Final Report 2011-2012

Recommendations 68

• R1
  2: Child rights. The BOS, CEO, and the Director of DCFS should take steps for Los Angeles County to become a national leader in the promotion and perpetuation of children’s rights and adopt and maintain a charter for children’s rights. DCFS currently has a children’s rights charter specifically for children in its care in the child welfare system, but the County does not have one for all children. The United States is one of only three countries, including Somalia and South Sudan, which has not joined the international community in supporting the Convention on the Rights of the Child (CRC), an international human rights treaty setting out the civil, polit- ical, economic, social, health, and cultural rights of children. The County of Los Angeles is often known nationwide as a trend-setter and a leader on social issues. Children’s rights should be one of these areas. Although the United States has not adopted the CRC, the County of Los Angeles should reaffirm and pro- mote its own child rights charter as an example for the nation. Children’s rights to a safe and nurturing upbringing should be a societal commitment. 1.2.1. The Director of DCFS should ensure the County’s child rights’ charter for chil- dren in its care is updated and operational within DCFS. The updated charter should also include tighter definitions of what constitutes psychological, emotional, or verbal abuse; neglect; and failure to thrive and are 194 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHILD DEATH MITIGATION consistent with existing penal code definitions. Once tighter definitions and ex- pectations are developed, the BOS will have the ability to lobby for improved leg- islation. This updated charter will help clarify DCFS’s expectations of staff as they carry out their duties. 1.2.2. Although DCFS reports directly to the BOS, the BOS should direct the CEO and involved cluster Deputy CEOs to work with DCFS and the other County depart- ments to develop a children’s rights charter for the BOS to review, refine, and adopt.
• R2
  6. A check list for child death investigations. The Coroner, working with law enforcement officials and the Director of DCFS, should develop a check list for law enforcement and DCFS staff of unique factors to look for in child death cases. To address reports that law enforcement officers and DCFS staff members have varying levels of experience and skill in investigating child deaths, a new comprehensive check list could be a first step toward standardization of this important procedure and would provide a valuable training tool that could be improved over time.
• R3
  1. A 23-hour assessment center. The Director of DCFS should evaluate the potential for implementing a 23-hour assessment center for children who are at risk, and seek BOS approval based on the results of that evaluation. Such assessment centers, similar to Orangewood in Orange County, California, are staffed with skilled professionals, similar to DCFS CSWs, DMH psychiatric social work- ers, and DPH public health nurses. They can build trust and assess the child in a safe environment, and are more likely to make accurate assessments and appropriate placements if deemed necessary. This recommendation is similar to one made by the CGJ in 1999-2000. (Note: The in- tent of this recommendation is not to replicate the McLaren model of the past.) Given the size of the County, DCFS should pilot one 23-hour assessment center and, once fully operational, evaluate its relative effectiveness and determine if additional centers are warranted.
• R4
  1. DCFS technology and information system improvements. The Director of DCFS should work with the State of California to close the gap in the Department’s information needs and propose operational improvements to the systems, particularly interfaces with the State and County systems. This information should then be integrated into DCFS’s own Information Technology (IT) Plan with quick milestones – six months or less – for enhancing access to information critical to effective DCFS operations. A DCFS IT Plan should also outline needed:  Report writing tools  Key performance indicators, metrics, and dashboards for monitoring performance and outcomes  Standard management reports for analyzing data, identifying trends, and making empirically based decisions  Priorities for approaching the State for system upgrades and refinements, making access to needed data and information easier
• R5
  All charter cities reviewed in this report should adopt a method and practice of sav- ing into a reserve or “rainy day” fund to be supplement operating revenue in years of short fall.
• R6
  Charter cities should develop and adopt a strategic plan that articulates the mission, vision, core values and priorities (goals and objectives) for the City. The following cities should develop and adopt such a strategic plan: Arcadia, Compton, Industry, Inglewood.
• R7
  Charter cities should develop and report on performance measures or indicators to evaluate outcomes or progress on priorities. These performance measures should be quantified, focused on outcomes or results, and information should be provided for several years to allow evaluation of progress over time. The following cities should develop such performance measures for indicators: Arcadia, Bell, Compton, Industry, Inglewood, Lancaster, Temple City.
• R8
  Charter city councils should continue to maintain a governance policy that specifical- ly defines the relationship between the council and executive. Charter city councils should continue providing specific annual goals for the city’s executive (City Manag- er or City Administrator) and conduct meaningful evaluations annually. The following cities should do so: Alhambra, Bell, Industry, Inglewood, Lancaster. 56 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHARTER CITIES – RECOMMENDATIONS
• R9
  Charter cities should formally establish an audit committee making it directly respon- sible for the work of the independent auditor. The following cities should formally establish an audit committee: Alhambra, Arcadia, Bell, Cerritos, Compton, Industry, Inglewood, Irwindale, Palmdale, Pomona, Santa Monica, Signal Hill, Temple City, Torrance, Whittier.
• R10
  All charter cities reviewed in this report should continue requiring compliance with standards of independence for the external auditor. Cities that do not currently se- lect the auditor through a competitive process should do so. Cities that allow the auditor to provide non-audit services should ensure appropriate review and approval of those services.
• R11
  Charter cities should review and update accounting policies and procedures to en- sure they are appropriately detailed and define the specific authority and responsibility of employees. Cities should also establish a policy requiring policies and procedures to be reviewed annually and updated at least once every three years. The following cities should review and update accounting policies and proce- dures at least once every three years: Alhambra, Arcadia, Bell, Burbank, Industry, Inglewood, Lancaster, Pasadena, Pomona, Santa Monica, Temple City.
• R12
  Charter cities should review and update policies and procedures for reporting fraud, abuse and questionable practices including a practical mechanism, such as a fraud hotline, to permit the confidential, anonymous reporting of concerns. The following cities should adopt such policies and procedures: Alhambra, Arcadia, Burbank, In- dustry, Inglewood, Irwindale, Santa Monica, Temple City.
• R13
  Charter cities should periodically review and update internal control procedures over financial management. The Following cities should review and update internal con- trol procedures over financial matters: Bell, Industry, Inglewood.
• R14
  Charter cities that have not adopted a policy requiring an unrestricted fund balance of no less than two months of regular general fund operating revenues or regular general fund operating expenditures should develop such policies. The following cit- ies should adopt such a policy: Alhambra, Arcadia, Bell, Cerritos, Compton, Downey, Glendale, Industry, Lancaster, Pomona, Redondo Beach, Temple City, Torrance, Vernon, Whittier.
• R15
  Charter cities must develop and publish a timely Comprehensive Annual Financial Report (CAFR). The city of Bell should do so.
• R16
  Charter cities that have not published financial reports on the city’s website should do so. The city of Industry should do so.
• R17
  Charter cities should develop controls over sole sourced contracting to prevent pref- erential granting of contracts. The following cities should develop such controls: Bell, Industry, Irwindale, Temple City. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 57 CHARTER CITIES – RECOMMENDATIONS
• R18
  Charter cities should develop policies and procedures for selecting and negotiating fair prices for architectural and engineering services consistent with state codes. The following cities should develop such policies and procedures: Arcadia, Bell, Cerritos, Industry, Inglewood, Irwindale, Pasadena, Whittier.
• R19
  All charter cities reviewed in this report should provide policies and procedures for ensuring prices negotiated for substantial contract change orders are fair and rea- sonable, and establish internal controls over substantial contract change orders so that same contractors not repeatedly awarded contracts. The following cities should do so: Alhambra, Bell, Cerritos, Inglewood, Irwindale, Lancaster, Temple City, Tor- rance, Whittier.
• R20
  All charter cities should develop policies and procedures for documenting compli- ance with procurement requirements, and provide contract compliance and oversight and have annual audit oversight with an outside accounting firm. The following cities should do so: Bell, Cerritos, Inglewood, Irwindale, Lancaster, Whittier.
• R21
  All charter city councils, and citizens of the cities, reviewed in this report should an- nually review the actual compensation received by employees of their cities.
• R22
  All charter city councils of the cities reviewed in this report should have access to prevailing municipal wage rates and/or salary ranges for comparable cities in order to identify any individual city position(s) whose salaries exceed the normal salary range for those positions. Approval of any exceptional salaries should be based on justifications of exceptional and unique job responsibilities. 58 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHARTER CITIES ACRONYMS AICPA American Institute of Certified Public Accountants CAFR Comprehensive Annual Financial Reports CalPERS California Public Employees Retirement System CFO Chief Financial Officer CGJ Los Angeles County Civil Grand Jury CPCC California Public Contract Code FPPC California Fair Political Practices Commission FY Fiscal Year GAAP Generally Accepted Accounting Principles GAAS Generally Accepted Auditing Standards GAS Government Auditing Standards GASB Governmental Accounting Standards Board GFOA Government Finance Officers Association IIA Institute of Internal Auditors RFP Request for Proposal SWOT Strengths, Weaknesses, Opportunities, and Threats APPENDICES A
• R23
  Are accounting policies and procedures reviewed annually and updated at least once every three years on a predetermined schedule? o Yes o No
• R24
  Do the accounting policies and procedures specifically define the authority and respon- sibility of all employees, including the authority to authorize transactions and the responsibility for safekeeping of assets and records? o Yes o No
• R25
  Please provide a copy of the accounting policies and procedures manual.
• R26
  Please provide any comments or explanations regarding accounting policies and proce- dures: 66 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHARTER CITIES –
• R27
  Does your City have policies and procedures to encourage and facilitate the reporting of fraud or abuse and questionable accounting or auditing practices? o Yes o No
• R28
  Does your City have a formally adopted and widely distributed and publicized ethics pol- icy? o Yes o No
• R29
  Does your City have a practical mechanism, such as a fraud hotline, to permit the confi- dential, anonymous reporting of concerns about fraud, abuse, or questionable practices? o Yes o No
• R30
  Are concerns received regarding fraud, abuse, or questionable practices reviewed by in- ternal auditors, with documentation reviewed by the Audit Committee. o Yes o No
• R31
  Please provide a copy of the ethics policy and information on mechanisms for reporting concerns of fraud, abuse, or questionable practices.
• R32
  Please provide any comments or explanations regarding reporting of fraud, abuse, and questionable practices: Internal Controls
• R33
  Are internal control procedures over financial management formally documented? o Yes o No
• R34
  Do internal control procedures include practical means for lower level employees to re- port instances of management override of controls? o Yes o No
• R35
  Are internal control procedures evaluated to determine if those controls are adequately designed to achieve their intended purpose, have actually been implemented, and con- tinue to function as designed? o Yes o No
• R36
  Are potential internal control weaknesses documented in exception reports? o Yes 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 67 CHARTER CITIES –
• R37
  Is there a process in place to identify changes in what is being controlled or controls themselves, and corrective action plans are developed with an appropriate timeline? o Yes o No
• R38
  Please provide a copy of the internal control procedures over financial management.
• R39
  Please provide any comments or explanations regarding your responses on internal con- trols: Internal Audit
• R40
  Does your City have an internal audit function formally established by charter, enabling resolution, or other legal means? o Yes o No
• R41
  Is the work of the internal audit function conducted in accordance with the U.S. General Accounting Office’s Government Auditing Standards? o Yes o No
• R42
  Are all reports of the Internal Audit function provided to or available to the Audit Com- mittee? o Yes o No
• R43
  Please provide a copy of the formal action establishing the internal audit function.
• R44
  Please provide any comments or explanations regarding your responses on internal au- dit: 68 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHARTER CITIES –
• R45
  Does your City have a formal policy on the level of unrestricted fund balance to be main- tained in the General Fund? o Yes o No
• R46
  Does this policy require an unrestricted fund balance of no less than two months of reg- ular general fund operating revenues or regular general fund operating expenditures? o Yes o No
• R47
  Please provide a copy of the formal policy on the level of unrestricted fund balance to be maintained in the General Fund.
• R48
  Please provide any comments or explanations regarding your responses on general fund unrestricted fund balance: Financial and Public Reporting Practices
• R49
  Does your City maintain an accounting system adequate to provide all the data needed for the timely preparation of financial statement for the entire entity in conformity with Generally Accepted Accounting Principles (GAAP)? o Yes o No
• R50
  Does your City issue timely financial statements for the entire financial reporting entity in conformity with GAAP as part of a Comprehensive Annual Financial Report (CAFR)? o Yes o No
• R51
  Has your City’s financial statements been independently audited in accordance with ei- ther generally accepted auditing standards (GAAP) or Government Auditing Standards (GAS)? o Yes o No
• R52
  Are the annual budget documents or CAFR for your City published and readily accessible to the general public on your City’s website? o Yes o No 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 69 CHARTER CITIES – APPENDIX B
• R53
  Please provide any comments or explanations regarding your responses on financial and public reporting practices: Employee Compensation
• R54
  Please provide a list of all employees with total compensation for CY 2011 in excess of $175,000 as reported to the Internal Revenue Service (IRS). Please provide detail about the compensation for each employee (salary, overtime, car allowance, vacation payout, sick leave payout, etc.).
• R55
  Please provide any comments or explanations regarding employee compensation: Procurement and Contracting
• R56
  Does your City have formally adopted policies and procedures defining competitive bid- ding requirements and practices for the procurement of goods and services? o Yes o No
• R57
  Does your City Charter or City ordinance provide exemption from competitive procure- ment requirements of California’s Public Contracting Code? o Yes o No
• R58
  Does your City have formally adopted policies and procedures for documenting compli- ance with procurement requirements? o Yes o No
• R59
  Does your City have formally adopted policies and procedures for selecting firms that provide architectural and engineering services? o Yes o No
• R60
  Does your City have formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable? o Yes o No 70 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CHARTER CITIES – APPENDIX B
• R61
  Does your City have formally adopted policies and procedures for ensuring that prices negotiated for contract change orders are fair and reasonable? o Yes o No
• R62
  Does your City have formally adopted policies and procedures establishing internal con- trols over sole-source contracting? o Yes o No
• R63
  Does your City have formally adopted policies and procedures establishing internal con- trols over contract change orders? o Yes o No
• R64
  Does your City have formally adopted policies and procedures for providing contract compliance and oversight? o Yes o No
• R65
  Please provide copies of the:  formal policy defining competitive bidding requirements and practices for the procurement of goods and services,  City Charter or City ordinance providing exemption from competitive procure- ment requirements of California’s Public Contracting Code,  formally adopted policies and procedures for documenting compliance with pro- curement requirements,  formally adopted policies and procedures for selecting firms that provide archi- tectural and engineering services,  formally adopted policies and procedures for ensuring that prices for negotiated contracts are fair and reasonable,  formal policy establishing internal controls over sole-source contracting,  formal policy establishing internal controls over contract change orders,  formal policy and procedures for providing contract compliance and oversight.
• R66
  Please provide any comments or explanations regarding your responses on procure- ment and contracting: 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 71 CHARTER CITIES –
• R18-21
  for a 12 month period. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 165 AGING-OUT - TAY RECOMMENDATIONS The CGJ recommends: 1. The Department of Consumer Affairs establish a dedicated hotline and webpage for TAYs. 2. The Department of Consumer Affairs continue and expand their consumer education workshops for youth preparing to exit the foster care system (ages 16-18), at group homes, probation facilities, and designated locations per DCFS requirements for TAYs prior to their leaving foster care and probation. These consumer education workshops should address specific consumer issues facing TAYs as they prepare for adulthood to help them identify, prevent and resolve consumer issues, such as landlord/tenant disputes, car purchasing difficulties, education scams, credit/finance problems, and identity theft. 3. The Department of Consumer Affairs actively solicit volunteers, including those from the senior citizen population, to assist TAYs with consumer issues during their transition to adulthood, and also have volunteers accompany TAYs when they are seeking things such as transportation needs, renting of housing, banking, and applying for a job. 4. The Department of Consumer Affairs provide unpaid internships for TAYs so they could gain first-hand experience in helping consumers resolve financial scams, and learn about how to protect themselves and their friends from consumer fraud. DCA consider establishing paid internships with a stipend. 5. The Department of Children and Family Services Youth Development Services Division, Independent Living Program reorganize the Emancipation Resource Directory to a more user-friendly document with the contact information for DCA listed as one of the first contacts in the directory, and that physical copies be bound for easy access and use by TAYs. 6. The Metropolitan Transit Authority Board of Directors follow through with their commitment slated to begin 7/1/12, to provide "no-cost EZ Transit Passes" on all municipal and rail systems to DCFS and probation youth transitioning out of the county systems, for youth ages 18-21, for longer than a 12 month period, and on a continuing basis until the youth reaches his or her 22nd birthday. 166 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT AGING-OUT - TAY REQUIRED RESPONSES Recommendations Responding Agencies 1, 2, 3, 4 DCA 5 DCFS Youth Development Services Division, Independent Living Program 6 Metropolitan Transit Authority Board of Directors ACRONYMS CGJ Civil Grand Jury DCA Department of Consumer Affairs DCFS Department of Children and Family Services TAY Transitional Age Youth TILP Transitional Independent Living Plan 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 167 AGING-OUT - TAY – EXHIBIT 1 EXHIBIT 1 – EMANCIPATION RESOURCE DIRECTORY UTILITIES THE GAS COMPANY – WWW.SOCALGAS.COM Call Center 1-800-427-2200 Call 800-427-2200 (Residential Customers) Call 800-427-2000 (Commercial & Industrial Customers) Call 800-772-5050 for Interactive Voice Response Self Service Option (in English & Spanish) Call 800-342-4545 for information in Spanish (Residential Customers) Call 800-427-6029 for information in Spanish (Commercial & Industrial Customers) Southern California Edison – www.sce.com Account Balance 1-800-950-2356 Authorized Payment Agencies 1-800-747-8908 Billing Questions 1-800-684-8123 Hearing and Speech Impaired Line (TDD) 1-800-352-8580 Low Income Rate Assistance 1-800-447-6620 Multicultural Services . Cambodian 1-800-843-1309 Chinese 1-800-843-8343 Korean 1-800-628-3061 Spanish 1-800-441-2233 Vietnamese 1-800-327-3031 Payments, Extensions or Payment Options 1-800-950-2356 Rates or other Service Related Questions 1-800-655-4555 Los Angeles Department of Water and Power – www.ladwp.com Local Calls 1-818-342-5397 Toll Free 1-800-DIAL-DWP (1-800-342-5397) TTY 1-800-HEAR-DWP (1-800-432-7397) Commercial Customers (1-800-499-8840) 168 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT AGING-OUT - TAY – EXHIBIT 1 SBC Pacific Bell - www.SBC.com Hours of Operation Weekdays from 7 AM to 9 PM and Saturday from 8 am to 5 PM Service Center 1-800-310-2355 Disconnect or Transfer Service 1-800-310-2355 MCI THE NEIGHBORHOOD – WWW.THENEIGHBORHOOD.COM Local Customer Service 1-888-MCI-LOCAL (1-888-624-5622) VERIZON Local Phone Service www.verzion.com Customer service – Billing 800-483-3000 Monday - Friday 8:00am - 6:00pm Comcast www.comcast.com Cable Customer Service - 888-255-5789 High-Speed Internet Customer Service: 866-447-7333 Time Warner Cable – www.timewarner.com Customer Support 24 Hours A Day / 7 Days A Week! - Canyon Country (661) 252-2318 - Orange County (714) 903-4000 - South Bay (310) 974-1337 - South Pasadena/ San Marino (626) 441-4559 - Stevenson Ranch (661) 255-2155 - West San Fernando Valley (818) 700-6500 JOB ASSISTANCE Emancipated Youth Job Services - Phil Stripling – (213) 351-0129 California Employment Development Department www.edd.ca.gov (See Attachment) One Stop Centers (800) 292-7200 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 169 AGING-OUT - TAY – EXHIBIT 1 MEDICAL ASSISTANCE/COUNTY HOSPITALS Los Angeles County+USC Medical Center - 1200 N. State St., Los Angeles 90033 Phone (323) 226-2622 General Hospital - 1200 N. State St., Los Angeles 90033 Phone (323) 226-2622 Harbor-UCLA Medical Center - 1000 W. Carson St., Torrance 90509 Phone (310) 222-2345 Martin Luther King, Jr.-Drew Medical Center - 12021 Wilmington Ave., Los Angeles 90059 Phone (310) 668-4321 Olive View/UCLA Medical Center - 14445 Olive View Dr., Sylmar 91342 Phone (818) 364-1555 PUBLIC ASSISTANCE Provides financial, employment and health-related assistance to residents of Los Angeles County. Programs and services include: California Work Opportunity and Responsibility to Kids (CalWORKs); which provides temporary financial assistance, as well as employment services to families with children; Cal-Learn, a CalWORKs program for pregnant and parenting teens; and General Relief (GR), which provides temporary assistance and work opportunities to indigent adults. DPSS programs also include Food Stamps, Medi-Cal, Cash Assistance Program for Immigrants (CAPI), and In-Home Supportive Services (IHSS). 12860 Crossroads Pkwy. South, City of Industry 91746 Phone (562) 908-8400 Phone (562) 908-8454 - Public Information TTY: (562) 908-6650 Internet home page: http://www.ladpss.org DPSS: Public Help Line (877) 481-1044 TDD (for hearing impaired) (562) 908-6650 Child Care Hotline (877) CHILD-99 Health & Nutrition Hotline (877) 597-4777 170 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT AGING-OUT - TAY – EXHIBIT 1 Time Limited Program Hotline (800) 746-1176 Toy Loan and Volunteer Services (213) 744-4344 Los Angeles Homeless Services Authority www.lahsa.org RENTERS INFORMATION Whenever you rent an apartment, you should sign either a rental agreement or a lease, which is a contract that sets the conditions for renting the apartment for a specific period. Or the landlord may rent the apartment to you on a month-to-month basis. (Even with a month-to-month rental, however, your landlord must give you certain advance notice if he or she plans to raise your rent or ask you to move out.) www.renters.com www.westsiderentals.com www.craigslist.com CREDIT INFORMATION A credit report is a summary of your debts and a history of how promptly you have paid your bills. The information comes from the companies where you have credit accounts and from public court records. It is collected and stored by companies, often called credit bureaus, which make the information available to creditors whenever you apply for a loan or credit card or make a purchase on time payments. Under a new federal law, you have the right to one free credit report every 12 months from each of the three major credit-reporting agencies. Check your reports for inaccurate data that could hurt your ability to get credit or a loan. Also, incorrect information can be a red flag that someone is using your identity to get credit without your knowledge. One main fact about debt is that it follows you. Credit card debt can ruin your credit rating and damage your chances to make purchases like buying that new car after graduation. In fact, if you miss a payment by just 30 days, you tarnish your credit rating for the next seven years after you pay it off! And, if you haven't made a payment in three months, your account can be turned over to a collection agency. This also stays on your credit record for seven years after you finally pay it off. Keeping your credit clean: www.accountingnet.com Credit Reports: TransUnion (800) 888-4213: www.transunion.com Equifax (800) 685-1111: www.equifax.com Experian (888) 397-3742: www.experian.com 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 171 AGING-OUT - TAY – EXHIBIT 1 Banking Most people manage their money through checking and savings accounts at banks. Banking can be very confusing, even to people who have been on their own for a long time. You do not have to have a checking account or a savings account, but they do help you to organize your money and pay bills. They also provide a safe place for any extra money you might have. Check on the fees that banks and saving and loans charge for checking and savings accounts. Information you need to open a checking or saving account:  Your full name  Your address and phone number  Your driver’s license or ID  Date an place of birth  Mother’s full maiden name  Social security Number  Beneficiary (this is a person who is to receive any existing funds in your account in the event of your death) Federal and State Taxes If you work in this country and make a certain amount of money you have to pay taxes. Tax laws change each year, but basically, you must pay three different types of taxes – federal, state and social security. It is your responsibility to keep informed about taxes. You can get information on tax laws at the library, a post office, or by calling the state tax office or the federal government’s tax office the Internal Revenue Service or “IRS.” There is IRS office in almost every town, unless it is a very small town. W4 and W2 Forms: The W4 is an official tax document you fill out when you get a job. The W4 authorizes your employer to deduct a certain amount of money from your paycheck for federal taxes. This is called “withholding” and is something all employers must do by law. Your employer can help you if you don’t understand how to complete this form. Budgeting Tips Keep it simple. Don't detail your plan to the penny. Keep track to the nearest dollar or even the nearest five dollars. This works only if you set you’re “breaking points” and stick to it. For example, if you prefer to keep track to the nearest dollar, set $.50 as your "breaking point." If the amount to be recorded is $21.49, you drop the cents and write down 21 dollars. But, if the amount is $21.50, you write 22 dollars in your records. Such a system keeps some of the drudgery out of record keeping. 172 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT AGING-OUT - TAY – EXHIBIT 1 Be realistic. Consider all expenses, including vacations, spending money, alcohol, tobacco and hobbies. To build in a margin of safety in your plan, overestimate your expenses and underestimate your income. Keep trying until you find a system that works for you. Provide for personal allowances for everyone in your plan. Then, give each person total control of his or her allowance. By providing everyone with an allowance, no matter how small, you are giving everyone money to "blow" when the urge comes. Don't try to use someone else's budget and expect it to work for you. When you see a budget in the newspaper or magazine, realize it is for a particular situation or for an "average" or "typical" family. We have to tailor-make a spending plan to fit us. Distinguish between wants and needs. Buy what you need first. The wants belong in the "what's left over" category. Borrow with care. Remember that you create a fixed expense each time you charge something or pay "on time." Plan for and develop an emergency fund. TRANSPORTATION Los Angeles County Metropolitan Transit Authority www.mta.net 1-(800) Commute Car Insurance If you are a student, your parent may be able to continue to carry you on their car insurance until you are 24 (if your parents are co-owners of your car). Otherwise, you will have to get your own insurance. Also, when you buy a car, you will receive the California Certificate of title, commonly known as the “pick slip.” It is a very important document, which contains detailed information about the car and provides proof of ownership. When a car changes ownership, the seller is required to sign this certificate and to have it recorded by the DMV to finalize the transfer and discharge the seller from any further responsibilities connected with that particular vehicle. Life Skills The Community College Foundation: www.cccf.org TCCF is the foundation, through a contract with the Emancipation program, that develops, organizes and presents for probation and foster youth age 14 and older, the Independent Living Program (ILP) classes, financial aid workshops, and the Early State to Emancipation Program (ESTEP). The Foundation also assists in the training of foster parents and other human service workers. For further information, Contact your ILP Transition Coordinator or Call The Community foundation at. (213) 427-6910. (See Attachment) 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 173 AGING-OUT - TAY – EXHIBIT 1 GENERAL INFORMATION Grocery Shopping Tips www.about.com/cs/grocerysavings/a/groceryshoptips.htm Los Angles County Public Library www.colapublib.org Passports www.travel.state.gov Immigration www.uscitizenship.info/index.htm Social Security Administration www.socialsecurity.gov To obtain a social security cards or apply for disability call: 1-800-772-1213 TTY 1-800-325-0778 Department of Motor Vehicles www.dmv.ca.gov 1 (800) 921-1117 To apply for an original driver license if you are over 18, you will need to do the following:  Visit a DMV office (make an appointment for faster service)  Complete application form DL 44 (An original DL 44 form must be submitted. Copies will not be accepted.)  Give a thumb print  Have your picture taken  Provide your social security number. It will be verified with the Social Security Administration while you are in the office.  Verify your birth date and legal presence  Provide your true full name  Pay the $25 application fee (the application fee for a commercial driver license is $57)  Pass a vision exam  Pass a traffic laws and sign test. There are 36 questions on the test. 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• R30-45
  days after acceptance of a referral. However, according to DMH management, though DCFS requires Initial Medical Examinations to be completed at the Hub Clinics of initial placement, the actual timing of the Initial Medical Examinations does not always coincide with the 30-45 day requirement for the completion of the MAT Assessment. As discussed in Section 3 of this report, 22.9 percent of the referrals to the Hub Clinics in FY 2010-11 resulted in missed appointments. Because the findings of the MAT Assessment must be presented to the Court, the medical exam is often provided by a community provider. As previously mentioned, a MAT team consisting of various stakeholders and service providers is assembled to evaluate the detained youth’s condition and service needs. According to the Memorandum of Understanding between DCFS and DHS, one of the goals of the Hub Clinics is to “improve coordination and child health care outcomes.” Though their input could be valuable, particularly for youth with Special Health Care Needs,11 except for rare occasions, Hub Clinic staff do not participate in the MAT team meetings. Without the participation of medical Hub Clinic staff and PHNs in MAT team meetings, an opportunity is lost to improve coordination and integration of medical and other care in service plans. PHNs could serve as the critical link between the Hub Clinics and the MAT Assess- ments because of their understanding of medical issues and their responsibility to coun- sel CSWs on medical issues related to their cases. With the approval of additional Title IV-E Waiver funds for hiring PHNs to be co-located at the Hub Clinics, DCFS and DHS should include attending MAT Assessments as one of the prioritized responsibilities of these PHNs. Mental Health Screenings and Ongoing Mental Health Services An additional shared goal of the MAT Assessments conducted by MAT Providers and the Initial Medical Exams conducted at the Hub Clinics is to perform mental health screenings, identify mental health needs, and ensure linkage to additional services. Though there are shared goals in identifying mental health needs, the MAT Providers and the Hub Clinics were provided different mental health screening tools by DMH. In particular, the MAT Providers use a more in-depth screening tool. According to DMH management, the use of different mental health screening tools at the Hub Clinics is dic- 11 Special Health Care Needs is defined by DCFS Procedural Guide 0600-505.10 as: 1) a condition that can rapidly deteriorate resulting in permanent injury or death, or 2) a medical condition that requires specialized in-home health care. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 287 EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES tated by the varying levels of expertise of the screeners at the Hubs. Inconsistent train- ing and the use of a different screening tool could potentially lead to: 1) inability to iden- tify mental health services that are needed or 2) referrals for mental health services that are not needed. Although DMH-contracted MAT Providers are able to provide MAT Assessments as well as ongoing mental health services, there is limited linkage between the MAT Providers and Hub Clinics for ongoing mental health services. There are 50 organizations in the County that contract with DMH to be MAT Providers and provide MAT Assessments and ongoing mental health services. In contrast, there are seven Hub Clinic locations and only two are affiliated with organizations that have contracts with DMH to be MAT Providers and ongoing mental health service providers: LAC+USC and Children’s Hos- pital. The East San Gabriel Valley Satellite Hub Clinic has access to mental health ser- vice providers through its affiliation with LAC+USC. Data on mental health screenings at the Hub Clinics in FY 2010-11 illustrates that as high as 80 percent of youth screened at the clinics have a positive result, indicating a need for additional mental health services. Without strong linkages to the DMH system, these youth are in danger of not receiving needed mental health services, violating the intent of the Katie A. Settlement. Table 4-1 below shows the number of mental health screenings and results across all Hub Clinics in FY 2010-11. Table 4-1. Number of Mental Health Screenings and Results (FY 2010-11) ESGV H-UCLA LAC+USC MLK OV-UCLA HD CHLA TOTAL # Screenings 1,184 1,713 6,244 1,537 1,051 1,238 466 13,433 # Positive Results 482 859 3,253 322 844 802 369 6,931 % Positive 41% 50% 52% 21% 80% 65% 79% 52% Source: DHS records System of Integration LAC+USC and Children’s Hospital are the only Hub Clinics that are able to provide mental health services simultaneously or immediately after an Initial Medical Examina- tion because they are both affiliated with larger organizations that contain separate mental health service divisions that are also DMH contractors. (The Violence Interven- tion Project is the parent non-profit organization for the LAC+USC Hub Clinic and the Children’s Hospital Hub Clinic is part of Children’s Hospital LA.) The East San Gabriel Valley Satellite has access to mental health providers through LAC+USC. The new Children’s Medical Village at LAC+USC, which is slated to begin operations in 2012, will also provide mental health services to its patients as part of its comprehensive, multi- disciplinary approach. Two other Hub Clinics are poised to provide more direct linkages to mental health ser- vices. Though they are not officially affiliated, the Martin Luther King, Jr. Hub Clinic is located in the same building as SHIELDS, a DMH contractor and MAT Provider, while the Harbor-UCLA Hub Clinic is located a few bungalows away from Children’s Institute, 288 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES also a DMH contractor and MAT Provider. To help the Hub Clinics ensure that linkage to ongoing mental health services occurs for their patients, DHS and DCFS should re- quire that each Hub Clinic establish contractual relationships with DMH contractors/MAT Providers to enable integrated mental health services at the clinics and documented as- surances that Hub Clinic patients are receiving needed mental health services from those contractors. The remaining two Hub Clinics, Olive View-UCLA and High Desert, do not have strong linkages to mental health providers at this time and currently do not have Clinical Psy- chologists on their staff. Olive View-UCLA Hub Clinic staff reported that they have lim- ited access to Clinical Psychologists staffed by the hospital for emergency cases only (i.e. suicidal youth) and are rarely able to follow up on youth referred for mental health services outside of the hospital. The youth screened at Olive View-UCLA and High De- sert could be receiving mental health assessments and services through other MAT Providers, but a stronger system should be established to coordinate the mental health screenings and services at the Hub Clinics to: 1) ensure that youth are receiving mental health services; and, 2) reduce any duplication of efforts. Development of a more integrated system and structure for the MAT Assessment, Initial Medical Examinations, and ongoing mental health services would require the collabora- tion of the directors of DCFS, DHS, and DMH, along with MAT Providers and Hub Clinic staff. While DMH management generally agrees with the concept of better integrating the Initial Medical Examination and MAT Assessment processes as well as ongoing treatment, Department representatives raised a concern about ensuring an even distri- bution of workload among MAT Providers. For example, a MAT Provider located in close proximity to a Hub Clinic, could end up with a higher volume of referrals for ser- vices as compared to other MAT Providers. DMH management noted that there is already an uneven distribution of workload among the MAT Providers because the distribution of funding to these contractors is based on where youth are detained, not where they are placed. For instance, a youth may begin the MAT Assessment Process in one service area, but must continue the Assessment or ongoing mental health services in another area because that is where he/she is placed. Even though DMH has a better understanding of the distribution of workload among the MAT Providers, DCFS is responsible for making referrals and MAT Providers respond to DCFS referrals on a first come, first served basis,. Therefore, in developing a more integrated system, DCFS, DHS, and DMH should con- sider developing agreements between the Hub Clinics and multiple MAT Providers in the same service area for one or more MAT Providers to provide office hours for mental health screenings/MAT Assessments and/or ongoing services at the Hub Clinics. This would allow multiple MAT Providers to each have a role in the provision of mental health services at the Hub Clinics as well as at other locations closer to the youth’s home or placement location. Further, DMH should consider alternative contracting options to bet- ter align services needed by DCFS youth and services actually provided by MAT Pro- viders, given that youth are placed in different areas throughout the County. Finally, 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 289 EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES DMH and DCFS should have better oversight of the distribution of referrals and provi- sion of ongoing mental health services among MAT Providers. Mental Health Services for Youth Ages 0-5 and their Families Youth ages 0-5 are the most vulnerable population in the child welfare system. Accord- ing to DMH management, one desirable skill for MAT Providers, which could help en- sure the provision of mental health services to this target population, is the ability to identify the medical necessity of such services among the youth ages 0-5 and their par- ent(s). Identification of medical necessity is critical for ongoing treatment for mental health issues and is required for Medi-Cal reimbursement through State Early Periodic Screening, Diagnosis and Treatment (EPSDT) funds. Most of the child deaths among DCFS involved youth occur when they are placed in-home with their parents. A mental health service that could address the needs of youth ages 0-5 is collateral treatment, or mental health services provided to both the parent(s) and child. To ensure that this population receives the mental health services it needs, DMH should continue training MAT Providers so they are all able to adequately screen, assess, and provide treatment to youth ages 0-5, including: 1) sufficiently identifying medical neces- sity, and 2) appropriately providing collateral treatment for the parent(s) and child. In addition to training staff, DMH should provide more support for the trained staff to help prevent staff burnout, while dealing with the traumatic experiences of vulnerable youth ages 0-5. SUMMARY The Department of Children and Family Services (DCFS) has mandated that youth in the child welfare system receive mental health screening or assessment and appropri- ate linkage to mental health services in a timely manner, as part of the County’s Katie A. lawsuit settlement. However, DCFS has created two separate systems by which a de- tained youth can receive such services, the Multidisciplinary Assessment Team (MAT) Assessment Program through its collaboration with the Department of Mental Health (DMH) and the Initial Medical Examinations at the Hub Clinics through its Memorandum of Understanding with the Department of Health Services (DHS). The MAT Assessment process and the Initial Medical Examinations at the Hub Clinics may utilize separate sources of medical information for the assessment of a youth, sometimes have disjointed timelines, generally use different mental health screening tools, and have access to different providers for ongoing mental health services. Great- er linkage between the two processes is needed for Hub Clinics to: 1) ensure that youth are receiving mental health services and 2) reduce duplication of efforts. Such integra- tion should be developed by DCFS, DHS, and DMH, with input from MAT Providers and Hub Clinic staff. Additionally, a system or structure that provides greater integration should also take into consideration the distribution of referrals, assessments, and ongo- ing services among existing MAT Providers to allow for multiple providers to have op- portunities to provide services in coordination with the Hub Clinics. 290 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES According to DMH management, two skills among staff of MAT Providers that could help further address the mental health needs of youth ages 0-5 are the abilities to: 1) identify medical necessity for ongoing mental health services among youth ages 0-5, and 2) provide collateral treatment, i.e., treatment of both the parent(s) and child. DMH has conducted training in these areas for MAT Providers in the past. FINDINGS 4.1. Linkage between the Multidisciplinary Assessment Team (MAT) Assessments and Initial Medical Examinations at Hub Clinics is very limited, though both are required by DCFS for newly detained youth. For example, medical reports from the Hub Clinics are not always completed or sent in time to be included in the MAT As- sessments and Hub Clinic staff and Public Health Nurses do not participate in the MAT team meetings. 4.2. MAT Providers, i.e., community-based organizations contracted by DMH, and the Hub Clinics that are not MAT Providers, use different mental health screening tools, though the goal for both processes is to identify a youth’s mental health needs. 4.3. There is limited linkage between the DMH-contracted MAT Providers and Hub Clin- ics for providing ongoing mental health services to clinic patients. Divisions of the LAC+USC and Children’s Hospital Hub Clinics’ affiliated organizations contract with DMH as MAT Providers and provide such services; the Martin Luther King, Jr. and Harbor-UCLA Hub Clinics are in close proximity to MAT Providers, but their linkage to these providers is limited; and Olive View-UCLA and High Desert’s linkage to MAT Providers is not as strong as in the other Hub Clinics. 4.4. The Olive View-UCLA and High Desert Hub Clinics do not have any budgeted clin- ical psychologists on-site. 4.5. The distribution of referrals for MAT Assessments and ongoing mental health ser- vices from DCFS to DMH contract MAT Providers is uneven and is a concern by DMH management regarding the development of a more integrated system be- tween the MAT Assessments, Initial Medical Examinations, and ongoing mental health services. 4.6. Youth ages 0-5 and their parents and families could benefit from ongoing mental health services when medical necessity is appropriately identified and when they participate in collateral treatment, or therapy that includes the parent and child. RECOMMENDATIONS – MENTAL HEALTH SERVICES THROUGH DMH 4.1. The Director of the Department of Mental Health should make the more in-depth screening tool available to all Hub Clinics and train staff on how to use the more in- depth screening tool to standardize mental health screens. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 291 EXPANDING HUB CLINICS – 4. MENTAL HEALTH SERVICES 4.2. The Directors of the Departments of Health Services, Children and Family Services, and Mental Health, with input from MAT Providers and Hub Clinic staff, should develop a structure that better integrates the MAT Assessment Process and ongoing mental health services conducted by MAT Providers and Initial Medical Examinations conducted at Hub Clinics. Similar to the processes at LAC+USC and Children’s Hospital, in-depth mental health screenings should be conducted in con- junction with Initial Medical Examinations, and ongoing mental health services should be coordinated with Hub Clinic medical care. 4.3. The Director of the Department of Mental Health should address the following issues in amending agreements between DMH and MAT Providers in the same service area:  Providing office hours for mental health screenings and/or ongoing services at all Hub Clinics.  Considering alternative contracting options to better align services needed by youth with those actually provided by MAT Providers.  Better oversight of the distribution of referrals and provision of ongoing mental health services among MAT Providers. 4.4. The Director of the Department of Children and Family Services should revise department policies to require PHNs to attend MAT Assessment meetings, particu- larly those co-located at Hub Clinics that are not already contracted by DMH to be MAT Providers. 292 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH SECTION 5. TRANSITION AGE YOUTH SERVICES The lower end of the range for Transition Age Youth (TAYs) typically begins between 14 to 16 years of age and the higher end of the range starts at 21 and ends at 25 years of age. Prior to January 1, 2012, most youth under the jurisdiction of DCFS had their cases terminated and were emancipated by the time they turned 18 years of age. There are exceptions to immediately terminating DCFS cases for youth on their 18th birthday. For example, if a youth has not graduated from high school or the Courts have found that the youth’s basic needs, such as housing, have not yet been met, then the youth may remain under the jurisdiction of DCFS. Per DCFS, as of November 30, 2011, there were 1,672 youth under the jurisdiction of DCFS that were 18 years old or older.12 This population includes youth that are still in foster care, as well as those in independent living programs that are obtaining youth de- velopment services such as housing, employment and education services on a volun- tary basis. From July 2011 through November 2011, only 141 youths aged 18 and older were referred to DCFS, none of whose case was opened. For youth 18 and older, DCFS services appear to be targeted toward transitioning the youth to independent liv- ing, as opposed to addressing concerns of possible abuse and neglect.13 National statistics illustrate the need to provide services to TAYs to prepare them for in- dependent living. For example, 27 percent of the nation’s homeless population spent time in foster care.14 Additionally, in its State of Homelessness in America 2011 report, the National Alliance to End Homelessness estimates that the odds that a youth eman- cipating out of foster care will be homeless within one year is one in six.15 Finally, youth transitioning from foster care have disproportionately high rates of mental health, physi- cal, and developmental problems.16 Extended Foster Care – Assembly Bill 12 On September 30, 2010, the Governor of California signed into law Assembly Bill 12 (AB 12), which extends foster care services, including Federal funding, for eligible youth aged 18 and older (called “nonminors” in the following quotations). Eligible youth could remain within a foster care setting or live independently based on an independent living 12 Source: DCFS 13 Ibid. Honoring Emancipated Youth. www.heysf.org League of Women Voters Life after Foster Care. League of Women Voters of California Education Fund, Juvenile Justice Study Committee, 2002. Available at http://www.ca.lwv.org/jjds/chap6.html 15 State of Homelessness in America 2011. National Alliance to End Homelessness. http://www.endhomelessness.org/content/article/detail/3668 16 Honoring Emancipated Youth. www.heysf.org American Academy of Pediatrics. Committee on Early Childhood, Adoption and Dependent Care. November 2000. Developmental issues for young children in foster care. Pediatrics, 106 (5), 1145-1150; Rest, E.R., & Watson, K.W. (1984). Growing up in foster care. Child Welfare, 62, 291- 306. Both cited in It’s My Life, Casey Family Programs. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 293 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH transition plan. A “nonminor dependent” is eligible for extended foster care services if he or she satisfies the age requirement:17 Effective January 1, 2012, these nonminor dependents shall be eligible to receive support up to 19 years of age, effective January 1, 2013, up to 20 years of age, and effective January 1, 2014, up to 21 years of age... He/she must also meets one or more of the following conditions:18 1. The nonminor is completing secondary education or a program leading to an equivalent credential. 2. The nonminor is enrolled in an institution which provides postsecondary or vocational educational education. 3. The nonminor is participating in a program or activity designed to pro- mote, or remove barriers to employment. 4. The nonminor is employed for at least 80 hours per month. 5. The nonminor is incapable of doing any of the activities described in sub- paragraphs (1) to (4), inclusive, due to a medical condition, and that inca- pability is supported by regularly updated information in the case plan of the nonminor. Based on data provided by DCFS, the total population in Los Angeles County eligible for extended foster care services due to AB 12 is estimated to be between 3,800 (16 and 17 year olds as of Nov. 30, 2011) to 5,483 (including those 18 and older as of Nov. 30, 2011). However, this estimate does not include Transition Age and eligible youth that may enter or exit the child welfare system up until 2014, the expected sunset date for AB 12 unless it is extended by the State legislature. Medical and mental health services for youth aged 18 years or older and under the ju- risdiction of DCFS have been limited. However, there are services offered by DMH that youth can continue to receive after they turn 18, independent of their status with DCFS. With the implementation of extended foster care services under AB 12, DCFS, DHS, and DMH should improve or create systems to address the specialized needs of youth aged 18 years or older. Medical Services for 18 Year Olds and Older Prior to the implementation of AB 12, DCFS provided youth aging out of the system with referral information on medical and mental health services and requirements for receiv- ing Medi-Cal under the Former Foster Care Children Program (FFCC) which allowed coverage until the age of 21. However, the former foster care youth would have to re- new their enrollment in Medi-Cal themselves, and DCFS management reported that not all of them were doing so. California Welfare and Institutions Code §11403(a) 18 California Welfare and Institutions Code §11403(b) 294 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH Since most Transition Age Youth are eligible for Medi-Cal coverage, they can obtain medical services from any Medi-Cal provider. There is no mandate or requirement for this population to go to a Hub Clinic. As a result, a majority of the Hub Clinics report serving very few youth aged 18 years or older. Medically Fragile/Vulnerable Youth who are medically fragile/vulnerable are those with special needs due to a mental health diagnosis, developmental delay or a physical or medical condition that requires specific care.19 As of November 30, 2011, there were 2,163 youth under the jurisdiction of DCFS identified as medically fragile/vulnerable, of which 198 were 18 years old or older. Within the medically fragile/vulnerable group, there is a subgroup of youth receiving DCFS services from the Medical Case Management Services (MCMS) Unit. These youth have special health care needs defined as: 1) a condition that can rapidly deterio- rate, resulting in permanent injury or death, or 2) a medical condition that requires spe- cialized in-home health care such as an enteral feeding tube, ventilator, intravenous therapy, or other medical or surgical procedures or special medication regiments.20 Youth under the supervision of the MCMS Unit require the most medical care and atten- tion of all the medically fragile/vulnerable youth under the jurisdiction of DCFS. The MCMS Unit works with families, caretakers, and the youth to ensure that the youth ob- tain the medical services they need. As of February 2012, there was a total of 580 youth under the MCMS Unit, of which 52 are 18 years old or older. The medical services for youth under the supervision of the MCMS Unit are funded through 1) Medi-Cal’s fee-for-service or managed care, depending on their enrollment; 2) California Children’s Services for special equipment such as wheelchairs and beds; and 3) Regional Centers21 for services such as occupational, physical and behavioral therapy. When youth under the supervision of the MCMS Unit turn 18, they may either remain under the supervision of the MCMS Unit because they are still in high school or the Courts have not terminated their DCFS cases due to severe health conditions. Medical- ly fragile/vulnerable youth over the age of 18 who are eligible for long-term Regional Center services are transitioned to service coordination by their local Regional Centers. If a youth does not fall under any of these categories, he/she could be emancipated and transitioned out of DCFS or any other supervision and oversight. DCFS Procedural Guide 0900-522.10 (Specialized Care Increment – D – Rate), DCFS Procedural Guide 0900- 522.11 (Specialized Care Increment – F – Rate). DCFS Procedural Guide 0600-505.10 (Assessments of and Services for Children with Special Health Care Needs) 21 Regional Centers are non-profit agencies under contract with the California Department of Developmental Services that help coordinate services needed because of a developmental disability. Depending on eligibility, most services offered at Regional Centers are free regardless of age or income. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 295 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH Medically fragile/vulnerable youth aged 18 and older who do not remain with DCFS or who are not eligible for Regional Center services are at risk of abuse, isolation, home- lessness, neglect, or self-neglect. However, these youth are eligible for referrals to Adult Protective Services (APS) so that they may continue to have contact with social workers and access to needed services. It is unclear if all medically fragile/vulnerable youth ag- ing out of DCFS services are referred and transitioned to APS, when they are not eligi- ble for Regional Center services, but DCFS should strive to make such referrals when- ever possible. According to DCFS management, the medically fragile/vulnerable youth under the su- pervision of the MCMS Unit only access or interact with Hub Clinic staff when they are newly detained and require an Initial Medical Examination. These exams provide the medical history for the newly detained youth. However, continued medical services are obtained at specialized clinics across public and private hospitals throughout the Coun- ty. Although Hub Clinics may not offer the specialized services and clinics needed by the medically fragile/vulnerable youth under the MCMS Unit, the Hub Clinics can still play a role as the medical home for youth with multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. The Hub Clinics can also serve as the medical coordinators for the medically fragile/vulnerable Transition Age Youth who are 18 and older and have not transitioned to Regional Center services, such as an 18 year old who is diabetic and is in constant need of insulin shots. To serve as the medi- cal home, Hub Clinics would have to obtain and maintain all medical records for the pa- tient from multiple service providers within the hospital system affiliated with each Hub Clinic. Currently, DCFS staff coordinates services across multiple providers in different hospital systems for these youth, and should continue doing so for youth with medical providers across both County and private hospital systems. However, the specialized medical knowledge of Hub Clinic staff could facilitate the transfer of medical information more easily for medically fragile/vulnerable youth with specialists in the same hospital system. Ideally, youth aging out of DCFS would be transitioned to a program where they still have access to social workers and coordinated medical and mental health services ei- ther through a Regional Center, if developmentally disabled, or Adult Protective Ser- vices. For youth transitioned to Adult Protective Services, the Hub Clinics could com- plement the social services provided by coordinating the youth’s medical services. Mental Health Services for TAYs According to data provided by DMH, 3,904 DCFS youths with open DMH cases were aged 16 or older, representing 16.2 percent of the a total of 24,116 DCFS youths with open DMH cases. This also represents 71.2 percent of the 5,483 youth under the juris- diction of DCFS who were 16 years old or older as of November 30, 2011. These youths could have received DMH services through any number of DMH programs pro- 296 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH vided throughout the County including: 1) services provided through the Multidisciplinary Assessment Team (MAT) Assessment Program,22 2) Full Service Partnership Program (FSP),23 3) Assertive Community Treatment (ACT),24 and 4) Specialized Foster Care In- tensive In-Home Mental Health Services (IIHMHS),25 etc. Only two of the seven Hub Clinics, LAC+USC and Children’s Hospital, have contracts with DMH and have multiple mental health service professionals onsite. The East San Gabriel Valley Satellite Hub Clinic has access to mental health service providers through its affiliation with LAC+USC. Children’s Hospital is the only Hub Clinic that has services directed specifically toward Transition Age Youth. These are provided by the Children Hospital’s Division of Ado- lescent Medicine and located in a clinic separate from the CHLA Hub Clinic for younger children. Services for 12 to 21 year olds include specialized services for adolescents dealing with anger management, depression, substance abuse, homelessness, HIV and transgender issues. These services are provided to all adolescents, not just those re- ferred to the Hub Clinic by DCFS. Furthermore, LAC+USC hopes to obtain additional funding and resources to expand its Children’s Medical Village to include service for adults. This would require staffing the Medical Village with providers who are trained in both pediatrics and adult medicine, similar to the staff at the Children’s Hospital Division of Adolescent Medicine. Further, LAC+USC hopes to include Adult Protective Services staff in its proposed expanded Medical Village to provide easy access to social work services while remaining the med- ical home and coordinator of medical and mental health services for medically frag- ile/vulnerable Transition Age Youth aged 18 and older. Targeted Medical and Mental Health Services for Transition Age Youth As discussed in Section 1 of this report, “The Model Medical Hub Clinic”, model Hub Clinics should serve as the medical home and provide onsite mental health services for youth under the jurisdiction of DCFS. With the implementation of AB 12, youth aged 18 years old and older will continue to be eligible for medical and mental health services at Hub Clinics. At this time, Children’s Hospital is the only Hub Clinic that is able to pro- vide both medical and mental health services that are targeted toward the issues and 22 The Multidisciplinary Assessment Team (MAT) Assessment Program provides comprehensive assessments to evaluate a foster youth’s needs and strengths in various areas including medical, dental, developmental, hear- ing/language, education, mental health, vocational, and family/caregiver issues. The Transition Age Youth Full Service Partnership Program offers intensive services with 24/7 staff availability to help 16 to 25 year olds address emotional, housing, physical health, transportation, and other needs to help them function independently in the community. Assertive Community Treatment is a team-based approach to the provision of treatment, rehabilitation, and support services. A variety of services are offered under the Specialized Foster Care Intensive In-Home Mental Health Services (IIHMHS) program, including 24/7 intensive case management, Trauma Focused Cognitive Behavioral Therapy, Functional Family Therapy, as well as programs to assist caregivers with behavioral and emotional problems in young children. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 297 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH concerns of youth 18 years old and older. Therefore, DCFS should encourage youth 18 years old and older with complex medical and/or mental health needs to go to the Chil- dren’s Hospital services. According to Children’s Hospital staff, should referrals to the adolescent clinic from DCFS increase, the clinic would then consider applying for Federally Qualified Health Center (FQHC) status, which would allow the clinic to receive greater reimbursement for costs than they currently receive through Medi-Cal. However, until the adolescent clinic officially receives such a status, the clinic will need grant funding to absorb the addition- al referrals. Children’s Hospital is not conveniently located for all Transition Age Youth located throughout the County, particularly for the medically fragile/vulnerable youth aged 18 and older. DCFS, DHS, and DMH should work together to identify funding for additional transportation services to and from CHLA. Currently, Children’s Hospital is able to pro- vide transportation passes to youth participating in its Full Service Partnership Program, funded through a DMH contract. Similar funding should be identified or expanded for the additional DCFS referrals of youth to the Children’s Hospital. For youth who are not lo- cated near public transportation, DCFS, DHS, and DMH should explore funding for van services. This type of service is already provided to youth living in the Lancas- ter/Palmdale area for services at the High Desert Hub Clinic. Children’s Hospital currently has the greatest capacity to serve the special needs of Transition Age Youth aged 18 and older. Additionally, resources could be designated or reassigned to LAC+USC to expand its Children’s Medical Village to include medical services for adults and access to Adult Protective Services social workers to meet the medical and mental health needs of Transition Age Youth aged 18 and older. SUMMARY Prior to January 1, 2012, most youth under the jurisdiction of DCFS were emancipated and their DCFS cases were terminated after they turned 18 years old. Though there were exceptions for some 18 year olds to remain under foster care and receive inten- sive case management services, a majority of the youth 18 years old or older received additional DCFS services on a voluntary basis but did not access medical and mental health services at the Hub Clinics. Though most of these youth were eligible for Medi- Cal after they turned 18, which could reimburse the Hub Clinics if used by the youth, their choice of medical provider was left up to them. None of the County-affiliated Hub Clinics made special efforts to encourage these youth to obtain medical care from them. With the passage of extended foster care services through AB 12, as of January 1, 2012, youth under the jurisdiction of DCFS can remain in the child welfare system until the age of 21, as long as they meet certain criteria. Therefore, Transition Age Youth aged 18 to 21 could continue to use Hub Clinics for medical and mental health needs. Their medical care would continue to be reimbursed under the Medi-Cal fee-for-service arrangement, which provides a better cost recovery for the clinics than Medi-Cal man- aged care rates. 298 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH A majority of the Hub Clinics currently do not provide medical services to youth under the jurisdiction of DCFS that are 18 years old or older. Youth that are medically frag- ile/vulnerable currently receive medical services from specialized medical providers and clinics throughout the County. Further, only two of the Hub Clinics have Department of Mental Health contracts and multiple mental health providers at their Hub Clinics to pro- vide mental health services to DCFS youth. Only Children’s Hospital LA offers an ado- lescent clinic that provides medical and mental health services targeted toward youth aged 12 to 21. However, LAC+USC has plans to expand its Children’s Medical Village with medical services for adults, particularly Transition Age Youth aged 18 and older, including access to Adult Protective Services social workers. The Hub Clinics could serve as medical homes for medically fragile/vulnerable TAYs by coordinating services among the various specialized medical and mental health provid- ers, as long as they are within the same hospital system. Such coordination would re- quire additional training for the medical providers to be aware of the various issues spe- cific to TAYs. Finally, DCFS and DHS could refer other medically fragile/vulnerable TAYs to Children’s Hospital to benefit from their specialized Adolescent Clinic and initi- ate a plan to establish similar specialty clinics for TAYs at some or all of the County Hub Clinics. The Hub Clinic with the greatest capacity for expansion of services for Transi- tion Age Youth is currently LAC+USC because it is building a Children’s Medical Village with an aim to provide access to subspecialty medical services beginning in the summer of 2012. FINDINGS 5.1. According to national statistics, youth transitioning out of foster care are at risk and have higher rates of homelessness, as well as mental health, physical, and devel- opmental problems. For example, 27 percent of the nation’s homeless population have been in foster care, while youth emancipating out of foster care have a one in six chance of being homeless within one year. 5.2. As of November 30, 2011, there were 1,672 youth under the jurisdiction of DCFS that were 18 or older. Prior to January 1, 2012, most of these youth were emanci- pated and their DCFS cases were terminated after they turned 18 years old. Most of these youth were only able to receive additional DCFS services on a voluntary basis and, though not precluded from doing so, most did not access medical and mental health services at the Hub Clinics which are generally geared toward chil- dren, and have not made efforts to encourage Transition Age Youth emancipating from the child welfare system to use their services. 5.3. With the passage of extended foster care services through AB 12, youth under the jurisdiction of DCFS may now remain in the child welfare system until the age of 21, as long as they meet certain criteria. Based on DCFS data on youth 16 years old and older and under DCFS jurisdiction as of November, 30, 2011, the estimat- ed total number of Transition Age Youth that could remain in DCFS through 2014 ranges from 3,800 to 5,483 youth. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 299 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 5.4. The number of medically fragile/vulnerable youth with special needs due to a men- tal health diagnosis, developmental delay or a physical or medical condition that requires specific care under the jurisdiction of DCFS was 2,163 as of November 30, 2011, of which 198 were 18 years old or older. Though Hub Clinics may not of- fer the specialized services and clinics needed by the medically fragile/vulnerable youth, the Hub Clinics can still play a role as the medical homes for youth who need to see multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. 5.5. The majority of the Hub Clinics currently do not provide medical services to youth aged 18 years old or older. Further, only two of the Hub Clinics have Department of Health contracts and multiple mental health providers onsite at their Hub Clinics to provide mental health services to DCFS youth. Only Children’s Hospital LA current- ly offers an adolescent clinic that provides medical and mental health services tar- geted toward youth age 12 to 21 years old. However, LAC+USC has plans to ex- pand its Children’s Medical Village, which will provide access to several medical subspecialty services, to include adult medical services for Transition Age Youth aged 18 or older. RECOMMENDATIONS –TRANSITION AGE YOUTH SERVICES 5.1. The Director of the Department of Children and Family Services should require that CSWs refer Transition Age Youth to Adult Protective Services, where appro- priate, if they are about to be emancipated from the jurisdiction of DCFS. 5.2. The Director of the Department of Health Services should require that the Hub Clinics also serve as medical homes for the medically fragile/vulnerable Transition Age Youth under the jurisdiction of DCFS who are receiving services from the hos- pital system affiliated with each Hub Clinic. 5.3. The Director of the Department of Children and Family Services should strong- ly encourage DCFS youth 18 years old and older with complex mental health needs to go the Children’s Hospital for mental health services or the other Hub Clinics to the extent they begin to offer age-appropriate services similar to those of- fered at the Children’s Hospital clinic. 5.4. The Directors of the Departments of Children and Family Services, Health Services, and Mental Health should collaborate to identify funding resources and provide transportation services for DCFS youth 18 years old and older with com- plex medical and mental health needs to obtain such needed services. 5.5. The Directors of the Departments of Children and Family Services and Health Services should identify resources, possibly including reallocating already ap- proved Title IV-E waiver funds, for LAC+USC to expand its Children’s Medical Vil- lage to include medical services for Transition Age Youth, which would require staffing the Children’s Medical Village with providers that have both pediatrics and 300 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH adult medicine training, as well as access to Adult Protective Services social work- ers. 5.6. The Directors of the Departments of Children and Family Services and Health Services should provide additional training to current medical providers at the Hub Clinics to better identify medical and mental health needs of Transition Age Youth, and ensure linkages to specialized adolescent medicine and mental health, in order to provide age appropriate services for youth with expanded foster care services under AB 12. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 301 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH ACRONYMS AB12 Assembly Bill 12, “Extending Foster Care Services” signed 9/30/2010 ACT Assertive Community Treatment CBRC Cost Based Reimbursement Clinic CGJ Los Angeles County Civil Grand Jury CHLA Children’s Hospital Los Angeles COLA Cost of Living Adjustment CSW Children’s Social Worker CWS/CMS Child Welfare Services Case Management System DCFS Los Angeles County Department of Children and Family Ser- vices DHS Los Angeles County Department of Health Services DMH Los Angeles County Department of Mental Health E-mHub Enterprise mHub medical referral and information-sharing sys- tem EPSDT Early Periodic Screening, Diagnosis and Treatment ESGV East San Gabriel Valley Hub Clinic FFA Foster Family Agency FFCC Former Foster Care Children Program FQHC Federally Qualified Health Center FSP Full Service Partnership Program FTE Full Time Equivalent FY Fiscal year H-UCLA Harbor-UCLA Medical Center HD High Desert Multi-service Ambulatory Care Center ICAN Inter-Agency Council on Child Abuse and Neglect IIHMHS Intensive In-Home Mental Health Services LAC+USC Los Angeles County and University of Southern California Medi- cal Center MAT Multidisciplinary Assessment Team MCMS Medical Case Management Services MLK Martin Luther King, Jr. Multi-service Ambulatory Care Center MOU Memorandum of Understanding OV-UCLA Olive View-UCLA Medical Center PHN Public Health Nurse TAY Transition Age Youth Title IV-E Waiver Child Welfare Waiver Demonstration Capped Allocation Project UCLA University of California, Los Angeles VIP Violence Intervention Program 302 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – ACRONYMS RECAPITULATION OF RECOMMENDATIONS RECOMMENDATIONS – MODEL MEDICAL HUB CLINIC 1.1. The Directors of the Departments of Health Services and Children and Family Services should consider amending their Memorandum of Understanding (MOU) to mandate coordination and oversight of the provision of mental health services (onsite or offsite of the Hub Clinics) for youth under the jurisdiction of DCFS. 1.2. The Directors of the Departments of Health Services and Children and Family Services should also consider amending their MOU to strongly encourage provi- sion of ongoing primary care services at the Hub Clinics for high risk populations such as children between the ages of 0-5, non-detained youth who remain with their families while under DCFS jurisdiction, medically fragile Transition Age Youth aged 18 or older, or those with multiple placements. 1.3. The Directors of the Departments of Health Services and Children and Family Services should also consider amending their MOU to mandate that the Hub Clin- ics serve as a “medical home” to youth under the jurisdiction of DCFS for ongoing medical services. If that is not feasible for their caregivers, have their medical care provided by a community provider, overseen by DCFS and the court. CSWs should be responsible for ensuring that each child continually has a medical home while under the jurisdiction of DCFS, whether being seen at a Hub Clinic or by a community provider, and that a medical home is maintained every time the child has a placement change. 1.4. The Director of the Department of Children and Family Services should refer non-detained youth to a “medical home” at the Hub Clinics for ongoing medical services, to the extent feasible. 1.5. The Director of the Department of Health Services should track primary medical care visits at the Hub Clinics, in order to accurately quantify follow-up care for youth under the jurisdiction of DCFS, and to measure any given Hub Clinic’s pro- gress toward implementing the medical home model. 1.6. The Directors of the Departments of Health Services and Children and Family Services should support the expansion of the Children’s Medical Village at LAC+USC to provide comprehensive medical and mental health services to non- detained youth and TAYs. RECOMMENDATIONS – STANDARDIZING THE HUB CLINICS 2.1. The Directors of the Departments of Health Services and Children and Family Services should collaborate and establish staffing, resource, service level, and cost per patient visit standards for the Hub Clinics to ensure that the same mix and level of services are provided to all youth under the jurisdiction of DCFS. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 303 2.2. The Director of the Departments of Health Services should redefine Hub Clinic patient visits for the clinics’ statistical reports so that the classification “Follow-Up Care” is refined to distinguish ongoing medical care from Initial Medical Examina- tion and Forensic Evaluation follow-up services. 2.3. The Director of the Department of Health Services should produce monthly management reports for use by the countywide director of the Hub. These reports should include at a minimum:  patient visits by type  patient visits per medical provider  cost per visit  health outcomes  suspected cases of abuse and neglect  other measures of productivity and outcomes RECOMMENDATIONS – DCFS ACCOUNTABILITY 3.1 The Director of the Department of Children and Family Services should en- force the department’s mandate for the utilization of Hub Clinics by revising the pol- icies and procedures related to referrals to Hub Clinics and follow up for medical and mental health linkages. 3.2 The Director of the Department of Children and Family Services should require the DCFS managers at the regional offices to 1) use management reports, 2) hold individual supervisors and CSWs accountable for making Hub Clinic referrals, 3) follow up on missed appointments and 4) troubleshoot and problem-solve for youth that consistently miss Hub Clinic and mental health appointments. These duties would include identifying miscommunication or the lack of information transfer among different CSWs assigned to the same case at multiple points in time. 3.3. The Directors of the Departments of Children and Family Services and Mental Health should collaborate on a system that refers non-detained youth remaining in their family homes and their parents to outpatient mental health services for a peri- od of six months after the date they enter into the child welfare system. 3.4. The Director of the Department of Children and Family Services should modify the department’s current Title IV-E waiver plan, or apply any new waiver funds, to enable expansion of Hub Clinic services for non-detained youth who live in their family homes. 3.5. The Directors of the Departments of Children and Family Services and Health Services should collaborate on the assignment of co-located Public Health Nurses (PHNs) or Children’s Social Workers (CSWs) at every Hub Clinic to specifically fol- low up on missed appointments and referrals for specialized services (medical and mental). A strong emphasis and priority should be placed on non-detained youth who miss their Forensic Evaluations. When extended hours are an option at the 304 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – ACRONYMS Hub Clinic, the PHNs or CSWs should work during evening hours to conduct most of the follow ups to increase the probability of reaching caretakers. 3.6 The Directors of the Departments of Children and Family Services and Health Services should promote the use of the Hub Clinics as medical homes for children under the jurisdiction of DCFS by providing education to CSWs about the services and benefits of the Clinics and requiring the CSWs to communicate this information to caregivers. RECOMMENDATIONS – MENTAL HEALTH SERVICES THROUGH DMH 4.1. The Director of the Department of Mental Health should make the more in-depth screening tool available to all Hub Clinics and train staff on how to use the more in- depth screening tool to standardize mental health screens. 4.2. The Directors of the Departments of Health Services, Children and Family Services, and Mental Health, with input from MAT Providers and Hub Clinic staff, should develop a structure that better integrates the MAT Assessment Process and ongoing mental health services conducted by MAT Providers and Initial Medical Examinations conducted at Hub Clinics. Similar to the processes at LAC+USC and Children’s Hospital, in-depth mental health screenings should be conducted in con- junction with Initial Medical Examinations, and ongoing mental health services should be coordinated with Hub Clinic medical care. 4.3. The Director of the Department of Mental Health should address the following issues in amending agreements between DMH and MAT Providers in the same service area:  Providing office hours for mental health screenings and/or ongoing services at all Hub Clinics.  Considering alternative contracting options to better align services needed by youth with those actually provided by MAT Providers.  Better oversight of the distribution of referrals and provision of ongoing mental health services among MAT Providers. 4.4. The Director of the Department of Children and Family Services should revise department policies to require PHNs to attend MAT Assessment meetings, particu- larly those co-located at Hub Clinics that are not already contracted by DMH to be MAT Providers. RECOMMENDATIONS –TRANSITION AGE YOUTH SERVICES 5.1. The Director of the Department of Children and Family Services should require that CSWs refer Transition Age Youth to Adult Protective Services, where appro- priate, if they are about to be emancipated from the jurisdiction of DCFS. 5.2. The Director of the Department of Health Services should require that the Hub Clinics also serve as medical homes for the medically fragile/vulnerable Transition 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 305 Age Youth under the jurisdiction of DCFS who are receiving services from the hos- pital system affiliated with each Hub Clinic. 5.3. The Director of the Department of Children and Family Services should strong- ly encourage DCFS youth 18 years old and older with complex mental health needs to go the Children’s Hospital for mental health services or the other Hub Clinics to the extent they begin to offer age-appropriate services similar to those of- fered at the Children’s Hospital clinic. 5.4. The Directors of the Departments of Children and Family Services, Health Services, and Mental Health should collaborate to identify funding resources and provide transportation services for DCFS youth 18 years old and older with com- plex medical and mental health needs to obtain such needed services. 5.5. The Directors of the Departments of Children and Family Services and Health Services should identify resources, possibly including reallocating already ap- proved Title IV-E waiver funds, for LAC+USC to expand its Children’s Medical Vil- lage to include medical services for Transition Age Youth, which would require staffing the Children’s Medical Village with providers that have both pediatrics and adult medicine training, as well as access to Adult Protective Services social work- ers. 5.6. The Directors of the Departments of Children and Family Services and Health Services should provide additional training to current medical providers at the Hub Clinics to better identify medical and mental health needs of Transition Age Youth, and ensure linkages to specialized adolescent medicine and mental health, in order to provide age appropriate services for youth with expanded foster care services under AB 12. REQUIRED RESPONSES Recommendations Responding Agency 1.1, 1.2, 1.3, 1.5 Department of Health Services 2.1, 2.2, 2.3 3.5, 3.6 4.2 5.2, 5.3, 5.4, 5.5, 5.6 1.1, 1.2, 1.3, 1.4 Department of Children and Family Services 2.1 3.1, 3.2, 3.3, 3.4, 3.5, 3.6 4.2, 4.4 5.1, 5.3, 5.4, 5.5, 5.6 3.3 Department of Mental Health 4.1, 4.2, 4.3 5.3, 5.4 306 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT (cid:44)(cid:44)(cid:39)(cid:39)(cid:40)(cid:40)(cid:49)(cid:49)(cid:55)(cid:55)(cid:44)(cid:44)(cid:55)(cid:55)(cid:60)(cid:60) (cid:55)(cid:55)(cid:43)(cid:43)(cid:40)(cid:40)(cid:41)(cid:41)(cid:55)(cid:55) (cid:50)(cid:50)(cid:41)(cid:41) (cid:41)(cid:41)(cid:50)(cid:50)(cid:54)(cid:54)(cid:55)(cid:55)(cid:40)(cid:40)(cid:53)(cid:53) (cid:38)(cid:38)(cid:43)(cid:43)(cid:44)(cid:44)(cid:47)(cid:47)(cid:39)(cid:39)(cid:53)(cid:53)(cid:40)(cid:40)(cid:49)(cid:49) (cid:38)(cid:38)(cid:50)(cid:50)(cid:48)(cid:48)(cid:48)(cid:48)(cid:44)(cid:44)(cid:55)(cid:55)(cid:55)(cid:55)(cid:40)(cid:40)(cid:40)(cid:40) (cid:48)(cid:48)(cid:40)(cid:40)(cid:48)(cid:48)(cid:37)(cid:37)(cid:40)(cid:40)(cid:53)(cid:53)(cid:54)(cid:54) (cid:39)(cid:39)(cid:76)(cid:76)(cid:68)(cid:68)(cid:81)(cid:81)(cid:68)(cid:68) (cid:54)(cid:54)(cid:17)(cid:17) (cid:47)(cid:47)(cid:72)(cid:72)(cid:72)(cid:72) (cid:164)(cid:164) (cid:38)(cid:38)(cid:82)(cid:82)(cid:16)(cid:16)(cid:38)(cid:38)(cid:75)(cid:75)(cid:68)(cid:68)(cid:76)(cid:76)(cid:85)(cid:85) (cid:53)(cid:53)(cid:17)(cid:17) (cid:37)(cid:37)(cid:85)(cid:85)(cid:88)(cid:88)(cid:70)(cid:70)(cid:72)(cid:72) (cid:48)(cid:48)(cid:70)(cid:70)(cid:38)(cid:38)(cid:82)(cid:82)(cid:85)(cid:85)(cid:80)(cid:80)(cid:76)(cid:76)(cid:70)(cid:70)(cid:78)(cid:78) (cid:164)(cid:164) (cid:38)(cid:38)(cid:82)(cid:82)(cid:16)(cid:16)(cid:38)(cid:38)(cid:75)(cid:75)(cid:68)(cid:68)(cid:76)(cid:76)(cid:85)(cid:85) (cid:37)(cid:37)(cid:82)(cid:82)(cid:69)(cid:69) (cid:38)(cid:38)(cid:85)(cid:85)(cid:72)(cid:72)(cid:80)(cid:80)(cid:72)(cid:72)(cid:85)(cid:85) 01 egaP MP 31:4 2102/11/6 SBAT YTNUOCAL:sbaT 4 Identity Theft