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HCS Highlights SPRING 2022

CONTENTS 04

KRISTIN’S MESSAGE

REGIONAL UPDATES

QUICK NEWS

STRATEGIC OBJECTIVE 2.1

WELLNESS: EATING WELL AT EVERY AGE

PLANNING NOW TO AGE YOUR WAY

HCS CLIENT STORY: KERRIE FINDS A HOME

EDI: CULTURAL COMMUNITY ONBOARDING

HCS PARTNERSHIP: DEMENTIA ACTION COLLABORATIVE

TEAM SPOTLIGHT: FOSTERING WELL-BEING

Photo by Denise Maroney

KRISTIN’S MESSAGE It’s been a season of change here in HCS as we adjust to shifts in leadership within ALTSA. I am honored to be leading our division during this interim period as Bea serves as Assistant Secretary, and I am committed to supporting you and our work however I can.

Kristin Byrne Interim Director

My primary goal over these next few months is to lead a smooth and seamless interim period in which we continue our important work. That means you can expect that we won’t make any major changes to policies or programs unless they’re essential. I know with so much uncertainty, it can be hard to look toward the future. But I have a lot of things I’m looking forward to being a part of over the coming months and ongoing, as your interim Director or your Deputy Director. Some of the most important goals on my mind right now are filling position vacancies, pushing all efforts and pursuing all opportunities to support workforce development, and leading with action and intention in our administration’s Pro Equity, Anti-Racism movement. None of us knows what the future holds, but until Secretary Meneses announces a new Assistant Secretary, I will focus on supporting all of you however I can. If you have any questions, comments or concerns, please don’t hesitate to reach out to me. Kristin

REGIONAL UPDATES

Photo by Denise Maroney

REGION 2

REGIONAL UPDATES REGION 1

Tami Rucker, Region 1 Administrator

As spring arrives and flowers begin to bloom, we at Region 1 Home and Community Services are also BLOOMING with excitement as we return to the field for in-person assessments, which began April 1. We used a “phase” approach in this transition with our different setting types and transitioned to full in-person assessing at the end of April. Our goal with this phased approach is to ensure the transition is smooth for clients, providers, community partners and case managers. We, along with most other agencies around the state, have been impacted by the workforce shortage. In the last 6 months, we have hired 28 Social Service Specialists 3 (SSS3) and 8 Public Benefits Specialists 4 (PBS4). These new employees are currently in different stages of their training plans. This has required us to be creative and innovative in our planning, training strategies and support to ensure quality and timely service delivery to our clients as we phase back into in-person assessing. We continue to recruit for our vacant positions, which include 5 SSS3s and 2 PBS4s. As staff return to in-person assessing, safety continues to be a top priority. We will continue to follow the DSHS Roadmap to Recovery guidelines and continue to use source control/PPE and complete prescreening questions before in-person contact. We will continue to monitor and analyze our work if changes occur in the public emergency and as we’ve demonstrated in the last two years, we will reset and pivot as needed. I am so very grateful to have such amazing, dedicated, and committed professionals to work beside in serving our clients receiving Long-Term Services and Supports.

REGION 2 Region 2 HCS, like other offices, has vacancies we are looking to fill. As of this writing, we have 34 open positions for social services, PBS and clerical. We are working as swiftly as possible as a region to fill positions with qualified, skilled and trained staff. This is the most vacancies R2 has ever seen, and it is an overwhelming task to fill these positions timely. A count of staff coming and going is just as daunting. In 2020, 61 new staff joined HCS and 24 staff left HCS. In 2021, 53 new staff joined HCS and 71 staff departed.

Sonya Sanders, Region 2 Administrator

Congratulations are in order to Quyen Huynh for being nominated for the SnoKing/UWCFD Rookie Coordinator of the Year award. The Rookie of the Year award is given annually to new CFD coordinators who have gone the extra mile during the Combined Fund Drive campaign. Each agency or campus nominates its best and brightest coordinators who have helped make the campaign a success. Quyen’s nomination stated, “Quyen was eager to assume the local coordinator role and she brought an enthusiasm and desire to do a good job. She asked questions, took trainings, and availed herself of the supports from both DSHS and CFD campaign managers. She tried using the credit card option, one not used very often within DSHS. She learned to use pledges, either paper or online, for ease of staff. She just wanted to do a great job which made her so valuable to the DSHS overall campaign, her manager, and her fellow workers. I hope she chooses to participate again next year. And build on her successes.” Quyen, R2 are very proud of you. Great job and service. Region 2 HCS management went through a process to create a word of the year for 2022. Our 2022 Word of the Year is “Resilience.” Resilience means the capacity to recover quickly from difficulties; it means toughness. It is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. I think we all can agree that these past two years have been a source of stress for employees, clients, and community partners. However, R2 managers and employees continued the good fight with their dedication and professionalism. For example, many staff jumped to work overtime to assist with Acute Care Hospital work. Without this extra added support, we would not have met assessment timeframes and discharges. R2 is resilient. We are also flexible, tough, proficient, skilled, humble, and vulnerable. These qualities make staff in Region 2 more than resilient. We are indestructible. I am thankful for all the R2 employees for sticking it out these last two years and assisting me in moving the region forward.

REGION 3 “We rise by lifting others.” – Robert Ingersoll

Debbie Willis, Region 3 Administrator

Creating a culture of belonging is something Region 3 HCS continually strives to create. It is an important focus and one that takes continual effort and intentionality. It requires an ongoing inventory of ourselves and asking the questions to help get us where we want to be. These questions include: • How do we support our staff in meaningful and inclusive ways that create a culture of belonging? • How do we lift each other up and support each other in tough times, especially in our new virtual work world? • How do we work through some of the hard issues that bubble up through the employee surveys, evaluation feedback, all-staff meetings, etc.? These, and many more, are the questions and issues that we grapple with, and they are questions that cannot be answered alone, in a silo, by one person. This is where our HCS Regional Advisory Board comes in. The Regional Advisory Board consists of about 15 people, including line staff, supervisors, and members of our regional management team. The board is tasked with working on regional improvements. We take feedback from staff (via the employee survey, annual evaluations and other communication opportunities) and find the themes and areas where staff want to see improvements. We then set goals and develop implementation plans to make those improvements. The lens for this group is equity, diversity, and inclusion. The focus for the Regional Advisory Board in 2022 will be: Creating and enhancing job development opportunities that include: Roadmap for job development – Where do I start? That is the most common question! We are creating a Roadmap and SharePoint site that will include details and information on: • Current opportunities • Mentoring • Leadership workshops • Informational interviews (what are they and how to make the most of them) • Developmental Job Assignment (what is it and how does it work in our Region?) • New opportunities (in development) • Develop a Success Center • Interviewing workshops • “Day in the Life of a Supervisor” with panel of current supervisors Mastering the new work environment: We will be gathering regional staff input on how we make the most of our hybrid work environment (teleworking and in-office work). Our goals are to ensure our staff: • Have what they need in this new work environment (communication, training, tools, access to technology, etc.) • Feel included and part of a team while working remotely • Feel empowered and have the support they need to create opportunities to get know each other and build strong relationships in the workplace As a team we will continue to be intentional about creating a culture that is inclusive and supportive of each other and we will continue to push forward and grow. We are better together. “The most successful people in life are the ones who ask questions. They’re always learning. They’re always growing. They’re always pushing.” – Robert Kiyosaki

QUICK

NEWS Photo by Denise Maroney

FUNDAMENTALS OF CAREGIVING After two years of hard work by our Training, Communications & Workforce Development (TCWD) team, we are moving forward with a new edition of Fundamentals of caregiving, the core training textbook for home care aides in Washington.

Samuel Cooke of our TCWD team, with the assistance of his colleagues, have completed a pre-pilot draft of the new materials. The team is moving forward with final adjustments to the curriculum and deployment. The new materials will be fully deployed by January 1, 2023.

Fundamentals of Caregiving hasn’t been revised since 2015 and its last major update happened in 2005. We’ve learned a lot about providing appropriate, person-centered care in the last 17 years, and it was past time that we incorporated that knowledge into our caregiver training materials. The textbook is used by community and facility instructors around the state and provides the foundational knowledge our caregivers need to successfully and respectfully care for clients.

Do you have some news or information you’d like to share with your HCS colleagues? Let HCS Communications Manager Meghan Erkkinen know!

This is an unprecedented time in the world of affordable housing. Federal, state, and local resources and guidelines are changing and growing at dizzying speed. We update our Roads to Community Living Housing Resources internet webpage frequently to provide a centralized place to get WA State housing resource information. If you haven’t visited the site recently, please take a look. There are state and local links for vouchers and service resources along with guidance about how to reach our regional specialists. Please put a link on your desktop! Braiding resources is an important way to ensure our services are well utilized. Consider authorizing a Community Choice Guide or Supportive Housing provider to assist with housing and stabilization. These services are key in assisting clients to find and keep affordable housing and maintaining their in-home setting. We also keep our LTC Chapter (5b) updated. Please use it instead of older documents you might be referencing on regional SharePoint sites as our guidance, of necessity, has to change regularly as we respond to new resources. And of course, let us know if

HOUSING

RESOURCES there’s something you’d like us to cover in the chapter if you can’t find what you’re looking for. We have created easy to view and use videos and brochures to help you spread the word about independent housing resources. Here are some direct links, but know that they are also available on the Housing Resources page: • Options for Housing Through LongTerm Care Services Video • What is the Governor’s Opportunity for Supportive Housing? Video • ALTSA Housing Brochure (English) – translations available on the website • ALTSA Housing Resource 811 Brochure • ALTSA Housing Resource NED Brochure • ALTSA Housing Resource-Bridge Subsidy Brochure • Translated Housing Brochures • GOSH One-Pager • Statewide GOSH Provider Network Map We hope this is useful for you and your partners. Thanks for your help!

Photo by Denise Maroney

STRATEGIC OBJECTIVE 2.1:

SUPPORTING ACUTE CARE HOSPITAL TRANSITIONS About 75 percent of hospital patients who are referred to HCS are new to our system and need functional and/ or financial eligibility determinations. Our staff must make these determinations quickly to transition these individuals from acute care settings when they no longer have a medical need to be there. This has become even more important during the COVID-19 pandemic, when keeping beds available in acute care settings is critical to ensure people receive the emergency care they need. The effort of supporting people to quickly transition from acute care settings requires strong collaboration and cross systems partnerships that include providers, HCS staff, hospitals, managed care organizations, the Health Care authority and communities. Through these partnerships, we can provide appropriate services and community options that honor patient choice and reduce medical costs while increasing individual wellbeing and quality of life. ALTSA’s Strategic Objective 2.1 is to support people to transition from acute care hospitals to services in their homes or communities. This supports the DSHS strategic priority to serve people in their home community. To learn more about the work we’re doing to support clients transition from acute care hospitals, read Kerrie’s story on page 13.

Success Measure 2.1.1: ALTSA has remained below the target since April 2021. The goal is to ensure that the number of clients who remain in the hospital over 100 days is below 5%. Success Measure 2.1.2: This effort requires strong collaboration and cross systems partnerships. ALTSA continues to build on what has been developed to reach the target goal of 75%. The goal is to ensure at 75% of our clients are transitioned out of the acute care hospital within 30 days.

EATING WELL AT EVERY AGE New Dietary Guidelines for Americans (DGA) are published every five years, and the most recent updates came in 2020. For the first time, the DGA provided guidance on healthy dietary patterns for every life stage, including for older adults ages 60 and above. Every adult, no matter their age, should follow a few key guidelines when choosing what they eat: Follow a healthy dietary pattern at every life stage. Customize and enjoy nutrient dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. Limit foods and beverages higher in added sugars, saturated fats, and sodium, and limit alcoholic beverages.

Older adults also need to focus on a few key nutrients and reminders. Protein is important in preventing the loss of lean muscle mass that occurs naturally with age. You can get protein through lean meats, nonfat and low-fat dairy, soy products, nuts and eggs. Pay attention to your Vitamin B12 intake. Older adults’ ability to absorb Vitamin B12 can decrease with age and the use of certain medications. You can find B12 in meat, eggs, dairy products, and fortified breakfast cereals, as well as over-the-counter supplements. Stay hydrated by drinking plenty of water and nutrient-dense beverages. If you or a loved one is an older adult, you can support healthy eating by sharing meals with friends or family, identifying acceptable and enjoyable food textures, and practicing safe food handling to decrease the risk of foodborne illness.

To learn more about healthy eating at all ages, review the Dietary Guidelines for Americans.

PLANNING NOW TO AGE YOUR WAY Older adults play vital, positive roles in our communities – as family members, friends, mentors, volunteers, civic leaders, members of the workforce, and more. Just as every person is unique, so too is how they age and how they choose to do it. In Home and Community Services, we pride ourselves in offering a broad array of innovative services and supports so that our older adults can choose to age how they want. This May, as we celebrate Older Americans Month, you can take the time to consider this year’s theme: Age My Way. According to the Administration for Community Living (ACL), this year’s theme focuses on how older adults can age in their communities, living independently for as long as possible and participating in ways they choose. This May, adults of all ages should take a moment to consider the question: how can I prepare to age my way? It’s never too early to plan for aging and for where and how you’d like to age. Here are some questions to consider while you’re thinking: •

What will you need and want in the future? What home- and community-based services would be of interest to you?

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How can you remain involved and contribute to your community through work, volunteer, or civic participation opportunities?

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How can you make improvements and modifications to your living space, use assistive technologies, or plan customized supports to help you better age in place?

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How can you maintain social activities and relationships to combat social isolation and stay connected to your community?

Diverse communities are strong communities. Ensuring that older adults remain involved and included in our communities for as long as possible benefits everyone. For more information on Older Americans Month, visit the official Older Americans Month website.

May is Older Americans Month. This year’s theme is “Age My Way,” encouraging all adults to plan for where and how they’d like to age.

HCS CLIENT STORY:

KERRIE FINDS

A HOME

Kerrie is an HCS client who was added to our caseload when she was a patient at Sacred Heart Medical Center in October 2021. She had already been in the hospital for 3 months and needed long-term care placement. According to her HCS case manager, Kerrie is a young, funny and sassy woman. She suffered a TBI following an incident of self-harm during a period when she was separating from her husband and felt hopeless. At the time, she was living in Florida. After she was stabilized, she moved from Florida to Washington state to live with her sister. Unfortunately, Kerrie’s sister was diagnosed with cancer shortly after her arrival and was unable to provide the level of care Kerrie needed. When Kerrie was admitted to Sacred Heart for a surgical repair to her skull, she could not return to her sister’s home.

When Kerrie met with her HCS case manager, she said she wanted to “live happy” and preferred to live with her friend, Barbie. After some investigation, the case manager determined that Barbie was a family friend and employee of the hospital who visited Kerrie frequently.

Barbie was not a member of the medical staff and had no experience with caregiving. She had an extended conversation with Kerrie’s case manager, gave the matter some thought, and decided she would be willing to bring Kerrie into her home and become Kerrie’s caregiver. The case manager, a public benefits specialist, Barbie and Kerrie’s guardian ad litem all worked to process Kerrie’s financial eligibility, which was complicated by the fact that Kerrie was still married with a divorce pending. Meanwhile, Barbie worked on becoming certified as an individual provider. They also all worked together to gather the necessary equipment, set up Kerrie’s living space, and transfer Kerrie’s medical care to a primary care provider. Kerrie was officially discharged from the hospital in July 2021, after 212 days, and went to live with Barbie and Barbie’s husband, where she can “live happy” with her friend.

EQUITY, DIVERSITY & INCLUSION

CULTURAL COMMUNITY ONBOARDING

What is ALTSA Cultural Community Onboarding? ALTSA Cultural Community Onboarding is a workshop designed for new employees who are joining ALTSA. This workshop has a focused emphasis on Equity, Diversity and Inclusion (EDI). This offering for new employees is not intended to replace the new employee orientation offered by Human Resources. It is an introduction from the EDI team to welcome and invite new staff into a conversation around EDI. Why is this important? • Studies show that onboarding staff with an emphasis on EDI makes the onboarding experience for new employees much better and allows for them to make a connection to equity, diversity and inclusion. • Diversity and inclusion are important values to ALTSA. By offering this program, it provides the EDI team with an opportunity to connect new staff to the understanding of and commitment to equity, diversity and inclusion as a core value.

Photo by Denise Maroney Expectations for Attending: • All new staff should join the conversation within six months of joining the agency.

When are the workshops offered?

The workshops are offered from 9:00 a.m. to 3:00 p.m. the 4th Wednesday of each month. Sign-up is available in the Washington Learning Center. Click here to register: https://bit.ly/3sIqaeM (Remember to use Google Chrome. If there are any issues with registering, copy this link and paste it into the search bar in Google Chrome.)

Benefits of EDI Onboarding Studies show that onboarding staff with an emphasis on EDI makes the onboarding experience for new employees much better and allows for them to make a connection to equity, diversity, and inclusion. Goals: • To define what EDI means to DSHS/ALTSA. • To communicate by having a conversation, and not instruct. • To work with new staff toward feeling comfortable talking about EDI. • To introduce and connect organizational values to their values. • Connect EDI to their position. • Provide an opportunity to check in over the year. Topics: • Introduction to DSHS/ALTSA’s Mission and Purpose • Culture (Organizational, Work, and Own Culture) • Cultural Script • Values (organizational and personal values) • What is Equity, Diversity and Inclusion? • Acknowledging Diversity • Introducing policies relating to EDI • Employee Resource Groups During the workshop, we explore a deeper level as to WHY people do what they do. They are asked to provide their WHY for joining ALTSA. Here are some of their responses: • To advocate, connect, provide support, help, serve, give back. • Career commitment/alignment to career goals • To give back to the vulnerable population. • Like working with vulnerable adults • Challenging position

• • • • • •

Connect with the community Being a voice for the voiceless Rewarding Passion for the work. Learn and grow Work with a diverse team.

Before we get started with the conversation, we often sense and hear hesitancy from staff. Many are uncertain about the flow of the day and what to expect. When staff are asked at the end of the day to provide their takeaway, here are some of the responses: • Like the diversity connections made. • Reinforces DSHS is trying to impact all lives. • Importance of shining a light on the issues of EDI. • The training didn’t take us down a rabbit hole on EDI. • Looking forward to a workplace that values EDI but understanding that we have a long way to go. • Nice to hear different perspectives. • Improve interaction with clients/coworkers. • Long way to go but a great start. • Respect that DSHS is putting forth the effort to engage in the conversation and are committed to doing the right thing • Voice empowerment and having EDI backs it up • Happy to work for an agency that values EDI. • Enforces EDI related topics are ongoing, lifelong and an evolving conversation.

HCS PARTNERSHIP: DEMENTIA ACTION COLLABORATIVE

By Lynne Korte As of 2020, there were an estimated 120,000 people living with Alzheimer’s or other dementia in Washington, and the number is expected to rise to 140,000 by 2025. In addition, there are around 295,000 family members caring for a person with dementia. While this can be a rewarding experience, caring for a loved one with dementia can also be challenging and of long duration. The anticipated increase in the number of people with dementia spurred a call to action in 2014. The Washington state legislature authorized development of the first state plan to address Alzheimer’s disease along with the appointment of an Alzheimer’s Disease Working Group (ADWG) to accomplish the task. The ADWG, which included expertise from multiple sectors and community partners, was spearheaded by DSHS under the leadership of Bill Moss, former ALTSA Assistant Secretary. The group worked together to better understand the impacts of dementia, the needs of Washingtonians living with dementia, and the opportunities to improve our

state response to address the needs. A key takeaway from this early work was the importance of connection and coordination between public health, health care and long-term care. The Washington State Plan to Address Alzheimer's Disease and Other Dementias with its 7 aspirational goals recognizes the need to collaborate over time. When the plan was published in 2016, the enabling legislation expired. The ADWG, though, wanted to see the plan implemented. With the support of DSHS, the members of the ADWG decided to continue on voluntarily and renamed themselves the Dementia Action Collaborative (DAC). The DAC has continued, fueled by the passion of its partners, to operate as an effective collaboration of multi-sector public and private partners committed to preparing our state for the future. The DAC focused its first years on actions that could be accomplished through heightened collaboration and existing resources. Over the last several years, DAC advocates put forth several successful proposals to the state legislature to fund high-value priorities. “It takes all of us working together across the DAC

subcommittees to get all this excellent work done, said Bill Moss. “One of the very effective actions was getting the legislature to fund part-time, dedicated staffing at the HCA, DOH, and DSHS for the DAC. This allows us to reach out to both publicly-funded and private partners – to increase awareness and focus the State on dementia.” Several collaboratively developed publications such as the Dementia Road Map and Dementia Legal Planning Toolkit serve to keep the work visible and are used to start conversations Dementia – which impacts a person’s memory, problem-solving and other thinking abilities severely enough to interfere with daily living, and often accompanied by behaviors that put them at risk – cries out for a multi-sector coordinated approach from our varied systems to improve the quality of care and quality of life. “I have been consistently amazed,” said Kris Rhoads, PhD, Chair of the DAC Health Medical subcommittee and a neuropsychologist from the UW’s Memory and Brain Wellness Center, “at how many large organizations have been involved from the very beginning, and how much coordination and collaboration has shaped the shared vision and goals for the DAC. It has been so important to be able to leverage this passion into platforms that build community, including the cross-institutional work.” What has been impressive with the DAC is the ongoing passion and commitment. Even during the pandemic, when meetings turned virtual, the DAC tracked between 1,800 and 1,900 hours of in-kind work per year from its dedicated partners as they continued to work on recommendations within the plan.

“There is so much awareness that has been raised, and stigma tackled and lowered since the DAC has started,” said Maureen Linehan, Chair of the DAC LTSS Subcommittee and former director of Aging and Disability Services of King County. “This has had a widespread positive impact. It was our consumer partners who initiated the idea for the Dementia Road Map: A Guide for Family and Care Partners – and the result has been very successful and helpful across both professionals and family caregivers.”

What is the Dementia Action Collaborative? The Dementia Action Collaborative is a publicprivate collaboration that crosses multiple sectors. Representatives include: • Providers of health care and dementia care specialties • Representatives from the Health Care Authority and the Department of Health • Providers of home and adult day care • Association representatives from longterm care settings • The Washington Association of Area Agencies on Aging (W4A) and the Ombuds office • Alzheimer’s organizations • Representatives from policy/advocacy groups such as AARP, State Council on Aging and the Developmental Disabilities Council • Members of Washington state’s House of Representatives and the Senate • People with dementia and family caregivers. In this legislative session, a bill (SHB 1646) passed that codifies the Dementia Action Collaborative as the body to update the Washington State Plan to Address Alzheimer’s Disease and Other Dementias. With this new bill, the DAC is established to assess the current and future impact of Alzheimer's disease and other dementias on Washington residents. It will examine progress in implementing the Plan, adopted in 2016, assess available services and resources for persons with Alzheimer's disease and other dementias and their families and caregivers, examine strategies to address disparate impacts of Alzheimer's disease and other dementias on people of color, and develop a strategy for an effective state response. The group will submit an updated plan to the Governor and Legislature by October 2023. Unlike the first plan, in which the legislation expired upon publication, this bill provides continuity through 2028 and requires recommendations to the Governor and Legislature each year. The DAC Progress Report 2021 shares the many activities and accomplishments from 2016 through 2021. To access resources or learn more: Dementia Action Collaborative or Lynne Korte at Lynne.Korte@ dshs.wa.gov.

TEAM SPOTLIGHT

FOSTERING WELL-BEING Providing care coordination to our clients is central to helping them live with good health, independence and control over their decisions. Although most of HCS’s work involves older adults and adults with disabilities, the Fostering Well-Being team focuses on care coordination for children. Fostering Well-Being, part of the Office of Well-Being, Improvement and Nursing (WIN), provides expert medical consultation for children in foster care who have significant medical, behavioral and/or mental health needs. Every year, the Fostering Well-Being team works with about 4000 kids – about 300 every month – with the goal of improving health outcomes through care coordination services. “It’s such a unique body of work for ALTSA and HCS,” said Dawn Shuford-Pavlich, Office Chief for WIN. “The volume of work they do is off the charts. It has been for years and they just keep going steady. It’s really amazing. This is very challenging and compelling work with limited resources and this team has an

unwavering commitment to these medically fragile children in foster care. I am so proud of this team and the work they do!” This tiny team consists of Chani Hayes, the Fostering Well-Being Unit Manager, one Outcome Improvement Specialist, one Program Specialist, and two registered nurses and five pediatricians who serve as part-time Regional Medical Consultants. Chani has been with the program since its inception 11 years ago and has served as its Unit Manager since January 2020. Originally part of Health Care Authority, the program migrated to ALTSA several years ago. Now, the program staff work in coordination with social workers and program management at the Department of Children, Youth and Families (DCYF) to support the care coordination needs of kids in foster care. Through care coordination, the team aims to provide appropriate health care and timely and accessible services so that children don’t experience gaps in

health care when they move. The team also assists with coordination of wraparound services, including educational services, therapies, and behavioral health. One of the biggest pieces of work is the development of comprehensive health overviews for children so that their new medical teams have a full picture of the child’s health history and can begin appropriate care immediately. This not only helps the kids with their transitions, but it provides risk mitigation for DCYF and provides social workers with a resource to answer Medicaid benefit questions or services such as durable medical equipment or pharmacy issues resolved. “It’s difficult work. These aren’t fun stories that my team reviews,” Chani said. “But they’re so resilient and find ways to support each other. The dedication to continue to improve these kids’ lives is pretty amazing for this small team.” In 2021, this tiny team handled more than 11,000 contacts and completed 131 comprehensive health overviews. Some of the children served are on the Fostering Well-Being caseload for a short period, while others may remain for longer, depending on their needs, such as high medically complex or medically fragile children. Although the team is very busy with their current caseload, they do take time to support foster children in other ways too. Over the holidays, the team works with the DCYF office in Shelton to collect gifts for kids in foster care. “The thing that really sticks out to me is the dedication of all the team members and how much they care deeply about the kids and ensuring they get all the care they need,” Dawn said. “I don’t know that I’ve seen a group work harder with the endless volume of work that just keeps coming. It’s not the kind of work that’s ever finished.” For more information on the team, visit the Fostering Well-Being webpage.

Alexis’s Story Alexis is a non-verbal, non-mobile client who lived in a medically fragile group home. She was going to age out at 21 years of age and needed to be transitioned to adult services before her birthday or the group home would lose funding every day that she remained. Not only did Alexis need to move to a home with the appropriate level of care, such as an adult family home, but she also had specialty equipment and a sand bed that had to be coordinated in this move. The coordination with Health Care Authority, Developmental Disabilities Administration and the vendor for the specialty equipment took months but she was successfully transitioned to her new home. Naya’s Story Naya was seen by a dermatologist in Washington due to a skin anomaly. Her biological parent thought that Naya had previously been seen by a dermatologist in Texas and that she had a biopsy with a diagnosis of skin cancer but couldn’t remember where she was seen. The Washington dermatologist tried to contact Texas providers but was not successful. The Fostering WellBeing nurse called every dermatologist in the area the child lived in previously in Texas and was able to find the provider, obtained records and connected the providers from each state for continuity of care.

Photo by Denise Maroney

Do you have a story tip? Want to submit a photo of Washington’s scenery? SEND THEM TO MEGHAN.ERKKINEN@DSHS.WA.GOV!