not enough funding available it could be considered an unfunded mandate. Ginny replied that from our perspective we already have a system in place and the costs are to the Health Department, so she is not sure that we could call it an unfunded mandate.
The current voluntary team and the newly required team review all child fatalities, including accidents, SIDS deaths, etc., looking at trends and issues to make recommendations. Starting in 2015, if the State DHS team reviews the child fatality in the child welfare system, then the State Health Department team will not have to do a review. The Health Department review consists of a paper review. This is different from the State Department of Human Services child fatality review team that Commissioner Gaiter and Ginny Riley are on. Commissioner Gaiter explained that this team does reviews of child fatalities in the child welfare system, looking at policy in the department and systemic improvements that can be made.
Ginny indicated that Ruth Long will be reporting on the Network of Care. Ginny announced that Ruth Long will be retiring and then Lynda Meyer will be replacing her. Lynda is a graduate of CSU and from Alaska, returning to the area. Lynda will start in September.
Office on Aging Update: Network of Care & New Personnel
Manager for the Office on Aging Ruth Long provided the Commissioners with two handouts that explained Network of Care:
Ruth explained that our Senior population in Larimer County is growing. By 2030, 17 years from now, 25% of our population will be 60 and over. Office on Aging is trying to be ready for that increase in population. $90,000 was lost from our budget this year due to sequestration, but Senate Bill 127 passed and provided $100,000, which covered the amount we lost, plus another $100,000 for senior services. Ruth explained that the Office on Aging is using the money to hire a new staff person and to purchase Network of Care, software from Trilogy, a company from California which will provide our resource guide online in a searchable format.
Network of Care provides a service directory, getting information on local services out to our seniors, their families and caregivers; a call center that provides a client database which will allow us to track numbers which will allow us to see gaps in service; a personal health record, which allows you to enter your medical information in one secure location that can be accessed only with a password; a library with articles and fact sheets about medical conditions, aging and topics related to seniors; and a section providing nationwide news on aging and disabilities.
Network of Care is launching in Larimer County on Tuesday, September 10th, with a demonstration provided by Trilogy at Pathways Hospice. The demonstration is open to the public. You can see more information on the Network of Care at www.locanetworkofcare.org. We will also provide a link for this resource from the Virtual Courthouse.
Denver, Boulder, and Colorado Springs have purchased this program, but our purchase ensures local resource information is available with live updates. Larimer County will still provide the printed guide, which is updated annually. Commissioner Donnelly asked how much Network of Care cost. Ruth explained that the initial cost for setting it up is $10,000 plus $12,000 a year in maintenance fees. It is an annual contract that does not have to be renewed if it is not used. It will provide a better way than the manual method we have been using to track data for reporting and budget proposals.
The new funding also allows us to add a staff person who will be a trained information specialist knowledgeable on local resources. This will be an improvement on the current phone tree that would eventually get callers to an administrative support person, which is not popular with seniors. We have a high number of people who call and hang up when they realize it is a phone tree.
Commissioner Johnson asked about the impact of the loss of the Larimer Lift transportation service and Compass. The importance of the information from Compass was discussed, and Ginny explained that Joni Friedman from the Workforce Center has been working to see if she could find someone who could take it over. Neil added that the City of Fort Collins economic development group seemed interested, and Ginny said she would be attending a meeting on that topic in early September.
Commissioner Johnson thanked Ruth for her work for the County and said she would be missed. Ruth will be continuing to have influence in the area of an aging population on CD2, volunteering as the chair person.
Health Care Reform Changes/Activities: Partnerships & a Visit from the CIA
Division Manager Marsha Ellis reviewed the partnerships Benefits Planning has had with the community related to health care reform. This is the end of the first year of a two year grant with the Colorado Health Foundation, which allowed us to have staff at Salud to help with issues regarding Medicaid problems.
Human Services has been working with the Health District. We will have a Navigator in Fort Collins, two in Loveland, four of our people will be trained on what the Navigator does, and the staff at Salud will be trained on how to answer some of the Navigator questions for clients who will not be eligible for Medicaid. This training will consist of online training and three days of off-site training.
Applications to apply for Affordable Care Act (ACA) programs originally were 26 pages long, but the state has worked to get those reduced and they are now down to 8 pages. People should apply through PEAK and through a central phone number as opposed to a manual application. Applications will also cover Food Assistance and TANF. Human Services had staff involved in rewriting some of the Medicaid rules and what the new expanded categories will look like, including adults without dependent children. We have been very involved in the process.
It is estimated that there are an additional 6,000 people in Larimer County who will be eligible for Medicaid. Currently, we have a total of 33,601 clients on Medicaid. We are working with Jane Hunt, our representative for Hunger Free Colorado, who will be doing presentations to the community to show that the Food Assistance application will allow them to apply for Medicaid and the ACA. We will have posters available for our locations and for other community organizations.
Commissioner Johnson verified that you can apply for the Exchange by October 1, 2013. Ginny added that we wanted to provide Navigators in our office in order to provide a resource in the same location if the client finds out they are not eligible for Medicaid to make it easy for the consumer. Having Health District Navigators on site allows them to enroll people who qualify in the tax benefit if the customer has low enough income.
Commissioner Johnson asked about CBMS and its capability to handle this volume and these changes. Marsha responded that there is a huge build going into effect in CBMS at the end of September that has a lot of changes and we are hoping it is going to work.
Ginny explained that we anticipate an increase to the caseload across the board because clients who are now eligible for health care will also will be screened for food assistance and cash benefits. We cannot predict what that increase will be.
The CIA is the Change and Innovation Agency who was contracted through the Colorado Department of Human Services to look at efficiencies within programs. They are looking at how counties can meet the requirements of the Work Support Strategies Group which says we should have all of our cases approved within 7 days. The CIA did an assessment on July 11th and 12th. We were the first assessment done, and they will be assessing other counties. They are doing the ten large counties and then we will receive a written report. The CIA is looking at recommending some of the things we have done at Larimer County for quite some time, including mass caseloads, something similar to our One Touch and Done, templates, a script for interviews, and other time saving measures. We had an exit interview with them, but we are looking for more feedback on how to improve. The CIA will come back to help with innovations and implementing them, but there is no timeline on that yet. Ginny added that we have had a number of other counties come to see what we have done and that is why she thinks we were selected to be assessed first.
Child Welfare Allocation & IV-E Waiver
Division Manager for Children, Youth and Family Jim Drendel explained that he will be talking about the Child Welfare Allocation and the IV-E Waiver and that Memorandum of Understanding (MOU), per the Commissioners request. Jim started off by saying that our Community Life Centers are going to be visited by State Director Reggie Bicha and Julie Krow on August 28th at 11am in Loveland at the House of Neighborly Services and 12:30 at the Mathews House in Fort Collins. An invitation was extended to the Commissioners for this visit.
Jim would like to explain that we were given less than three weeks to submit an application for the IV-E Waiver so we could have it in effect by a July 1st deadline. Shannon Reiff was the principle writer; Thad Paul, Deb DeLuca-Forzley, John Gillies, and Angie Mead were also involved. We requested input from over 200 community members at three different meetings, including both magistrates from our Court system.
The IV-E Waiver has the purpose of getting children to permanent homes faster than the current system does. The State has elected two different areas of focus including kinship and family engagement. In our application we put in for Kinship Expeditors and under Family Engagement we put in for Family Advocates, Extended Visitation and 21 Day Evaluation. These are all new programs that we have contracted. Kinship Expeditors are provided by Turning Point. Family Advocates are provided by Mathews Home and Extended Visitation is provided by Remington House. Kinship Expeditors will help us find family as soon as possible instead of placing children with strangers.
Commissioner Donnelly asked how we check the backgrounds of family we find at the last minute. Jim explained that this is a challenge. We do background checks and we don’t always place children with families because of what we find. We are in the process of looking for new software that will do a better job of providing background checks. Ginny added that we do check to see if the family members have a history in Trails. We can look at criminal backgrounds through Court systems, but fingerprint checks take a long time.
Linda asked if this shortens the amount of time it takes that a child is in limbo if they come into our care at 2:00AM. Jim replied that it changes who we would place them with. We have a list of foster homes that we license, but we can place the child with family if we can do the checks necessary and someone is watching the children while we do this. The most common reason to pull children from their homes is because adults are doing meth. We reviewed 30 some court cases, and two-thirds of them are methamphetamine-related.
The IV-E Waiver is all federal dollars. There is no County or state match in it. It is new funding because it is looking for innovative ways to keep children out of foster care, especially congregate care/institutional care. Colorado is number one in the nation in putting children in institutions, any residence or treatment center run by staff. Outcomes for children in institutional care are not good; children should be placed with families.
Commissioner Johnson provided background by explaining that Colorado is decreasing the number of children in institutional care, so our federal funding was decreasing. Colorado asked for the IV-E Waiver to stop that decrease of funding. For the next five years, we can stay level at $8.4 million for 5 years so the money doesn’t decrease. But then the problem becomes the state dividing the money up between the counties.
Example for the big ten counties we have 757 children in institutional placement (this does not include Department of Youth and Corrections) at $5,000 (actually $5,500) per month, times twelve. So the State is spending $45 million in congregate care in the State. The IV-E Waiver says that 55% of those foster care dollars, $24 million, could be spent on other things like in-home programs we designed if these children were removed from congregate care.
The state has an allocation formula for those funds that does not benefit Larimer County, and we believe the implications are counter to the IV-E Waiver. Other counties get six times the money that Larimer County gets because they have more children in congregate care. Larimer County is the lowest in having children in congregate care, but we get the lowest amount of $ from the allocation (which is separate from IV-E waiver), and we cannot change that for three years.
Larimer County is spending a lot of money at the front end to keep children out of congregate care. Larimer County’s success is coming back to bite us. We are second to Boulder at having the least number of children in foster care in Colorado.
The Memo of Understanding should be approved in September but the effective date will be backdated to July 1st. It states that we will decrease the number of children in foster care for 12 months or more and children in foster care for more than 24 months. If children are placed in private foster care, they stay an average of 14.5 months because they can be placed outside of the County due to availability of foster homes, which makes it difficult to visit with parents. On the other hand, kin care has an average five month stay.
The Federal government gives you 24 months from the last time a child is removed from the home to complete an adoption. The state is one of the best in the nation at getting adoptions done timely. The state average is 55% are completed on time and Larimer County is at 45%. We have committed to improve in that area.
Larimer County had 17 out of 120 children re-enter the foster care system. We are the third best in the state at preventing re-entry into the system, which means sending the children home and having them successfully stay with the parents. The Federal goal for reunification is 80%. We are the best in the state at keeping children in their homes, which does not come free. We have hundreds of programs available, and there are currently 252 children enrolled in in-home programs. The State has refused to use for consideration in the funding formula the 95% of our children who remain in the home. This seems counter to the purpose of the IV-E Waiver. As of today, there will be money for the County to reapply next year. The IV-E Waiver lasts for five years, the allocation formula is set for three years, but we have to do the MOU each year. If our numbers improve, then we could lose more money. If the state does not recognize the 95% of our cases that remain home, that will be a problem.
There is an extensive evaluation process for the IV-E Waiver, which seems reasonable. However, Trails is not set up to track IV-E Waiver clients, and we already have clients. So we are tracking them manually. The savings will come from what everyone else does. If a county increases the amount of children in congregate care, then we all lose reinvestment money, so it must be a statewide, group effort.
Larimer County gets savings in three places:
· Can keep or reinvest 30% of the state match because we are a 1451 county
· 20% County match is for the entire budget
· 25% Federal match only for foster care money, what we save in congregate care
Commissioner Johnson asked what this means for the bottom line. Jim explained that with the waiver, we were awarded $370,000.00 at the front end. The idea is that we would save it on the back end for reinvestment to reduce children in congregate care. For example, next year we can apply for different programs. Federal reinvestment money can be carried over, which could not be done before. However, with the allocation formula, we are getting less money than we did before. The allocation formula does not correlate with the IV-E Waiver.
Commissioner Johnson asked where the allocation formula came from. Ginny replied that it is a statutory committee, the Child Welfare Allocation Committee, who makes a recommendation to the State Director, Reggie Bicha. If the State Director and the committee can’t agree, then they go to the Joint Budget Committee. Commissioner Johnson recommended the commissioners write a letter to Reggie and copy the committee to inform them of what the large counties feel about the process. There is some turnover with the people involved at the state level, so a letter should be written soon. Jim indicated that we are second in the state in children who are in our system not being re-abused, and his goal is to get better. It is important to let Director Bicha know making more money available to us through a better allocation formula would increase our ability to keep children safe.
Ginny wanted to acknowledge the people who worked unbelievably hard to get the application in, then revise the application in less than a week, and the two hundred people who showed up to explain what they would need.
Change in Staffing at the Director’s Office
Director Ginny Riley said she wanted to commend the Human Resources Department for working with Human Services’ request to do a job swap which originated from the employees. Ann Marie Grobarek is now the Business Operations Coordinator and Eileen Brittingham is now the Human Resources Generalist for the department.
Client Activity Report
Human Resources Generalist, Eileen Brittingham, presented an overview of the department’s client activity. Eileen reviewed: monthly average caseloads, program activity, complaint totals, and client follow-up survey regarding complaints from April 1, 2013 through June 30, 2013.
During the 2nd Quarter:
· The Food Medical & Financial Assistance program averaged 29,463 cases
· The Benefits Information Center took 10,794 calls and 92% were resolved on the 1st contact
· Child Support collected a total of $4,507,837
· Children, Youth and Family (Child Protection) received 1,689 referrals, 752 were assigned for assessment, with 96% of children involved with our services remaining in their homes when that was the case plan
· The Director’s office received 9 formal complaints during the 2nd Quarter
Eileen explained that there is an increase in caseloads in all areas. Child Support has received more referrals because of the increase in our TANF applications. Child Protection saw a seasonal increase in referrals in the month of May due to school ending for the year. The increase in Fraud & Recovery has more information to start from which allows them to inquire more about possible duplicate issuance of benefits.
Commissioner Gaiter indicated that it was important to notice that we only had 2 Child Welfare complaints with an average of 1300 open cases and referrals assigned for assessment. Complaints that are tracked are only the ones that come to the attention of the Director’s office, but other issues are resolved by supervisors or Deputy Division Managers. So it’s not that people don’t call or have issues, it’s that they are resolved by the time they get to the Directors’ office or the person chose to go straight to the Director’s office.
There were no grievances brought to the Citizen Review Panel, which we report on an annual basis to the state. The Citizen Review Panel is for Child Welfare and is only available to specific participants in the cases and it is restricted to reviewing the conduct of a current employee. It has been two years since our last Citizen Review Panel grievance.
Even if a person cannot do the Citizen Review Panel, the complaint process allows us the opportunity to provide reminders to supervisors or training for employees. Commissioner Johnson indicated that sometimes what a person wants is a change in the result of what happened with their child, and sometimes that was a decision made by the Courts and we cannot change it. Although if there is a problem that is discovered and it can be amended, that will be done even if the employee is no longer employed with the Department of Human Services.
Neil Gluckman wanted to note that Susan Beckman, previous Commissioner for Arapahoe County, was just named Director of Administrative Solutions for the Department of Human Services.
The next Board of Social Services meeting has been scheduled for November 18, 2013 from 10am to 12pm, in the Commissioners Conference Room.