COORDINATED CASE PLANNING WORK GROUP

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NTRODUCTION

CalWORKs income support and employment services and Child Welfare Services (CWS) are programs typically offered by the same agency in most California counties. However, families requiring services from both programs routinely find that they are assigned one or more caseworkers for each program, asked many of the same questions by those different workers, and must agree to participate in a different service plan for each program. Each program has its own focus and goals with particular requirements and established time limits. The programs are so distinct that clients may not even realize that they are receiving services from the same agency.

Families involved in both CalWORKs and CWS can benefit from a coordinated case plan that is thorough and comprehensive and avoids overlapping or conflicting assessments, plans, time limits, and requirements. Such a coordinated plan enhances achievement of family self-sufficiency and stability and thus supports the best interests of the children involved.

Through improved screening and prevention services, coordination of CalWORKs and CWS can also make it possible, in some cases, for service providers to assist clients and their families to avoid public assistance or an active case in CWS.

Table 1 on the next page summarizes how coordinated case planning in CalWORKs and CWS can help families and counties. Overall, the purpose of case coordination is not simply to coordinate, but also to improve outcomes for children and families, to promote safe and stable families, and to increase government accountability. Through this approach, coordinated case planning serves an overall county mission wherein CalWORKs is a primary prevention program for child welfare and CWS is an

antipoverty program.

Coordinated Case Planning Work Group Members

Co-Chairs Members

Wes Beers Susan Arteaga Rosemary Capobianco Bonnie Pierce

Chief Deputy Director Assistant Deputy Director Program Specialist Manager

Children’s Services Department of Social Services Health and Human Services Agency Social Services Department CDSS Madera County San Diego County San Luis Obispo County

Virginia Wilson Susan Brooks Lisle Smith Cohen Kathy Volf

Program Manager Director Social Services Program Manager Client Services Director Community Services Agency Northern California Social Services Agency Health and Human Services Stanislaus County Children and Family Services Santa Clara County Yuba County

Training Academy

Jim Brown Jann Donnenwirth Facilitator: Linda Orrante Regional Advisor Program Manager Project Coordinator CDSS The Center for Human Services CalWORKs/Child Welfare

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Table 1

Benefits of Coordinated Case Planning How Coordinated Case Planning Can Help Families

Coordinating services and providing quicker access to services can yield better outcomes for families because they won’t have competing plans, goals, and timelines.

Improved screening and assessment means that prevention services can be added, expanded, or offered earlier.

One point of entry for families makes life easier for families who already have significant stress and few resources.

Coordinated case planning provides more assessments, referrals, and intensive

coordinated services for families with domestic violence, mental health, alcohol and drug abuse, and other barriers to self-sufficiency.

A coordinated system can establish more accountability. There is less opportunity for miscommunication between families and staff.

Families reduce the amount of time spent with program administration and increase the time spent in applying the skills learned.

How Coordinated Case Planning Benefits the County

Staff serving the same families have a common purpose and a stronger sense of community by reducing divisions between programs.

Coordination of services means better use of existing resources – funding, staff, and time. Administration may be able to set up policies and procedures once for both programs. Cost avoidance may result by reducing overlapping services and improving client outcomes and recidivism.

Staff feel more knowledgeable, effective, and empowered; better morale among staff also helps with retention and recruitment.

Coordination of programs may mean that the county can more effectively implement statutes and regulations.

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Coordinated case planning is the lynchpin of a county’s effort to offer coordinated services. The purpose of this document is to offer information and advice to county leaders interested in launching or enhancing coordinated case planning.

Coordinated case planning

is a concept that is widely

known and supported, but

the words mean very

different things in

different counties.

As the Work Group researched coordinated case

planning efforts both within and outside of California, several observations were key.

Coordinated case planning is a concept that is widely known and supported, but the words mean very different things in different counties.

Coordinated case planning is implemented in many different ways.

There is no commonly accepted definition or model of coordinated case planning. The current use of the phrase indicates that in a county, there is, at minimum, an

acknowledgement that families may have two different case plans and that the workers should communicate with each other to share information about the families’ needs.

Based on interviews, research, and case studies, the Work Group also determined that when people discuss coordinated case planning, they often refer to different organizational arrangements:

two or more case plans that are coordinated; or a single, shared case plan between the two programs.

Furthermore, the Work Group observed that coordinated case planning can be implemented by having: a single point of intake or different points of intake;

a single case manager or shared case management; and/or

staffing only from CalWORKs and CWS, or a multidisciplinary team approach that also includes staff from other departments or agencies.

The recognition that there is neither a common definition nor a standard model of coordinated case planning complicated the Work Group’s original mission of developing recommendations about coordinated case planning. Consequently, the Work Group began with an analysis of the common features or elements of coordinated case planning and identified different types of coordinated case planning for the purposes of this briefing paper and the CalWORKs/Child Welfare Partnership Project. Using this approach, the Work Group developed recommendations to assist counties in the design and implementation of coordinated case planning.1

The Work Group offers observations, guidelines, and recommendations in the following areas:

the continuum of coordinated case planning; the five components of case planning; and

administrative decisions related to coordinated case planning.

1_{The Work Group also made state-level recommendations which are contained in the publication, Recommendations for}

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The Work Group observed that the degree of coordination for activities identified as coordinated case planning can be placed on a continuum. This continuum ranges from informal communication to a unified case plan.

Informal Communication

CalWORKs and CWS workers have knowledge that both programs are working with the same family. Workers in each system are encouraged to cross-check to determine if the family has an open case in the

other program.

Identification of mutual families (families in both systems) happens more or less depending on the worker and his or her supervisor.

There are two independently prepared case plans.

Supervisors encourage staff to discuss their cases with the other program worker as needed.

Managed Informal Coordination

The agency has written protocols to ensure the coordination of services.

CalWORKs and CWS workers are informed when the same family has an open case in each program. The respective caseworkers are required to communicate with each other about the family’s needs; e.g.,

after dually involved families are identified, caseworkers are required to meet together to share appropriate information they each have about the family.

Workers develop two independently prepared plans, but they are required to share these with each other. One of the workers may be assigned as the primary or lead case manager for the family.

There is a required process to evaluate progress by all parties; e.g., the lead case manager must talk with the other worker to update the plan and discuss the progress, or lack of it, on the plan.

Linked Case Plans

CalWORKs and CWS workers have a high level of coordination at the earliest opportunity and throughout the life of the case. The workers work together with the family to follow through on the family’s prioritized service needs and activities.

Formal protocols require workers to share information between programs when client and family needs are assessed.

Two case plans are developed.

The workers coordinate case plan goals, services, and timelines when possible to meet the prioritized needs of the family.

The case plans include, as appropriate, any treatment plans with substance abuse, mental health, or other service providers.

A primary case manager may be assigned.

Workers from both CalWORKs and CWS may meet together with the family, e.g., joint home visits at critical junctures in the assessment, planning, and case implementation phases.

The workers have regular contact with each other to track the progress of the two case plans. Adjustments are made to the case plans as needed.

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Unified Case Plan

One comprehensive case plan addresses the family’s needs and stays with the family regardless of which program the family is involved in.

A protocol requires one unified case plan when a client has an open case in CalWORKs and in CWS. Critical to this model is an accurate, joint/interdisciplinary assessment which identifies and describes the

needs of the family regardless of how they entered the system.

There is agreement between the family, the workers, and the service providers on the plan and desired goals/outcomes.

The unified plan identifies:

• the services needed by the family, e.g., the action plan necessary to get to a sufficient/ideal resolution; • the services that the county can make available to the family, whether funded through the TANF

employment plan or the CWS plan;

• substance abuse and mental health goals as components of the same plan; • the agencies that can provide services; and

• a case implementation strategy which includes time frames and deliverables for both the family and the workers.

There may be a CWS court case component that, due to privacy, is not shared. There is one primary or lead case manager.

The workers operate as a team on all aspects of the case from assessment to case resolution.

Counties need to determine what degree of coordination best meets their goals for serving families. The Work Group strongly recommends that counties aim for the highest level of coordinated case planning possible in their organizations. Table 2 provides a comparison of the

features of the different types of coordinated case planning.

Table 2

Comparison of the Features of the

Different Types of Coordinated Case Planning

TYPE OF COORDINATED CASE PLANNING Client Matching Worker Communication Coordination of Case Plans Primary or Lead Case Manager Evaluation of Progress INFORMAL COMMUNICATION Encouraged _{Encouraged on as}

needed basis Two independently prepared plans; workers encouraged to share Two different case managers Workers encouraged to discuss progress MANAGED INFORMAL COMMUNICATION Workers informed of common clients Required – workers meet to share information Two independently prepared plans; workers required to share A primary case manager may be assigned Workers required to jointly evaluate progress LINKED CASE PLAN Formal protocol Required – workers share assessment information

Two case plans are developed in coordination with each other A primary case manager may be assigned Workers required to jointly evaluate progress UNIFIED CASE PLAN Formal protocol Required - joint assessment process

One unified case plan There is one primary case manager Workers operate as a team to evaluate progress

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In addition to identifying various types and degrees of coordinated case planning, the Work Group concluded that most, if not all, coordinated case planning systems are designed using five components.

1. Client Identification and Referral 2. Team Development and Communication 3. Client and Family Assessment

4. Development of a Coordinated Service Plan

5. Case Management and Case Resolution

County leaders need to determine how to configure each component in order to best implement

coordinated case planning. In making decisions about each component, it can be helpful for line staff in CWS and CalWORKs to assess what will best assist their coordination efforts to serve families. At each point, it is also important to acknowledge and address the fact that some clients will fear losing their children (see Table 3).

1. Client Identification and Referral

Administrators face a number of decisions in identifying the target families, decisions that affect the reach of prevention services and the efficiency of the coordination effort. Decisions must be made in three areas: choosing target populations, identifying clients, and referring clients.

Choosing Target Populations

Table 3

Recipients’ Fear of Losing Their Children and Mistrust of the System

Families may be reluctant to participate in coordinated services if they believe they can lose their children over issues such as mental health or alcohol and other drug problems, or domestic violence issues.

These concerns need to be acknowledged and addressed with recipients prior to or as early as possible in their contact with the system. Both CalWORKs and CWS staff should

acknowledge recipients’ concerns and be forthright about the policies of CWS. Each county should develop clearly written policies regarding what constitutes grounds for removal of children. These policies should be widely publicized in the community and made available through all recipient education efforts, such as those describ in the Work Group report on confidentialitiy. ed

e child. It is important to note that policies and related education efforts will vary throughout the state. For example, some counties in California remove every child in a family when the parents have a drug problem, while other counties only remove the child if there is evidence that the drug problem is causing a risk or detriment to th

Will clients be families who have an active case in both CalWORKs and CWS programs? The Coordinated Case Planning Work Group recommends beginning with these mutual clients.

See Table 4 for a depiction of the kinds of families that can be served through coordination, identified along two axes:

• participants receiving or not receiving CalWORKs services; and

• participants receiving or not receiving CWS services.

By identifying target populations that are or

could be dually involved in both systems,

counties can develop program linkages to more efficiently or comprehensively serve these participants and their families, including the provision of preventive services to prevent entrance into one system.

Each county can make choices about which populations to target, based on that county’s philosophy and resources. Counties can select one or several populations and continue to expand the types of families served as resources are developed.

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Table 4

Possible Target Populations for Coordinated Case Planning

2

In CWS and in CalWORKs

Families in CalWORKs and receiving CWS voluntary or court-ordered Family Maintenance

or Preservation Services

Families in CWS Family Reunification services eligible for CalWORKs 180-day employment services

Families in CalWORKs with children in Permanent Placement Services Non-needy relatives

In CWS but not in CalWORKs

Families in CWS Family Preservation or Family Maintenance who are not in CalWORKs, but may be eligible for CalWORKs, CalWORKs Diversion, Food Stamps, or Medi-Cal Services Teenagers coming out of Foster Care who have children and are eligible for CalWORKs

Non-custodial parents of children in CWS who are linked to CalWORKs families through the custodial parent Families with a current CWS

Emergency Response investigation that will not be opened as a case

Not in CalWORKs and not in CWS

Families not receiving CalWORKs, but meeting the “needy family” criteria

Families not receiving CalWORKs, but receiving prevention services under the auspices of goals 3 and 4 of TANF

Families referred for eligibility determination for Medi-Cal, Food Stamps, or Diversion Services Families referred by mandated domestic violence, substance abuse, or mental health reporters

In CalWORKs but not in CWS

Non-needy relatives

Families who are in CalWORKs sanction Families who are reaching 60-month time limits

Families with no CWS history, but with risk factors such as domestic violence, substance abuse, poor school attendance, and lack of compliance with CalWORKs requirements Families transitioning out of CWS with an ongoing CalWORKs case

Families with prior Child Welfare history, e.g., referrals

Teens in CalWORKs, including teen parents Kin-Gap families In CalWORKs Not in CalWORKs No t in CW S In CWS

2_{The Work Group strongly recommends beginning the coordinated case planning effort with mutual clients, those currently in}

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Identifying and referring clients

Once the target populations have been chosen, the families that meet the designated criteria need to be identified. There are different ways to design your intake and screening to identify clients for

coordinated services. Table 5 provides examples of different ways that counties identify clients and families.

Table 6

Options for Intake and Screening One intake process that screens for both

programs.

Each program has its own intake process. Some intake data is shared to avoid redu requests for information from the family. ndant Case plans are developed later in the process. Below are some of the questions that county

administrators need to address.

me of the questions that county administrators need to address.

Will clients be identified through a clerical process or an automated process? Or will identification occur during intake? If screening occurs during intake, will intake screen for one program or both? In making these decisions, consider staff size, training needs, capacity to co-locate, demands on participants, etc. See Table 6.

How can intake in both programs be streamlined so that basic demographic information is collected only once prior to assessment?

How often will the data on mutual clients be available? Weekly? Monthly? Quarterly? How often will the data on mutual clients be available? Weekly? Monthly? Quarterly?

Who will receive the data? Will it go to both programs? What will be the responsibilities of those who receive the information on mutual clients?

Will the family be informed that they have

been selected to receive coordinated services? A Will the family be part of the decision-

Will the family be informed that they have

been selected to receive coordinated services? A Will the family be part of the decision-

Table 5

Identifying Clients and Sharing Client Information

Riverside County identifies clients through

a weekly automated match system from th eligibility, employment, and CWS files. e

ligibility

s the ms.

Yolo County has a full-time Public

Assistance Specialist who identifies dual clients and provides follow-up to ensure that there is no break in program eligibility, thereby reducing barriers to various program service components.

San Diego County has assigned an

eligibility technician to identify and track all clients in both systemswho are part of that agency’s Substance Abuse Recovery project. On other cases, the social worker, e

technician, and employment case manager identify common clients and talk with each other.

In El Paso County, Colorado, when a worker opens a TANF case, the worker checks for a CWS case. When a CWS worker opens a case, the worker checks for TANF involvement. There are two separate automated systems. All intake and

screening workers have codes to acces two syste

making about whether or not they participate making about whether or not they participate in coordinated services?

in coordinated services?

Can workers in CWS screen for possible need of income support or employment services? Can workers in CWS screen for possible need of income support or employment services?

Can CalWORKs workers screen for families at risk of entering CWS? Eligibility and employment workers are mandated reporters which means they must be alert to any signs of child abuse or neglect, but actually screening for possible CWS needs is a prevention strategy.

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How can screening be used to offer

diversion services to prevent entrance into

a program? Intake may determine that a client is not eligible for a program, but that a client and his or her family are in crisis. What services can be provided to

divert the client from needing more

intensive services in the immediate future?

Table 7

CalWORKs Diversion Services in San Luis Obispo

CWS Emergency Response workers are trained to screen for CalWORKs Diversion Services and to refer families to an established contact person in CalWORKs.

ard

es, nce, and child care.

CalWORKs Diversion provides services to anyone potentially eligible for CalWORKs to prevent them from entering CalWORKs. If a family enters CalWORKs within six months, the diversion payment is recouped from their grant. If the program participant and their family do not enter CalWORKs within six months of receiving Diversion, the Diversion grant is forgiven. Diversion services can include car repairs, child care, provision of tools needed for employment, and other services to assist in obtaining or retaining employment. As part of Diversion, the family is also screened for eligibility for Food Stamps and Medi-Cal.

Example of Diversion Services after a Domestic Violence Episode or Report

After a domestic violence report is made to the CPS Hotline, the CalWORKs worker and CWS Emergency Response worker coordinate with a domestic violence service provider to develop a plan to ensure safety for the non-offending parent and children. The plan uses resources from both programs. If the non-offending parent has left the abuser, services are geared tow getting employment for the newly separated parent in order to prevent a need for public assistance. The non-offending parent is potentially eligible for CalWORKs servic including housing, transportation, employment assista

Some counties (see Table 7) have devised intake procedures that identify near-crisis situations that can be assisted or resolved before they require intensive and more expensive services.

How can screening address the needs of a program participant’s family?

Increasingly, county service providers are recognizing that helping clients often requires assisting all members of the family. Consider setting up initial intake to screen the family’s needs (not just focusing on a parent or child) and determine eligibility for a myriad of county programs, including prevention services.

It is important to establish that

participation in prevention services should not be perceived by parents to be a

requirement to qualify for CalWORKs. Services must truly be optional and have no penalties for non-participation. How can the concept of triage be

effectively designed into the intake and screening system? Every participant who enters the CalWORKs system does not need intensive services, either individually or for his or her family. Every client who

enters the CWS system may or may not need services from CalWORKs. At the same time, given the initial successes of CalWORKs in assisting people to gain employment, it is generally felt that many of the families who are still in CalWORKs may face multiple issues and are more likely to be in need of intensive services.

What new protocols and training will be necessary to implement the new intake and screening procedures? Implementing new intake and screening procedures will require development of new protocols and training of staff in the new procedures. See the Organizational Change and

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2. Team Development and Communication

Coordination of services requires that there be a team, whether it consists of two workers or more. Many administrative decisions need to be made to select the team members and to ensure their effective communication and their commitment to coordination and to working with families. Table 8 showcases team development and communication arrangements in three counties. Team Development

Table 8

Team Development and Communication he d nurses from e Health Department. for s ed agency clients so information shared.

s ues are

Ks. e department, one vision” hilosophy.

Yolo County has a multidisciplinary team

which includes 7 CWS Social Workers, 1 CalWORKs Employment Services Social Worker, 1 CalWORKs Public Assistance Specialist, and 1 Medi-Cal/Food Stamp Public Assistance Specialist. Staff are supervised by their respective program supervisors and the team is supervised by the on-site Child Welfare Supervisor. T CWS Social Worker acts as a lead case manager. Also co-located with the team are clinicians from Alcohol, Drug and Mental Health Services an

th

Orange County has a Mutual Clients

Project which involves all CalWORKs district offices and all CWS court and non-court services units. Staff are supervised by their respective CalWORKs and CWS supervisors. All referrals services are done through the CalWORK case manager. Mutual clients are consider

can be

Kern County has court-ordered family

maintenance cases handled by teams of CWS, Eligibility, and Employment Social Workers. The initial home visit for Family Maintenance is by all three CWS and CalWORKs workers. Staff are supervised by their respective CalWORK and CWS Supervisors. CWS is lead for planning services. After CWS iss resolved, the case can stay in CalWOR Information is shared freely under the agency’s “on

p County leaders must make decisions about the

composition, roles, and responsibilities of the team that will be involved in coordinated case planning.

Who will be the members of the team? Who will be the team leader? What decision-making authority will they have and to whom will they report?

Who will select the team members? How will the families/cases be referred or assigned to the team?

Will there be community partners on the team? Will they be permanent members or assigned as needed according to a family’s need? Will the role of the community partner be purely advisory or will they be involved in policy making or direct service? Will the community partners address issues in both program areas? For example, will the community mental health provider address employment barriers and child welfare issues?

Will there be a primary case manager for the family to ensure follow-through with the plan? If so, will that be predetermined, e.g., always the TANF worker or always the CWS worker? Or will that be decided on a case-by-case basis using certain criteria? In developing a team, the Work Group advises that county leaders carefully consider the roles of each member. Some members of the team, like CWS social workers, will have legal mandates and responsibilities not shared by other team members. Involving community partners can strengthen the process, but this should be done with awareness that the activities of community partners cannot be coordinated to the same degree as those of county employees. The role of community partners needs

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to be thought through carefully to ensure that their time and expertise is wisely used and that

commitments made to them can be met. For example, in choosing community partners, county leaders might consider how child care providers can be a resource both to identify risk and to provide support for parents. Domestic violence counselors can offer similar benefits. Finally, while the focus of the CalWORKs/Child Welfare Partnership Project is on the coordination of these two programs, county leaders should consider whether or not it makes sense for the county to involve representatives from other governmental agencies on their teams. For

example, representatives providing services relating to substance abuse, mental health, and public health may also be developing case plans with requirements or deadlines for clients and their families, so coordination with these providers can improve services. It may be that the county decides to begin case coordination with CalWORKs and Child Welfare Services and later expands to include other programs and service providers to offer more integrated planning for clients and their families.

It may be that the county

decides to

begin

case

coordination with CalWORKs

and Child Welfare Services

and later expands to include

other programs and service

providers to offer more

integrated planning for

clients and their families.

Team Communication

There must be a system to ensure that workers from the coordinating programs communicate with each other about common clients, the families’ needs, and the services available to help them.

How will team members communicate with each other? In-person meetings? Phone conversations? E-mail? How frequently? Daily, weekly? As needed?

How will the team make decisions? How will differences or disputes be resolved? Where will the team members be located? Co-location of staff and services is not a requirement for coordinated case planning. What is required is a consistent method of sharing client information. Counties can consider co-location an opportunity for workers from different programs to develop informal relationships, learn about and understand the resources they each have to offer, and more easily coordinate services for the families. How can confidentiality requirements support coordinated case planning? In multi-program cases, responsible sharing of client information is often necessary for program administration and the achievement of case outcomes that can benefit families. In some counties, different confidentiality requirements in CalWORKs and CWS make the sharing of information and coordinated case planning difficult.

Through their research, however, the Work Group has concluded that it is entirely possible and legal to establish client confidentiality requirements that can both safeguard a family’s

expectations of privacy and allow for sharing of client information between CalWORKs and CWS. The Work Group strongly recommends that all California counties adopt procedures that allow respectful sharing of client information between programs. See the recommendations on confidentiality from the Data Systems and Confidentiality Work Group.

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3. Client and Family Assessment

In most counties, it is likely that CalWORKs and CWS will each conduct its own separate assessment. In order to enhance the likelihood that the family can meet the requirements of both programs, there must be a system for coordinating the information from the two assessments – and developing either two coordinated service plans or one unified plan .

Some of the key decisions that need to be made about coordinating the assessments from the two programs

include: Table 9

Unified Assessment Tool Not Available at This Time

In interviews with leaders and researchers in California, Work Group members were not able to identify a comprehensive assessment tool that had been developed or was being used for families in both CalWORKs and CWS.

Counties in North Carolina participating in that state’s TANF/Child Welfare

Collaborative have, through an intensive and time-consuming process, developed comprehensive, strengths-based assessment tools. Some counties are now testing versions of such tools and working to define how the tools can best be blended with existing agency approaches. A committee comprised of representatives of nine counties and the State Division of Social Services meets regularly to share work accomplished and lessons learned in this

.

after develop such l than it is worth.

,

essential for shared it it to a core set of critical questions.

area

Consequently, the Work Group, considerable discussion about a

comprehensive assessment tool, concluded that it may take more effort to

a too

The Work Group recommends not spending time trying to develop the perfect

assessment tool, but rather focusing attention more on sharing assessments, using computers to make information available to workers and partner agencies having regular contact on client and family status, and making the elements of the service plan understandable to all involved. If an assessment tool is

work, lim Who will determine when a coordinated

assessment might be needed?

How will the assessments be conducted? Will caseworkers assess separately, in serial fashion, and then share information? Or will they conduct a joint meeting or home visit?

What can be done to ensure adequate assessment of clients from diverse populations in the county? For instance, what is the availability of bilingual services?

At what point are assessments shared?

Who receives and/or has access to the assessment information?

What are the indicators that trigger a family assessment?

Can clients or their families be assessed for voluntary prevention services, and if so, when does this happen? For example, some CalWORKs families might benefit from services traditionally offered in CWS (parenting skills, etc.) and many CWS families might benefit from public assistance and employment services. Other examples include assessing families with unsubstantiated child welfare cases for prevention and employment services or assessing CalWORKs cases with domestic violence concerns for child welfare services.

What kind of training is required for workers involved in the assessment process?

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4. Development of a Coordinated Service Plan

A primary objective of coordinating case planning is to link services for clients and their families, so that they can avoid conflicting goals and timelines and so that they are more likely to achieve positive outcomes. Coordinated service plans can be developed using different approaches (see Table 10), which gives counties options to tailor the process to their own objectives and resources.

Table 10

Approaches to Developing a Coordinated Service Plan

One comprehensive service plan is developed in a joint meeting and used by all case managers and providers. Separate service plans are developed for each program, and a team meeting is held afterwards to coordinate plan goals, services and timelines based on each family’s priorities.

A separate service plan is developed in each program, and programs only consult with each other as needed evaluate a family’s progress toward goals and to resolve conflicts.

to The Work Group offers the following guidelines as counties

choose an approach to developing a coordinated service plan: Staffing

Staff needs specific training in developing a coordinated case plan and group decision making.

Management needs to provide clear lines of responsibility, authority, and supervision. The plan must clearly state who is responsible for each activity in the plan, including specifying who will resolve staff disputes.

Accountability is critical to ensure that the plans are successful.

Management shouldn’t assume that co-location means that staff are coordinating services. Co-location can assist with coordination, but communication protocols are necessary. Staff needs training on how to engage families in the process.

Clear guidelines need to be established on confidentiality to allow smooth transfer of client information and to avoid having confidentiality become a reason not to coordinate services. Staff will have valuable feedback on how to improve the coordinated case planning process; there should be opportunities offered for staff to provide this feedback in a setting where it can be thoroughly discussed.

County leaders need to determine which agencies will be involved in developing a coordinated plan and, possibly, consider coordinating with plans developed in other systems, such as juvenile justice, mental health, and education.

Consider how paraprofessionals, parents, teens, persons in recovery, and others might assist as service staff or in a liaison role with clients, families, and the community.

Family Involvement

Families need to participate in developing the coordinated case plan, and case plan requirements need to be identified and prioritized for and with each family.

Steps should be taken to prepare families for participating in meetings, empowering the families to speak for themselves.

While families should be included in case plan meetings, they should not be present when the different departments are deciding who is going to be the lead or what department will provide or pay for a service.

Family participation in prevention services should not be perceived by parents to be a requirement to qualify for CalWORKs.

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Other Considerations

Consider how services can be designed to address the needs of the family and of the children, regardless of how they enter our system or where they are assessed. What are the least intrusive services that can be effective in assisting the family?

Table 11

One Way to Achieve a Unified Plan: he CWS Plan Meets the Requirements

f the CalWORKs Plan T

o

alWORKs.

When clients and their families are involved in both CWS and CalWORKs, they frequently have competing or conflicting plans. Some counties have established policies that allow the CWS plan activities to meet the requirements of the CalWORKs plan. In this way, families are provided the opportunity to work to keep their family intact and focus first on services to help them address issues of child safety or neglect. After CWS issues are resolved, the family may continue in C

The Orange County Social Services Agency has established policies and procedures to implement a unified plan. See Appendix C.

Domestic violence is a critical issue and not always fully considered until a crisis occurs. Consider how all coordinated case plans can include provisions to ensure the safety of clients, family members, and workers. In domestic violence cases where restraining orders exist, separate plans need to be developed for victims and batterers. Maintain a focus on designing a process that results in good outcomes for families and guard against process for process’ sake. Consider adopting a county policy that requires consideration of the CWS plan activities as part of the CalWORKs plan requirements and thus unifies the two plans.

If the CWS service plan includes poverty issues, there will be a better fit with the CalWORKs plan, and the plan can be identified as meeting the requirements for both programs (see Table 11). County Examples

In their research into how counties develop coordinated service plans, the Work Group identified valuable examples from counties. A comprehensive approach is used in Santa Clara County which integrates plans when a client has open cases in both CWS and CalWORKs (see Appendix A). Appendix B provides a flow chart that shows how Santa Clara County develops coordinated service plans to link a CWS client to CalWORKs.

Appendix C excerpts policies and procedures used at the Orange County Social Services Agency. To coordinate service delivery, these policies and procedures guide staff in assisting clients who have both an open or pending CalWORKs case or a CalWORKs retention case and an open CWS case.

Appendix D presents policies and procedures from Cuyahoga County, Ohio, that guide planning for clients in both TANF and CWS, as well as for TANF clients who have reached time limits or have been sanctioned.

Finally, Table 12 presents two descriptions of case plans for the same family, a composite of actual circumstances for families in CalWORKs and CWS. These descriptions illustrate how uncoordinated and coordinated case plans can impact family life in dramatically different ways. The descriptions also showcase strategies to coordinate plans, approaches currently in use in Orange County.

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Table 12

Comparing Uncoordinated and Coordinated Plans: Impacts on Family Lives

Below are two descriptions of case plans for the same family, a composite of actual circumstances for families in CalWORKs and CWS. These descriptions illustrate how uncoordinated and coordinated case plans can impact family life in dramatically different ways. The descriptions also showcase strategies to coordinate plans, approaches currently in use in Orange County.*

An Uncoordinated CalWORKs and CWS Plan CalWORKs Plan

Mom and Dad are on CalWORKs. The CalWORKs worker did not inquire whether they are also receiving CWS services, and the clients did not mention it. Dad is participating 35 hours per week in approved CalWORKs Welfare-to-Work activity. His CalWORKs

Welfare-to-Work plan includes 32 hours of vocational training at the community college in a four-month intensive training program. Dad will have a refrigeration repair certification at the end of the class. Dad must also receive three hours a week of Behavioral Health Services. No child care is provided because Mom is staying home with the children.

CWS Plan

The CWS worker did not inquire whether the family is on a CalWORKs Welfare-to-Work plan, and the clients did not mention it. Child Welfare Services activities require parenting education classes and counseling three times a week for three months for both parents. Mom has mandated drug testing weekly and is required to participate in substance abuse treatment. In addition to a weekly therapist session, she has to attend a one-hour group session at least four times a week. Dad must attend Al-Anon once weekly.

A Coordinated CalWORKs /CWS Plan

Agency identifies clients who are in both programs and informs both the CalWORKs and CWS workers that Mom and Dad are in CalWORKs and CWS. For CalWORKs, Dad is participating 35 hours per week in an approved Welfare-to-Work activity. Dad's CalWORKs plan includes CWS activities: parenting classes and Al-Anon totaling ten hours per week and three hours coordinated with Behavioral Health Services.

RKs activities.

The CWS worker uses participation in CalWORKs Behavioral Health Services to meet Mom and Dad's counseling and parent education requirements. The CWS worker also uses the CalWORKs requirement of 20 hours of vocational training, which will be completed in six months, to demonstrate Dad's cooperation and efforts towards stability.

Child care for the children will be paid through CalWORKs while Mom attends drug counseling and testing as required by the CWS case plan. The CWS and CalWORKs workers jointly address the appropriateness of the child care provider and Trustline

requirements. Transportation is paid through CalWORKs for parents to get to various CWS and CalWO

* Composite case plan descriptions provided by Ray Gallagher, Program Manager, Children and Family Services, and Pam Boozan, Program Manager, CalWORKs, both from the Orange County Social Services Agency.

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5. Case Management and Case Resolution

The Work Group offers the following guidelines for case management and resolution for coordinated service delivery, guidelines that emphasize a family focus.

A

system

must be in place

to ensure that

communication takes place

between the CalWORKs

and Child Welfare Services

workers.

Case Management

A system must be in place to ensure that communication takes place between the CalWORKs and CWS workers.

The family must have clear and definite information throughout the process about expectations and about what will happen if the family fails to comply with or meet the conditions of the plan. This information needs to be stated at the beginning and throughout the life of the plan. The family must have a primary contact person to call.

Services must be specific to the identified problem, not generalized.

Goals and outcomes for the family's participation and progress must be measurable. There must be a timeline and a time limit.

Workers should not ask families to accomplish the unrealistic feat of completing distinct program expectations simultaneously.

There must be clear criteria that trigger case review. Consider length of time in the program, a request from a caseworker, likelihood of sanctions, and lack of school attendance by children. Case review, which can be a formal process, offers the opportunity to reassess what changes in services might be needed by families to strengthen the service plan(s).

Case Resolution

Protocols must be clear on who has final authority to close a case and on the process to reach the final decision.

Protocols and processes must be clear on how to transition case management and service delivery:

• To one program in cases when dual involvement is no longer necessary or beneficial. • To support systems outside of public social services.

Decisions need to be made about the degree to which the family will be involved in discussions about case closure.

When cases close, families should be offered information and contacts on transition services. Because coordinated case planning can offer a higher and more tailored level of service, the Work Group considers a county’s commitment to coordinated case planning an indicator of their commitment to develop meaningful plans for families, as opposed to boilerplate plans that are similar for every family.

Work Group members also believe that coordinated case planning offers a special opportunity for counties to provide after-care services to families once they have accomplished their original service plan objectives. For example, a family can have their case closed in CWS, but remain eligible for and possibly obtain CalWORKs services to further stabilize the family situation. This avoids setting up a family to fail by not providing follow-up services to assist with remaining issues (even though CWS intervention is no longer needed). After-care services can also reduce recidivism.

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A

DMINISTRATIVE

D

ECISIONS

R

ELATED TO

C

OORDINATED

C

ASE

P

LANNING

In addition to the decisions that county leaders must make about the five components of coordinated case planning, there are a number of overarching administrative decisions that need to be made:

Policy, Procedures, and Forms

To institutionalize coordinated case planning and to convey that it is a permanent reform in service delivery, administrators will need to develop formal policies and procedures, as well as analyze how intake, assessment, and other forms need to be revised.

Performance Evaluations

Performance evaluations need to hold staff at all levels – workers, supervisors, managers, and administrators – accountable for the coordination of services between the two programs. Goals are shared, which means that each worker is, in part, evaluated on the success of the team. Program Evaluations

Coordinated case planning programs need to be evaluated with assessments from staff, managers, clients and their families, and other partners.

Funding Coordinated Services

The Work Group recommends that the state and counties take action to assist service delivery workers in their ability to focus on providing families with needed services which are within the scope of the service plan, rather than on trying to determine which funding stream to bill. The Work Group recognizes that caseworkers must be mindful of budgeted resources, but it should be the responsibility of fiscal and contract staff, not caseworkers, to make decisions about funding stream issues.

Ongoing Funding for Family Services

Counties need to designate appropriate funding to meet families’ needs and to implement service plans. Currently, some counties use TANF incentive dollars to provide services, such as

parenting education (previously available only through CWS) to TANF-eligible families. Title IV-E can also be used in a variety of ways to support coordinated case planning, prevention services, and training activities (see Table 13).

Funding for Training

The Work Group recognizes that there is not one funding stream fordeveloping curricula and training staff from CalWORKs and CWS. However,a careful understanding of the flexibility afforded under Title IV-E fundswill help county directors maximize their training dollars. Title IV-E trainingfunds can be used to develop, coordinate, and present any training for anypublic agency staff as long as that training assists in the provision ofchild welfare services.

For example, staff from any county department can attend a basic orientationon child welfare, with the curriculum development and presentation beingcharged to Title IV-E training codes. Staff attending training would timestudy to the appropriate training code for their program. Another exampleis also valuable. CWS staff could attend a CalWORKs training on CalWORKsand charge their staff time to Title IV-E, as long as the purpose of thetraining is to train CWS workers to better serve their child welfare clientsthrough CalWORKs services and resources and/or to implement or improvecoordinated services for mutual clients.

In summary, non-CWS staff cannot time study against Title IV-E forattending a Title IV-E training, but there are no restrictions on themattending a presentation developed or supported with Title IV-E funds. Norare there restrictions on using Title IV-E funds to develop curricula orpresent curricula to non-CWS staff, as long as the intention of thecurricula is to support child welfare services.

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Table 13

Allowable Uses of Title IV-E*

Title IV-E can be a source of reimbursement for activities defined in the recommendations on coordinated case planning, including for planning and coordination activities, for prevention services, and for training.

To the extent that planning and coordination activities assist in the more efficient administration of the state’s Title IV-E plan, they can be claimed by counties as Title IV-E administrative costs.

If a county wishes to develop and implement a coordinated case planning model, the county may claim the costs associated with developing policies and procedures and implementing the project as start-up non-recurring costs (including those costs incurred by other public agencies). Allowable costs include salaries and benefits, equipment, supplies, purchase of vehicles, furniture, moving costs, and electronic data-processing

equipment. The costs can be claimed as direct start-up in accordance with claim instructions outlined in County Fiscal Letter No. 97/98-26, which i available on the CDSS web site at www.dss.cahwnet.gov/cdssweb under CDSS Le

s tters and Notices.

's eload counts.

Specifically, for those children the county reasonably views as foster care candidates, Title IV-E allows reimbursement for pre-placement prevention activities that include completing an assessment, developing a case plan, and referral to services. Reimbursement does not cover an investigation.

To meet federal requirements for documenting a child's candidacy for foster care, an individual case plan must verify that without the services outlined in the plan, the child would be placed in out-of-home care. For multiagency teams completing coordinated case planning services, the “County Welfare Department” must review the cases to validate the child risk. All costs must be discounted using nonfederal cas

In addition, Title IV-E training funds can be used to develop, coordinate, and present any training for any public agency staff as long as that training assists in the provision of child welfare services.

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Master Contract

The Work Group recommends that CalWORKs and CWS have a single master contract with partnering service organizations. For example, there could be one service contract with a mental health agency for both CalWORKs and CWS clients. This ensures that the partnering organization will appropriately prioritize the delivery of services to clients and that it has adequate capacity to address the clients’ total needs. A single master contract may also save time and effort spent in contract administration for both programs.

Training for Delivery of Coordinated Case Planning Services

The Work Group recommends that a strengths-based approach for families be a theme interwoven throughout all training. The Work Group recommends covering, at minimum, the following training components for staff involved in coordinated case planning:

• Basic orientation of both CWS and TANF – an overview of the “other program,” including goals, objectives, legislative mandates and regulations, staff responsibilities, job descriptions, and daily experiences

• Organizational culture – How to Build Bridges? • Client identification and referral

• Team development and communication • Client and family assessment

• Development of a coordinated service plan • Case management and case resolution • Family group decision making • Conflict resolution

• Meeting facilitation • Confidentiality

E

ND

N

OTE

This document provides county leaders both a conceptual framework and practical guidelines to implement coordinated case planning to achieve family-focused and strengths-based coordination of CalWORKs and CWS services.

Early in their research process, the Coordinated Case Planning Work Group determined that while coordinated case planning is a widely known and supported concept, there is no commonly accepted definition or model of coordinated case planning. When people discuss “coordinated case planning,” they often refer to different organizational arrangements.

To assist in establishing common definitions and vernacular, the Work Group offers four different models of coordinated case planning, arrayed along a continuum. The Work Group also identifies five basic components that are used to design most, if not all, coordinated case planning processes. County leaders are offered guidelines to determine how to configure each component to implement coordinated case planning in their counties.

Finally, the Work Group offers administrative recommendations, including recommendations relating to funding and contracting, to help county leaders implement and support coordinated case planning.

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A

PPENDIX

A

County of Santa Clara

CalWORKs-DFCS Collaboration Effort

On Crossover Active/Open Cases

Service Delivery Model – In Development

Case Assigned

Employment Technician ET Lead receives Crossover/Joint Caseload list and reviews with Supervisor. Case is assigned to ET if CWS case will be open 30 days or more.

Staff and Family Meet on Service Plan

ET convenes service coordination meeting (within 2 weeks) with assistance from CWS SW and, with input and buy-in from client, identifies strengths, barriers, needs and concerns; identifies activities and hours to be integrated into plan; and identifies and secures services to support plan; secures client’s agreement to the plan; and reviews expectations and verification requirements and next steps with client.

First Staff Meeting to Coordinate Case

Assigned ET and CWS Social Worker meet to discuss case, case status, court plan, and potential needs, and schedule a service coordination meeting that includes client and all of the service providers.

Employment Services Orientation

Employment Technician (ET) conducts CalWORKs Employment Services 1:1 Orientation, if necessary.

Need for Employment Services Assessed/Appropriate Referrals Made

Employment Counselor conducts group or individual testing, discusses results, and develops plan to address barriers with client, secures client’s agreement, leverages support services and refers client to CalWORKs Social Worker, if appropriate.

Case Resolution and After-Care

CWS Case Closes. CalWORKs case remains open (up to one year) with existing ET and a CWS who is assigned to provide after care services in order to prevent family from re-entering CWS Child Welfare System.

Staff Coordinate Case Plan Monitoring and Modifications

CWS SW and ET monitor Crossover/Joint case plan for progress and compliance to agreements. Necessary modifications to plan are facilitated jointly with ET and CWS SW – always securing involvement of the client.

Active/Open CalWORKs and CWS Case Appears on Crossover/Joint Caseload List generated monthly.

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A

PPENDIX

B

The CalWORKs-DFCS (CWS) Collaboration Effort

Santa Clara County

Identifying Cross-Program Eligibility

Eligibility Determined/Referral Made

Employment Technician Lead makes contact with each client/family to review eligibility requirements, determine potential eligibility and refer client to CalWORKs Intake Office with an Intake Referral Form.

Family Applies for Benefits

Family/parent(s) applies for benefits and follows through with eligibility verification. Eligibility Worker provides outcome eligibility determination to Employment Technician Lead by returning the Intake Referral Form.

Eligibility Determined Family determined eligible for Food

stamps/Medi-Cal.

or

Family determined ineligible for benefits.

Eligibility Determined Family determined eligible for cash aid/CalWORKs benefits.

Outcome: Not a Crossover Case Case determined not to be a

Crossover/Joint case and there is no CalWORKs involvement.

Outcome: Crossover Case CWS Court Orders are established and case is opened. Case is a CalWORKs/ CWS Crossover/Joint case. Client participates in CalWORKs Employment Services group or individual orientation. (Case becomes an Active/Open Crossover case from this point.)

Outcome: Not a Crossover Case

No CWS Involvement – Family case goes through regular CalWORKs service delivery and is assigned to a CalWORKs Social Worker to provide support services in order to ensure that family stays out of CWS system. Economic Issues Assessed

CWS Social Worker identifies families that have issues around meeting basic needs and/or economic barriers through a comprehensive bio-psychosocial assessment and refers families to Employment Technician Lead by

completing the CWS/CalWORKs Intake Referral Form.

Note: Only cases where children are in the home will be referred.

Family is Identified

Family is known to CWS via Child Abuse Investigation or is linked with Early Intervention/Dependent Intake Unit (before or during Juvenile Dependency and Detention/Jurisdictional/Dispositional Hearing processes.)

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A

PPENDIX

C

Orange County Social Services Agency

CalWORKs-Children and Family Services Collaboration

An Excerpt from the CalWORKs Policy Manual/ Children & Family Services Policy and Procedure Manual

on How to Coordinate Case Plans

The purpose of this collaboration is to identify clients who have both an open or pending CalWORKs case or a CalWORKs retention case and an open Child Welfare Services (CWS) case in order to coordinate and enhance service delivery to mutual clients. In addition, the goal of collaboration is to identify and remove barriers to cooperation between the two Divisions.

POLICY

1. This policy will ensure the coordination and support of the CalWORKs/Welfare-To-Work plan and the CWS case plan. 2. Confidential information shall be shared between CWS and CalWORKs staff as needed to serve the best interests of the

clients. This will not require a signed release from the client, as involved staff are all part of the Social Services Agency, and, therefore, may share case information.

3. Whenever possible, CWS case plan activities should be a WTW activity or part of the WTW plan. If other than Mental Health, Substance Abuse or Domestic Abuse Services the activities should be listed as the

“CWS”.

4. The CWS Social Worker will discuss the case with the CalWORKs Social Worker, Contracted Case Manager, Employment Eligibility Specialist or Eligibility Technician to obtain information that may influence the CWS case plan. If appropriate, information obtained will be incorporated into casework decisions including, but not limited to, court reports or case plans.

Determination of Participation In Welfare-To-Work Activities

CalWORKs applicants and recipients who receive CWS services are to be encouraged to take advantage of CalWORKs requirements which may be incorporated into the Children and Family Services case plan as well as be approved as a CalWORKs Welfare-to-Work activity. Good cause or exemption from participating in WTW activities may be granted on a case-by-case basis as appropriate.

A. Good Cause

The CalWORKs Social Worker or CalWORKs Contracted Case Manager may grant good cause from participating in WTW activities based on the CWS Social Worker’s recommendation. This may occur when there are multiple court dates, visitation requirements requiring out of county travel, or while referrals to appropriate services are in process but not in place. (It is recommended that CWS activities be included

towards meeting participation requirements as all Time on AID (TOA) rules are applicable to mutual client cases.)

B. Exemption Criteria

The CalWORKs Social Worker or CalWORKs Contracted Case Manager will make a recommendation to the Employment Eligibility Specialist as to whether the mutual client is exempt from WTW activities based on CalWORKs Procedure 100–F-1 (Welfare-to-Work Exemptions). Exemptions should be reviewed when changes are reported or when the exemption expires.

C. Non-Compliance

Any time a mutual client is not complying with either the WTW plan or CWS case plan, the CalWORKs Social Worker or Contracted Case Manager or CWS Social Worker will contact the collaborative partner assigned to the case.

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A

PPENDIX

D

Cuyahoga Work & Training Service Delivery Protocols3

SUBJECT: Child Safety Review Protocol PROTOCOL NUMBER: PS-023

EFFECTIVE DATE: 04-01-01 DEPARTMENT: Participant Services

PURPOSE & SCOPE

To establish a policy and procedure for Self-Sufficiency Coaches (SSCs) to coordinate with Social Workers (SWs) at the Department of Children and Family Services (DCFS) to develop joint case plans promoting self-sufficiency and child safety through the Child Safety Review Process. This protocol applies to all individuals receiving Ohio Works First (OWF), individuals transitioning off of cash assistance and former OWF participants in need of supportive services and benefits.

POLICY

The Child Safety Review Process shall achieve the following:

A.

Assist families in caring for their children after they leave assistance through combined support services and benefits;

B.

Ensure that children at risk of abuse and neglect receive protective services through close coordination between Cuyahoga Work & Training (CW& T) and DCFS; and

C.

Assure service coordination for families already active with DCFS through coordination between CW& T and DCFS.

PROCEDURE

I. The SSC reviews intake lists, joint lists and/or time-limited lists, depending on the circumstances described below, to determine the appropriate action to take.

II. If the family is active in both CW& T and DCFS, the following shall occur: A. For those receiving cash benefits

1. The SSC identifies families with active cases in both agencies from monthly list.

2. The SSC contacts the assigned SW by e-mail within 10 calendar days from date of review to identify the family.

3. The SSC coordinates self-sufficiency plan with SW’s case plan to ensure matching goals and objectives. Both plans should be amended to reflect the same assigned activities.

4. The SSC shares amended plan with family and family signs amended plan. 5. The SSC updates SW monthly on family’s adherence to self-sufficiency plan. 6. The SSC reviews all joint cases and their status with his/her Team Leader (TL). 7. The SSC documents all case changes in the following:

CLRC

Provider GATEWAY

B. For those who have exhausted the 36-month time limit

1. The SW receives a list of former OWF clients who have active cases with him/her on a monthly basis.

2. The SW conducts an unannounced, investigative home visit to the families on the list within 3 days.

3. The SW updates SSC with findings.

4. The SSC and SW should both provide information and guidance on available resources.

3_{An example of county policies that require consideration of the Child Welfare Services Plan activities as part of the}

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III. If family is only active with CW& T and the family has exhausted the 36-month OWF limit, the following shall occur:

A. Steps to determine whether family is active with DCFS

1. By the 15th_{of the last month of OWF eligibility, the SSC reviews list of time-limited families,}

which has been cleared by DCFS, for those families not active with DCFS.

2. The SSC applies the three criteria below and if family meets all three, procedures in III (B) are executed:

a. Family has reached its time limits.

b. Family has no known source of income (both earned and unearned). c. Family is not engaged in any of CW& T’s post time-limit options. B. Steps to take if family meets all criteria

1. The SSC refers the family to a community home visitor (HV).

2. The HV contacts family to arrange a meeting time within 5 days of the referral from the SSC. 3. The HV conducts home visit(s) to assess basic family needs and well-being of children. 4. The HV links the family with post time-limit options, supportive benefits and community

resources as appropriate.

5. The HV documents his/her findings and reports family status to the SSC. 6. The SSC reviews family status and takes appropriate action.

IV. For those who have been sanctioned, but have not reached the 36-month time limit (refer to Sanction/Safety Net Procedures for more detail)

A. The SSC faxes a service request form and IQAM screen to DCFS to determine whether there is an active case with DCFS.

B. DCFS clears to determine case status.

C. Sanction disposition form with case status is sent back to SSC. D. The SSC enters the sanction into CRISE.

E. The SSC completes the Safety Net service request form and forwards to Team Coordinator’s (TC) secretary along with sanction disposition form.

F. TC’s secretary enters information into the Safety Net database. G. TC’s secretary sends service request form to appropriate provider.

FOLLOW-UP & MONITORING

I. Team Leader reviews joint cases and CLRC notes with SSC’s on a monthly basis to ensure appropriate action has occurred.

II. Team Coordinator reviews findings of monthly Child Safety Reviews and reports results to Center Managers.

III. Center Manager forwards outcomes to the Regulatory Compliance Department.

Information provided courtesy of Cuyahoga County, Ohio, Office of Health and Human Services.