The2nd meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, September 15, 2004, at 10:00 AM, in Room 129 of the Capitol Annex. Senator Katie Stine, Co-Chair, called the meeting to order, and the secretary called the roll.
Guests: Charles DeWitt of Bardstown; Barbara Carter, Jim Grace, Elizabeth Caywood, Tina Webb, Jason Moseley, Paula Woodworth, Brenda Jones, and Gil Lawson for the Cabinet for Health and Family Services; Cindy Holmes and Shawna White for SCS; Karen Hinkle for Kentucky Home Health; Germaine O'Connell and Steve Davis for the Department for Public Health; Bill Doll for the Kentucky Medicaid Association; and Lee Ann Jung for the University of Kentucky.
LRC Staff: DeeAnn Mansfield, Murray Wood, and Cindy Smith.
The first item on the agenda was a Child Abuse Investigation Update by Barbara Carter, Protection & Permanency, Cabinet for Health and Family Services. Ms. Carter said 50,319 CPS reports were received in State Fiscal Year 2004. Of those reports, 30,853 investigations were conducted. For an additional 15,294 of the reports, Family in Need of Service Assessments (FINSA) were conducted and 773 non-caretaker investigations with law enforcement were conducted. Less than 5 percent of reports (4,172) referrals did not meet criteria for an abuse or neglect investigation, FINSA, or law enforcement investigation. Of the 30,853 investigations of abuse and neglect, there were 10,069 substantiated cases of abuse, neglect, or both. Ms. Carter also discussed the reports by type. Among the substantiated cases, about 20 percent (2,835) had physical abuse, 5 percent (3,881) had sexual abuse, 70 percent (12,272) had neglect, and 3 percent had emotional abuse. More than one type of abuse or neglect may be reported for each substantiated case.
Senator Stine asked about data on families that have substance abuse problems and if they are more likely to abuse their children. Ms. Carter said she could get that information to the committee.
Representative Burch asked if in cases where gays or lesbians adopt if there are more instances of violence or sexual assault. Ms. Carter said she can provide that information to the committee at a later date.
Senator Tori asked for the average amount of children in families with substance abuse problems. Ms. Carter said it was about 80 percent and would be a high number, and she could get that exact number to the committee, but didn't have it with her.
Ms. Carter also said between January and August 2004, 23 families with infants having suspected drug exposure entered the system in Jefferson County. In regard to the number of referrals for prosecution, the status of each CPS report is shared with the County Attorney and law enforcement. Referrals for prosecution are tracked on an individual basis as part of the case work provided by the Cabinet. Due to system limitations, the number o statewide referrals is not available. Ms. Carter also reported that there have been a total of seven abandoned infants statewide. Of those, five have been adopted, one infant termination of parental rights has been grant and one mother came back to claim her child.
The next item on the agenda was a Program Improvement Plan Update by Jim Grace, Protection & Permanency, Cabinet for Health and Family Services. Mr. Grace said the Child and Family Services Review (CFSR) took place in March, 2003. Fifty cases from 3 counties were reviewed. Findings were based on data profiles, statewide assessments, on-site case reviews, and interviews. Areas of non-conformity resulted in a Program Improvement Plan (PIP). The foundations of the PIP include increasing the consistency of social work interventions, trengthening professional development, enhancing continuous quality improvement, expanding and improving community networks, and building partnerships with the Courts. Mr. Grace also discussed a chart indicating the recurrence of child abuse, data on children with two or fewer placements, and data on adoptions in 24 months or less. In regard to the Court Improvement Projects, they are conducting judicial forums, doing quarterly review of the PIP, implementing the Termination Barriers Project, providing tip sheets and developing protocol for the Annual Permanency Reviews, and promoting statewide implementation of Family Courts. He also stated that the PIP is a two year plan that will end on November 3, 2005. A second Child and Family Services Review will occur after the completion of the PIP. Substantial conformity will be measured by a 95 percent compliance rate.
Representative Burch said he has heard that some children have 14-16 different placements and he asked what the Cabinet does to prevent this. Mr. Grace said there is a specific series of events to prevent the removal of the child from the home. There is also a large push to work with the parent toward reunification with the child. They have a plan that the family must follow.
Senator Roeding asked if sometimes the child goes back too quickly to the abusive parent. Mr. Grace said they have a permanency goal, which is to return the child to the parent. They try to give the process up to one year. After one year, they decide if the parent is ready to have the child back or if an adoption needs to take place.
Senator Roeding asked how quickly a termination of parental rights can happen. Mr. Grace said there is one year to look at all the options and they can move forward with other alternatives.
Senator Tori asked why adoptions take so long and if that time frame could be reduced. Mr. Grace said there is a two year timeframe for adoptions. He said everything possible must be done to be sure that removal from the biological parent is the right thing to do and there are also procedural issues that have to be followed. He said reducing the two year time frame would be a challenge and he doesn't see that happening in the near future.
The next item on the agenda was a discussion regarding Child Care Subsidies by Paula Woodworth, Division of Child Care, Cabinet for Health and Family Services. Ms. Woodworth said the source funds available in State Fiscal Year 2004 were $176.5 million. There is an average of 43,518 families served monthly. The average cost per family is $3,139.70 per year, excluding the co-pays. Between May and September of 2003, 10,000 children were placed on the waiting list. In December 2003, eligible families on the waiting list were contacted. Families who responded were provided child care assistance benefits. She said the Child Care Assistance Program(CCAP) has been able to serve all families who meet the eligibility requirements since January 2004. The CCAP program serves all KTAP families who are in a component that is included on their Transitional Assistance Agreement.
Representative Burch asked how many families were effected by dropping to 150 percent of the poverty level. Ms. Woodworth said about 5,000 families.
Senator Roeding asked how many families would be effected if Kentucky dropped to 125 percent of the poverty level. Ms. Woodworth said about 7,500 additional families.
Ms. Woodworth did say that the drop to 150 percent of the poverty level only effected new families coming into the system and not existing clients.
The last item on the agenda was a First Steps Update by Dr. Steve Davis, Director, Division of Adult and Child Health Improvement, Cabinet for Health and Family Services, and Lee Ann Jung, Chair, Interagency Coordinating Council, Kentucky Early Intervention System. Dr. Davis said by administrative order, the First Steps Program was transferred from the Commission for Children with Special Health Care Needs to the Department for Public Health. At that time, the workgroup began the redesign process based on three guiding principals: (1) children will receive necessary services, (2) families will receive necessary support services, and (3) the program will stay within the budget. In June 2004, the statewide provider trainings began. In July 2004, the emergency regulations were put in place and the ordinary regulations began the process. In regard to the current status of the program, immediate and short term redesigns are in place and the workgroup continues to develop long-term recommendations.
Next, Dr. Davis responded to questions that were asked previously by Co-Chair Burch. Dr. Davis said the total agency funds were $18,579,200, and the federal funds were $5,381,800. The grand total expenditure was $35,804,000 of which the central office costs were 2.08 %, the indirect costs were 14%, and the direct costs were 97.78%. There waw a total of 11,511 children served in fiscal year 04 and there are 5,849 children currently being served. Dr. Davis also stated that if the individual family service plan team recommends additional services they can apply for approval through the record review team process. In fiscal year 04, 6,555 children were referred with 1,079 deemed not eligible for first steps services. The breakdown of type of services utilized from most utilized to least were language therapy at $89.00 per hour, developmental intervention at $81.00, occupational therapy at $89.00 per hour, service coordination at $83.00 per hour, and physical therapy at $89.00 per hour. The average number of services per recipient in fiscal year 2004, were 2.3. The average total cost per recipient in fiscal year 2004 was $3,020.91. Dr. Davis reported that the process for handling services complaints is that once the record review team makes its recommendations to the lead agency, the lead agency review the recommendations and sends them to the Family and Service Coordinator. If the IFSP team does not agree with those recommendations, they send additional information to the First Steps Coordinator for a second review. A team of three persons at the lead agency reviews that appeal and sends final recommendations. If the IFSP team still feels the need for more than the recommended services, they can request an IFSP meeting with the First Steps Coordinator and a representative from the Record Review Team in attendance. At that time, the IFSP must concur on the final outcome or file a formal due process complaint through the Cabinet's Hearing Branch. The appeals process started July 1, 2004. To date, there have been two appeals to the First Steps Coordinator with one of those requesting the follow-up IFSP meeting. The outcome of the first appeal was that the recommendations of the Record Review Team were supported (pending IFSP meeting) and in regard to the second appeal, the recommendations of the Record Review Team were supported and one service was redistributed. The average length of time to process and appeal is three working days.
Next, Dr. Lee Ann Jung said that the Interagency Coordinating Council is very involved and are completely supportive of the First Steps Program. She said the administration gets the information out to the parents and the providers. The providers have the information to give to the families and they have the power to make changes with the families and children. They have had a consultative service delivery without a review for ten years which has been discussed.
Representative Burch asked if Dr. Jung feels like her agency has been more accepted since the administration change. She said they feel very accepted and they have seen drastic changes in the last six months.
Representative Burch asked if the administrative streamlining of costs has been successful. Dr. Davis said it has been.
Representative Burch asked about the results of First Steps being the payor of last resort. Dr. Davis said that half the children are medically eligible, but half aren't. Many have private insurance. There is a potential $2 million payment that could go toward the payment of first resort.
Representative Burch asked what kind of feedback Dr. Davis has been receiving from First Steps families. Dr. Davis said he has been receiving positive and negative feedback, but the positive feedback is outweighing the negative at this time.
The meeting was adjourned at 12:15 p.m.