Taking a Hard Look at Fixing the Budget

My friend, Charlie, said that he does not think we should give the government more money to solve the budget crisis. He sees raising taxes or throwing money at the problem is the easy solution. I was in an intense discussion with him about what California’s leadership was doing, pointing out that the politicians did not want to raise taxes on those who could best afford it, but instead they “taxed” those who could least afford it by cutting back on the safety net of children, the elderly, the poor, the disabled.

Taxing those vulnerable and who are least able to resist is also “the easy solution.” These individuals are less likely to make the difference in an election and certainly in no position to gather signatures or congregate in protest because they are working too hard to live day to day.

The harder solution would be to look realistically at how much we are being taxed. What is the corporations, businesses and citizens contribution to our tax base? Is it fair, reasonable and equitable? After all, don’t they benefit from the services provided by the state and local government? Is it really out of proportion to the rest of the country? Are we really over taxed for what we get?

What about the waste within our government? I recently wrote about the cost of L.A. County to audit Hillsides’ contract estimated at $200,000 to $250,000 to recoup $37,000 (which we believe is in error). Is there a better, more efficient way to audit? I think so.

How about the number of audits we get from different departments (many times a duplication of what another entity has done), by the state and local governments? We have approximately two audits a month. What about the amount of time and staff it takes to submit an invoice to Los Angeles County?

A business would never stand for this. If I can identify waste in my little corner of business with the County, multiply it by the thousands who do business with the state and local governments. Let’s start at the State and then move to local entities. Do we need all the commissions that we have? Do the legislators need all the staff they have? Are there procedures that could be streamlined or eliminated? I am sure that, taking an honest look, we could preserve the level of services for those vulnerable and still cut costs.

An example of this is our local school district’s new Superintendent reorganized the infrastructure of the district and saved millions of dollars. We should do the same thing across the State and Counties.

But no, the sad thing is our government would rather raise taxes or cut services to those who need them without ever looking at the real culprit.

DCFS Chooses Procedures over Substance

Recently the Department of Children and Family Services has been working on a pilot program to demonstrate that children will fair better if the residential treatment program includes parents in all phases of the child’s experience while in residence. In addition, the residential treatment program will follow the child’s return to the parents. It makes sense: the residential treatment program that knows the child in residence is better equipped to help the parents when the child returns home.

So I was hopeful that when Hillsides wraparound program was referred a child from another residential treatment center that DCFS would be open to and refer this child back to that residential treatment program for the follow up wraparound service. This was in line with this new movement of “the program that has the child in residence is the program that follows him home.”

I was wrong to assume that DCFS would follow sound substance over procedures.

It turned out that DCFS was not used to an agency turning down business in favor of another agency doing it. There was no clear cut procedure, so my attempt to refer the child back to the original agency was bungled and DCFS reaffirmed their decision to have Hillsides do the wraparound service.

Further attempts to get DCFS to “act in the best interest of the child” were ignored, in favor of following the proper procedures. This back and forth took four weeks of negotiations. Hillsides reluctantly opened the case when DCFS refused to reconsider, even though some of their administrators believed that it probably was in the best interest of the child for the other program to provide the wraparound services.

A few months ago, I praised DCFS for doing a study on the re-entry rate of children placed into the community from foster homes, kinship homes and group homes. It was an honest look at their practices and it came out of their concern that their re-entry rate rose from 4% to10% over a three year period. One of the major findings was that “there is a lack of after-care services to provide ongoing formal and informal support.”

What is most troubling about this situation is that, on the heals of releasing this report, the Department is unable to bend over backwards, jump through hoops, do what ever it takes to do what is clearly “in the best interest” of one of their clients.

The Fifth in a Series of Seven Stories

S. A. was first admitted to Hillsides on 2/07/06 and was discharged to his grandmother and legal guardian 8/27/08. S. came to Hillsides after multiple suicide attempts resulting in numerous psychiatric hospitalizations. While living here, program staff had to intervene repeatedly to prevent self-harm. Over time, these crisis contacts developed into healthy, secure relationships, and the self-injurious behavior gradually disappeared.

They received family therapy during his entire stay, Therapeutic Behavior Services from Hillsides upon discharge and Wraparound from another agency. (Therapeutic Behavior Services offer intensive one-on-one services to children whose needs go beyond a weekly therapy session. Trained therapeutic behavior specialists work with a child in school, in the community, and in the home, devising an attainable behavioral goal, and then meeting with the child to assist him or her in developing the skills to reach that goal. ) In spite of everything, he was readmitted 12/24/08. We have reinstituted family therapy with a new focus.

REFLECTION
This was a case in which Hillsides and the County agreed on the plan. The one thing that “may” have made a difference would have been if Hillsides provided the Wraparound services since we had the relationship with the client and the family. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).

CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)

Working Together to Resolve Foster Care Concerns

Some good news has developed as a result of sharing the stories of the children in foster care who have re-entered the system after leaving Hillsides. While I have been concerned and writing about the need for the Los Angeles County Department of Children and Family Services (LA DCFS) to take up the issue of children who are moved into homes and then re-enter the system within six to 12 months, another advocate has been looking at the issue. It turns out that one of the Commissioners from the Los Angeles Commission for Children and Families, Helen Kleinberg, has been concerned about the same issue.

She and selected LA DCFS staff have been involved in taking a sample of some of these re-entering clients, studying the issues and listing the causes (not unlike what I have been doing with the children that we have in our program). They have a laundry list of issues that should be addressed. However, two important conclusions they highlighted was the need for a better discharge planning process to be developed and the need for a better way of engaging support services to the families receiving these children be introduced. These are some of the same issues that I identified in the stories of the children who re-entered the system after leaving Hillsides.

Commissioner Kleinberg and the LA DCFS staff working on this study invited a limited group of providers to look at what had been identified and the areas that we thought they should address. It was a most meaningful discussion and, for the most part, their findings reflected our experience. All participants agreed we needed to address a better process for transitioning the children from foster care and group care into the “family homes.” The meeting ended with suggestions of a few more avenues for collecting data and then a commitment to work on developing systems to increase the probability of a successful transition.

I look forward to future meetings of working together with the Department of Children and Family Services in developing those systems.

The Second in a Series of Seven Stories

A .K. was first admitted to Hillsides on 4/05/06 and was discharged on 6/5/07. When A.K. entered Hillsides, he was morbidly obese, weighing more than 148 pounds. When he was discharged a year later, he had dropped to 122 pounds through a combination of diet and intensive exercise supervised by the nursing and recreation departments. While still overweight, his general health had improved dramatically. Upon his re-entry into Hillsides’ residential program in July of this year, after having been removed, he weighed 226 pounds.

At the time of discharge, A.K. was still not stabilized, although he had been doing better. Hillsides’ advocates were opposed to the discharge both for his fragility, and also because his mother had barely been released from jail and had not received services to help her deal with this boy. The Los Angeles County’s Department of Children and Family Services made the decision to move him with no input from Hillsides. It wasn’t until Hillsides’ intervention that the County agreed to a post-discharge Team Decision Making meeting (TDM). (A TDM meeting is an opportunity for all interested parties in the life of the foster care child to convene and address his discharge and treatment plan for a successful replacement.)

At that point, Wraparound Services were initiated and provided by Hillsides’ team. A.K. did not do well at home, and his mother was not effective. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes). He was readmitted to Hillsides on 7/22/08.

REFLECTION
1. Have a TDM that would include the mother in the planning process
2. Set up a plan that would insure that she was established back into the community with a job that could support A.K. (the mother and son were homeless when he returned to Hillsides).
3. Provide Wraparound services well in advance of his returning home

CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)