Child, Youth and Family Integrated Services
County Level Interagency Memorandum of Understanding/Agreement
Recommendations for Development and Use
Background:
Building upon California’s recent Foster Care reform efforts, opportunities exist for county youth and family service agencies to build and reinforce local collaborative service systems. Outcomes research has long established the positive impact and return on investment, when integrated systems are fully developed. This document is intended to provide background and support to county welfare, behavioral health, probation, education and other divisions or departments, in development of local Child and Family Services Integrated Memoranda of Understanding. A county’s Child, Youth and Family Interagency Leadership Team plays a key role in coordinating these responsibilities, and most effective systems use a formal document to bind that group’s work. County agencies are aligned by a set of values captured within the state’s Integrated Core Practice Model and Integrated Training Plan and includes delivering services which are Family and Youth Guided, permanency focused, Community-based, Trauma Sensitive, and Culturally and linguistically competent.
(These recommendations may not be as valuable in counties where existing structures are in place which already satisfactorily bind these functions. In some existing county Health and Human Services Departments, for instance, legally established cross system authority makes an MOU unnecessary or of limited utility).
Shared Values and Principles
The ultimate objective of this collaboration, on behalf of California’s youth and families, is to have a local spectrum of effective, community-based services and supports that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs in order to help them to function better at school, home and throughout life. There are many areas of shared responsibility where an MOU may be used to establish committed understanding of cross system work. Suggested content areas are included below.
The Interagency Child and Family Services MOU template is intended to be a highly customizable document, which county partners may use to craft elements of agreement at the local level.
Scope:
This template is intended to allow local jurisdictions to apply the spirit and intent of this agreement in the most flexible manner possible. To that end, the MOU may be designed and the partnerships which it supports, may be constructed to apply to whatever scope or reach is desired by the county. At a minimum, those partners would typically include the Child Welfare Agency, the Children’s Mental Health Division or MHP, the Probation Department, and the County of Office of Education, or a county’s largest SELPA agencies.
Alternatively, a county may take a broad view, and craft an MOU to capture an expansive and shared continuum of services affecting most or all youth being served by all public-sector partners. Inherently, this is a larger and more challenging approach, but one which has potential benefits in terms of making prevention, diversion, and early intervention services available in a far more accessible and collaborative way, connecting the “upstream” services to those in need, and maximizing impact on more costly, downstream provider partners.
General Suggestions:
1. The contents of the MOU should be drafted initially by the youth and family serving agencies. While it may be usual practice to request county counsel’s office to draft such an agreement, it can be difficult for legal and contracting experts to create language which effectively binds or ties departments or agencies together. Most often, counsel’s approach to crafting agreements of this type will be to indemnify their clients, rather than seek language which effectively binds agencies in a form of shared responsibility. Once a draft MOU is created, the assistance of county counsel expertise will, of course, be necessary to fully complete and empower the document and the processes it seeks to support.
2. Begin with your collaborative’s active and present partner agencies. While there is certain value in securing the participation of as many youth serving partners as possible, for jurisdictions which are just beginning this process, starting with a limited number of core partners may be helpful. Significant sharing of power, authority and trust is required to create a fully functional integrated system. The greater the number of partners, the greater the energy, effort and resources needed to build the trust, communication and power sharing processes.
3. Each partner agency will have its own needs and challenges in crafting MOU content and the greater the number of partners, the longer and more complex the creation process becomes. Additional partners may be added as they emerge and as the collaboration develops and matures, but it is possible to burden the partnership process unduly in the beginning by having too many agencies involved at the start.
4. Build on existing MOU’s. Use this MOU as a “master MOU” or a clearinghouse to the fullest extent possible. Some specific existing agreements may not lend themselves to a broader shared multi agency MOU process, but long-term sustainability to the interagency MOU will be enhanced when as much relevant content as possible is included in this larger Interagency MOU.
5. As with any process, don’t let the perfect be the enemy of the good or acceptable. Having some binding guide which memorializes the shared work will sustain and build long term success. The MOU should be reviewed and adapted at least every three years, and likely more often for counties where the collaborative process is new or in its early use.
Suggested Potential Content:
Interagency Leadership Team/Policy—Interagency practices are often subject to usual pressures of business and operations and the ebb and flow of public financing. A routine, planful and consistent Interagency Management or policy team meeting is critical to the long-term success of cross system work. Typically comprised of Department heads or Deputies, this group designs and approves shared policy, revenue/expenses; training resources; new programs; leverages human resources and otherwise charts mission and vision for the collaborative. The MOU should capture the composition of this senior management team, and the frequency and process it uses to carry out its shared leadership work.
Interagency Placement Committees—Grounded in long standing state code, regular and consistent IPC or IAPC processes have been a stable of effective cross system care approval and coordination. IPC purposes and goals typically include:
Ø Support Effective, Collaborative Service Planning
Ø Review Child and Family Team Recommendations for Intensive Services/STRTP
Ø Prevent Residential or congregate care
Ø Bring creative and innovative solutions to the family
Ø Uncover Resources
Ø Engage Families in a Culturally sensitive and proficient manner
Ø Coordinate and implement the direction of the Interagency Management or Leadership Team.
Integrated Core Practice Model Implementation— Research regarding effective youth service delivery from nearly any discipline, indicates that highly integrated and coordinated cross-system service planning and delivery, better meet the needs of children, youth and families. Coordinated care results in improved outcomes and lower rates of re-entry or recidivism. Coordinated, integrated care reduces redundancy of effort, increases access to specialty expertise and resources, and can significantly improve the care experience for the family. Adoption and implementation of California’s Integrated Core Practice Model across the child welfare, juvenile probation and behavioral health systems requires the investment of time, resources, patience, and system support at all levels, including direct involvement from parents, families and youth with lived experience. Including ICPM implementation content in the MOU is highly recommended.
Screening, Assessment and Entry to Care – Assessment processes are a useful and necessary element in delivery of any and all services to youth, regardless of the agency or department(s) holding primary responsibility. While Probation, Mental Health and Welfare agencies have unique purposes and uses for assessment and the information the assessment yields, much of the assessment process and some content contained within most assessment tools is similar. Uniform, integrated assessment processes will yield information about different areas such as family member’s behaviors, the presence of trauma, other mental health needs, risk for substance abuse or chemical dependency, and community risk factors. An assessment should also inform the Child and family Team’s conversation and ultimate decision as to the level of need and the type and intensity of care needed. For these and other purposes, assessment cannot be effectively done in a vacuum or by a single agency.
County youth serving agencies may find it both helpful to the shared planning and service delivery process, and cost effective to the departments, to identify a process for conducting uniform, singular and comprehensive assessment for youth in care and for using jointly prepared and agreed upon tools which enhance the sharing of needed information. Assessment tools and processes should be used in a way that minimizes impact on caregivers and disruptions to school, work and home life for youth and families.
Child and Family Teaming and Universal Service Planning--CFT practice requires a commitment from the professionals working with the child, youth and family to recognize they are not working alone within their own professional silo. Rather, they work across the systems, building positive relationships and sharing creative energy and resources that result in an integrated approach to meet the family’s complex needs.
Relatedly, the most important purpose of CFT work is to include youth and families as equal partners and decision makers within the team. Effective teaming encourages inclusion of youth and families with lived-experience in participation at every level of program development, implementation, evaluation and service delivery. A county’s MOU should capture the fundamental approach in use to engage and empower family members and inform a single, connected service plan.
Alignment and Coordination of Transportation and other Foster Youth Services—Federal and state law place shared responsibilities on schools and county welfare and probation agencies, to assure timely access to educational services, and to maintain school stability. The MOU is an ideal place to capture how county partners will approach this challenge.
Recruitment and Management of Resource Families and Delivery of Therapeutic Foster Care Services--While countychild welfare and probation partners have the primary investment in capacity building, recruitment and retention of foster care providers, county MH providers are also committed to oversight and service delivery outcomes for Therapeutic Foster Care services.
TFC service providers therefore, typically a licensed Foster Family Agency, have obligations to both Welfare and Mental Health authorities. In order to operate a TFC Program, FFA providers must meet state social service licensing standards and applicable specialty mental health/Medi-Cal requirements and be certified by the county MHP as a Medi-Cal provider. If the FFA is county owned or operated, DHCS will conduct the Medi-Cal certification.
Often there will be great value in contracting TFC in tandem with other SMHS services. Cross System oversight would likely involve a Mental Health Program Manager and Child Welfare Program Manager to coordinate and facilitate meetings with local FFAs to determine the counties needs and desired processes for TFC care delivery. Additional MOU content in this area might include how the agencies will provide oversight and technical assistance to providers, and to actively assist in removing barriers to effective administration of the program. Because an FFA must have a contract with the MHP to provide TFC services to youth in the Foster Care system, the interagency MOU is a logical location to capture the necessary shared efforts relative to obtaining, managing and overseeing TFC contracts.
Information and Data Sharing—Delivery of cross system/multi agency care requires the timely and accurate sharing of both youth/client specific and program/aggregate data and information. While this area is universally challenging, statewide guidance is available. Privacy laws, both federal and state, were never intended to impede the appropriate access to or delivery of care. The Interagency MOU is a critical location to endow and concretize the local understanding by and between the youth serving agencies, specific to the county’s information sharing and service coordination processes. The MOU can include a commitment to timely and appropriate information sharing, as well as how the agencies will aggregate and monitor systemic data in support of shared outcomes. MOU may cite federal and state code, and where possible, any local rules of court in use. See 42 U.S.C. § 671(a)(8)(A). (42 U.S.C. § 1396(a)(7); 42 C.F.R. § 421.302 (2009).
Quality Improvement and Provider Oversight—County Mental Health plans currently conduct program reviews and on-site certification of private SMHS providers in delivery of Medi Cal/EPSDT services. While county CWS or Social Service agencies may not have formal obligations to audit or evaluate providers, increasingly, there is value in sharing this process, particularly in review of new CDSS/CCL required Program Statements, policies and procedures and other provider delivered process that touch both welfare and MH accountabilities. If county Social Service or Probation authorities choose to conduct provider oversight, they should do so jointly with the MHP, merging both process and content of the site visits and reporting thereon.
Relatedly, state mandated System Improvement and Performance Improvement processes, while required by different state agencies, can often be synchronized and shared, maximizing local resources, and better connecting improvement efforts. The MOU is an ideal place to capture these elements of shared accountability.
Staff Recruitment, Training and Coaching— County public agency partners should memorialize within their MOU agreements, the shared delivery of training and coaching that advance collaboration among child and family service agencies, affiliated human service organizations, families, tribes, and related support networks.
Integrated Training refers to training whose content crosscuts agencies and organizations that serve children, youth, and families involved in publicly administered services, and is rooted in the affirmation that social and behavioral services are more effective, efficient and culturally proficient when service providers and family members collaborate as a child and family team, with the meaningful participation of the family in formulating objectives and planning services to accomplish their goals.
In order to strengthen the integration of public service systems and partnering organizations, a shared training plan builds awareness of common practice concerns, outlines basic organizational functions of the collaborating agencies, and describes methods for working collectively. The integration of training topics and audiences among multiple sectors supports consistent practice standards and values, and mutual goals for improving short- and long-term outcomes for individuals and families.