About Us Formed in 1979, the West Virginia Child Care Association is comprised of professional service agencies that operate a wide variety of behavioral health and child welfare programs throughout the state. Our role is to provide a voice for the most vulnerable children who have experienced abuse, neglect, emotional and behavior challenges, substance abuse and/or delinquency. We pledge to take a stand for our kids by championing quality behavioral health and child welfare programs found right here in West Virginia, supporting the dedicated providers who care for our children in need, and working together to provide care for our kids within our state’s borders.
2018 LEGISLATIVE PLATFORM ELIMINATE OVER–REGULATION Eliminate over–regulation in the child serving system in order to increase the volume, quality and access to services for West Virginia's children and families. SUPPORT FOSTER CARE Strengthen support for West Virginia’s treatment foster care and foster care providers by allocating adoption service reimbursement and recruitment funding, increasing the stipend provided for treatment foster care parents, and an additional service provision for providers and their families that place youth in foster homes after hours. ASSISTING TRANSITION Transform & strengthen West Virginia’s system of care to improve outcomes for older youth transitioning to adulthood by developing a comprehensive, collaborative service model.
www.wvcca.org 304.340.3611 One United Way Square Charleston, WV 25301
ELIMINATE OVER-REGULATION in the child serving system in order to increase the volume, quality and access to services for West Virginia’s children and families.
Currently the regulatory burden is vast and often duplicative, and, as a result, too costly to the state and its partners in the child serving system. The focus of Regulations should be aimed toward the quality improvement of services that ensure the safety and well-being of children. Once streamlined rules are collaboratively developed, performance and service enhancement will naturally occur within the system of care. Thus, the WVCCA proposes that government assist providers in delivering a higher standard of quality care versus taking a punitive role.
The Benefits By removing unnecessary regulatory barriers, providers of services for children and families would have increased human and fiscal resources to devote directly to serving, treating and impacting those who are reliant upon those services. WVDHHR would be able to streamline its regulatory mission and processes, thus increasing budgetary savings and accountability throughout the whole system. Additionally, public officials in the state legislature, the executive branch as well as the state’s taxpaying citizenry would benefit.
The Issues Outlined here are issues that require direct intervention in the matter of an over-regulated environment which impacts workforce related matters. Established, unfortunately, in the current environment are duplicative and burdensome processes that hinder access and the rendering of essential services.
www.wvcca.org 304.340.3611 One United Way Square Charleston, WV 25301
The West Virginia Child Care Association supports the following recommendations: 1. Eliminate the presence of burdensome regulations that strain providers' ability to hire staff so as to meet the treatment needs of children and families. For example, providers were previously able to train and certify their staff to provide certain services. Several years ago, the WVDHHR mandated that only specified staff can provide supportive services such as supportive counseling as prescribed by the WVDHHR thereby creating a negative impact in an industry and a state with a severe labor shortage. These changes were not driven by federal agencies but rather by an over interpretation. This overreach by the WVDHHR hinders innovation and service provision across West Virginia. It is exacerbated by the lack of knowledge, awareness and understanding by the WVDHHR on what is actually required to provide the essential services to children and families. 2. Promote, encourage and allow the use of existing technology such as video conferencing to improve access to treatment services in order to circumvent socioeconomic and academic challenges for children and families as well as transcend West Virginia’s geographic barriers. 3. Write rules and regulations clearly and objectively that will eliminate the use of interpretive guidelines. Thus, a rule is strictly a rule not subject to bias or agenda. 4. Regulatory staff should focus within their scope. Develop an inter-rater reliability process to ensure an accountable, easily understood and unambiguous regulatory review. The enforcement of rules and regulations should vary as little as possible from one regulatory staff to another, up to and including contracted regulatory providers, therefore eliminating misinterpretation and enforcement of a regulation and/or rule and abolishing contradictory messages from the WVDHHR and their contractors. 5. Examine the feasibility of Council on Accreditation, Joint Commission, and CARF accreditation being used in lieu of state licensing reviews to minimize the cost and resources associated with duplicative reviews. New legislation would be required to allow Office of Health Facilities Licensure and Certification (OHFLAC) and the Bureau of Children and Families (BCF) to deem a license based upon accreditation by these national organizations. 6. Establish accountability by eliminating the silo approach to regulatory oversight, thus confirming that regulatory bodies work seamlessly and connectively to ensure the safety and wellbeing, as well as the provision of treatment services, for West Virginia’s children and families. The streamlining and/or reorganizing of these silos and processes would eliminate contradictory messages, interpretations, guidance and directives often emanating from the WVDHHR. This requires the leadership and vision of those currently in charge of these silos. 7. Establish, where it does not exist, a formal appeal process to ensure the integrity of the inter-reliability process remains intact and to serve as an efficacious stop gap device for the process.
Over–Regulation of the Child Serving System How We Fix It The Idea Eliminating over–regulation in the child serving system would increase the volume, quality and access to services for West Virginia’s children and families. Currently the regulatory burden is vast and often duplicative, and, as a result, too costly to the state and its partners in the child serving system.
The Benefits By removing unnecessary regulatory barriers, providers of services for children and families would have increased human and fiscal resources to devote to directly serving, treating and impacting the children and families who are reliant upon the services rendered by the providers. Also, the West Virginia Department of Health and Human Resources (WVDHHR) would be able to better streamline its regulatory mission and processes thus increasing budgetary savings and accountability throughout the system as a whole. As a result public officials in the state legislature, the executive branch as well as the state’s taxpaying citizenry would benefit with an increase in time efficiency, a decrease in costs with the stop of investment into additional, unnecessary staff, and a movement of funding towards direct services rather than administrative overhead.
The Issues Below are issues that require the direct intervention in the matter of an over–regulated environment which impacts workforce related matters as well. Established, unfortunately, in the current environment are duplicative and burdensome processes hindering access and the rendering of essential services. The first issue is the presence of burdensome regulations that strain providers’ ability to hire staff so as to meet the treatment needs of children and families. For example, previously providers were able to train and certify their staff to provide specific services such as supportive counseling. Several years ago the WVDHHR reversed this and mandated that only certain staff could provide certain supportive services as prescribed by the WVDHHR thus creating a negative impact in an industry and a state with a severe labor shortage. These changes were not driven by federal agencies but rather by an over interpretation. This overreach by the WVDHHR hinders innovation and service provision across West Virginia. This is exacerbated by the lack of knowledge, awareness and understanding by the WVDHHR on what is required to actually provide the essential services to children and families. The next change is to promote, allow and encourage the use of technology such as video conferencing to provide better access to treatment services, minor judicial hearings, MDT meetings, medication evaluations, etc., due to the limitations and barriers children and families face when accessing services. This would circumvent socio-economic and academic challenges for children and families as well as transcend West Virginia’s geographic barriers. Additionally, rules and regulations should be written clearly and objectively that will eliminate the use of interpretive guidelines. Thus, a rule is strictly a rule not subject to bias or agenda. Also, develop an inter-rater reliability process to ensure an accountable, easily understood and unambiguous regulatory review. The enforcement of rules and regulations should vary as little as possible from one regulatory staff to another, thus eliminating the drastic misinterpretation and enforcement of a regulation and/or rule. Therefore, eliminating contradictory messages from the WVDHHR.
Examine the feasibility of Joint Commission, CARF, COA accreditation being used in lieu of state licensing reviews so as to minimize the cost and resources associated with duplicative reviews. New legislation would be required to allow Office of Health Facilities Licensure and Certification (OHFLAC) and the Bureau of Children and Families (BCF) to deem a license based upon accreditation by these national organizations. Additionally, establish accountability by eliminating the silo approach to regulatory oversight, thus ensuring that regulatory bodies work seamlessly and connectively to ensure the safety and wellbeing as well as the provision of treatment services for West Virginia’s children and families. This requires the leadership and vision of those currently in charge of these silos. The streamlining and/or reorganizing of these silos and processes would eliminate contradictory messages, interpretations, guidance and directives often emanating from the WVDHHR. Also establish, where it does not exist, a formal appeal process. This would ensure the integrity of the inter-reliability process to remain intact and to serve as an efficacious stop gap device for the process.
Why These Changes are Necessary Over the past several years, the necessary focus on how to provide the most access to the most essential services to children and families lost. The focus of Regulations should be aimed toward the quality improvement of services that ensure the safety and well-being of children. Once streamlined rules are collaboratively developed, performance and service enhancement will naturally occur within the system of care. Therefore, it is proposed that government should be assisting in delivering a higher standard of care versus taking a punitive role.
West Virginia Child Care Association • One United Way Square, Charleston, WV 25301 • 304-340-3611
SUPPORT FOSTER CARE
All levels of Foster Care from Intensive Treatment Foster Care to Foster to Adopt, are solely dependent on having families who are willing and able to provide services and homes for youth. These youth may be a single individual to large sibling groups of varying ages and intensity of needs. The struggles for agencies providing these services across the state include: no provider funding for recruitment of needed families, a lack of adequate funding for services and expertise, no funding for adoption services, and the growing need for middle of the night placements. Despite the increase in the cost of living each year, provider agencies have not received rate increases for services therefore forcing them to do even more with inadequate reimbursement.
Strengthen support for West Virginia’s treatment foster care and foster care providers by allocating adoption service reimbursement and recruitment funding, increasing the stipend provided for treatment foster care parents, and an additional service provision for providers and their families that place youth in foster homes after hours.
The West Virginia Child Care Association supports the following recommendations: 1. Establish Adoption Service Reimbursement Reimburse agencies for costs associated with adoption case facilitation, which manages documentation throughout the entire court process and individual proceedings in addition to the required foster care case management and/or treatment services provided to the youth while in the foster to adopt home. Currently: There is no reimbursement of costs to the provider agency for, or associated with, the complete adoption process and services they provide.
2. Provide Recruitment Funding to Providers As families adopt, capacity has to be replenished. There is no funding allocated to child placing agencies responsible for replenishing as well as building additional foster home, foster to adopt home, Treatment Foster Care, and Intensive Treatment Foster Care home capacity. Explore any existing recruitment funding efforts being allocated by WVDHHR to non-child placing entities to determine the amount of funding being allocated and the productivity/results being provided. Determine if efforts are being duplicated by the non–child placing entities for the purposes of reallocating funds to replenish foster care homes.
3. Funding Treatment Foster Care Parents
www.wvcca.org 304.340.3611 One United Way Square Charleston, WV 25301
Treatment and Intensive Treatment Foster Care requires Treatment Foster Care Training, targeted individualized training, smaller caseload sizes due to treatment needs, and additional services provided to families by child placing agencies through increased staff support, adaptive equipment and/or services, and staff expertise training. These are vital to providing treatment and follow National Best Practice standards to service youth in WV and in homes; unfortunately, this is simply underfunded.
The West Virginia Child Care Association supports the following recommendations: Impact of Inadequate Funding to the items above means Foster Care reimbursement rates do not cover providers’ costs of doing business which is a vital and necessary services for the health and well-being of our youth. Therefore resulting directly in: •Higher caseloads •Less recruitment resources •Less specialized trainings resulting in less expertise •Foster parent reimbursement rates remain stagnate and inadequate as the cost of living rises •Agency administrative and operational costs rise, salaries decrease or remain stagnant •Workforce recruitment and retention for child placing agencies are in direct competition with private forprofit and other non-profit industries who have higher reimbursements and salary scales which results in an inability to acquire or retain staff •Infrastructure costs are not met and continue to increase resulting in a lack of adequate resources to efficiently and effectively support service provision
4. Support ‘After Hours Referral Funding’ Fund efforts to increase and support the well-being of youth, foster families and multiple child placing agencies’ staff who are often awakened in the middle of the night to respond to the immediate needs of youth being removed from their homes. Issue: Many agency staff and families are awakened in order to determine if the referred youth can be placed with them regardless if the placement will ultimately occur or not. This results in foster parents who are less willing to accept emergency late-night placements as they are consistently disrupted after hours and often late at night. This impacts the daily schedule and functioning of all staff and foster parents/families and is further taxing to all resources due to schedule adjustments of staff and families. Recommendations include: • Create a financial incentive for agencies that make placement for the night, after hours until 8am, to allow time for a home to be secured for placement. The provider will provide an incentive to the foster parents who accept after hours to 8am placements. • Determine the number of needed placements which came to the WVDHHR’s attention after hours. • Exhaust and stop looking for kinship placement once the decision is made to contact the private providers for that night. • Once a provider has successfully located a home for placement, establish a system to immediately notify other providers that a home has been secured to prevent further disruption for the family, especially during sleeping hours.
ASSISTING TRANSITION
Transform & Strengthen West Virginia’s system of care to improve outcomes for older youth transitioning to adulthood by developing a comprehensive, collaborative service model.
For the hundreds of older youth transitioning into adulthood from West Virginia’s system of care, the pathway is often challenging, the odds great, and the reality sometimes frightening. Many have been diagnosed with serious mental illness, have substance addictions, and have experienced multiple traumatic events during their lifetime. Often, as they age out of the system, these youths find themselves homeless and jobless. Historically, they are provided services based on their chronological age versus traumainformed, flexible support and services appropriate for their developmental age. To best serve our youth, developmental stages, trauma impact, intellectual disability, mental health needs, as well as the impact of disabilities or handicapping conditions and childhood experiences should be carefully considered. Support and housing must take into consideration the impact of trauma, developmental versus chronological age and the full transition to adulthood continuum must be trauma informed.
Recommendations for Older Youth Transitioning to Adulthood Service Model Development: • Transition to Independence services and programs be provided by licensed agencies with the proven ability, experience, training and well-being standards that provide quality programming for transitional living supports, services, housing and treatment provisions and connections. • Follow a developed set of unified standards for all providers. By establishing clearly defined standards, the model will be easy for youth and young adults to understand, navigate and access, regardless of the provider they choose. • Utilization, monitoring and oversight of Chafee Funds be thoroughly reevaluated to support a model that maximizes funding and encourages value-based outcomes. The model should include evidenced-based best practices of crisis services, social support, life skills training and in-vivo experiences, transition facilitation, financial literacy, job coaching and support, and developmentally appropriate accountability. • Include the following components: Crisis Prevention and Support, Education, Employment and Training Support, Financial Literacy, Housing Support, Life Skills Training & Support, and Medical & Mental Health Support. • Provide Transition Coaching and Life Coaching, regardless of custody or FC-18 agreement, for all youth that have been in an out-of-home-care setting at any time within two years of turning 18, up to the age of 22. Access should be available with any Transitional Living provider in addition to BCF staff. • Implement Future/Transition Plan development, including Life Skills Assessment and Training, by approved Transitional Living Transition and Life Coaches, via contract, for all youth age 14 and up in designated catchment areas. • Ensure youth are discharged from care with safe and stable housing options available to them.
www.wvcca.org 304.340.3611 One United Way Square Charleston, WV 25301
• Designate a specified time period for Transition and Life Coaches to follow-up with all aging out youth in contractually designated catchment areas in order to further coach, maintain connections, and link to available services, housing and supports, as well as collect National Youth in Transition Database information for WV DHHR BCF. • Fund providers with a reliable reimbursement methodology that allows flexible and stable funding that will provide secure, safe, and affordable housing for youth transitioning into their first apartment/home.