2016 Forensic Forum Group Discussion April 26, PDF

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2016 Forensic Forum Group Discussion April 26, 2016 Day 1 Group Discussion: Question 1: Considering the demographics of your forensically involved population, how do you think your regional center can
2016 Forensic Forum Group Discussion April 26, 2016 Day 1 Group Discussion: Question 1: Considering the demographics of your forensically involved population, how do you think your regional center can best meet their needs? Have crisis beds for short term stays Crisis team where do they go? Shelters are closed forensically involved clients can t go to a licensed facility Having specialized facilities/homes Each regional center should have a forensic specialist and forensic review team WRC- has a database to schedule who s in court, where, charges and hearings NBRC- needs a forensic specialist, has database and calendar of hearings and has staff who remind involved staff to attend court hearings SDRC- has a liaison for sex offenders; has staff member at each office for forensic cases; forensic director position for clients that are incarcerated SGPRC forensic specialist, database overseen by specialist who ensures attendance at hearings, reports, forensic review committee SARC gathering data to have database, wants to develop forensic specialist position IRC- Unit with manager for CPP/forensic cases caseload 60# NLACRC- database, forensic specialist who reviews court reports- drafts from Service Coordinators Centralized information is critical, live database with good communication Need specialized day treatment services for substance abuse issues; dually diagnosed who need medication treatment; domestic abuse issue Rates are too low to attract new service providers; rates are too low for developing individualized services to deal with forensic and substance abuse Existing providers are not willing to do the service Providers often are afraid of these clients Training for providers who do not currently work with developmentally disabled Need to work with other agencies generic resources to be trained on developmental disabilities- other entities want to get the training to serve the developmentally disabled (DD) forensically involved population What do SCs need to better serve forensic clients? o Sensitivity training o Specialized forensic team-dedicated unit o Answering to a program manager and a forensic manager is not functional o RCs need to recognize the elevated risk to the caseload and reimburse accordingly o Dedicated staff establish relationships with other agencies o 1 of 90 clients who is forensic could and will take a lot of time to handle Demographics o 15+ years old; at 8-9 years old seeing red flags o Be aware of all groups that resources are needed for-keep in mind that options are needed for children-enhanced Behavioral Services Homes (EBSH) for kids o EI- service for mental health kids-start early on o 0-5 mental health programs No easy answer to the question; there are rural areas in SARC; problems such as transportation Responding to rate freezes Need immediate stabilization needs/options Programming during the day for clients at risk of elopement Finding employment for high risk clients- SOS or felons Jobs that pay minimum wage Allocating funds to develop the above Finding appropriate placements for difficult to serve clients in areas where there is a lack of housing options Interaction with six county court systems which are all very different. This is a challenge due to distance and urban vs. rural areas Regional center staff are assigned to forensic cases so the criminal justice system gets to know and develops a relationship with staff Consider the development of a forensic specialist position and of a forensic review team; also consider measures to educate the court system about regional center and their services Develop a good relationship with the system; current gap is addressing consumers who have already plead out and then inform the regional center Have a forensic assessment team; jail liaison; court liaison; case management unit that specializes in forensic cases and inter-agency collaboration Collaborative efforts amongst RCs to place sex offenders Enriched rate to accommodate staff qualifications, hours, and lessen turnover All regional centers (RCs)should work the same SRFs/CPP homes for forensic or sex offenders should be exempt from upcoming CMS changes Have a forensic service code or a forensic model like that of the EBSH (facility rate/consumer rate). Same for day programs Strong cross collaborations with Department of Mental Health (DMH) RC training presentations to all psychiatric hospitals in catchment area More education to other agencies Forensic day programs Trainings for providers on mental health /forensic All new inclusive day programs (therapy/vocational) New service codes MARS Group- October 2015 license- possibly a few homes in each area Forensic day program- tri-fold model- recommendations that go in all areas, home, D.P., etc. Rate enhancements for day programs Unfunded mandates are difficult for service providers Where will competency training be conducted outside of jail? Placement where do we place them? (forensically involved consumers) Homes are needed for this population All RCs should have a forensic specialist (not all RCs have one) Specialized caseloads/units Forensic Forensic Advisory Committee- what SC can do- write diversion plans Develop more resources Existing vendors are not trained Lack of knowledge with staff We need expertise in our vendors for drug, alcohol, sex offenders. Even if we have a vendor, they are not being filtered down (the training) to direct care staff, and who is going to fund this? Big question is always funding source having to piece services together; hard to get MH clinicians- this is a scarce resource It would be ideal to have staff trained in sex offender therapy Specialized service codes to be created by DDS? Have mixed rates-pay higher rate when working with a specific type of client More training for SCs the forensic liaison can t possibly be at all court hearings especially for those RCs that cover large service area More day programs for clients who are forensically involved Language issues are big barriers Providers don t have the language capacity Providers want a higher rate for specific language want RC to pay ASL clients are especially challenging Drug and alcohol resources are scarce, court orders RC to find and pay Domestic violence court ordered. SCLARC has a vendor Vendors want supplemental staffing to transport clients to therapy RCs to employ a Forensic Specialist Lack of ethnic diversity Utilize retired law enforcement for care providers? Train case managers Use forensic teams at the regional center For RCEB population, majority are African Americans (90%) Case managers lack of diversity in those who service the population Only one person at the table was a forensic specialist without a caseload The consensus it would be good for RCs to be funded for forensic specialists Hard to find staff to serve: Mexican families, Spanish speaking families Retired law enforcement might be an untapped resource for staff Case managers are inexperienced in court procedures and Penal Code (PC) and Welfare & Institutions Code (WIC) they don t ask for or request documents Having a presence early on in court system would be good Having a forensic team/specialist would be good Develop specialized homes & day programs for sex offenders SCLARC- Specialized ID team; court liaison, LA County Jail law enforcement liaison for developmentally disabled; sheriff department liaison SCLARC formal protocol to be in the specialized services unit. Then the client can be moved out of the unit. An annual training for staff would be excellent TCRC not all RCs have specialized team but it would be beneficial; sound clinical services in the community; good data can be obtained if funded better; We can find out what works and not CVRC RC general counsel/attorney and Appeals Specialist hold legal consultations; create a support system; know the next steps; use specialty to be on the team; LSST Legal Services and Supports Team IRC Forensic Specialist to assist with the cases; consult with legal departments; train the courts, build a rapport Question 2: What additional community resources do you need for those forensically involved? Please list in order of priority. Specialized Day/employment programs People coming out of the DC making money or jobs for dually diagnosed Locked facility, secured perimeter, delayed egress, Community Care Licensing (CCL) approval Better crisis interventions in homes Day program/vocational, tailored services, earn money Better substance abuse programs, inpatient/outpatient specifically for Intellectual Disabilities clients Competency trainers Competency training/assessors Residential programs; day treatment centers; Supported Living Services (SLS) Substance abuse o Education to SCs & service providers- it is an intense service o Educate advocacy organizations o Outpatient treatments o Residential treatment options Sex offender treatment program for both children and adults Risk assessor and on-going treatment (i.e., fire setting) Crisis response Group/individual therapy Have we exhausted our current providers? Substance abuse/drug treatment providers Enhancing Department of Rehabilitation (DOR) and vocational rehabilitation (VR) Housing for women Mental health services Treatment for sex offenders Facilities for registered sex offenders; day services for the hard to serve; Agreement among regional centers and clinicians regarding what is the appropriate type and amount of training. What is required, who is eligible and are there multiple tiers based on types of offenses Mobile competency training or competency training embedded into the day program (braided services) Rates to support the new models of service provision required for the consumers regional centers are serving Consistencies among regional centers on program design components to serve and support individuals with forensic issues Treatment resources that move with the consumer from the Developmental Center (DC) to the community Consider examining models of service in other countries Commitment from DMH to support RCs Crisis response team Vocational programs Training for existing providers Outreach to law enforcement-psych hosp. Training to all levels of law enforcement, not just key personnel Training for parents (how to support your forensically involved child) Forensic model home like EBSH but with forensic focus not behavioral Substance abuse support geared to RC consumers Crisis Intervention team & support services; wrap around services Training for service providers for forensic population Crisis beds with step down Mental Health/psychiatric Employment/jobs for forensic population RC staff that can oversee the forensic cases Day programs with employment component Residential services ILS/SLS with forensic specialty Rent subsidy coming out of jail no SSI in place Transportation getting to and from day program because they can t use public transportation Lack of clinical resources that take Medi-Cal Juvenile forensic clients brand new area for RCs- Porterville not available Specialized training for ILS workers Need competency based training for the staff Low rates don t support the cost of additional training, or for experienced staff Need more delayed egress homes Need day treatment programs, since forensic consumers might not be accepted to the Day programs Eloping and sexual activity behaviors need day programs that collaborate with residential services for population with these issues Work services that can support persons who need delayed egress Develop microenterprise experts to find work opportunities- individualized funding-self determination Residential resources - RFP through Mental Health since MH has the expertise and resources Tap into the providers with RC funding Tap into the expertise Sound recovery model married with ABA Access to IMDs can have good outcomes due to secured setting; amendments needed to AB 1472 CVRC MARS Group Delayed egress, secured perimeter home; CVRC pays for the psychiatrist; dually diagnosed Need more money to attract psychiatrists and psychologists, for example Help the individual to be in their least restrictive environment Design a level of care specific to a consumer Allow services to follow the person without moving, like EBSH but in other models too; do a two-tier model: facility and individual CVRC: vendor as a 4I but pay based on client s level (i.e., 4D and other); this gives RC the flexibility; hard on providers due to various staffing level but providers prefer the full house Non CPP start-up funding is needed; consumers are in the community; hard to entice providers Have dedicated programs for substance abuse Enough money is needed for the individuals that are being deflected People who are forensically involved-things move so much faster- keeping projects in the pipeline Homes are taking too long to license, especially non DC related homes Need to figure out what a can t say no resource would look like System has to be a continuum prisons, secured perimeter, etc. IMD type- professional expertise in a locked setting Competency training continue with the ARCA task force to have training that is consistent Establish a new service for competency training with a good rate; talk with DDS about service code Individualized day services for forensic population, and a carve out in current day programs 7 crisis homes at SDRC currently. Law enforcement takes them to the home Key is diversion instead of going to jail Question 3: What supports or resources to you need to develop these resources? Rate increase, salaries Competency training rate reform Substance abuse program- vendored program, RFP for start-up funds Day program individual, 1:1 supervision, teach vocational skills, M-F availability; Request For Proposal (RFP) for start-up funds-higher rate; employment; clarify different work options Crisis intervention, training for administrators/staff Rates- ongoing market rates-competitive rates Start-up funds Well trained service providers-even licensed Resource developers dedicated to developing these resources Rate increases Qualified providers Training to providers Quality assurance Get rid of median rates Find providers with expertise and infrastructure Better training for service providers Access to funds for housing reallocation Get start-up for projects that aren t tied to CPP Ability to create new service codes and new rate structures that will support the new types of services required Consideration for the consumers in the community with similar service needs as those in the DC Embed flexible programming into the ongoing service so crisis situations can be prevented. Mental health resources should be at the table ad more accessible Ability to develop specialized services. Consider regional center work groups to address topics discussed. For example, the mental health task force group. Also consider representatives from implementation side of services. This could include regional center forensic specialists, case managers, DC liaisons and resource developers Money Commitment from all agencies involved: DDS, RCs, DMH Stop asking RCs to be creative with a dinosaur system Need for qualified providers to develop these resources, Some way to contact experts in the field who may not be already affiliated with RC Training of new/existing providers, changing regulations for residential and day programs Title 17 & 22 Medical professionals experienced with RC consumers RC staff that can oversee the forensic population Clinical staff (i.e., BCBA, Psychiatrist, nurses) Training for service coordinators Funding for all (competitive funding not SMA etc.) More flexible rates Hold licensing accountable Be more creative with service codes More training for service coordinators Training for all courts, group homes Cultural competence trainings Substance abuse; homeless It is hard to find housing/homes for DC movers especially sex offenders Keeping children 200 yards away how to do this? Need to educate judges, DAs as to the actual (limited) resources available Blend funding for shared agency responsible for consumers Bring in experts on how to be an entrepreneurs Find how traditional supports can be used for their creativity and know how (DOR not useful for job development) At the state level, shift funding streams to support creative supports ARCA support of limitations of RCs in some forensic cases where no viable resource especially living arrangement or SLS is available to safely manage cases Question 4: How can you maximize available partner resources {i.e., mental health, Department of Health Care Services (DHCS)} to develop the needed resources? List strategies: Partnership with outside generic resources If a client does not have Medi-Medi, it is a barrier Collaboration between RC and DMH on Mental Health Services Act (MHSA) project Ongoing meetings-regular meetings-stakeholder meetings Utilize partner agencies to provide training for RC vendors Maintain MOUs Increase cross training between agencies Shared funding Grants Trainings with other agencies (i.e., DMH) Cross trainings increased frequency Better understanding of how different systems of care work Make sure liaisons are at an SC level Expand maps/establish maps over CA Courts to follow model of having Mental Health (MH) liaison of social worker (SW) available Recruit physicians and mental health professionals. The exemption to hire and contract state employees Establish better relationships with jail and prison staff. For example, assistance would help with transitioning consumers back into the community Ability to maximize the services that should be available through managed care plans Encouraging managed care to do more single services agreements, allowing them to contract with more professionals/specialists MOU agreed upon by heads of DDS, DMH and to actually follow it and have that information trickle down to all levels of employees DDS to collaborate with DMH, want both departments to work simultaneously with consumers Eliminate problems with Medi-Cal coverage RCs working together to develop shared resources Task force where RC & DCFS are collaborating to develop homes- use this model with DMH DMH (Mental Health); Probation; Courts; Health Care (generic) Law Enforcement Take me home - City of Hemet (Inland RC catchment area and also in Sacramento County in Alta CA RC area); Get Safe (RCOC) cards that law enforcement carry to see signs of our population Maximize DMH training cross training re: our population MOU with all community/county hospital Legislature focusing on DD with mental health for more specific funding Need to develop relationships with partners, work closer with probation Stop hot potato mentality Department of Children and Family Services (DCFS) is especially hard to work with MH is open to collaborate Share resources with agencies There are probation group homes that RCs can t access Communicate with other RCs Forensic specialists (SoCal) meet monthly to share resources, ideas, etc. Need collaboration among all forensic specialists across the state on a regular basis Need to do trainings with law enforcement More mobile crisis vendors Need top down meetings between agencies o RC, Mental Health, Probation/Sheriff, Social Services, Rehabilitation, Health, Housing Authority Working with local law enforcement on training deputies/police on how to recognize DD; how to de-escalate; how to utilize RC mobile crisis teams Doing combined training with local mental health, offer continuing education units (CEUs) Court system may need consequence rather than some solutions which don t work Some other form of DOR Regional center system is voluntary educate the court system on limitations Increase collaboration amongst agencies that work with forensic consumers Watch Code Black documentary about the LA County hospital ER system our system is next Provide more funding for county hospitals Need for top down leadership to create change amongst related age
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