Wraparound Program Audit

Recommendations 8

• R1

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  Status of Compliance with Wraparound Program Requirements Recommendations Summary of Findings: Many of the recommendations from the January 2006 Wraparound (cid:137) program audit pertaining to compliance with Wraparound Program requirements have been implemented or partially implemented. Improvements have been achieved in the areas of management oversight and tracking and reporting of program participants and costs. Audit recommendations still needing to be implemented are management (cid:137) establishment of annual program goals, objectives and operational guidelines and conduct of annual evaluations of program outcomes and cost-effectiveness. The Department of Human Services has not yet conducted its first evaluation of the program yet but is planning to conduct Harvey M. Rose Associates, LLC i Executive Summary one at the conclusion of FY 2006-07 and provide it to the Board of Supervisors in the first quarter of FY 2007-08. As demonstration of the need for program evaluation and Interagency (cid:137) Advisory Council involvement in setting annual goals, objectives and operational guidelines, 25 percent of participants exiting the program in the last year have been placed in group homes and 22 percent left because the family chose to withdraw. Since these two reasons for departure account for nearly half the program exits, they should be analyzed by program staff and used to determine if changes in program protocols are needed or if this is an acceptable rate of program completion given the population served. Graduations from the Wraparound program also need to be more fully (cid:137) defined and reported on so that County managers and the program’s Interagency Advisory Council understand the outcomes of the youths who have participated in the program. 2007 Recommendations The Board of Supervisors should: 1.1 Direct the Interagency Advisory Council to immediately establish measurable Wraparound program goals, objectives and outcome measures and methods for regularly monitoring and evaluating those goals and measures including an assessment of the reduction in number of group home placements resulting from the program, to ensure that is operating effectively and cost efficiently and to be reported annually to the Board of Supervisors. 1.2 Direct the Interagency Advisory Council to conduct some short-term, focused evaluation as soon as possible requiring staff to report on current program outcomes including an analysis of the 43.8 percent graduation rate through January 2007 and to provide details on graduations and other exits by reason such as group home placements, stabilization of family situation, child arrested, child terminated from dependency, etc. 1.3 Direct the Interagency Advisory Council to continue current efforts to measure family satisfaction with the Wraparound program so that these results can be included in annual program evaluation reports, the first of which will be presented to the Board of Supervisors by the Department of Human Services in the first quarter of FY 2007-08. 1.4 Direct the Interagency Advisory Council to identify specific characteristics about the Wraparound program target population for internal management purposes and for inclusion in the first annual evaluation report to be prepared for the Board of Supervisors in the first quarter of FY 2007-08. Harvey M. Rose Associates, LLC ii Executive Summary 1.5 Direct the Interagency Advisory Council to prepare an analysis for the Board of Supervisors regarding why six Wraparound program service allocation slots are sufficient relative to total need of the program’s target population in the County.
• R2

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  Status of Wraparound Program Fiscal Management Recommendations Fiscal management and reporting for the Wraparound program has (cid:137) improved substantially since the January 2006 audit. The Department of Human Services has assumed the fiscal management role for the program and maintains an up to date database of expenditures and revenues and program participants, all of which is reported regularly to the program’s Interagency Advisory Council. All six service allocation slots have been close to full for the first half of FY 2006-07 which maximizes state and County revenue available for the program. Budgeted and actual expenditures and revenues for the current fiscal year appear to be more closely aligned than they were in the years reviewed for the January 2006 audit. The $173,244 in unspent program funds identified in the January 2006 (cid:137) audit is still largely unspent. In fact, the amount has increased to approximately $247,775 due to the collection of subsequent revenues in excess of expenditures and the discovery of approximately $50,000 in previously unreported revenue by the Department of Mental Health. Though protocols are now in place for determining how these surplus funds will be spent, and most of the funds have been committed for contract services, the rate of expenditure for these services has been slow, with only $15,467 of the $247,775 spent. County staff point out that the County contracting process contributes to the time it has taken to expend these funds. Most of the planned uses of program surplus funds are for parent/staff (cid:137) trainings and services such as foster parent respite and transitional housing services that could also be provided directly to program participants if, consistent with the Wraparound program approach, that is what participant teams identified as most beneficial to them. But for the most part the program does not provide services to participants other than those offered by the Department of Mental Health and its contractors. The availability of a broader array of services such as tutoring, job training for youth and parents, substance abuse counseling, private mental health clinicians, parent coaching and others should be made know to program participants rather than only services planned and provided by County officials. Program funding is flexible and can also be used for services provided by other County departments, the private sector or community organizations. 2007 Recommendations Harvey M. Rose Associates, LLC iii Executive Summary The Board of Supervisors should: 2.1 Direct the Interagency Advisory Council to consider using a portion of the surplus program funds available to enhance or replace direct services provided to participants by the Department of Mental Health and their contractors and to report back to the Board of Supervisors a timetable regarding planned expenditure of the surplus funds to ensure that services are provided within the next six months in a way that is most beneficial to youth at risk of group home placement as a first priority, and, second, to children’s services in general. 2.2 To ensure that Wraparound program parameters are clearly communicated to participants, their families and teams, direct the Interagency Advisory Council to include information in the “Family Guide to Wraparound Care in El Dorado County” document that funding is available for emergency support of necessities and for non-County services such as private clinician services, private lessons and fees for clubs and extracurricular programs, if determined to be in the best interests of the child.
• R3

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  Status of Wraparound Program Records Recommendations Accurate staff time records were not in place for a number of the (cid:137) Wraparound program years reviewed for the January 2006 audit, resulting in charges to the program funds that were lower than actual costs. There were no records kept on the basis for which non-revenue generating children were admitted to the program. These records are now being maintained by the Departments of Mental Health and Human Services. The January 2006 audit found that youth participating in the program were (cid:137) not always receiving the clinical mental health services specified in their plans and it was recommended that Wraparound program managers identify program capacity each year to enable the development of realistic service plans. These comparisons are no longer possible as the Department of Mental Health has discontinued specifying hours of services to be provided in their mental health service plans, making it difficult for program managers to determine staff utilization and to assess if more children can be accepted in to the program. The range of services and funding available to children and families (cid:137) participating in the program are not publicly documented. Since a key tenet of the Wraparound approach is for participant teams to determine the services that best meet their needs, written information should be provided to participants in addition to oral representations at team meetings to document the flexibility in types of services and funding that can be made available. 2007 Recommendations 3.1 Direct the Department of Human Services to modify its “Family Guide to Wraparound Care in El Dorado County” and other Wraparound program literature to make clear the wide variety of services available to participants and their Harvey M. Rose Associates, LLC iv Executive Summary families and that it is the family team’s choice, not that of County officials, about who provides needed services. 3.2 Direct the Department of Human Services to prepare a Wraparound program capacity analysis to estimate the level of Wraparound services that can be provided through the program through County, contractor and community-based services providers. 3.3 Direct the Department of Human Services to combine the capacity analysis with the recommended target population analysis to determine if there is a need and opportunity to expand the program to ensure that services are available for and accessible to all County youth at risk of group home placement. Harvey M. Rose Associates, LLC v Executive Summary Feedback from the Departments of Mental Health and Human Services Both the Departments of Mental Health and Human Services reviewed and provided comments and feedback on a draft version of this report. The Department of Mental Health had several comments, corrections and suggestions for changes. The Department of Human Services (DHS) provided a 20 page response with 104 concerns. Some of those concerns were typographical errors, requests for clarifications or other matters that have been addressed in this version of the report. A number were of a broader nature and with which we have some fundamental disagreement, as follows.
• R4

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  2 from the January 2006 audit included a provision that Wraparound program managers should prepare written procedures regarding eligibility and services offered to children receiving services with Wraparound funding but not assigned to service allocation slots. Eligibility criteria and services for these participants is now included in the Wraparound program plan document since there is no distinction made between the two groups according to representatives of the Department of Human Services. What is still needed for participants, whether revenue generating or not, and their family teams is a documented list of services, or examples of services, and service providers available to families participating in the program. As discussed in the previous section, most services now provided to participants, whether in service allocation slots or not, are provided by the Department of Mental Health and its contractors. While these are undoubtedly very valuable services and should be continued as a key part of the program, one of the tenets of the Wraparound program is that the participants and their family teams should be determining the services that will best meet their needs and help them achieve their goals. The Wraparound program tenets should be codified and communicated to participating families in official written program documents such as the County’s new “Family Guide to Wraparound Care in El Dorado County” and examples should be provided of services that could potentially be made available to make it clear that the participants do not have to rely entirely on services provided by the Department of Mental Health or other County departments only. The document currently describes how family needs should be identified in the Wraparound planning process. What could be more clear is that those services or needs can be addressed by County service providers or others and that the decision about how the services are provided is up to the family teams.
• R5

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  Number of psychiatric hospital admissions by Wraparound program participants.
• R6

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  Number of participating families reporting satisfaction with program and services received.
• R7

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  Measures of performance at school such as attendance. These measures would allow the Interagency Advisory Council to better assess the Wraparound program’s overall effectiveness and to assess whether interventions or program changes are needed in terms of staff training, new procedures or other measures to achieve other outcomes. As noted in the discussion of Recommendations 2.3 and 2.4 in the Status of Recommendations table above, state law calls for counties to assess their Wraparound program participating families’ satisfaction with the program as well as the program’s overall accessibility to its target population. The Department of Human Services (DHS) has recently developed a Wraparound program family satisfaction questionnaire that, starting in November 2006, it has been distributing to participant families upon exiting the program asking them to assess program services and staff. As of the writing of this report, only nine families have exited the program and returned a completed questionnaire so it is too early to draw any conclusions about overall family satisfaction with the program and services provided. DHS staff report that it is not always easy to get family members to respond to the questionnaires and to provide honest answers or criticisms to the County when they are in the middle of receiving services. The Department will need to continue to request families’ responses to these questionnaires Harvey M. Rose Associates, LLC 11
• R14

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  Funding is provided for these six slots by the State and County on a formula basis at the same level as would be provided for group home payments for these youth. To the extent the funding provided for these six youths exceeds the actual cost of services provided to them, which so far has always been the case, the remaining funds are used to provide services to other youth at risk of group home placement but whose risk is determined by the County to be not as imminent as those assigned to the six County “slots”. This arrangement, allowed by the State, enables the County to provide Wraparound services to more than the six youth in the County’s designated slots. In fact, there are more youths participating in the program in non-revenue generating slots than in revenue generating slots. In FY 2006-07 through mid-January 2007, there were a total of eight youths assigned to the six service allocation slots and 29 youths had been assigned to non-revenue generating slots. While inclusion of youths other than those eligible for the service allocation slots in the Wraparound program is a good example of the County’s ability to leverage program funding, it raises the question of the adequacy of the number of County service allocation slots since some of non-revenue generating children actually meet the slot criteria but can’t fill a slot until there is a vacancy. Though their situations may be less severe than those of the youth assigned to the service allocation slots, this indicates that there are more at-risk youth in the County than those filling the six slots. By increasing the number of program slots, the County would be eligible for additional funding to use for these and other at-risk youth. It should be noted that any increase in the number of slots would also increase County costs as the County is responsible for 60 percent of the revenue per slot generated by the program; the State pays the other 40 percent. California Welfare & Institutions Code §18252(a) Harvey M. Rose Associates, LLC 12