SPECIAL COMMITTEE ON OVERSIGHT Rachel Marsh, JD, MSW August 25, 2020

INTRODUCTION Chair Concannon, Vice-Chair Baumgardner, and members of the Committee: My name is Rachel Marsh, Vice President of Advocacy with Saint Francis Ministries. Rooted in the Episcopal tradition, Saint Francis is an independent not-for-profit that has served Kansas children and families since our beginnings as a Boys Home in Ellsworth, Kansas, in 1945. Today in Kansas, Saint Francis cares for over 3,100 children in foster care, sponsors over 620 foster care homes, directs 2 youth residential programs including a Psychiatric Residential Treatment Facility (PRTF) and a Qualified Residential Treatment Program (QRTP), and serves children and with innovative and evidence-based mental health and substance use treatment services in new Family First Prevention Services Act programs. Saint Francis employs over 1,100 dedicated social workers, therapists and other staff members across 19 offices in 66 counties in Kansas. The mission of Saint Francis today includes a multi-faceted child and family services ministry in six states and around the globe. We appreciate the opportunity to provide an overview of our organization’s role in serving children and their caregivers every day. I am here with Karen Wahlmeier and Michelle Albertin, our Regional Vice Presidents over the foster care case management grants in Wichita and Western/Central Kansas.

SERVICES TO SAFELY REDUCE THE NEED FOR FOSTER CARE Saint Francis provides evidence-based services to safely reduce the need for foster care through two Family First Prevention Services Act programs, Family Centered Treatment and Seeking Safety.

Family Centered Treatment (FCT) is an evidence-based and well-supported trauma treatment model of home-based family therapy. FCT is extremely cost effective and stabilizes traumatized youth and families. FCT is one of few home-based treatment models that has extensive experience with families and youth who move between the child , mental health, and juvenile justice systems, otherwise known as “crossover youth.” Saint Francis provides FCT in the Wichita and West region (Colby, Dodge City, Garden City, Manhattan, Salina, & Hutchinson). As of today, 98.87% of children who have participated in FCT have been maintained in their homes safely. Our Kansas FCT programs are supported by long-term experience providing this model in Nebraska and a growing implementation of FCT in Arkansas.

Seeking Safety is an extremely flexible, evidence-based model designed for people with a history of trauma and/or addiction. Common referrals are for teenagers, pregnant women, and families where more than one family member has a substance use problem. Family members are often affected by the person in the family who is using substance. Family members receive services to help the whole family heal. Saint Francis offers Seeking Safety in Saline, Sedgwick, Thomas, Barton, and Finney, and we are expanding this quarter into Sherman, Cloud and Ottawa counties. Our Seeking Safety programs are supported by our long-term work in providing substance use treatment services in Kansas.

CASE MANAGEMENT GRANTEE SERVICES Saint Francis provides comprehensive case management services to children and families when a referral is made by DCF for out-of-home placement. SFM currently has responsibility for over 3,100 children placed in foster care in Western Kansas, Sedgwick County, and much of Central Kansas. Key components of case management services for children in foster care include coordinating and connecting with child placements in kinship, foster care, and residential services, and providing and coordinating services for the child and family to prepare for reintegration, , or independent living.

Child Placement Coordination SFM works with biological families, Child Placing Agencies, and residential providers to place children in the safest, least restrictive environment possible while maintaining connections with family, kin, school, and home community.

Service Coordination SFM engages with biological family, courts, DCF, placement providers, educators, mental health providers, safety net clinics, doctors, dentists, domestic violence advocates, anger management providers, substance use treatment providers, workforce supports, housing assistance, parenting skills trainers, services, safety net assistance, attorneys, probation services, law enforcement, and any other appropriate services to meet the unique needs of each child and family. Service coordination ensures parents access community supports to ameliorate family stressors and challenges. Access to community services makes reunification possible and provides parents with local resources for ongoing assistance after reunification is complete.

Program highlights: support, placement stability, and education.

Intensive Immediate Parent Support Each parent is assigned a parent support person – different than the case manager – immediately upon referral. We designed this based on feedback from partners that parents are often overwhelmed and confused upon entering the foster care system. The parent support worker is assigned to assist the case management team in coaching parents through perceived barriers and to identify services to rectify issues that caused a child’s removal. This support worker is devoted to providing intensive support to parents during the first 90 days of the case. The support worker meets with parents at least once a week to assist them in organizing case plan tasks for completion. The first 90 days is key in building resilience, positive social connections, identifying resources, building rapport and helping to identify relatives and natural family resources as placement and support options.

Placement Stability Coordination Saint Francis has been working at the individual child level, the administrative level, and the system level to support efforts at placement stability following the placement crisis precipitated by a variety of systems changes that began to increase the numbers and needs of youth placed in

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foster care. Those changes included reduced access to PRTF, juvenile justice reform, and a steep increase in overall foster care placement numbers. We have placement coordinators assigned to certain children to ensure placements are made with full information and the right fit between needs and skills. We have been working with Child Placing Agencies and residential programs to support and enhance capacity to meet the needs of youth. We have a clinical/mental health team associated directly with our placement coordination team to coordinate access to mental health services to support placement stability and access to the appropriate level of care for each child.

Education Saint Francis employs education coordinators to liaison between schools and children in foster care. We support enrollment and address barriers to enrollment, track credits, communicate with schools, support compliance with federal law processes, and work on systems improvement with DCF and education workgroups.

KINSHIP PLACEMENT, FOSTER CARE PLACEMENT, AND RESIDENTIAL SERVICES Kinship Care Saint Francis has significantly expanded our focus on kinship connections and supports over the past few years. The kinship department has 54 staff members. Currently our kinship department coordinates placement supports for over 600 kinship families and 1,000 children served by Saint Francis in our role as case management grantee. The kinship department employs Family Coordinators who search for family and kin for youth using the Family Finding model. Kinship Specialists are licensed staff who do comprehensive assessments of kinship homes to determine whether the placement is appropriate for the child/ren. This assessment addresses the family’s ability to ensure the health and well-being of the child/ren. Kinship Support Workers provide direct support of the kinship homes, ensuring the kinship family has the resources necessary for the home to support the child/ren. Kinship Compliance Technicians monitor and track all kinship documentation, run background checks, and enter information into CMS. Kinship children can be placed anywhere in the state, so kinship staff work with homes in all 105 Kansas counties.

Foster Care Homes As a Child Placing Agency, SFM recruits, trains, and supports licensed foster families to provide the least restrictive out of home placement for children and youth. Foster Care Homes (FCH) staff provide professional support, ongoing training and support groups, crisis intervention, and other identified services for every foster family. Saint Francis currently sponsors approximately 620 foster care homes – about 22% of homes in Kansas today. Saint Francis continues to provide a therapeutic foster home program for youth involved in the juvenile justice system. With COVID-19, we have moved preservice and ongoing foster parent training to virtual platforms. 224 foster homes were licensed this past year, which includes new parents to fostering and non-related kin placements. At this time, staff continue to support foster families in their caregiving efforts, helping through adjustments necessitated by the pandemic, be it employment changes for foster parents; day care, school, and extracurricular activities that have been altered for all children in

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the family home; and alterations in platforms and scheduling with visitations, service provision, and court hearings.

Residential Services Saint Francis manages a state-of-the-art Psychiatric Residential Treatment Facility (PRTF) that serves 42 youth between the ages of 6-18 who are deemed medically unable to reside safely in the community.

We also transitioned our youth residential beds to become a Qualified Residential Treatment Program (QRTP) serving 16 clients ages 12-18. QRTP services in Salina provide structured environments for youth on PRTF waitlists or discharged without readiness for family-like placement. A unique aspect of our QRTP is that it is located on the same campus as the PRTF. This gives clients at the QRTP access to the support of the additional services and staff that are located on the campus – 24-hour nursing, administration, psychiatric, and on-site training staff and physical access for the equine therapy program and ropes course.

MENTAL HEALTH AND SUBSTANCE USE SERVICES Substance Use Assessment & Treatment Saint Francis provides addiction services in Salina, Wichita, and Great Bend with individual, group, and family counseling/therapy. Our Substance Use Assessment & Treatment program serves foster children and parents based on referrals from Reintegration / Adoption case management services where available.

Mental Health Services Through our Permanency Clinic, Saint Francis supplements community mental health services to support timely and consistent access to care for children and families served through Reintegration / Adoption. SFM provides medication management, psychological and other mental/behavioral health testing / evaluation, in-home family therapy, and specialized, child- focused therapies. SFM utilizes evidence-based models to provide mental health services targeted for the child welfare population, such as Parent Management Training – Oregon (PMTO), which is implemented with support and oversight by certified trainers, coaches, and fidelity raters. This evidence-based practice model was developed and implemented in Kansas through partnership with DCF, KVC, and the University of Kansas. Trauma Systems Therapy (TST), which is a systemic interventional model for the treatment of children that have experienced traumatic events and continue to exhibit trauma-related reactions, is also used. The TST model is being implemented within SFM with oversight from our Director of Trauma Services, who is Level II certified in the Neurosequential Model of Therapeutics (NMT) with the Child Trauma Academy. Saint Francis is continuously monitored for fidelity with the implementation of the TST model. We go to the homes and in the community to cross over potential barriers and provide services. We strive to set the service up immediately when we get a referral so there is no delay in delivery. SFCS We have therapists working in Wichita, Colby, Manhattan/Emporia, Hays, and Hutchinson/Newton to provide services. SFM has worked to find creative ways to continue to provide these stabilizing

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mental health services and overcome proximity and COVID barriers through the use of a televideo platform delivery. Saint Francis continues to hire and train clinicians to provide trauma-specific therapy for survivors of human trafficking. These clinicians follow the client through transitions so as to maintain rapport and continuity of care. We work in partnership with DCF to provide immediate response assessments when youth in the community are identified as possible victims of human trafficking.

RECOMMENDATIONS Our long-term history as providers in Kansas mental health, youth residential, foster care, and child welfare systems allows us a unique perspective on Kansas child welfare and foster care system today.

• Invest in recruitment and retention of the child welfare workforce, which includes mental health. Key needs are staffing and support at community mental health centers and disability provider services, as well as a long-term workforce development plan for child welfare training. This committee could recommend that state agencies, providers, and secondary and post-secondary educators work together to analyze and design a long-term plan for investment in the child welfare workforce. • Improve safety, monitoring, coordination, and efficiency through investment in technology. When DCF’s foundational system is in place, immediate needs are support for interagency collaboration to allow for information exchange before foster care referrals are made, such as between child welfare and mental health, juvenile justice, and education. • Address the behavioral health needs of high-risk youth in and out of foster care through enhancing the continuum of available services, including continuing to address the needs of youth on the PRTF waitlist. One significant opportunity for enhanced early intervention is through enhanced child welfare and education communication, collaboration, and services. • Invest in evidence-based prevention services for children, parents, and caregivers through the Family First Prevention Services Act. Key issues are mental health and substance use treatment, juvenile justice behavioral interventions, and parent concrete support needs and system coordination prior to foster care. Significant opportunity exists for expanded and enhanced kinship navigator programs to find the for youth before foster care is necessary. • Recognize that COVID-19 will stress and impact families, and we will need to increase and enhance services to children and families during times of stress. Key issues are child care, access to broadband, access to technology, and adding mental health and substance use treatment access and availability. I am happy to stand for questions.

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