Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

2020 PROGRAM MANUAL

Kentucky Strengthening Ties and Empowering Parents

Acronyms CHFS: Cabinet for Health and Family Service DCBS: Department for Community Based Services DPP: Division for Protection and Permanency KSTEP: Kentucky Strengthening Ties and Empowering Parents SSW: Social Service Worker CMHC: Community Mental Health Center

Definitions Assessment means the evaluation of the strengths, challenges and needs of an individual and family through the use of the North Carolina Family Assessment Scale (NCFAS) and any other research based assessment tools as appropriate. Other assessment tools include, but are not limited to: 1. Addiction Severity Index (ASI 2. Parenting Stress Index (PSI).

3. American Society of Addiction Medicine (ASAM) 4. The North Carolina Family Assessment Scale (NCFAS) Solution Based Casework (SBC) means the case management approach to assessment, case planning, and ongoing casework that KSTEP follows. The approach is designed to help the caseworker focus on the family in order to support the safety and well-being of their children.

Cognitive Behavioral Therapy (CBT) means a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression.

Child Adult Relationship Enhancement (CARE) is a trauma-informed modification of specific PCIT skills for general usage by non-clinical adults who interact with traumatized children and their caregivers within various milieu settings.

Motivational Interviewing (MI) means a directive, clientcentered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.

Evidence Based Practice (EBP) means the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002). EBPs are rated well-supported, supported and promising.

Families served means the number of families served through to case closure/ completion of the service.

Family Team Meeting (FTM) is a tool for engagement used to assist a family in achieving safety, permanency and well-being outcomes and sustainable family changes.

The FTM consists of the family’s informal supports, service providers, other community resources and DCBS staff.

Imminent risk of removal means the referring entity and the family for whom services are sought believe that without immediate intensive intervention, out of home placement of a child/children is necessary (to assure the ongoing safety of the child and or family).

Initiate Contact means face to face contact or documented attempts made to initiate contact.

Intensity of services means the hours of direct client contact and the number of sessions per week varies based on the needs of the family.

Out of Home Care (OOHC) means a child who is not living with their birth family and is placed in the Cabinet’s custody by a court order.

Parent Child Interaction Therapy (PCIT) means a combination of play therapy and behavioral therapy for young children and their parents or caregivers.

Referral means when the designated DCBS staff person sends it to the designated provider staff.

Contacts Jennifer Topping, MA

Jennifer Thornhill, MSSW, CSW

Melissa J. H. Segress, MS

KSTEP Program Specialist

Prevention Branch Manager

KSTEP Evaluation Coordinator

Email: Jennifer.Topping@ky.gov

Email: Jennifer.Thornhill@ky.gov

Email: missysegress@uky.edu

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

BACKGROUND AND PROGRAM RATIONALE

CONTENTS 4

Background and Rationale for KSTEP Program

7

Program Overview and Description

PROGRAM OVERVIEW AND DESCRIPTION

CORE IMPLEMENTATION PRACTICES

KSTEP Overview Target Population Theory of Change/Logic Model

13 Core Implementation Practices

PROGRAM IMPLEMENTATION

• Essential Components • Family Eligibility Requirements • Service Delivery Timeline • KSTEP Phases

24 Program Implementation

PROGRAM EVALUATION

• Stages of Implementation – Staffing – Training – Adherence to Model • Methods of Communication

31 Program Evaluation LESSONS LEARNED

• Background and Literature Review • Overview of Model and Purpose of Evaluation • Data Collection – Demographic/Descriptive Data – Process/Fidelity, Outcomes and Cost • Data Analysis and Outcomes Indicators • Use of Data for Knowledge Building • Research Approval and Data Confidentiality

REFERENCES

35 Lessons Learned LIST OF FORMS

36 References 37 List of Forms 62 Appendix

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APPENDIX

Contents

BACKGROUND AND PROGRAM RATIONALE

Background and Program Rationale Substance use disorders (SUD) are characterized as “recurrent use of alcohol or drugs (or both) that results in problems such as being unable to control use of the substance; failing to meet obligations at work, home, or school; having poor health; and spending an increased amount of time getting, using, or recovering from the effects of using the substance,” (Lipari & Van Horn, 2017).

Estimates indicate that about 1 in 8 children lived with at least one parent who had a substance use disorder the past year (SAMHSA, 2017). SUD is a growing concern for child welfare agencies as parental substance abuse is a recognized risk factor for child maltreatment and child welfare involvement (Institute of Medicine and National Research Council, 2013). Parent substance use and parent experience of an SUD can have negative effects on children, both immediate and long term. Studies have shown that children with a parent who has an SUD are more likely than children who do not have a parent with an SUD to have lower socioeconomic status and increased difficulties in academic and social settings and family functioning (Peleg-Oren & Teichman, 2006). Other studies have shown that once a child welfare report has been substantiated, children of parents with substance use issues are more likely to be placed in out of home care and more likely to have longer stays in out of home care compared to other children (Barth, Gibbons, & Guo, 2006, HHS 1999).

Statement of Need According to the U.S. Department of Health and Human Services (HHS), in 2014 of the 353,040 children found to be victims of maltreatment, more than one in four (or 91,903) was reported as having caregivers with drug abuse problems. While the problem exists in every state in the country, Kentucky led the nation in the use of prescription drugs for non-medical purposes during the last year, according to the state’s Office of Drug Control Policy. Officials stated that prescription drug abuse is particularly acute. In 2015, at least 485 people died in Kentucky from prescription drug overdoses, according to the state’s Cabinet for Health and Family Services (CHFS).

Medical examiners’ records indicate the drugs most commonly found in those death cases were methadone, painkillers oxycodone and hydrocodone, alprazolam (Xanax), morphine, diazepam (Valium), and fentanyl.

With the increasing misuse of opioids and opioid use disorder (OUD), the number of children negatively impacted by OUD/SUD has been on the rise causing

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unprecedented numbers of children coming to the attention of pubic child welfare agencies. According to the United Hospital Fund’s (2019) National and States Estimates of the U.S. Opioid Epidemic’s Impact on Children, an estimated 2.2 million children and adolescents had at least one parent with an OUD or had an OUD themselves. Of the 50 states, Kentucky ranked fourth overall with 42 per 1,000 children affected resulting in a total of 45,500 children. The report warns that if current trends continue, an estimated 4.3 million children will have had an OUD or a parent with OUD by the year 2030. “Children and adolescents who grow up in households with opioid misuse and OUDs may experience a myriad of adverse consequences, including: increased risk of mental health problems and drug use; accidental opioid poisoning; increased risk of developing a substance use disorder; and family dissolution that results from parents’ incarceration, foster care placement, or loss of parent to an opioid overdose.” Parental drug use has also been linked to child neglect or deficits in parent child attachment, and parents with an Opioid Use Disorder (OUD) may be less likely to be reunified with their children (Winstanley & Stover, 2019).

The negative effects of having a parent with OUD/SUD are not limited to children and adolescents, but also impact infants before they are born. Neonatal Abstinence Syndrome (NAS) is neonatal withdrawal after intrauterine exposure to certain drugs (illicit or prescription). This occurs with the abrupt cessation of the drug exposure at birth. NAS is most commonly seen with opioid exposure, but also seen after exposure to sedatives, poly-substance abuse, and occasionally barbiturates and alcohol. NAS develops in 55-94% of drug-exposed infants.

Since 2003, the Child Abuse Prevention and Treatment Act (CAPTA) has included a state plan requirement regarding policies and procedures to address the needs of substance affected infants, including requirements to make appropriate referrals to child protective services and other appropriate services, and a requirement to develop a plan of safe care for the affected infants.

In 2016 changes to CAPTA required each state to implement statewide laws, policies and/or procedures requiring health care providers involved in the delivery or care of infants born and identified as affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (FASD) to notify child protective services of the occurrence of such conditions of infants.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Kentucky Profile KSTEP was developed and implemented within the structure of Kentucky’s Cabinet for Health and Family Services’ Department for Community Based Services.

Kentucky’s Department for Community Based Services (DCBS) was formed in CHFS in 1998 to give local offices more decision-making authority and the ability to collaborate more effectively with service providers.

The department is comprised of more than 4,400 employees in five divisions with offices in every county and one central office leadership team managing staff and operations. The five divisions include: Protection & Permanency, Family Support, Child Care, Service Regions and Administration and Financial Management.

The department is led by a Commissioner who is appointed to the position by the governor.

DCBS services are administered through nine service regions and offices serving all 120 Kentucky counties. In addition, DCBS uses a network of contract officials to deliver services, such as child care. Service is enhanced through a close relationship and coordination with community partners. The department provides family support; child care; child and adult protection; eligibility determinations for Medicaid and food benefits; and administration of an energy cost-assistance program.

The department also administers the state foster care and adoption systems and recruits and trains parents to care for the state’s children who are waiting for a permanent home. With offices in every county, the department provides services and programs to enhance the self-sufficiency of families; improve safety and permanency for children and vulnerable adults; and engage families and community partners in a collaborative decision-making process.

prevention efforts. The division coordinates more than 180 contracts with vendors that provide a variety of services statewide and for specific service regions to enhance family violence prevention and intervention services. The division provides consultative services and technical assistance to local child protective services offices regarding child and adult protection cases. The division coordinates permanency services including the coordination of state efforts to recruit and certify adoptive homes for children in foster care.

The division creates standards of practice for local office operation and implements statewide changes in coordination with state and federal legislation changes.

The division also gathers data and creates reports to monitor the state’s progress toward federal goals in child welfare services.

The vision of DPP is “To protect children and vulnerable adults and to promote self-sufficiency and permanency by providing the best regulatory framework and state plan structure possible. Our mission is also to ensure maximum flexibility for interpretation and implementation of policy and procedures, which best meet the needs of the community.

The Division of Protection and Permanency (DPP) recognizes the importance of a safe, secure and nurturing environment for each Kentucky child, adult and family. Within such an environment, we believe that families and their individual members become the most critical component of a strong society. Our vision is a division that is: • Focused on families, children and vulnerable adults • Committed to families as partners in decision making • Proactive, responsive and accessible to all members of the community • Sensitive to cultural and community differences • Committed to innovation, continuous improvement, shared accountability and measurable outcomes • Community focused and partnership-oriented • Recognized as the best human service delivery organization in the nation”

The KSTEP program is housed within DCBS’ Division of Protection and Permanency (DPP) which is responsible for coordinating the state’s child welfare and violence

Background and Program Rationale

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BACKGROUND AND PROGRAM RATIONALE

In Kentucky, data from the State Agency Child Welfare Information System indicated that substance use was either a directly contributing or indirectly contributing factor in 70% of all substantiated reports of child maltreatment (TWS-272, 8/19). In 2018, approximately 1500 reports were accepted surrounding a substance affected infant. Of these reports, 43.5% had a substantiated finding and/or a designation of services needed. Of these reports, 80% received ongoing services from the Department for Community Based Services.

BACKGROUND AND PROGRAM RATIONALE

DCBS Service Regions NORTHERN BLUEGRASS SALT RIVER TRAIL

Kenton Boone Campbell

NORTHEASTERN

Gallatin Pendleton Bracken Carroll Grant Mason Trimble Greenup Robertson Lewis Owen Harrison Henry JEFFERSON Oldham Boyd Fleming Nicholas Carter Scott Franklin Shelby Bourbon Rowan Jefferson Bath TWO RIVERS Elliott Fayette Montgomery Lawrence Woodford Spencer Anderson Clark Bullitt Menifee Morgan Meade Jessamine Nelson Hancock Johnson Martin Powell Mercer Breckinridge Henderson Wolfe Washington Madison Magoffin Daviess Hardin Estill Union Garrard Boyle Lee Floyd Marion Breathitt Webster McLean LaRue Grayson Lincoln Ohio Pike Jackson Owsley Knott Crittenden Rockcastle Taylor Casey Perry Hopkins Hart Livingston Green Butler Edmonson Muhlenberg Clay Caldwell Letcher Pulaski Laurel Leslie Adair Ballard McCracken Metcalfe Lyon Russell Warren Barren Christian Knox Logan Marshall Carlisle Harlan Wayne Cumberland Trigg Todd Whitley EASTERN MOUNTAIN Allen Graves Simpson McCreary Bell Monroe Clinton Hickman Calloway Fulton

THE LAKES

Kentucky’s Public Child Welfare Workforce DCBS is comprised of more than 4,400 employees in five divisions with offices in every county and 1 central office leadership team managing staff and operations. The Division of Protection & Permanency is comprised of 80 employees housed in the DPP central office and throughout county offices statewide. Direct services, moving families toward self-sufficiency and providing adult and child protection and permanency, is performed by 2,410 (data as of 2.11.20) employees, through nine services regions throughout Kentucky.

DCBS’ frontline employees are responsible for a continuum of public child welfare services including intake, investigation, assessment, case planning, case management (in home and out of home), child placements, permanency planning, termination of parental rights, kinship, foster care and adoption services, and preparing youth for independent living.

In urban areas of the state such as Louisville and Lexington, protection & permanency staff may provide the above services through specialized teams (e.g., investigative teams, ongoing teams, etc.). However, in more rural areas of the state (less population, less staff), workers may be expected to provide multiple aspects of the continuum. DCBS contracts with community partners and private providers for prevention and in-

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SOUTHERN BLUEGRASS

CUMBERLAND

home services, therapeutic foster care, and residential treatment services. DCBS staff work in collaboration with community partners, private providers, court systems/Administrative Office of the Courts, schools, and other state agencies including the Department for Juvenile Justice and the Department for Behavioral Health, Developmental and Intellectual Disabilities.

OUD/SUD treatment is effective at reducing parental opioid use and improving child outcomes; however, stigma and cross-system collaboration may limit access to treatment and timely reunification of families. In 2015, as part of the Title IV-E Waiver Demonstration project, Kentucky embarked on a journey to fill a gap in existing services and improve the cross-system collaboration necessary to effectively served families and children experiencing child maltreatment with substance use as a contributing factor.

Whereas the state had an existing in-home service and community-based service array, there were gaps resulting in services for families affected by OUD/SUD with children six years of age and older, as well as gaps in geographical areas where the Sobriety Treatment and Recovery Teams (START) program (START serves families experiencing SUD with at least one child under age 6) was not operating.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Program Overview and Description

The intensive case coordination provided by the in-home provider is intended to remove barriers to treatment engagement, retain a parent in treatment, and re-engage parents who may have stopped

TABLE 1

treatment. Treatment interventions include Cognitive Behavioral Therapy (CBT), MI, Child-Adult Relationship Enhancement (CARE) skills, and/or Parent Child Interaction Therapy (PCIT). The providers assess child safety, risk of future maltreatment, and teach parenting and other strategies to parents with a focus on improving family functioning and child wellbeing.

In-home providers also identify and make referrals for counseling (if unable to provide this in the home) and for additional needs such as medication, housing, necessities, education, and employment. Some of the referrals made have been for psychotropic medication, higher education, food stamps, mental health counseling, a home visiting program for pregnant mothers, domestic violence shelter, and a home and community-based Medicaid waiver program.

In addition to the substance use screening and assessment process, in-home providers complete a comprehensive range of screenings and assessments.

Depending on the needs of the parent, these assessments evaluate the need for mental health, family violence, parenting, and family support services. They also utilize SBC to develop an action plan in partnership with the family. The in-home provider coordinates the SBC action plan with the DCBS service plan and CMHC treatment plan to ensure consistency across planning and service delivery processes. Case coordination provided by the in-home provider helps the family to act on plans and to coordinate all services.

Table 1 includes the number and percentage of abused and neglected children under the age of 10 with a finding of “substantiated” and substance abuse as contributing factors between September 2015 and August 2016, totaling 68.3 percent statewide. The table further delineates those cases that remain in-home versus those that resulted in OOHC.

KSTEP Target Population Data

September 2015 – August 2016

Number of Children Under Ten with Substantiated/ Services Needed Reports

Substance Abuse

In-Home

11,108

7,362 (66.3%)

Out-of-Home

2,749

2,116 (77%)

Total

13,857

9,478 (68.3%)

Program Overview and Description

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PROGRAM OVERVIEW AND DESCRIPTION

The KSTEP model consists of a comprehensive approach involving the state public child welfare agency, contracted in-home service providers and contracted behavioral health providers. All KSTEP cases receive the same delivery of services, by providing immediate access to intensive in-home services within 24 hours of referral. The in-home provider conducts a thorough substance use screening at first contact and assessment to determine if a parent is appropriate for a treatment recommendation and referral. If a parent meets American Society of Addiction Medicine (ASAM) criteria for treatment, they are immediately presented with treatment options, per Medicaid guidelines, and assisted with arranging an intake appointment with one of KSTEPs contracted Community Mental Health Centers (CMHC), based on the county where the participant resides or with a treatment provider of their choice. The contracted CMHCs ensure quick access to substance use treatment by providing the parent an appointment within 48 hours. If the parent chooses to not utilize the CMHC, the in-home provider ensures the selected treatment provider is able to serve the parent promptly and communicate weekly with the in-home service provider regarding progress. The in-home providers are available to provide transportation for the parent(s) to this and other appointments whenever needed. The in-home provider’s role is critical in assisting parents with addressing their substance use issues and helping parents engage in treatment as quickly as possible. The in-home providers and CMHCs are responsible for ensuring that KSTEP parents with substance use disorders are randomly drug screened according to program guidelines to monitor compliance.

PROGRAM OVERVIEW AND DESCRIPTION

Kentucky’s Strengthening Ties and Empowering Parents (KSTEP) is a practice framework that integrates several evidence-based practices with in-home service offered to families with an open protection and permanency (P&P) investigation, with children at moderate to imminent risk of entering out-of-home care (OOHC), based on a comprehensive family assessment that includes safety, risk and protective factors.

KSTEPs in-home providers make regular home visits and work with families to identify and obtain resources the family may be eligible to receive, such as Medicaid and TANF. Furthermore, they work to ensure children can remain safely in their homes with flexible tangible supports such as childcare, transportation, utilities, and other needed resources. Examples of expenditures include paying rent for a parent facing eviction, changing locks due to intimate partner violence, the purchase of a toddler bed, baby monitors, childproofing items, housing down payments, startup payments for

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car insurance, and groceries. Flexible funds are limited to $500 per family.

The in-home provider prepares a weekly progress report to DCBS that incorporates weekly reports from CMHC substance use treatment providers. If the parent chooses a substance use/mental health provider other than the CMHC, the in-home service provider obtains this information from the provider and includes it in their report. If a parent or child is participating in counseling for mental health issues or family violence with another behavioral health provider, the in-home provider also obtains this from the provider and submits this to DCBS. KSTEPs in-home providers facilitate monthly family team meetings (FTMs) that include the family, involved DCBS social service workers (SSWs), and behavioral health providers from CMHCs to facilitate collaborative efforts and decision-making that includes the family and all of their supports.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

KSTEP Theory of Change SO THAT PROGRAM OVERVIEW AND DESCRIPTION

Community partners (including judiciary) are engaged and KSTEP strategies are communicated; AND the provider community and child welfare staff received additional certifications and training in needed services/evidence-based programs including: Solution Based Casework, Part Child Interaction Therapy, Motivational Interviewing, Cognitive Behavioral Therapy, and Family Behavior Therapy (Adult Focused);

SO THAT Families with co-occurring child maltreatment and substance abuse, with at least one child in the home under the age of 10 at the time of referral who is at imminent or moderate risk of removal, receive (immediate) intensive in-home services utilizing Solution Based Casework (SBC) through a contracted provider;

SO THAT Families are partners in the assessment, planning, and service delivery processes; family team meetings occur, comprehensive assessments are conducted, safety plans are implemented, individualized treatment needs are identified, and treatment plans are created (in alignment with DCBS case plans);

SO THAT Children can remain safely in the home as families are receiving services and participating in treatment programs;

AND Funding through KSTEP is provided for needed supportive (concrete) services to families (e.g., transportation, childcare, utilities, etc.) to meet basic needs and remove barriers that could prevent families from participating in services;

SO THAT Families actively participate in appropriate and timely evidence-based services/treatment programs delivered with fidelity to the models;

SO THAT Parental capacity improves, sobriety is achieved and maintained, safety risks are eliminated/reduced, family functioning improves, and child well-being improves;

SO THAT Repeat maltreatment decreases in families receiving KSTEP services; Children are able to remain safely in the home during and after KSTEP services; Children who do have to enter OOHC during provision of KSTEP achieve permanency in a timely manner;

SO THAT Fewer children enter/reenter OOHC, Kentucky’s OOHC costs decrease, AND Title IV-E Budget cost is neutral.

Program Overview and Description

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Background Purpose of IV-E Waiver Demonstration Project IV-E waiver demonstration project status allows Kentucky the flexibility to use IV-E monies on previously non-allowable expenses including prevention, early intervention and reunification.

Goals for Kentucky’s IV-E Waiver Demonstration Project-KSTEP Intervention: • Reduce the number of children entering OOHC through the implementation of the KSTEP program.

• Reduce the amount of time children in the target population spend in OOHC. • Reduce repeat maltreatment, and increase wellbeing of families by enhancing caregivers’ capacity to care for children, and maintain them safely in their own homes.

Target Population: Families with children under age 10 identified as being at moderate to imminent risk of the child(ren) being removed from the home subsequent to a confirmed abuse or neglect allegation where parental substance use is a co-contributing factor to child maltreatment.

Sites for KSTEP Implementation: • Pilot will occur in four counties located in the Northeastern Region • KSTEP will be rolled out by region; poised to go statewide by end of Waiver period KSTEP Philosophy and Strategies: • The KSTEP program will achieve Waiver Demonstration Project Goals by employing the following philosophy and strategies: • System of Care Approach-promote collaboration between agencies and coordination of services toward shared outcomes (partnerships with behavioral health providers, courts, DCBS, and community service providers) • Solution Based Casework (SBC)-full partnership with family is a critical and vital goal for each family. Partnership for protection should focus on patterns of everyday life of the family, solutions should target prevention skills needed to reduce risk in everyday life situations (grounded in family life cycle theory, relapse prevention/ CBT and solutions-based family theory) • Immediate Access to Substance Use Treatment

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Inputs KSTEP Program Administration • KSTEP Program Administrator • DCBS Leadership (CO, Prevention Branch) IV-E Waiver KSTEP Workgroup and IV-E Waiver Steering Committee Partnerships with Courts

Activities Project staff coordinate state and local efforts in pilot KSTEP region/counties: • Engagement of key stakeholders • Training on KSTEP philosophy and strategy • Execution of contracts for KSTEP services

Regular meetings (regions, counties) to resolve barriers, provide updates, and monitor and improve program fidelity

Education of court personnel on KSTEP philosophy and strategies; strategic approaches to court action regarding safety and permanency

Parents’ adherence to treatment plans reinforced; Individualized permanency plans for children-if needed

KSTEP Teams: Dyads of contracted community providers (intensive in home services using SBC) and DCBS ongoing caseworkers DCBS Supervisors

KSTEP Community Partners provide in home support to families

Training for DCBS, contracted community providers, SUD treatment providers and community partners

KSTEP Teams receive specialized training and technical assistance-includes SBC, Motivational Interviewing and other EBP’s

Screening/assessment of all families served by KSTEP

KSTEP community providers administer NCFAS, PSI and ASI for assessment of family members, results shared with DCBS, needs identified and referrals made to appropriate services

Flexible funding for families’ basic needs/concrete services

Families’ basic needs are identified and addressed (e.g., housing, clothing, food, child care and transportation)

Service coordination with treatment providers for quick access to behavioral health assessment and recommended treatment

Access provided to individually appropriate substance abuse services within 48 hours of referral

Funding for drug testing

Monitoring and support of abstinence for therapeutic and child safety measures; real time communication of and response to test results

Community-based services and supports for families

Comprehensive evaluation plan to assess KSTEP effectiveness (Evaluation Team)

Outputs

DCBS staff provide child welfare case management services to families; safety and prevention planning to allow child to remain in home; case planning

Community capacity building and targeted service development (EBP’s) EPB’s/services for children, parents and other family members provided through community partners

KSTEP program implemented, supported and monitored with fidelity; project progress monitored and results measured

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Families are partners in casework process; receive weekly contact, encouragement, improved service coordination, aligned case plans and treatment plans, enhanced visitation between parent and child (if in OOHC)

All adults with SUDs participate in MI, CBT, CARES, and PCIT; Children and adults referred to and receive EBP’s/services based on needs identified through assessments Concrete services provided to families to meet needs; Barriers to services removed

Parents attend a 12-step or other addiction support program Addicted parents receive at least out-patient substance abuse therapy, severity of drug/alcohol abuse decreases Parents with SUD-randomly drug tested on weekly basis initially and less often as they progress; weekly written reports from treatment provider to KSTEP Team Team and family make joint decisions about case planning and permanency (if applicable) All children and adults requiring treatment receive treatment Progress reports and presentations, focus groups, ongoing CQI

Proximal/Medium

Outcomes

Long-Term

PROGRAM OVERVIEW AND DESCRIPTION

PROGRAM OVERVIEW AND DESCRIPTION

KSTEP Logic Model Collaborative system of providers/partners in place to provide necessary services in a timely manner

Fewer children enter OOHC

Favorable discharge (completion of treatment); Improvements in severity of parental drug and alcohol abuse

Increased rates of parental sobriety/Parents achieve and maintain sobriety (recovery)

Children who do enter OOHC stay for shorter lengths of time

Increased rates of reunification for children serviced through KSTEP (exits to permanency if in OOHC)

Costs for OOHC decrease

Decreased rates of repeat maltreatment of children served through KSTEP

IV-E Budget is cost neutral

Individualized decisions are made about permanency/OOHC (least restrictive placements for children used) Protective capacity of parents improves, safety risks are reduced

Decreased rates of entry into OOHC of children serviced through KSTEP during service provision

Families receive needed services and are connected to resources during treatment

Child well-being improves (decreased trauma, improved behavior/emotional/social functioning)

Treatment retention increases and short-term relapse is reduced; Favorable discharge (completion of treatment) is achieved; Improvements in severity of parental drug and alcohol abuse (ASI)

Decreased rates of reentry into OOHC of children serviced through KSTEP after case closure

Family functioning improves; adult and child well-being improves

KSTEP implemented with fidelity KSTEP budget, expenditures, cost-avoidance tracked Practice changes are based on evidence and stakeholder input

Program Overview and Description

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Background Purpose of IV-E Waiver Demonstration Project IV-E waiver demonstration project status allows Kentucky the flexibility to use IV-E monies on previously non-allowable expenses including prevention, early intervention and reunification.

Goals for Kentucky’s IV-E Waiver Demonstration Project-KSTEP Intervention: • Reduce the number of children entering OOHC through the implementation of the KSTEP program.

• Reduce the amount of time children in the target population spend in OOHC. • Reduce repeat maltreatment, and increase wellbeing of families by enhancing caregivers’ capacity to care for children, and maintain them safely in their own homes.

Target Population: Families with children under age 10 identified as being at moderate to imminent risk of the child(ren) being removed from the home subsequent to a confirmed abuse or neglect allegation where parental substance use is a co-contributing factor to child maltreatment.

Sites for KSTEP Implementation: • Pilot will occur in four counties located in the Northeastern Region • KSTEP will be rolled out by region; poised to go statewide by end of Waiver period KSTEP Philosophy and Strategies: • The KSTEP program will achieve Waiver Demonstration Project Goals by employing the following philosophy and strategies: • System of Care Approach-promote collaboration between agencies and coordination of services toward shared outcomes (partnerships with behavioral health providers, courts, DCBS, and community service providers) • Solution Based Casework (SBC)-full partnership with family is a critical and vital goal for each family. Partnership for protection should focus on patterns of everyday life of the family, solutions should target prevention skills needed to reduce risk in everyday life situations (grounded in family life cycle theory, relapse prevention/ CBT and solutions-based family theory) • Immediate Access to Substance Use Treatment

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Inputs KSTEP Program Administration • KSTEP Program Administrator • DCBS Leadership (CO, Prevention Branch) IV-E Waiver KSTEP Workgroup and IV-E Waiver Steering Committee Partnerships with Courts

Activities Project staff coordinate state and local efforts in pilot KSTEP region/counties: • Engagement of key stakeholders • Training on KSTEP philosophy and strategy • Execution of contracts for KSTEP services

Regular meetings (regions, counties) to resolve barriers, provide updates, and monitor and improve program fidelity

Education of court personnel on KSTEP philosophy and strategies; strategic approaches to court action regarding safety and permanency

Parents’ adherence to treatment plans reinforced; Individualized permanency plans for children-if needed

KSTEP Teams: Dyads of contracted community providers (intensive in home services using SBC) and DCBS ongoing caseworkers DCBS Supervisors

KSTEP Community Partners provide in home support to families

Training for DCBS, contracted community providers, SUD treatment providers and community partners

KSTEP Teams receive specialized training and technical assistance-includes SBC, Motivational Interviewing and other EBP’s

Screening/assessment of all families served by KSTEP

KSTEP community providers administer NCFAS, PSI and ASI for assessment of family members, results shared with DCBS, needs identified and referrals made to appropriate services

Flexible funding for families’ basic needs/concrete services

Families’ basic needs are identified and addressed (e.g., housing, clothing, food, child care and transportation)

Service coordination with treatment providers for quick access to behavioral health assessment and recommended treatment

Access provided to individually appropriate substance abuse services within 48 hours of referral

Funding for drug testing

Monitoring and support of abstinence for therapeutic and child safety measures; real time communication of and response to test results

Community-based services and supports for families

Comprehensive evaluation plan to assess KSTEP effectiveness (Evaluation Team)

Outputs

DCBS staff provide child welfare case management services to families; safety and prevention planning to allow child to remain in home; case planning

Community capacity building and targeted service development (EBP’s) EPB’s/services for children, parents and other family members provided through community partners

KSTEP program implemented, supported and monitored with fidelity; project progress monitored and results measured

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Families are partners in casework process; receive weekly contact, encouragement, improved service coordination, aligned case plans and treatment plans, enhanced visitation between parent and child (if in OOHC)

All adults with SUDs participate in MI, CBT, CARES, and PCIT; Children and adults referred to and receive EBP’s/services based on needs identified through assessments Concrete services provided to families to meet needs; Barriers to services removed

Parents attend a 12-step or other addiction support program Addicted parents receive at least out-patient substance abuse therapy, severity of drug/alcohol abuse decreases Parents with SUD-randomly drug tested on weekly basis initially and less often as they progress; weekly written reports from treatment provider to KSTEP Team Team and family make joint decisions about case planning and permanency (if applicable) All children and adults requiring treatment receive treatment Progress reports and presentations, focus groups, ongoing CQI

Proximal/Medium

Outcomes

Long-Term

PROGRAM OVERVIEW AND DESCRIPTION

PROGRAM OVERVIEW AND DESCRIPTION

KSTEP Logic Model Collaborative system of providers/partners in place to provide necessary services in a timely manner

Fewer children enter OOHC

Favorable discharge (completion of treatment); Improvements in severity of parental drug and alcohol abuse

Increased rates of parental sobriety/Parents achieve and maintain sobriety (recovery)

Children who do enter OOHC stay for shorter lengths of time

Increased rates of reunification for children serviced through KSTEP (exits to permanency if in OOHC)

Costs for OOHC decrease

Decreased rates of repeat maltreatment of children served through KSTEP

IV-E Budget is cost neutral

Individualized decisions are made about permanency/OOHC (least restrictive placements for children used) Protective capacity of parents improves, safety risks are reduced

Decreased rates of entry into OOHC of children serviced through KSTEP during service provision

Families receive needed services and are connected to resources during treatment

Child well-being improves (decreased trauma, improved behavior/emotional/social functioning)

Treatment retention increases and short-term relapse is reduced; Favorable discharge (completion of treatment) is achieved; Improvements in severity of parental drug and alcohol abuse (ASI)

Decreased rates of reentry into OOHC of children serviced through KSTEP after case closure

Family functioning improves; adult and child well-being improves

KSTEP implemented with fidelity KSTEP budget, expenditures, cost-avoidance tracked Practice changes are based on evidence and stakeholder input

Program Overview and Description

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Core Implementation Practices Essential Components

Family Eligibility Requirements

• Collaborative approach/Interagency collaboration to service delivery—DCBS, IHS providers, Treatment providers, Judiciary/Courts

DCBS investigative staff can make a referral to KSTEP at any time during the investigative process.

• Timely and comprehensive individual and family assessment

KSTEP Eligibility Requirements: 1. Child(ren) at moderate to imminent risk of removal from the home.

2. At least one household child is under age ten (10).

3. Parental substance abuse is a primary feature affecting child safety.

• Quick access to substance use disorder treatment

4. The family did not have an ongoing DCBS case at the time the investigation was received.

• Referrals/active participation in appropriate EBPs based on family and individuals identified needs

5. The investigation will result in the case being opened for ongoing services.

• Phased approach to services grounded in Stages of Change

6. The family is preferred to be a Medicaid recipient or to carry private insurance accepted by the provider agencies (all other situations accepted on a case by case basis).

Core Implementation Practices

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CORE IMPLEMENTATION PRACTICES

• Provision of intense in-home case coordination services using SBC as practice model for casework (and Motivational Interviewing)—Partnership with Family—In-home KSTEP Service Coordinators carry nine or fewer cases per the model.

KSTEP Timeline

CORE IMPLEMENTATION PRACTICES

CPS Referral

In-home provider accepts referral and initiated contract within 24 hours

Initial Family Team Meeting occurs and Action Plan created

≤ 0-45 Days

6–14 Days

Community Mental Health Center assessments occur and treatment begins

≤ 48 Hours

Phase 1: Orientation Stabilization and Engagement

1–2 Months

[households that have child(ren) at moderate to imminent risk of removal, parental substance abuse as a primary risk factor, and have at least 1 child in the home under the age of 10]

DCBS Investigative SSW makes preliminary finding and determines appropriateness for KSTEP

DCBS Investigative SSW contacts in-home provider agency and makes referral

KSTEP Services Timeline/ Timeframes 1. DCBS referral for KSTEP services to contracted inhome service providers should be accepted verbally or in writing upon receipt of the phone call with the referral.

2. SSW forwards family and referral information to the in-home service provider within three (3) days of referral.

3. DCBS worker completes Preventative Services Case Plan with the family within 10 working days.

4. KSTEP in-home service provider meets with family within 24 hours of receiving referral. Parent(s) or caretakers residing in home are screened per criteria.

Referrals to CMHC or other appropriate treatment provider are made immediately.

5. CMHC assesses parent(s), child(ren) and caretaker(s) within 48 hours of referral from KSTEP in-home service provider

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ASI, NCFAS, and PSI Assessments completed

6. KSTEP in-home services provider completes NCFAS, ASI and PSI within fourteen (14) working days of referral, administration of NCFAS is required again at three months and every three months thereafter, administration of ASI is required again at four (4) months and again at case closure, administration of PSI is required again at four (4) months and again at case closure.

7. CMHC shares initial treatment recommendations with DCBS and KSTEP in-home service provider within 24 hours of the assessment including selected EBPs. 8. CMHC ensures first treatment appointments occur within 48 hours of the verbal treatment recommendations are shared with DCBS and KSTEP in-home service provider. KSTEP clients are given top priority in CMHC’s Utilization Management process.

9. Within six (6) working days, but no later than 14 day of KSTEP referral and acceptance, KSTEP inhome service provider will convene a Family Team Meeting (FTM). FTMs are held at a minimum every 30 days thereafter.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Phase 2: Acquisition of Skills and Resources to overcome safety issues

1–3 Months

Phase 4: Maintenance and Aftercare

Family Team Meeting occurs monthly, ASI and PSI completed every 4 months, NCFAS completed every 3 months

1–3 Months

CORE IMPLEMENTATION PRACTICES

2–3 Months

Phase 3: Consistent Application of Skills and Resources to aid in Maintained Safety of Child(ren) and Recovery

≤ 8 Months

The duration of each Phase (1–4) will depend on family’s individual needs and will vary. KSTEP services will only exceed 8 months with extension approval.

KSTEP Services Phases Phase movement will be determined by the progress the family has made in lowering their risk level through collaboration and consensus of the entire KSTEP team.

This includes DCBS, KSTEP in-home provider, and substance treatment provider.

Termination of services is determined by the family’s progress on goals identified in the family agreement and action plans, administration of the NCFAS, ASI, and PSI to determine progress in critical domains, and a family team meeting where an aftercare plan will be developed. This decision should also be through collaboration of entire KSTEP team.

PHASE 1 Orientation Stabilization and Engagement (1 to 2 months) PHASE 2 Acquisition of Skills and Resources to Overcome Safety Issues (2 to 3) PHASE 3 Consistent Application of Skills and Resources to Aid in Maintained Safety of Child(ren) and Recovery (1 to 3 months) PHASE 4 Maintenance and Aftercare Planning (1 to 2 months)

A family can return to a previous phase if there is a relapse, new safety threat, new instance of maltreatment, etc. Phase movement will be decided collaboratively between the family, DCBS, and the KSTEP in-home provider.

Core Implementation Practices

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Services Phases

In-Home Service Provider Requirements Ongoing Requirements • Data entry into the web-based KSTEP database; ensure all case data is accurate, complete and timely • Ongoing communication with DCBS

CORE IMPLEMENTATION PRACTICES

• Participation in KSTEP program evaluation activities as needed

PHASE 1

PHASE 2

PHASE 3

PHASE 4

Orientation, Stabilization, and Engagement

Acquisition of Skills and Resources to Overcome Safety Issues

Consistent Application of Skills and Resources to Aid in Maintained Safety of Child(ren) and Recovery

Maintenance and Aftercare Planning

(1 to 2 months) • Minimum of 2 face-toface contacts with family every 7 days • Minimum of 1 face-toface contact with children every 7 days • Contacts are 5 to 10 hours per week, with 50% occurring in the home • Initial A & D Assessment with recommendations within 24 hours of referral using ASAM criteria • NCFAS, ASI and PSI completed • Initial FTM within 6 to 14 working days • Family Agreement and initial Action Plan created • Minimum 1 weekly verbal and written updates to DCBS worker • All KSTEP phase changes made at FTMs and are collaboration of all providers

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(2 to 3 months) • Miminum of 2 face-toface contacts with family every 7 days • Minimum of 1 face-toface contact with children every 7 days • Contacts are 5 to 10 hours per week, with 50% occuring in the home

(1 to 2 months) • Minimum of 1 face-to-face contact per month (children must be present)

(1 to 3 months)

• Contacts are 1 to 8 hours per month

• Minimum of 1 weekly face-to-face contact with family (including children) every 7 days

• Provide weekly written progress reports to DCBS worker and verbal contact as needed

• Contacts are 2 to 10 hours per month

• Reviews of progress based on Action Plan, ILOs, FLOs and tasks

• Reviews of progress based on Action Plan, ILOs, FLOs and tasks

• Provide weekly written progress reports to DCBS worker and verbal contact as needed

• Minimum 1 weekly verbal and written updates to DCBS worker

• Reviews of progress based on Action Plan, ILOs, FLOs, and tasks

• Consistent contact with treatment providers for coordination of care and progress updates

• Consistent contact with treatment providers for coordination of care and progress updates

• FTMs held at least every 30 days--all providers invited

• FTMs held at least every 30 days--all providers invited

• Update NCFAS every 3 months and ASI/PSI every 4 months, if last update was within 30 days of discharge, only complete a new assessment if there is a relevant documented change

• Update NCFAS every 3 months and ASI/PSI every 4 months

• Update NCFAS every 3 months and ASI/PSI every 4 months

• Establish a discharge date through collaboration of all providers

• All KSTEP phase changes made at FTMs and are collaboration of all providers

• All KSTEP phase changes made at FTMs and are collaboration of all partners

• Develop a thorough Aftercare Plan and make all necessary referrals and ensure followup appointments are made

• Consistent contact with treatment providers for coordination of care and progress updates • FTMs held at least every 30 days--all providers invited

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

KSTEP Phase Movement Indicators PHASE 1 Orientation, Stabilization, and Engagement (1 to 2 months) • Active participation in all required KSTEP activities including releases of information, assessments, case planning, Family Team Meetings, drug screens, etc. Follows through on appointments, engages in recommended treatment and services.

• Engagement in recommended level of treatment for substance abuse and/or mental health based on assessments • Participation in random drug screens at least once weekly.

• Engagement in treatment and KSTEP services consistently as evidenced by attending at least 85% of appointments and providing adequate notice of need to cancel/re-schedule.

• Engagement in completion of Change Plan through Family Team Agreement and Action Plan(s) to improve safety and well-being of child(ren). Participate in development of and follow all safety plans put into place.

• Regular contact/visitation with children if applicable and necessary.

PHASE 2 Acquisition of Skills and Resources to Overcome Safety Issues (2 to 3 months) • Movement through the Preparation Stage of Change into the Action Stage of Change; learns and practices new skills and behaviors to manage safety issues and problems.

• Demonstrated active learning and open communication with all providers on what is working/not working and if changes need to be made to Action and Safety Plans.

Doesn’t allow setbacks to deter progress but uses as a learning tool to modify tasks/skills as needed • Participation in random drug screens at least once weekly--screens should be negative or show decreasing levels. If lapse/relapse occurs, each

• Attendance in 90% of all KSTEP and recommended service appointments; Receives reports of positive participation in treatment activities/service appointments.

• Consistent contact/visitation with children and practices positive parenting.

• Demonstration of new safety/parenting/life skills to meet safety, permanency and well-being needs of children.

• Utilization of available community supports and resources.

• Identification of plan and observable steps taken to begin long-term financial stability.

• Obtainment of safe and stable housing.

• Development of stable child caring plan.

• Begins establishment of a positive support system including positive/sober peer and family support and participates in self-help group(s) e.g., Celebrate Recovery, AA/NA, etc.

• Addresses all safety issues and implements safety plans as needed as described in Action Plan Tasks.

PHASE 3 Consistent Application of Skills and Resources to Aid in Maintained Safety of Child(ren) and Recovery (1 to 3 months) • Remain in the Action Stage of Change with potential movement into Maintenance Stage in some areas; shows consistency in applying new behaviors to ensure safety and manage problems and ability to recognize and adjust skills as needed while still utilizing help from providers as needed.

• Completes random drug screens at least 2x per monthscreens should be clean or show decreasing levels.

If lapse/relapse occurs, each case will be addressed individually with all providers and considerations such as if new safety plan was implemented to keep child(ren) safe, time frames/amount used, ability/willingness to ask for help, honesty, etc. will be discussed.

• Attends in 95% of all KSTEP and recommended service appointments.

Core Implementation Practices

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CORE IMPLEMENTATION PRACTICES

• Movement from Pre-contemplation/Contemplation Stage of Change to Contemplation/Preparation Stage of Change; able to recognize the need for change in maintaining safety of child(ren) and verbalize a desire for change--still may fear change or feel change is too difficult.

case will be addressed individually with all providers and considerations such as if new safety plan was implemented to keep child(ren) safe, time frames/ amount used, ability/willingness to ask for help, honesty, etc. will be discussed.

• Reports of positive participation in all treatment activities and service appointments.

• Reaches level of proficiency with new safety/parenting/ life skills that all involved parties have confidence of safety of the child(ren).

CORE IMPLEMENTATION PRACTICES

• Children are in the home full time so that the parent(s) has the ability to demonstrate effective and safe parenting skills while still receiving ample support from providers.

• Demonstrates independence in stabilizing the family unit and ability to seek out needed resources on their own effectively. May still require assistance of KSTEP provider occasionally.

• Uses positive and sober network including family and peers consistently as well as encouraged attendance in self-help groups.

PHASE 4 Maintenance and Aftercare Planning (1 to 2 months) • Remain in the Action Stage with movement to Maintenance stage of change in all areas.

• Random drug screening at least 1x per month. Screens should be clean. Any use will be evaluated in an FTM by all providers to determine plan of action.

• Attends in 95% of all KSTEP and recommended service appointments.

• Reports of positive participation in all treatment activities and service appointments.

• A thorough and viable Relapse Plan is in place • Completion of all Action Plan tasks and resolution of all concerns identified on the Family Agreement regarding safety and well-being of the children.

• Ongoing demonstration of proficient use of safety/ parenting/ life skills resulting in resolution of all safety, permanency, and well-being concerns for the child(ren).

• Consistent use of positive and sober network including family and peers as well as encouraged attendance in self-help groups.

• Demonstrates full capacity to function independently or with assistance of natural supports and maintain family safety and stability without the aid or assistance of the KSTEP provider.

Essential KSTEP Components/Activities DCBS assessment and referral to KSTEP • The DCBS investigative social services worker (SSW), in consultation with their supervisor, identifies a KSTEP eligible family (the referral may take place any time during the investigation).

• The SSW identifies the referred child as a candidate for foster care by determining: The child ‘s safety is at risk or will be at risk in the immediate future without intervention; and the safety issues can be mitigated with the selection and use of child-specific, evidence based intervention.

• The DCBS social worker then reviews the EBP Selection Document for EBP intervention selection.

• The DCBS social worker completes the Prevention Services Referral Form in TWIST, ONLY identifying the candidate, the identified risk factors, and EBP interventions to mitigate risk factors.

• The DCBS worker enters the Prevention Services Referral Form in TWIST. • Referrals to KSTEP outside of the DCBS investigative process will not be accepted, i.e., no referrals

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will be accepted after DCBS has completed their investigation. All KSTEP referrals must include case transfer to ongoing services. Best practice is to make the referral from the family home.

• The SSW will discuss making a referral to KSTEP with the family and obtain signed releases (forms 1 & 1A).

The SSW will contact the KSTEP in-home provider agency to make the referral.

• The DCBS SSW completes their investigation and paperwork, addressing safety issues in the prevention plan or case plan for safety during the investigation, including information on court involvement and KSTEP consultation and support.

DCBS must flag all KSTEP cases in TWIST • There is a checkbox/flag in TWIST on the case management screen that indicates that the case is KSTEP. This box must be checked for outcome measurement purposes and to ensure that all KSTEP cases are flagged appropriately. The flag is not unchecked once the family completes services or is no longer involved in the program.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Referral paperwork to/from KSTEP in-home Provider Agency • The SSW will provide the KSTEP in-home provider agency with information that outlines the reason for referral and basic demographics or contact information from the DCBS Case Summary Referral Form. Additional details about the referral can be provided by phone or email.

• The SSW will forward to the KSTEP in-home provider agency the documents bulleted below within three (3) days of the provider referral (all documents will be sent electronically, if feasible): – Information about allegations of substance use and/ or family violence to include prior criminal charges and their disposition. This should include any charges that may indicate risk of safety to the family or to the KSTEP in-home provider agency. The SSW will notify the KSTEP in-home provider agency of immediate threats to child safety and any known threats to SSW/KSTEP in-home provider safety.

– Prior substantiated allegations including but not limited to physical abuse to child by parent, domestic or family violence, and neglect where substance use/abuse or family violence was a contributing risk factor.

– Copy of P&P prevention plan, case plan and/or court orders – A copy of the Case Summary Face Sheet, with correct and updated case member demographic and relationship information.

– Release of Information forms 1 & 1A signed by the family.

• The KSTEP in-home provider agency should accept the referral verbally or in writing upon receipt of the phone call by the SSW when the referral is made.

KSTEP in-home providers should not wait 3 days for the paper copies of the above information to be sent to them before acceptance of the referral. The above information should be provided verbally or in writing via email when SSW makes the referral.

Treatment Provider/CMHC Transfer • When a family decision or move has prompted a CMHC case transfer the following must occur to facilitate the transfer: – Normal CMHC transfer process occurs – A joint FTM and warm hand off has occurred – Ensure all documents, assessments, progress notes, status updates, treatment plans, etc. are shared with the new agency

In Home Service Provider Transfer • When a family move has prompted an in-home service provider case transfer the following must occur to facilitate the transfer: – A face to face visit occurring in the family’s new home, confirming the move has occurred – The agency has contacted the new agency and requested a transfer – The family has signed a new Release of information signed for new the agency – All assessments have been updated and shared with new agency – Initial referral paperwork has been shared with new agency – All collected documentation has been shared with new agency – The Action Plan and all SBC documentation has been shared with new agency – A joint FTM and warm hand off has occurred – The initial referral date is ensured to stay the same

Family notification and engagement • SSW discusses the referral to KSTEP and provides: – A description of KSTEP in-home services and supports that will be provided.

– The name of the KSTEP in-home provider agency – Review and discuss the Program Referral Information form and have the family sign the form, acknowledging their SSW has reviewed the form with them and their understanding of the expectations of the program.

Core Implementation Practices

19

CORE IMPLEMENTATION PRACTICES

• The KSTEP in-home provider agency will take the information and complete a referral form for the SSW and will email or scan it back to them within 24 hours of accepting the referral. The KSTEP in-home provider agencies are contractually obligated to accept all referrals; however, if the KSTEP in-home provider agency declines the referral they must provide a written explanation documenting this to the referring SSW and to the KSTEP program administrator.

• The KSTEP in-home provider agency can decline the referral if they discover an unidentified or undocumented safety concern that would be likely to place their staff in physical danger during their initial face-to-face meeting with the family or during their assessment of the family.

CORE IMPLEMENTATION PRACTICES

– An explanation of how participation will benefit the family and potential consequences of nonparticipation, i.e., participation is necessary to reduce risk and ensure child safety. Substance use treatment services will be expedited and they will have a substance use treatment coordinator who will work with the KSTEP in-home provider.

Drug testing will be paid for by the program.

Financial assistance is available to prevent removal.

Successful participation and progress will likely result in closure of the P&P case (after risk is reduced) and may avert the need to file a court petition, or avoid further court interventions, such removal of child(ren) and placement in out-of-home care (foster care). Families should be informed that participation in KSTEP services has the potential to greatly benefit the family and may reduce the likelihood of future contact with P&P.

KSTEP in-home provider meets parent w/in 24 hours of receipt of referral • KSTEP in-home provider screens parent(s) or caretakers residing in the home using criteria. Refers immediately to CMHC or other appropriate treatment provider for treatment, if screening and/or referral information warrants.

• KSTEP in-home provider will explain services to the family, schedule time(s) to assess the family, make other referrals to appropriate treatment providers, arrange drug testing, have the family sign release forms and review DCBS prevention/safety plan, case plan, and/or court orders with the family.

• KSTEP in-home provider then follows-up with DCBS on the first contact with the family and status.

Treatment Provider — Community Mental Health Center (CMHC) • CMHC assesses parent(s), child, and caretakers within 48 hours of referral by KSTEP in-home provider.

• At the time of the referral, the in-home provider will send the CMHC a completed Universal Referral Form upon scheduling the appointment. The in-home worker will provide the TWIST ID and Child ID to ensure appropriate IV-E claiming at this time • KSTEP in-home provider transports parents/caretaker to assessment • Treatment provider ensures that initial treatment recommendations are shared verbally or in writing

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with DCBS & the KSTEP in-home provider agency, within (24) hours of the assessment. The CMHC will provide the selected EBP’s with this recommendation.

Any time the selected EBP’s are added or changed the KSTEP coordinator or therapist will provide to the in-home provider. The in-home provider will then send any changes to the DCBS worker in writing, preferably during the weekly update • CMHC ensures that the first treatment appointment will occur within (48) hours of the verbal treatment recommendations that are shared with DCBS & KSTEP in-home provider agency and ensures that KSTEP clients will be given top priority in treatment providers Utilization Management process.

• CMHCs will use the KSTEP Services Approval Protocol when clients without Medicaid need services or when their MCO will not authorize or recertify.

KSTEP initial family team meeting (FTM) • Within six (6) working days, but no later than fourteen (14) days of KSTEP referral and acceptance, KSTEP in-home provider will convene a family team meeting (FTM). KSTEP in-home provider will coordinate a date, time, and place for the meeting by obtaining a few possible days/times from family, DCBS, and CMHC (Pathways and Comprehend) and will schedule the meeting with all. DCBS and the substance use treatment provider are to attend the initial and subsequent FTMs. If the referring SSW or CMHC substance use treatment coordinator cannot be at this meeting, they are to find someone else from their agency, such as supervisor or coworker, to represent them in the meeting. KSTEP in-home providers ensure that FTMs are held, at a minimum, every thirty (30) working days thereafter.

Substance disorder assessment/ referrals to treatment, case management, transportation • Early engagement in treatment is crucial to success of KSTEP. • KSTEP in-home providers will be hands on and will provide a warm hand-off to any outside referrals, such as substance use disorder treatment, mental health, or intimate partner violence treatment services. This means the KSTEP in-home provider will take clients to assessments or accompany them. They will also attend any scheduled meetings with treatment providers and maintain regular contact with other

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

providers involved in the case. KSTEP in-home providers will ensure that transportation is not a barrier to services by providing transportation or arranging it for the parent if there is none available. This will be particularly true for initial and follow-up appointments.

However, they will not be expected to provide daily transportation to treatment until the case closes.

They should work with the family on individual and family level plans to ensure that transportation to appointments occurs.

• Medication Assisted Treatment (MAT)-A variety of medications are used to complement substance use treatment for different types of substance use disorders including tobacco, alcohol, and opioids.

MAT increases retention in treatment, decreases illicit opioid use, decreases criminal activities, decreases drug-related HIV and Hepatitis-C, decreases pregnancy related complications, and reduces maternal cravings and fetal exposure to illicit drugs. MAT is designed to stabilize patients and may include provision of medications such as methadone or buprenorphine in conjunction with supportive services such as medical, nursing, psychiatric, counseling, vocational services, peer services, and case management. It is an evidenced based approach with the greatest likelihood of long-term success for opioid addicted patients.

• When using a MAT facility, it must be ensured the MAT facility is willing to honor releases of information and collaborate with DCBS and KSTEP in-home providers. MAT facilities or doctors must not have current disciplinary orders against them.

KYs buprenorphine regulations require regular drug screens, pill counts, and other measures to prevent medication abuse, but contain loopholes doctors can exploit. Patients must participate in “behavioral modification” such as counseling or 12-step programs, however, the rules do not say how often, so it can vary from several times a week to less than once a month. In addition, if patients fail drug screens, it is up to doctors to use “appropriate clinical reasoning” to support changes in treatment such as increased screening or more frequent visits.

KSTEP case plan, family agreement and action plan • The KSTEP in-home provider will utilize Solution Based Casework (SBC) tenets to develop the family agreement (family case plan) within six (6) working days of referral. It will align with the DCBS identified safety concerns and the prevention/safety plan, be

• The DCBS worker will complete their FFPSA Case Plan (DPP-1281) with the family within 10 working days.

• The DCBS social worker completes the DPP-1281; documenting the date of candidacy, candidate, prevention strategy (selected EBP), and the date of the prevention strategy (date of referral approval); and incorporating the objectives of the KSTEP in-home provider case plan into the DCBS case plan.

Core Implementation Practices

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CORE IMPLEMENTATION PRACTICES

Medically Assisted Treatment

solution focused, strengths based, and developed collaboratively with the family. The family agreement will be developed to focus on the overarching goals of the case and will include family and Individual level objectives. Family objectives will be specific to the childcare tasks that are at risk (e.g. supervision, environmental dangers, nutrition, medical care etc.). The individual objectives will be specific to the caretaker patterns of personal behavior that is threatening the ability of the caretakers to ensure the safety and well-being of their children (e.g. criminal behavior, anger management, substance abuse, emotional stability, and sexual behavior). The KSTEP in-home provider completes the family agreement and provides a copy is to the SSW. The SSW should incorporate the objectives of the KSTEP in-home provider case plan into the DCBS case plan. If there is a concern regarding the appropriateness of the objectives, the SSW should immediately contact the KSTEP in-home provider to share their concerns so both parties can work together to reach a consensus or seek assistance from their respective administrative leadership. Once the family agreement is completed, the KSTEP in-home provider will immediately begin to work with the family on developing an action plan for each identified objective listed in the family agreement. The action plan will also include ways for the KSTEP in-home provider and the family to assess and measure progress in ensuring safety session by session. Specific strategies should be included for documenting and celebrating what the parent is learning in treatment and how they are applying it and practicing it through the week. Tasks on the action plan will change almost every session, as they are small steps that will need to be adjusted and improved as the family is learning how to change their behavior.

The action plan will include the step-by-step actions for all involved parties to take to reach their goals within a specified time, as well as relevant goal tracking criteria.

Challenges and barriers to change are to be expected, however, the KSTEP in-home provider and the SSW will always be tracking the basic safety of the home and be assessing for dynamic changes in the family that threaten the safety of the children.

• The ongoing worker will update the EBPs utilized by the in-home providers as it is communicated to them.

• If needed, the DCBS social worker completes candidacy redetermination via the selection on the Inhome Prevention Case plan, when the need for service extends beyond 12 months.

• The DCBS worker selects the Family First Service end date in TWIST, under Preventative Services and in the In-home Prevention Case Plan when:

CORE IMPLEMENTATION PRACTICES

1. A candidate has entered foster care; or

Family Team Meetings (FTMs) Family Team Meetings should be held monthly. Any other providers serving the family or individuals that the family identifies as support systems, will also be invited to join FTMs by the KSTEP in-home provider. The substance use treatment provider coordinator is also required to attend the FTM.

2. The family has successfully completed services; or

• The family agreement completed by the KSTEP in-home provider & the family will serve as the first FTM form.

3. The family’s services were terminated unsuccessfully.

• The second FTM should also serve as case planning meeting for DCBS.

KSTEP and DCBS communication and information sharing • Open Cases- As long as the KSTEP case remains open, the SSW will maintain communication with the KSTEP in-home provider agency, share pertinent information, and participate in meetings including a monthly joint meeting (FTM) or phone conferences to receive updated reports and information.

• When a DCBS case is transferred from investigation to ongoing, either the investigative or the ongoing SSW will notify the KSTEP in-home provider agency.

If possible, both SSWs will participate in the first FTM after an ongoing SSW is assigned.

• The KSTEP in-home provider agency will schedule subsequent FTMs a minimum of every thirty (30) days following the initial FTM and will provide the SSW, substance use treatment provider, and other involved services providers no less than seven (7) days’ notice to attend each FTM held on an open case. When not feasible to provide 7 days-notice, the KSTEP in-home provider agency will notify the SSW and treatment provider as soon as possible.

• The SSW will notify the KSTEP in-home provider as soon as possible if a court petition is filed involving a family receiving KSTEP services. The KSTEP in-home provider and substance treatment KSTEP coordinator will make court appearances as requested.

• Closed Cases- Consistent with DCBS policy, after risk is reduced, DCBS may decide to close the DCBS case. When this occurs, they will notify the KSTEP inhome provider who will also close the KSTEP case at that time.

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• Additional FTMs are to be held as needed for crises such as relapse, changes in treatment, and placement moves, and within thirty (30) days of referral closure.

• DCBS is not precluded from holding additional FTMs; however, if DCBS does convene an FTM, the KSTEP in-home provider and substance use treatment providers should be invited.

FTMs should be held in a location which will elicit a productive meeting. For example, FTMs should not be held in a chaotic home or where space will not accommodate all in attendance, as neither will heed a productive meeting. FTMs should be held in a location which will remove any barriers to the family’s attendance or engagement in the meeting. For example, if the family has arranged transportation to an appointment with the CMHC on the day of the meeting, it would be most appropriate for the CMHC to host the meeting, as this would eliminate any transportation barriers the family may be facing.

Drug/Toxicology Testing Schedule for Parents/Caregivers KSTEP Phase

Frequency

Type

Phase One Phase Two Phase Three Phase Four

weekly weekly Twice monthly monthly

random random random random

Drug testing can be requested more frequently at the discretion of the KSTEP in-home provider, DCBS, and substance treatment providers. This should occur through collaboration and consultation between all service providers and DCBS.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Family Assessment Comprehensive assessment of the family will be conducted using standardized assessment tools including the North Carolina Family Assessment Scale (NCFAS), Addiction Severity Index (ASI), and the Parenting Stress Index (PSI): • The KSTEP in-home provider agency will complete the NCFAS within fourteen (14) working days of receipt of referral.

• Administration of the NCFAS is required prior to closure of the KSTEP case.

• The KSTEP in-home provider agency will complete ASI within fourteen (14) working days of receipt of referral.

• Completion of the ASI is required again at 4 months and at closure of the KSTEP case.

• The KSTEP in-home provider agency will complete the PSI within fourteen (14) working days of receipt of the referral, with scoring based on family’s initial status. For infants not in the care of the parent, not being cared for by a parent in the hospital, or for an infant under 1 month of age, the in-home provider agency will administer the PSI at the 4-month mark for the first time/baseline. For an infant/child in a temporary placement and over 1 month old, the in-home provider agency will administer the PSI to the parents within 14 days of receipt of the referral.

For an infant over 1 month old, in the hospital being cared for by the parents, the in-home provider agency will administer the PSI to the parents, within 14 days of receipt of the referral. For an infant/child in a longer-term placement and over 1 month old, the in-home provider agency will administer the PSI to the parents’, contingent on the amount of care they are providing the infant/child.

• Completion of the PSI is required again at 4 months and at closure of the KSTEP case.

Process for Closure of Referral by KSTEP In-Home Provider As part of any planned case closure, the KSTEP in-home provider creates an aftercare plan and makes referrals to any recommended services or resources in the plan.

• The KSTEP in-home provider will provide 30 days advanced notice of any planned service closure to DCBS. • The family may continue in the KSTEP program when children are placed in OOHC, to expedite their return, however, they are no longer eligible for Family First Preventative Services payment/claiming.

• Reasons for closure can include, but are not limited to a family moving to a county outside of the KSTEP in-home provider’s service area, or a family becoming unresponsive to the KSTEP in-home provider agency’s contact attempts for thirty (30) days or more.

Prior to any closure for unresponsiveness, the KSTEP in-home provider and SSW will exhaust alternate strategies for engaging the family, including court involvement. These will be outlined in the weekly progress report

Children in KSTEP Cases Moving to OOHC, Relative or Fictive Kin Placement If any/all children in the home are removed, placed in foster care, with relatives or fictive kin through a change of custody or temporarily through a prevention plan, the KSTEP in-home provider will continue to work with the family in an attempt to facilitate reunification more quickly.

• Provider visits with children in OOHC, relative, or fictive kin placement • At a MINIMUM should occur once every month • Should occur more frequently if the children remain in their county of residence • Should occur more frequently if clinically indicated • Efforts should be made to complete joint visits with the parent and child together, such as when the parent is visiting, etc. to assess, identify and provide for any parenting needs, family functioning needs, etc.

• The KSTEP in-home provider can supervise and facilitate parental visitation

Core Implementation Practices

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CORE IMPLEMENTATION PRACTICES

• Administration of the NCFAS is required again at three (3) months if the referral remains open and every three (3) months thereafter.

• The KSTEP in-home provider schedules an FTM with the family, the SSW, and all involved treatment providers. The SSW attends, reviews the plan, and coordinates the content with any aftercare plan that DCBS may create. If possible, the KSTEP inhome provider and DCBS SSW create a single, comprehensive aftercare plan.

Program Implementation Identification of Pilot Site(s)

PROGRAM IMPLEMENTATION

KSTEP was implemented in the Northeastern service region of due to its capability for implementing various interventions through the strengths of the region’s leadership, comparatively stable workforce, but also due to service array need. The area is not in proximity to more resource rich, urban areas of the state. In the past, Child and Family Service Review (CFSR) results and internal CQI process identified areas of the state that were not urban had fewer trained clinical professionals with the training necessary to service child welfare cases where substance abuse is a feature.

Between August 2015 and September 2016, 72 percent (695) of DCBS cases involving youth under the age of 10 who had a substantiated or services needed finding indicated the presence of substance abuse as a contributing risk factor. Figure 4 below illustrates the number of children that met the target population for KSTEP between March 2015 and February 2016 by county across the Northeastern service region.

Children Under 10yo in Substantiated/ Services Needed Cases with Substance Abuse as a Risk Factor 364 201

Mason 164

Rowan

152

Carter

127

Greenup

115

Lawrence 74

Bath Fleming

67

Lewis

63

Morgan

58

Bracken

40

Elliott

34

Menifee Robertson

25 13 Source(s): TWS-272

24

Children Under 10yo in Substantiated/ Services Needed Cases with Substance Abuse as a Risk Factor 64

Boyd 34

Mason 22

Rowan 17

Carter 13

Greenup

10

Montgomery

6

Bath

5

Fleming

4

Lewis

1

Morgan

1

Bracken

0

Elliott

0

Menifee

0

Robertson

0

Source(s): TWS-272

Needs of Target Population

103

Montgomery

KSTEP Target Population and Out of Home Care by Northeastern Region County

Lawrence

KSTEP Target Population by Northeastern Region County

Boyd

Furthermore, substance abuse was a major contributing factor in OOHC in the Northeastern service region as well as across the state. Figure 5 illustrates the number of children that required out of home placement for children under the age of 10 where substance abuse was a contributing risk factor.

The target population described above experiences a variety of negative psychosocial and environmental stressors including poverty, substance abuse, caretaker physical or psychological instability, and other stressors.

Figure 6 displays the most frequent family issues reported in cases marked substantiated or services needed for cases involving children less than ten years of age. Families often experience more than one of these issues simultaneously.

Figure 6 also reflects the significant increase in these family issues in cases where OOHC was determined necessary, especially when they occurred with substance abuse as a risk factor that contributed to maltreatment.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Types of Maltreatment Children Under 10yo in Substantiated / Services Needed Reports Physical– Assault/Injury

55.8% 44.2%

Medical Neglect

54.8% 45.2%

Exploitation

50.0% 50.0%

Supervision

44.7% 55.3% 42.6%

Sexual Abuse

57.4%

Environment

30.0%

Risk of Harm – Neglect

29.8%

Basic Neglect

69.0%

Carter

39

Greenup

22

Mason

31

Rowan

28

Total

120

Remaining 11 Northeastern Region Counties

220

Total

340

Staffing KSTEP

70.0% 70.2% 14.3% 85.7% SA not Risk Factor

Jan. 1, 2017 – Jan. 1, 2018 Year 1

SA Risk Factor Source(s): TWS-272

The specific types of maltreatment children in the target population experience are indicative of the complex experiences of families that struggle with poverty, substance abuse, family violence, mental health problems, and other traumatic stressors.

Securing and Developing Support for KSTEP The KSTEP workgroup identified the steps necessary to determine the capacity for delivery of EBPs and promising research practices that meet target population needs in the community, as well as opportunities to expand capacity through additional training. The KSTEP workgroup held meetings in the region and counties to promote KSTEP services and engage stakeholders, and to complete a statewide provider capacity survey to determine capacity and interest in providing EBPs. After reviewing the data with the project steering committee, meeting with regional department staff in the Northeastern Service Region, consulting with representatives from START and Public Consulting Group (PCG), and reviewing community mental health provider proposals and provider capacity, the state chose the following counties for the pilot: Carter, Greenup, Mason, and Rowan counties.

Competent staff with the knowledge, skills, attitudes as well as necessary resources to perform their job functions are critical to the success of any program. The KSTEP model uses a combination of in house (internal DCBS employees) and contracted provider resources (in-home services and behavioral health services) to deliver services to families.

Once a family is referred and accepted to the KSTEP program (has been determined to meet program criteria), services are delivered to families through a collaboration between DCBS, private providers of in-home services, and behavioral health treatment agencies. Each family is assigned an ongoing DCBS caseworker and an in-home services case manager who work together and in partnership with the family to assess, make appropriate referrals, coordinate services, and provide appropriate services (e.g., EBPs). The following tables demonstrate the key personnel involved in the delivery of KSTEP services, required qualifications for the positions, roles/responsibilities and the training necessary to perform job duties.

Program Implementation

25

PROGRAM IMPLEMENTATION

Emotional Injury

31.0%

Estimated Number of Children Served by KSTEP

DCBS Personnel DCBS POSITION

EDUCATION/ EXPERIENCE

ROLES/RESPONSIBILITIES

TRAINING

DCBS Investigative Worker

Graduate of a college or university with a bachelor’s degree in social work, sociology, psychology, marriage and family therapy or a related field.

1. Investigate allegations of child abuse, neglect, and/ or dependency.

• Academy training-includes intake, assessment, court, case planning, and sexual abuse training

2. Assesses child safety and risk and then makes appropriate safety plans.

PROGRAM IMPLEMENTATION

3. Makes KSTEP referral and sends required documents to the in home provider

DCBS Ongoing Worker

DCBS Supervisor (FSOS)

Graduate of a college or university with a bachelor’s degree in social work, sociology, psychology, marriage and family therapy or a related field.

Four-year degree, 2 yrs. related experience

• Solution Based Casework Overview

4. Attends FTMS and reviews weekly updates before the case moves to ongoing

• Basic Motivational Interviewing-recommended

1. Reviews weekly updates from in home provider and makes case decisions accordingly.

• Academy training-includes intake, assessment, court, case planning, and sexual abuse training

2. Assesses child safety and adjusts child placement accordingly.

• KSTEP Web-Based Training onsite follow up training with program lead

3. Attends monthly FTMs. Attends home visits with the in home providers, when possible

• Solution Based Casework Overview

1. Reviews weekly updates from in home provider

• Academy training-includes intake, assessment, court, case planning, and sexual abuse training

2. Providers case consults with the investigative and ongoing worker for case decision making consults with worker regarding risk and safety issues, if they can be mitigated and if the family/child meets criteria for KSTEP 3. Attends FTMs, when possible 4. Attends bimonthly Direct Line

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• KSTEP Web-Based Training onsite follow up training with program lead

• Basic Motivational Interviewing-recommended

• Supervisory and Personnel training • KSTEP Web-Based Training onsite follow up training with program lead • Solution Based Casework Overview • Basic Motivational Interviewing-recommended

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

In Home Provider Personnel IN-HOME PROVIDER POSITION

EDUCATION/ EXPERIENCE ROLES/RESPONSIBILITIES

Clinical Staff/Therapist

Graduate of a college or university with a master’s degree in social work, counseling, or psychology.

Maintain all required licensure (LCCC, LPCA, MSW

Graduate of a college or university with a bachelor’s degree in social work, counseling, or psychology.

• KSTEP Web Based Training • Solution Based Casework • Basic Motivational Interviewing

2. Provides Therapy and other clinical services

• Advanced Motivational InterviewingRecommended

3. Provides Evidence Based Practices to clients.

• Cognitive Behavioral Therapy Training

4. Completes NCFAS and PSI to determine family functioning and assess further recommendations

• PCIT- Optional

1. Provides in home case management – Main point of contact for family

• KSTEP Web Based Training

2. Assists in the removal of barriers 3. Provides weekly update to the social workers and arranges routine and emergency FTMs

• Solution Based Casework • Basic Motivational Interviewing • Advanced Motivational InterviewingRecommended • CARES training

4. Provides in home parenting skills to family 5. Completes NCFAS and PSI to determine family functioning and assess further recommendations Supervisor

1. Provides oversight and case consultation 2. Ensures data is entered into the database 3. Organized initial and ongoing trainings for workers

• KSTEP Web Based Training • Solution Based Casework • Basic Motivational Interviewing • Advanced Motivational InterviewingRecommended

Program Implementation

27

PROGRAM IMPLEMENTATION

Case Coordinator/Case Manager

1. Completes initial and ongoing assessments with the family. Completes ASI to determine appropriate referrals based on the level of care

TRAINING

PROGRAM IMPLEMENTATION

Treatment Center Personnel TREATMENT CENTER POSITION

EDUCATION/ EXPERIENCE ROLES/RESPONSIBILITIES

Coordinator

Graduate of a college or university with a master’s degree in social work, counseling, or psychology.

1. Makes initial appointment for CMHC assessment 2. Links client with other needed supports (peer support, self-help meetings, community supports)

TRAINING • KSTEP Web Based Training • Basic Motivational Interviewing • Advanced Motivational InterviewingRecommended

3. Acts as a liaison between the client, in home provider, and therapist to schedule appointments, provide weekly updates, and attend FTMs Therapist

Graduate of a college or university with a Master’s degree in social work, counseling, or psychology.

Maintain all required licensure

1. Completes initial and ongoing assessments to recommend substance abuse or mental health treatment 2. Provides treatment planning recommendations and information in weekly updates to in home provider

• KSTEP Web Based Training • Basic Motivational Interviewing • Advanced Motivational InterviewingRecommended • Behavioral Therapy Training • PCIT- Optional

3. Provides substance abuse treatment including individual therapy and group therapy

KSTEP Training In addition to the KSTEP position education requirements, multiple standardized trainings for staff (DCBS, in-home service providers, treatment providers) are required to prepare employees with the necessary knowledge, skills and attitudes to effectively delivery services. Trainings include: (1) Solution Based Casework Initial Training (private providers), (2) Solution Based Casework for Supervisors (private providers), (3) Solution Based Casework Overview (DCBS staff), (4) Motivational Interviewing: Basic Skills Proficiency, (5) Motivational Interviewing: Core Skills, (6) Motivational Interviewing:

28

Advanced, and (7) KSTEP Overview—Web-Based Training and Face-to-Face follow up (one hour).

Solution Based Casework: Initial (22.5 hours) This training is intended for KSTEP frontline staff, supervisors and managers. This training will focus on the basic concepts of the Solution Based Casework model with some practice on applications to assessment and case planning skills.

Solution Based Casework Overview (3 hours) This training is intended for P&P Staff and will provide an overview on Solution Based Casework.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Solution Based Casework for Supervisors (15 hours)

Kentucky Strengthening Ties and Empowering Parents WBT (1 hour)

This advanced training is intended for KSTEP provider supervisors and their managers and will provide a more in-depth review of the Solution Based Casework practice model concepts. A portion of the training will be spent on issues of coaching and mentoring staff toward implementing the ideas on new and existing cases with a focus on case consultations and concept integration.

This web-based training is intended for DCBS Staff and will include an overview of the KSTEP project and a review of Solution-Based Casework; Stages of Readiness for Change and Motivators for Change; Motivational Interviewing; and Substance Abuse Dynamics and Interventions.

Solution Based Casework: Supervisor Booster (5.5 hours)

During development of the KSTEP, administrators recognized the need for regular communication and collaboration of stakeholders for successful implementation. Modeled after the START program’s collaboration and engagement strategies, KSTEP instituted a series of meetings designed to engage multiple levels of stakeholders. The meetings are regularly occurring and serve a purpose in supporting the KSTEP teams and families with which they work. Regular meeting attendance by members of the evaluation team provides an ongoing platform for reviewing KSTEP program numbers and other process evaluation data with team members, behavioral health providers, and program administrators.

KSTEP Program Meetings MEETING

FREQUENCY

STAKEHOLDERS INVOLVED

PURPOSE/TOPICS/AGENDA ITEMS

KSTEP Direct line meetings

Monthly

All direct line staff (DCBS and KSTEP Providers), supervisors and regional management

Sharing challenges/barriers, brainstorming solutions, sharing what is working well to inform others’ practice, celebrating achievements

KSTEP Workgroup Meetings

Monthly

DCBS DPP leadership (Central Office and Regional), DBHDID Children’s Branch, KSTEP providers (KVC and Ramey), Behavioral Health Providers, Evaluation Team

Guidance on development of model, updates on implementation of KSTEP, proposed solutions to challenges and barriers, and action steps.

KSTEP Case Documentation Contracted providers are required to enter KSTEP case data into a statewide web-based database. Data captured includes family demographics, referral information, intake dates, assessment data (NCFAS, ASI), EBP’s used, dates of Family Team Meetings, child placement information, phase dates, date of case closure, reasons for case closure, use of flexible funding, SACWIS/TWIST case identifies for subsequent matching of data, etc.

Reports are periodically run to identify missing data and are shared with providers.

Contact notes/KSTEP In-Home Providers – KSTEP inhome providers must complete weekly contact notes and these are to be audited randomly by the KSTEP in-home provider supervisor on a monthly basis. These notes should include but not be limited to: safety assessment, family and individual level progress, barriers, and how barriers are being addressed. Notes should also include dates/times of contacts with the family, referrals, and collateral contacts (including drug screens/ treatment progress). The KSTEP in-home provider agency will request monthly written updates on progress from providers (other than the substance use provider)

Program Implementation

29

PROGRAM IMPLEMENTATION

The training is intended for both DCBS and Private Child Care Supervisor and will serve as an opportunity to practice the SBC Case Consultation Process on actual DCBS cases that will be very similar to the referrals that will be part of the KSTEP program. This will include going over in more detail the mentoring role of the Supervisor in the SBC Certification Process. The training will be conducted in a workshop format that will allow ample time for questions and discussion, and a flexible agenda to allow unanticipated topics to be added that the group finds useful.

KSTEP Program Communication and Collaboration

working with child or family, and summarize that information in contact notes.

Additionally, any missed appointment(s) by the parent(s)/ caretaker(s) and/or child(ren) should be documented with reasons for non-attendance. Expenditures of any funds and the amount for the family should also be included in contact notes when they occur. Weekly reports will be due to SSW, their supervisor, and the KSTEP Administrators by noon on Mondays for the previous week. Provider contact notes should be submitted to KSTEP Administrator.

PROGRAM IMPLEMENTATION

Substance use treatment providers are to complete a weekly report that has been provided to them by KSTEP Program Administrator. This report is to be provided to the KSTEP in-home provider (weekly). The report can be submitted in person or electronically.

Adherence to KSTEP Model The required trainings described above provide staff with the necessary knowledge, skills and attitudes to perform their roles and responsibilities according to the KSTEP

30

model. To promote and insure fidelity to the KSTEP model, case reviews of KSTEP cases are conducted by the KSTEP Program Specialist. Cases are randomly pulled by the Program Specialist for review. If the case is still open, the case reviewer attempts to attend a home visit/ Family Team Meeting with the family if appropriate. A KSTEP Case Review Tool is used to gauge whether the KSTEP model is being used to fidelity (e.g., are required timeframes met, are all activities performed. The following are examples of fidelity indicators assessed during the review: • Number of days between referral date and date of first contact • Number of days between referral date and date the InHome Assessment was completed • Are the EBPs selected/used appropriate for assessment findings—identified needs for services?

• Are FTMs occurring?

• Are families meeting KSTEP Phase requirements before moving on to next KSTEP Phase?

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Program Evaluation Evaluation of the KSTEP program serves multiple purposes. First, evaluation efforts guide early decisionmaking through the assessment of agency capacity/ readiness, monitoring of program implementation, and informing program improvements for both interventions.

Second, evaluation efforts examine program effectiveness by defining and measuring anticipated program outcomes specific to KSTEP as well as identifying factors associated with positive outcomes for KSTEP. Lastly, evaluation efforts provide information on program costs and future (long-term) cost avoidance realized through the achievement of anticipated program outcomes.

Hypothesis 1: By increasing services to families experiencing cooccurring child maltreatment and substance abuse through the KSTEP program, children will experience a lower rate of entry into OOHC.

Hypothesis 2: Participation in KSTEP will result in increased family functioning and child and adult well-being.

By decreasing the rate of entry in OOHC through KSTEP, expenditures associated with OOHC will decrease.

Evaluation associated with KSTEP will monitor outcomes in three overarching areas: safety, permanency, and child/adult well-being. These outcomes will be assessed via the collection and rigorous evaluation of primary and secondary data sources, from both the KSTEP and comparison groups.

Process Measures

The structure of the process evaluation, variables assessed, and outputs tracked are intended to provide the necessary information for which stakeholders can make decisions. The process evaluation is designed to provide the necessary data, to the necessary stakeholders, in a usable manner to effectively make decisions for each program’s successful implementation and sustainability.

Through the ongoing engagement and involvement of key stakeholders, incorporation of implementation science principles, and attention to organizational change and development theory, the process evaluation provides insight to the following: • Description of the context (system and organization) in which the interventions are being implemented.

• Operationalize and refine core intervention components and indicators.

• Monitor and report key aspects of the implementation process.

• Monitor and report progress toward the achievement of benchmarks and progress toward achieving anticipated program outcomes.

• Determine the impact of community context, intervention core components and implementation core components on program implementation and outcomes.

THE OUTCOME STUDY KSTEP

The process evaluation for the KSTEP program is informed by research in the areas of empowerment evaluation (Barbee, Christensen, Antle, Wandersman, & Cahn, 2011), Fetterman, Deitz, & Gesundheit, 2010), implementation science (Mowbray, Holter, Teague, & Bybee, 2003; Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005; Durlak & DuPre, 2008; Fixsen, Blasé, Naoom, & Wallace, 2008, Wandersman, Katz & Chien, 2012), and organizational change/development (Glisson & Hemmelgarn, 1998; Glisson & Green, 2010; Aarons, Hurlburt, & Horowitz, 2010).

Evaluation associated with KSTEP monitors outcomes in three overarching areas: safety, permanency, and child/adult well-being. These outcomes are assessed via the collection and rigorous evaluation of primary and secondary data sources, from both the KSTEP and comparison groups.

Accordingly, the process evaluation continues to engage key stakeholders throughout the evaluation process to assess the community context in which Kentucky’s IV-E waiver is implemented, core intervention components (KSTEP and START essential components) and core implementation components (implementation drivers),

The primary, overarching measures that KSTEP seeks to impact are safety, permanency, and child/adult wellbeing. These outcomes are congruent with foci of the CFSR. These outcomes will be assessed via the collection and rigorous evaluation of primary and secondary data sources, from both the KSTEP and comparison groups.

Outcome Measures

Program Evaluation

31

PROGRAM EVALUATION

Hypothesis 3:

and each set of components’ impact on implementation and program outcomes.

For the purpose of this interim report, safety and child/ adult well-being are operationalized in the following ways:

Child Safety

PROGRAM EVALUATION

Several data measures are used to assess safety.

Environmental, Parental Capabilities, and Family Safety domains of the North Carolina Family Assessment Scale (NCFAS; Reed-Ashcraft, Kirk & Fraser, 2001) are analyzed.

Improvements on these domain scores will be deemed as an improvement in familial safety. The NCFAS is administered to families upon entry into KSTEP and upon completion of the eight month KSTEP service period.

Additionally, child domains of Distractibility, Hyperactivity, Adaptability, Reinforces Parent, Demandingness, Mood and Acceptability and parent domains of Competence, Isolation, Attachment, Health, Role Restriction, Depression and Spouse/Parenting Partner Relationship of the Parenting Stress Index (PSI) are also used to assess safety. The PSI is administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period.

Again, improvements on these domain scores will be deemed as an improvement in familial safety.

Lastly, the Addiction Severity Index, Self-Report Form (ASI Self-Report Form; McLellan et al., 1992) is employed as a safety metric. Improvements on this metric will be considered an improvement in familial safety.

Child Well-being KSTEP evaluators also assess child(ren) and adult wellbeing. Child well-being is operationalized using scores on the child well-being domain of the North Carolina Family Assessment Scale (NCFAS; Reed-Ashcraft, Kirk & Fraser, 2001). This measure has been used in a myriad studies and has been observed to have appropriate psychometric properties. The NCFAS is administered at entry into the KSTEP program, and again at the completion of the eight month KSTEP service period.

An increase in child well-being as evidenced by improvements on the child well-being domain score of the NCFAS will be deemed as an improvement.

Adult Well-being Adult well-being will be assessed using three measures.

First, the Environment, Parental Capabilities, Family Interactions, and Family Safety domains of the North Carolina Family Assessment Scale (NCFAS; ReedAshcraft, Kirk & Fraser, 2001) are analyzed. The NCFAS is administered at entry into the KSTEP program, and again at the completion of the eight month KSTEP service period. Improvements on these domain scores will be deemed as an improvement in adult well-being.

32

Second, the Addiction Severity Index, Self-Report Form (ASI Self-Report Form; McLellan et al., 1992) is employed to assess the severity of parental drug and alcohol abuse.

A reduction in addiction severity, as evidenced by this metric, will be deemed an improvement for the purposes of this evaluation. The ASI is administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period.

Third, Parenting Stress Index (PSI), parent domains of Competence, Isolation, Attachment, Health, Role Restriction, Depression, and Spouse/Parenting Partner Relationship are utilized to assess adult well-being. The PSI is administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period. Improvements on these domain scores will be deemed as an improvement in adult well-being.

Data Sources and Collection Procedures To assess the interim program impact of KSTEP, primary data are collected from KSTEP families at a variety of intervals throughout the life of the case. Indubitably, the length of time a case will remain open will vary. The following paragraphs tersely outline what measures will be administered at what interval, and by whom.

The NCFAS will be administered to KSTEP families by the private providers upon entry into KSTEP and upon completion (at the end of eight months). The NCFAS will be administered to KSTEP families by contracted private service providers.

The ASI will be administered to primary caretaking adults (indicating substance misuse) residing in the home at the time the case is accepted to KSTEP. As indicated above, the ASI will be administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period. For KSTEP families, the ASI will be administered by contracted private service providers.

Similar to the ASI, the PSI is administered to all primary caretaking adults residing in the home at the time of the maltreatment report is substantiated. The instrument will be administered at the outset of acceptance in KSTEP, at the end of the fourth month in KSTEP, and at the conclusion of KSTEP services. For KSTEP families, the PSI will be administered by contracted private service providers.

All individuals (i.e., contracted private providers) involved in collecting primary data, no matter the measure, should be trained in appropriate data collection procedures. Data collection occurrences are expected to take between one (1) and two (2) hours. Please note that these times may vary depending on factors such as the size of the family, etc.

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Data Analyses For this interim evaluation, data were analyzed using IBM SPSS software and included exploratory analyses based on the intake test results of various scales and mean comparisons between different administrations of the tests for some KSTEP families (e.g., those with available data). Additional details for each design are provided below.

Safety As indicated, safety was measured by primary data collected from (a) the North Carolina Family Assessment Scale (NCFAS; Reed-Ashcraft, Kirk & Fraser, 2001), (b) the Parenting Stress Index (PSI), and (c) the Addiction Severity Index, Self-Report Form (ASI Self-Report Form; McLellan et al., 1992).

Mean NCFAS scores for pre- and post (e.g., data observation taken at the end of the eight month) were compared for these families using paired samples t test for possible significant differences in the above-listed 3 NCFAS domains.

Secondly, data from the child domains of Distractibility, Hyperactivity, Adaptability, Reinforces Parent, Demandingness, Mood and Acceptability and the parent domains of Competence, Isolation, Attachment, Health, Role Restriction, Depression, and Spouse/ Parenting Partner Relationship on the Parenting Stress Index (PSI) are also analyzed to assess safety. The PSI is administered upon entry into KSTEP and at the completion of the fourth (4) month, and at the conclusion of the eighth month in KSTEP. Lastly, the Addiction Severity Index, Self-Report Form (ASI Self-Report Form; McLellan et al., 1992) is employed as a safety metric. Improvements on this metric (shown as decrease in the domain scores) will be considered an improvement in familial safety.

According to the ASI manual (McLellan et al., 1992), there are two ways to interpret ASI scores for outcome evaluation: objective scores and subjective scores across the 7 ASI domains (including Medical Status, Employment Status, Drug Use, Alcohol Use, Legal Status,

Well-being KSTEP evaluators also assess child(ren) and adult wellbeing. Child well-being is operationalized using scores on the child well-being domain of the North Carolina Family Assessment Scale (NCFAS; Reed-Ashcraft, Kirk & Fraser, 2001). This measure has been used in a myriad studies and has been observed to have appropriate psychometric properties. The NCFAS is administered at entry into the KSTEP program, and again at the completion of the eight month KSTEP service period.

An increase in child well-being as evidenced by improvements on the child well-being domain score of the NCFAS will be deemed as an improvement.

Adult well-being will be assessed using three measures.

First, the Environment, Parental Capabilities, Family Interactions, and Family Safety domains of the North Carolina Family Assessment Scale (NCFAS; ReedAshcraft, Kirk & Fraser, 2001) are analyzed.

Second, the Addiction Severity Index, Self-Report Form (ASI Self-Report Form; McLellan et al., 1992) is employed to assess the severity of parental drug and alcohol abuse.

A reduction in addiction severity, as evidenced by this metric, will be deemed an improvement for the purposes of this evaluation. The ASI is administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period.

Third, Parenting Stress Index (PSI), parent domains of Competence, Isolation, Attachment, Health, Role Restriction, Depression, and Spouse/Parenting Partner Relationship are utilized to assess adult well-being.

The PSI is administered upon entry into KSTEP, four (4) months after entry into KSTEP, and at the conclusion of the eight month KSTEP service period. Improvements on these domain scores will be deemed as an improvement in adult well-being.

Program Evaluation

33

PROGRAM EVALUATION

First, data in the Environmental, Parental Capabilities, and Family Safety domains (score ranges from -3 to 2, where -3 = serious problem, -2 = moderate problem, -1 = mild problem, 0 = baseline/adequate, 1 = mild strength, and 2 = clear strength) of the NCFAS scale were analyzed. Matched NCFAS data (e.g., pre and the conclusion of the eight month) were available for 38 out of 74 KSTEP families.

Family/Social Status, and Psychiatric Status). Objective scores refer to a set of composite scores for each of the 7 domains calculated based on the interviewees’ selfreported data using psychometrically designed formulas, with higher composite scores indicating higher level of addiction severity. Whereas subjective scores are taken from the interviewers’ feedbacks based on their overall personal observation (scores range from 0 to 7, where 0-1 = “No real problem, treatment not indicated”, 2-3 = “Slight problem, treatment probably not necessary”, 4-5 = “Moderate problem, some treatment indicated”, and 6-7 = “Considerable problem, treatment necessary 8-9 Extreme problem, treatment absolutely necessary”) for each of the 7 domains.

Lessons Learned Kentucky learned numerous valuable lessons during implementation of the KSTEP program. Several of these lessons are identified below: • WE LEARNED that interagency competition affects collaboration even for a common goal.

• WE LEARNED that there would be the necessity of adding another (the 4th) phase and that we needed a larger focus on aftercare.

• WE DISCOVERED the necessity of relationships with other outside providers.

• WE LEARNED how difficult and financially burdensome it is to implement new Evidence Based Practices into a program.

• WE LEARNED that we needed to take a more structured approach for data entry with staff. We have had many issues with data not being entered timely, at all, or correctly.

• WE LEARNED that we need early staff training on which referrals meet criteria to avoid ineligible referrals.

LESSONS LEARNED

• THERE WAS A LEARNING CURVE with provider selection and the relationship child welfare has with those providers.

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

References Barth, R.P., Gibbons, C., & Guo, S. (2006). Substance use treatment and the recurrence of maltreatment among caregivers with children living at home: A propensity score analysis. Journal of Substance Abuse Treatment, 30, 93-104.

Lipari, R.N. & Van Horn, S.L. (2017). Children living with parents who have a substance use disorder. The CBHSQ Report, SAMHSA. Retrieved on 1/10/2020 https://www.samhsa.gov/data/sites/default/files/ report_3223/ShortReport-3223.html

United Hospital Fund (2020). The ripple effect: National and state estimates of the U.S. opioid epidemic’s impact on children. Retrieved on 1/15/2020 https:// uhfnyc.org/media/filer_public/6e/80/6e80760f-d57946a3-998d-1aa816ab06f6/uhf_ripple_effect_national_ and_state_estimates_chartbook.pdf Winstanley, E.L. & Stover, A.N. (2019). The impact of the opioid epidemic on children and adolescents. Clinical Therapeutics, 41, 1655-1662.

Peleg-Oren, N., & Teichman, M. (2006). Young children of parents with substance use disorders (SUD): A review of the literature and implications for social work practice. Journal of Social Work Practice in the Addictions, 6(1–2), 49–61.

REFERENCES

References

35

List of Forms FORM 1 Prevention Services Referral (R. 6/19) Prevention Services Referral Form Supervisory Review: Evaluation of Placement Risk:

Imminent Risk

Moderate Risk

Low Risk

FSOS/Chief Signature:

Date:

Date of Referral: Date the child/ren was identified as a candidate for foster care: Does this case have a substantiated or in need of services finding: Yes No If no, will the case have a substantiated or in need of services findings after completion of the ADT: Is this case currently open for ongoing DCBS services: Yes No If no, with the case be opened for ongoing services after completion of the ADT:

Yes

No

Program Desired (SSW/FSOS recommendation): Family Preservation Programs

Intensive Family Preservation Services (IFPS)

Families and Children Safely Together (FACTS)

Family Reunification Services (FRS)

Diversion

Kentucky Strengthening Ties and Empowering Parents (KSTEP)

LIST OF FORMS

Sobriety Treatment and Recovery Team (START)

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Yes

No

FORM 2 DCBS-1A Informed Consent and Release of Information and Records Supplement (R. 6/18) COMMONWEALTH OF KENTUCKY Cabinet for Health and Family Services | Department for Community Based Services INFORMED CONSENT AND RELEASE OF INFORMATION AND RECORDS SUPPLEMENT Name:

SSN:

I authorize the Department for Community Based Services (DCBS) and the following agencies and individuals: Name of Agency or Individual Name of Agency or Individual

To disclose to and communicate to one another the following information and records for: Name:

SSN:

Check Each Category That Applies My name and other personal identifying information Attendance Information about my status as a patient in alcohol or drug treatment Date of discharge and discharge status Information about my status as an HIV or AIDS patient Discharge plan Initial evaluation Employment related information Date of admission Education and training related information Other (specify) Assessment results and history

Summary of treatment plan, progress and compliance I understand that the purpose of these disclosures is to enable the DCBS staff, or staff of another agency authorized to act on the DCBS’ behalf, and the designated agencies and individuals to disclose and receive information and records to and from one another as may be necessary for the purpose of the determination of eligibility for assistance programs and the development and delivery of services.

Notice of Prohibition on Redisclosure: Any consent that I have provided for the disclosure of my AIDS/HIV information, or information concerning alcohol or drug abuse treatment, is based on a prohibition of redisclosure. The designated individual or agency that receives my information regarding HIV or AIDS or alcohol or drug abuse treatment information shall not make any further disclosure of such information without my specific written consent, or as otherwise permitted by state law or 42 CFR Part 2. A general authorization for the release of medical or other information is not sufficient for this purpose.

Signature: Client

Date:

Parent

Legal Guardian

Other person authorized to sign in lieu of client (specify) Witness Signature:

Date:

DCBS worker (specify program area) Other agency staff (specify)

List of Forms

37

LIST OF FORMS

I understand that: • This authorization will in effect for a period of (not to exceed 12 months) from the signature date.

• I may revoke this consent at any time in writing unless action has already been taken based on my consent.

• DCBS will not condition treatment, payment, enrollment or eligibility for benefits on receipt of this form. Signing this form is voluntary, but failing to sign it, or revoking it before the necessary information is obtained, could prevent an accurate or timely response and could result in denial or loss of benefits.

• Information disclosed to DCBS may no longer be protected by the health information privacy provisions of 45 CFR Parts 160 and 164 pursuant to the Health Insurance Portability and Accountability Act (HIPAA).

• Information may be redisclosed by DCBS without my consent if authorized by State Law or Federal Laws such as the Privacy Act or 42 CFR Part 2 or to comply with laws regarding mandatory reporting of suspected abuse, neglect or exploitation, or assessment that there is a danger of serious harm to self or others.

• I have received a copy of this form. I may also request a copy of the information retained with it.

FORM 3 DCBS-1 Informed Consent and Release of Information and Records (R. 6/18) COMMONWEALTH OF KENTUCKY Cabinet for Health and Family Services | Department for Community Based Services INFORMED CONSENT AND RELEASE OF INFORMATION AND RECORDS

LIST OF FORMS

Name: SSN:

I understand to help my family and I get the services we need, the Department of Community Based Services (DCBS) and other agency staff persons may need to share information and records in order to provide or verify eligibility for these services. By signing this form, I give DCBS staff or staff of another agency, authorized to act on behalf of DCBS, permission to get any information needed to see if I am eligible for any assistance program. I also give permission for DCBS and the following agencies or persons listed below to share information and records with one another about services, benefits or treatment provided to me and my family: Name of Agency or Individual Name of Agency or Individual Name of Agency or Individual

My consent includes the following information and records (Check each item that you consent to): Medical and Physical Health Records (not HIV or AIDS) Homeless Shelter Records Behavioral Health and Psychiatric Records (not Drug or Court Records Alcohol Abuse Patient Records or Psychotherapy Notes) Housing Records Residential Records Psychosocial History Psychological Test Results Child Support/Spousal Support Records Child Care Records Food Stamp Records Student School Records K-TAP Records Long-term Facility and Alternate Care Records Medicaid Records Statement of Legal Status and Custody Child Protective Services Records Home Care and Home Health Records Adult Protective Services Records Spouse Abuse and Rape Crisis Center Records Financial Records Senior Program Provider Records Other (specify) This consent applies to the following members of my family for whom I have the legal authority to consent: Member Name SSN Relationship Member Name SSN Relationship

– –

– –

– –

– –

– –

– –

– –

– – I understand that: • This authorization will in effect for a period of (not to exceed 12 months) from the signature date.

• I may revoke this consent at any time in writing unless action has already been taken based on my consent.

• DCBS will not condition treatment, payment, enrollment or eligibility for benefits on receipt of this form. Signing this form is voluntary, but failing to sign it, or revoking it before the necessary information is obtained, could prevent an accurate or timely response and could result in denial or loss of benefits.

• Information may be disclosed with the other DCBS Divisions to assist in obtaining the requested services.

• Information disclosed to DCBS may no longer be protected by the health information privacy provisions of 45 CFR Parts 160 and 164 pursuant to the Health Insurance Portability and Accountability Act (HIPAA).

• Information may be redisclosed by DCBS without my consent if authorized by State Law or Federal Laws such as the Privacy Act or 42 CFR Part 2 or to comply with laws regarding mandatory reporting of suspected abuse, neglect or exploitation, or assessment that there is a danger of serious harm to self or others.

• I have received a copy of this form. I may also request a copy of the information retained with it.

Signature: Date:

Client Parent Legal Guardian Other (specify) Signature: Date:

Client Parent Spouse Legal Guardian Other (specify) Witness Signature: Date:

DCBS worker (specify program area) Other agency staff (specify)

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

FORM 4 DPP-1281 Family Case Plan (R. 9/19 | 922 KAR 1:140) CASE PLAN Case Name:

Case Open Date:

Case Number:

Tranferred for Ongoing Service:

Case Plan Type:

CPS APS Out of Home Care

(All sections must accompany OOHC case plan)

Case Plan Conference Date:

Next Case Plan Due:

Case Plan Modified Date:

Modified Reason:

Prevention Services: Is this a Family First Prevention Services Act (FFPSA) case plan?

Yes

No

Prevention Services QRTP (Qualified Residential Treatment Program)

List of Family First Prevention Candidates: Candidates for Foster Care

Date Identified as Candidate

Date Candidacy What is Family’s Ended Prevention Strategy?

Date of Child’s Prevention Strategy

Candidacy will continue beyond 12 months of the original determination:

Yes

No

Family/Household Members Name

Age

Absent Parent

Address

Relationships Name

Relationship

Related to Whom?

Assessment for which the Case Plan is based: Intake ID

Date Created

Date Approved Outcome

Status

Results

LIST OF FORMS

Reason for Case Plan

What broke down in the family that led to abuse/neglect?

What is the overall goal of services to the family?

List of Forms

39

CASE PLAN EVALUATION *For Case Plan Evaluation Only 1. Family/Parents (Family Level Objectives

2. Individual (Individual Level Objectives)

LIST OF FORMS

3. Achieved: Yes

No

4. Date Achieved: ( / /____ )

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

FAMILY LEVEL OBJECTIVES – PRIMARY Name: Objectives:

Tasks:

Task to begin:

Status:

Objectives:

Tasks:

LIST OF FORMS

Task to begin:

Status:

List of Forms

41

FAMILY LEVEL OBJECTIVES – SECONDARY Name: Objectives:

Tasks:

Task to begin:

Status:

Objectives:

Tasks:

LIST OF FORMS

Task to begin:

42

Status:

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

INDIVIDUAL LEVEL OBJECTIVES Name: Objectives:

Tasks:

Task to begin:

Status:

Objectives:

Tasks:

LIST OF FORMS

Task to begin:

Status:

List of Forms

43

INDIVIDUAL LEVEL OBJECTIVES Name: Objectives:

Tasks:

Task to begin:

Status:

Objectives:

Tasks:

LIST OF FORMS

Task to begin:

44

Status:

Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

OUT OF HOME CARE SECTION Child/Youth Information *For children in out of home care Child/Youth Name: Specialized population: Permanency Goal: Reason for Permanency Goal:

Has the child been in out of home care 15 months out of the last 48 months?

Has a petition for termination of parental rights been filed?

Yes

Yes

No

No

If no, please explain: Date of Commitment

Birth Date

County with Case Responsibility

County of Custody/ Commitment

Date Parents were Notified of Removal

Permanency Hearing Due Date

Date of next court review: Date child/youth will have been in OOHC 15 of the most recent 48 months: If this is an initial plan, describe services offered and provided to prevent placement:

Qualified Residential Treatment Program (QRTP) placement during case plan period Placement Name

Date Entered placement

Date Moved from Placement

QRTP assessment is non-applicable If the child is placed in a QRTP indicate whether the following circumstances exist: All permanency team members were invited to the case planning conference.

Yes No Meetings of the family and permanency team, including meetings relating to the assessment were held at a time convenient for the family.

Yes No The family and permanency team had input into the QRTP assessment.

Yes No

LIST OF FORMS

There is a court determination that sibling separation is in the best interest of the child/ren.

Yes No NA, The child has no siblings.

The placement preferences of the family and permanency team related to the QRTP assessment were taken into consideration.

Yes No If no, document why the preferences of the team and/or of the child were not recommended:

List of Forms

45

QRTP Short and Long-term Mental and Behavioral Health Goals for Child: (Import from CRP Module) - SSW will use as a guide for Child/Youth Action Plan Beyond commitment custody, are there other judicial orders made with respect to the child/youth?

Yes No N/A (This includes court ordered visitation, parent or child counseling or other orders of the court.) If yes, explain:

Is concurrent planning appropriate? Yes

No

Have basic living skills and vocational or job preparation services been addressed for youth 16 or older on the child/ youth plan? Yes No

Permanency Goal for This Child/Youth

Reason for selection of this goal: Goals other than “Return to Parent” must include documentation, on the Child/Youth Action Plan, of the steps the agency is taking to find an adoptive family or other permanent living arrangement for the child.

N/A

Applicable

Current Placement Information Placement Type: Current County of Placement:

Date of Current Placement: [ / / ]

Is this placement the least restrictive?

Yes

No

Is this child/youth placed in the parent’s county of residence?

Yes

No

N/A

Is child/youth placed in same school district as prior to placement or since the last review?

Is the Placement Log attached to the Court’s copy?

Date Entered Resource

Date Moved From Resource

Yes

Yes

No

No

Date Exited Out of Home Care Resource

Approval Status

If the answer to any of the four previous questions is no, provide justification:

LIST OF FORMS

What steps address the safety and the appropriateness of this placement for the child/youth?

Placement factors not met:

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Provide justification for the placement factors not met:

Placement comments:

Reason for continued placement:

Child/Youth Health Status Attach a copy of the child’s/youth’s most recent immunization record to the case plan.

Has the child/youth’s Medical Passport been reviewed and up to date in connection with this conference? Yes

No

If no, explain: Record the discussion of the child’s/youth’s physical and mental health status, including medications. Beyond “Normal and Routine Medical Care,” identified needs must be addressed in the Child/Youth Action Plan.

Child’s/youth’s primary physician: Address:

Date the child’s/youth’s next comprehensive health examination is due: [ / / ] Mental/Physical Health Objective

Objective/Tasks to be Accomplished

Start Date

Status/Update

List of Forms

LIST OF FORMS

47

Education Status What is child’s current grade level? [ ] Is this level appropriate?

Yes

No

Name and address of school child/youth attends:

Provide history of the child’s/youth’s educational problems or needs:

List the child’s/youth’s assessed educational needs. Identified needs must be addressed on the Child/Youth Action Plan.

Educational Objective

Objective/Tasks to be Accomplished

Start Date

Status/Update

Independent Living/Court Orders Objective and Tasks Independent Living or Court Order

Objective/Tasks to be Accomplished

Start Date

Status/Update

LIST OF FORMS

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

CHILD/YOUTH ACTION PLAN Permanency Goal:

The child’s/youth’s health, educational, personal, social, and developmental needs must be assessed. Written objectives/tasks must include: • Each need identified in the risk assessment; • Basic living skills and vocational/job preparation for youth 16 and older; and • Steps the agency is taking to find an adoptive family or other permanent living arrangement if the child’s permanency goal is NOT “Return to Parent” Name: Objectives:

Tasks:

Objectives:

LIST OF FORMS

Tasks:

List of Forms

49

Objectives:

Tasks:

Objectives:

Tasks:

Objectives:

LIST OF FORMS

Tasks:

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

VISITATION AGREEMENT *Completed for each child in OOHC Child/Youth Name: Period plan is in effect: [ / / ] to [ / / ]

VISITOR Date/Frequency

Times

Transported To/ From By

Location

Supervised By

Comments:

SIBLING VISITATION: Special requests for visitation will be made at least [ ] in advance of the date.

A change in a scheduled visit should be made with at least [ ] notice to parties involved.

LIST OF FORMS

DCBS staff may be contacted at the following phone number: Signatures:

Date:

Date:

Date:

Date:

List of Forms

51

OOHC CASE PLAN EVALUATION A summary of progress must be included in the case plan.

This summary should be based on documentation in the assessment and case record.

1. Family/Parents (Family Level Objectives)

2. Individual (Individual Level Objectives)

3. Child/Youth/Children (Child/Youth Action Plan)

4. Parent and Child/Youth Visitation

If changes were made affecting visitation rights, were parents notified?

Yes, Date: [ / / ]

No

No changes

If no, explain: 5. State reasons for continued placement

6. Sibling Separation: Yes

No

Date of sibling separation:

LIST OF FORMS

Date sibling separation was approved: Consideration of sibling relationships (i.e. family treatment, visitation, etc.)

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

RIGHTS AND RESPONSIBILITIES OF PARENTS 1. To provide for and to consent to your child’s medical care.

2. To maintain contact with your child.

3. To be informed in advance of changes in your child’s placement whenever possible.

4. To be informed of actions initiated by the Cabinet in the courts which could result in a change in your child’s legal status.

5. To determine religious affiliation.

6. To be advised of and to participate in all case planning conferences and periodic or court reviews.

7. To be offered services that will help bring your child(ren) home again.

8. To file a formal complaint using the Department’s service or civil rights complaint procedures if you feel your rights have been violated.

9. To be provided the protection of confidentiality as provided by KRS 61.878 and KRS 620.050.

10. To receive a copy of court records, case plan and review (DPP-1281), or court review documents bearing on your child’s status or the services provided to them.

11. To financially support your child in accordance with your ability to do so.

12. To keep the Department advised of your whereabouts.

13. To maintain your parental role through various activities.

14. Stay informed about your child(ren)’s health, development, and progress in school.

15. Receive fair treatment regardless of race, culture, gender, or religion.

These are rights and responsibilities of all parents for whose children the Cabinet has legal responsibility. There may be instances when your child’s health or well-being is endangered and the Cabinet or the court would have to assume the responsibilities.

LIST OF FORMS

List of Forms

53

RIGHTS OF THE CHILD A child who is placed in foster care shall be considered a primary partner and member of a professional team. A foster child, as the most integral part of the professional team, shall have the following rights as established in KRS 620: 1. The right to adequate food, clothing, and shelter.

2. The right to be free from physical, sexual or emotional injury, or exploitation.

3. The right to develop physically, mentally, and emotionally to their potential.

4. The right to educational instruction.

5. The right to a safe, secure, and stable family.

6. The right to have their educational needs met.

7. The right to remain in the same educational setting prior to removal, whenever possible.

8. The right to be placed in the least restrictive setting in close proximity to his/her home that meets his/her needs and serves his/her best interests to the extent that such placement is available.

9. The right to information about the circumstances requiring his/her initial and continued placement.

10. The right to receive notice of, attend, and be consulted in the development of case plans during periodic reviews.

11. The right to receive notice of and participate in court hearings.

12. The right to notice and explanation for changes in placement or visitation agreements.

13. The right to visit the family in the family home, receive visits from family and friends, and have telephone conversations with family members, when not contraindicated by the case plan or court order.

14. The right to participate in social extracurricular, enrichment, cultural and social activities, including sports, field trips, and overnight activities.

15. The right to express opinions on issues concerning his/her care or treatment.

16. Youth 14 and older: The right to designate two additional people to participate in case planning conferences/ periodic reviews, who are not the foster parents or the child’s worker, and who may advocate on the child’s behalf. (The agency may reject an individual with reasonable belief that individual will not act appropriately on the child’s behalf.)

LIST OF FORMS

17. Youth ages 14 and older: The right to receive a written description of the programs and services that will help them prepare for the transition from foster care to successful adulthood.

18. Youth ages 14 and older: To receive a consumer report yearly until discharged from care and to receive assistance in interpreting and resolving any inaccuracies in the report.

19. Youth preparing to exit by reason of attaining 18 years or older are entitled to receive, free of charge: an official birth certificate, a social security card, health insurance information, a copy of their medical records, and a state issued ID.

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

YOUTH SIGNATURE PAGE *This signature sheet shall be completed for in home and OOHC case plans My case plan and my rights were explained to me in an age-appropriate manner. I have received a copy of my case plan, which includes a statement regarding my rights.

Youth Signature

Date

Youth Signature

Date

Youth Signature

Date

Youth Signature

Date

LIST OF FORMS

List of Forms

55

CONFERENCE PARTICIPANTS *To be completed for OOHC Case Plans only (this is not a signature page and can be completed by the DCBS worker).

Child/Youth Name:

LIST OF FORMS

List by name all persons invited to attend:

Received copy OOHC Case Plan Y/N

In Attendance Y/N

Date Notified

1.

Mother

2.

Father

3.

Parent’s Attorney

4.

Child/Youth

5.

Child/Youth

6.

Child/Youth

7.

Child’s/Youth’s Attorney

8.

Care Provider

9.

Objective Third Party (Periodic Review)

10.

County Attorney

11.

CASA

12.

FSOS

13.

SSW

14.

Other Agency Staff

15.

Other

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

OOHC CASE PLAN SIGNATURE PAGE *To be completed for OOHC Case Plans only Additional Copies Sent to: DPP-154 given to client: [ / / ] Copy of case plan given to client: [ / / ] Date Date Next scheduled conference date: [ / / ] Attention Parents: If your child/youth has been removed from your home, it was because the court has determined the risk was too great for the child(ren) to remain there. This case plan is designed to assist in reuniting you with your child/youth. However, failure to progress in this plan may result in termination of your parental rights and permanent placement of your child/youth.

My signature below verifies that I have participated in the case conference; I agree with the plan and I understand my rights and responsibilities as related to this case plan.

I understand that if I am dissatisfied with the action taken in this document, I may, within 30 days from the date of this action, file a written complaint (DPP-154) with the Office of the Ombudsman and Administrative Review, 275 East Main Street, 2E-O Frankfort, Kentucky 40621.

I further understand that the complaint shall be written and that an attorney may represent me.

Comments:

All conference participants should sign this case plan. Anyone declining to sign will be listed as “in attendance only” and noted in the comments section.

Family Member Date Signed

Family Member Date Signed

Social Services Worker Date Signed

Family Services Office Supervisor Date Signed

Date Signed

Date Signed

LIST OF FORMS

Date Signed

Date Signed

Date Signed

List of Forms

57

IN HOME CASE PLAN SIGNATURE PAGE *To be completed for In Home Case Plans only My signature below verifies that I have participated in this case conference. I agree with the plan and I understand my rights and responsibilities as related to this case plan. I also understand that absent effective preventative services, placement in foster care is the planned arrangement for the child(ren). I understand that if I am dissatisfied with the action taken in this document, I may, within thirty (30) days from the date of this notice, file a complaint with the Office of the Ombudsman and Administrative Review, Quality Advancement Branch, 275 East Main Street, 2E-O Frankfort, KY 40621. I further understand that the complaint shall be written and that I may be represented by an attorney.

Comments:

Signatures:

Parent Date Signed

Parent Date Signed

Social Services Worker Date Signed

Family Services Office Supervisor Date Signed

Preventive Services Provider Date Signed

Other Date Signed

Other Date Signed

LIST OF FORMS

Other Date Signed Copy of plan given to client on this date: DPP-154 given to client on this date: Next scheduled conference date:

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Kentucky Strengthening Ties and Empowering Parents (KSTEP) Program Manual

Appendix KSTEP Services Approval Protocol NORTHEASTERN SERVICE REGION Services requiring approval to use KSTEP funds: • All Pathways & Comprehend services for clients without Medicaid • Any Pathways & Comprehend services when the MCO will not authorize or recertify. DCBS will pay during the appeal process to avoid interruption in services for the client.

• Residential services with outside providers (not covered by Medicaid) • Any service denied on peer-to-peer appeal/review by the MCO that your team feels is needed.

• Co-pays, co-insurance, and deductibles for subsequent services.

• Drug testing, if client is not Medicaid eligible.

• Specialized drug tests. * Co-Pays and co-insurance (MCO and private insurance) for assessments will be covered by KSTEP with no approval needed.

4. All requests should copy pertinent parties and all correspondence should be copied to all parties on the email (KSTEP Provider Agency Coordinator, DCBS SRAA, Marrian Mota, Lauren Penrose, Jennifer Topping, Jennifer,Thornhill) Please keep all correspondence on one email chain to avoid confusion (remember to always use reply all).

6. In the official email request, please provide brief case synopsis (both DCBS and behavioral health) and reason for requested service. This should include whether or not the service has been appealed and denied by Medicaid/MCO.

Approval: 1. Approvals will be sent via email to all pertinent parties.

2. Approvals will come from Jennifer Topping, or Jennifer Thornhill.

3. Some scenarios will require a discussion before approval. Jennifer Topping, or Jennifer Thornhill will make themselves available for phone calls as quickly as possible especially in emergency situations.

4. Approvals/Denials will all be documented in a master log and compared to the invoice and supporting documentation submitted by the provider each month.

Request: 1. Provider and DCBS must be in agreement about the plan before request is made. Feel free to ask for consultation before making official request.

2. Request should be made via email to Jennifer Topping CC: Jennifer Thornhill .

3. Subject line of email should include the client’s first name, last initial. If urgent, please use the red exclamation point option and you can also text Jennifer Topping or Jennifer Thornhill to notify us of the email. Jennifer Topping’s cell phone number is 859-213-1646.

59

APPENDIX

Appendix