12 Colo. Code Regs. § 2509-4-7.303

Current through Register Vol. 47, No. 11, June 10, 2024

Section 12 CCR 2509-4-7.303 - [Effective 6/30/2024] CORE SERVICES PROGRAM

7.303.1DEFINITIONS [Rev. eff. 1/1/15]

The Core Services Program consists of the following services:

A. "Aftercare Services": any of the Core services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out-of-home placement of the child.

B. "County Designed Services": innovative and/or otherwise unavailable services proposed by a county that meet the goals of the Core Services Program.

C. Day Treatment": comprehensive, highly structured services that provide education to children and therapy to children and their families.

D. "Home Based Intervention": services provided primarily in the home of the client and includes a variety of services which can include therapeutic services, concrete services, collateral services and crisis intervention directed to meet the needs of the child and family. See Section 7.303.14 for service elements of therapeutic, concrete, collateral, and crisis intervention services.

E. "Intensive Family Therapy": therapeutic intervention typically with all family members to improve family communication, functioning, and relationships.

F. "Life Skills": services provided primarily in the home that teach household management, effectively accessing community resources, parenting techniques, and family conflict management.

G. "Mental Health Services": diagnostic and/or therapeutic services to assist in the development of the family services plan, to assess and/or improve family communication, functioning, and relationships.

H. "Sexual Abuse Treatment": therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse and victimization.

I. "Special Economic Assistance" means emergency financial assistance of not more than $2,000 per family per year in the form of cash and/or vendor payment to purchase hard services. See Section 7.303.14 for service elements of hard services.

J. "Substance Abuse Treatment Services": diagnostic and/or therapeutic services to assist in the development of the family service plan, to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol.

7.303.11Program Goals

The goals of the Core Services Program are to:

A. Focus on the family strengths by directing intensive services that support and strengthen the family and/or protect the child;

B. Prevent out-of-home placement of the child;

C. Return children in placement to their own home; or

D. Unite children with their permanent families.

E. Provide services that protect the child. "To return children in placement to their own home or to unite children with their permanent families" is defined as return to the home of a parent, an adoptive placement, guardianship, supervised independent living placement, foster-adoption placement or to live with a relative/kin if the goal for the child in the Family Services Plan is to remain in the placement on a permanent basis.

7.303.12Access

County departments must make all of the Core services, except for county designed services, available to any client who meets the criteria for the service as documented in the Family Services Plan.

7.303.13Program Eligibility [Rev. eff. 1/1/14]

In order to be eligible for the Core Services Program, each child, youth, and family shall:

A. Meet Program Area Three eligibility criteria; or,

B. Meet the criteria for Program Area 4, 5, or 6 target group; and,

1. Meet the Colorado out-of-home placement criteria at the time of each placement in any Core Services Program; and/or,

2. Require a more restrictive level of care but may be maintained at a less restrictive out-of- home placement or in his/her own home with Core Services.

7.303.14Service Elements

Core Services Programs may include any of the following elements of service:

A. "Collateral Services": teaching families to work with community agencies such as health care, mental health treatment services, substance abuse treatment services, job training, information and referral, advocacy groups, housing assistance agencies, and schools.

B. "Concrete Services": concentrated assistance in the development and enhancement of parenting skills, stress reduction, problem solving, communication skills, budget and household management and recreational activities.

C. "Crisis Intervention Services": phone or in-home counseling, medical services, respite or other interventions available on a 24-hour basis.

D. "Diagnostic and Treatment Planning Services": various evaluations of the child and family to facilitate the development of the Family Services Plan and the move of the child to a permanent placement.

E. "Hard Services": the purchase of services or distribution of cash payments for the following:

- housing funds, including rent, repairs, utilities, or rent deposits

- food or money for food

- clothing - transportation to include fares, auto repair, auto fuel, auto insurance or bus pass

- uncovered medical or dental expenses

- appliances, furniture

- emergency shelter

- employment related expenses, such as tools or dues

F. "Therapeutic Services": interactive parenting, family therapy, support groups, educational groups, problem solving methods, communication skills, and parent-child conflict management.

7.303.15Service Time Frames

A. Services may be provided for up to eighteen (18) months.

B. One or more six month extensions to the initial eighteen months placement are optional if approved by an internal county department administrative review and documentation of approval is in the case record. The in-house review shall include casework or supervisory staff and one or more administrators not providing direct services to the family.

7.303.16Workload Standards

A. Each worker engaged in home based intervention, intensive family therapy, and sexual abuse treatment programs shall have at least two (2) and not more than twelve (12) at risk families depending on the intensity of service needed per family.

B. Life skills shall have staff persons assigned to work no more than twenty (20) families.

C. Supervisory workload ratio shall be six (6) caseworkers per supervisor. Contractors shall provide comparable supervision.

7.303.17Performance Indicators [Rev. eff. 4/1/12]

Core Services Program success shall be measured by the degree to which the following performance indicators identified in the Family Services Plan are achieved by clients.

A. "Family Conflict Management": The family shall demonstrate capacity to resolve conflicts and disagreements contributing to child maltreatment, running away, status offenses and delinquent behavior.

B. "Parental Competency": Parents will show ability to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision.

C. "Household Management Competency": Parents will be able to provide safe environment for their children through competent household cleaning and maintenance, budgeting and purchasing, and structuring mealtime and families activities.

D. "Resources Access Competency": Parents will demonstrate ability to obtain help from the community and within the local, state, and federal governments.

E. "Personal and Individual Competency": Families will show awareness in terms of self-esteem, victim awareness, management of one's own history of victimization, sex education, peer relationships enhancement establishing appropriate physical and emotional boundaries for themselves and for their children, demonstrating assertive behavior, and assuming responsibility for one's own behavior.

F. "Academic, Behavioral and Emotional Competency": Children involved in day treatment settings will demonstrate ability to meet school requirements, to control behavior, and to control and communicate feelings.

G. "Competence in Maintaining Sobriety": Parents will be able to maintain sobriety and/or develop relapse plans to provide for the care, nutrition, hygiene, discipline, protection, instruction, and supervision of the child(ren). Child(ren) will be able to maintain sobriety and/or develop relapse plans to avoid running away, status offenses, or delinquent behavior.

7.303.2INTEGRATED CARE MANAGEMENT PROGRAM

7.303.21Definition

Integrated Care Management (ICM) allows a county-optional, State-approved plan for the provision of selected child and family services. County ICM plans shall identify specific principles, activities, and program components to improve outcomes for children, youth, and families; to support best practices; to advance selected care management strategies; to improve quality and accountability; and, to provide cost efficient delivery of needed services.

7.303.22Program Goals

The goals of the Integrated Care Management program shall include:

A. More efficient and responsive services systems for children, youth and families.

B. Increased flexibility and collaboration across multiple agencies and funding streams to meet consumer needs and avoid cost shifting between systems.

C. Encouragement and authorization for an integrated services system that incorporates blended funding and administration.

D. Focus on quality and outcome driven services with accountability for an entire array of services that families need.

E. Development of data systems to support these goals and to allow administrators and policy makers to better manage and evaluate.

7.303.23Availability

Integrated Care Management is an optional program for individual county or groups of counties. Counties may elect to participate by operating a State approved Integrated Care Management program.

7.303.24Program Eligibility

County departments shall define program eligibility criteria in the proposed plan, which must include all program components and define how each principle will be implemented. The county programs will be approved by the State Department.

7.303.25Program Components

Each plan must contain the following program components. Counties may operationalize the program components as listed beneath each component or in another manner approved by the State Department.

A. Utilization Management (UM) - A system of inter-agency services review and approval procedures designed to ensure that the services provided to a specific child or family at a given time are cost-effective, clinically appropriate and least restrictive. The goal of utilization management is to provide the most appropriate, least restrictive service that meets the needs of the child and the family. Utilization management may include:

1. Application implemented with any or all of the services used by the county departments.

2. Concurrent review activities that focus on reducing or increasing any level of service and may be conducted by dedicated staff and/or a multi-agency review team.

3. Written UM guidelines including standardized UM processes and criteria for UM that may include definitions for key levels of care.

4. Provider profiling where data is supplementally tracked, differentiating provider performance and competencies.

B. Case Management (CM) - Refers to a process by which the services provided to a specific child or family are tracked and managed to achieve optimum, cost effective outcomes. Case management activities may include:

1. Identification and tracking of selected cases or types of cases.

2. Systematic management approach that integrates tracking and targeting of cases for identified, targeted interventions and outcomes.

3. Varying levels of case management across different providers integrating provider profiling and collaborative activities, such as involving providers in case management activities.

4. Procedures which minimize time between referral and delivery of care, and provide dedicated resources and support for any or all of service referrals.

5. Prevention and early intervention in which the county offers supports before more intensive intervention is needed.

C. Resource Strategies - Involve efforts to organize and manage resources to achieve the goals of the county department paying for care. Resource strategies may include:

1. Contract incentives employing shared risks or performance incentives to influence provider behavior and service delivery.

2. Provider resource structure offering efficiencies and standardized care approaches that promote efficient and appropriate care delivery.

3. Resource blending using collaborative efforts with other child and family serving agencies.

D. Information Management Strategies (IM) - the identification, collection, analysis and use of various types of data to further the county's mission and goals. IM may include:

1. Tracking information related to service use including identifying service utilization costs, aggregating and reporting.

2. Creating routine reports and IM activities including trend analyses by case type, provider, services category and other variables; or using complex multi-level analyses to identify cost drivers and adjust risks.

E. Collaborative Integration (CI) - Inclusion of consumers and agencies in the community in the development of the agency's vision, mission and goals and in the implementation of the ICM program. Formal efforts may be directed at coordinating services, integrating care and cooperation between agencies and consumers and may include:

1. Plans for integration, contractual agreements or blending of resources with community agencies.

2. Strategies to utilize formal and informal community based organizations and family support networks to ensure child safety and promote child and family well-being.

3. Plans to have formal inter-agency agreements, Memorandums of Understanding and contracts with community based organizations and a process to engage community partners.

F. Quality Improvement (QI) - Formal organizational processes that emphasize the ongoing improvement of both the process of service delivery and client outcomes through the incorporation of data driven approaches and the institution of systems of monitoring, feedback and organizational learning. QI activities may include:

1. Implementing a formal QI process, which may be narrowly, implemented expanding over time to agency-wide including a written plan and formal process.

2. Implementing a training schedule that trains staff on some aspect of any of the ICM principles or information obtained as a result of use of the principles, such as the outcome of the quality improvement process.

3. Implementing Quality Improvement activities for at least one high cost driver and having dedicated staff for QI activities.

7.303.3COLLABORATIVE MANAGEMENT PROGRAM [Rev. eff. 8/1/15]

The Collaborative Management Program (CMP) is an optional county program approved by the Department of Human Services for a uniform system for agencies to share resources or to manage and integrate the treatment and services provided to children, youth, and families who would benefit from a multi-system approach to services and service delivery.

7.303.31Program Goals [Rev. eff. 8/1/15]

The goals of the Collaborative Management Program include:

A. Reducing duplication and fragmentation of services to children, youth, and/or families who would benefit from integrated multi-agency services or approach;

B. Increasing the quality, appropriateness, and effectiveness of services provided to children, youth or families who would benefit from integrated multi-agency services or approach; and,

C. Encouraging cost sharing among service providers.

7.303.32Availability [Rev. eff. 8/1/15]

A. Collaborative Management is an optional program for an individual county or groups of counties. Counties may elect to participate by entering into a Memorandum of Understanding (MOU) that is designed to promote a collaborative system to coordinate and manage the provision of services to children, youth, and families who would benefit from an integrated multi-system approach to service and service delivery. Counties must use the MOU template provided by the State and developed in conjunction with the Colorado Judicial Districts.

B. The MOU shall be between interested county departments of human/social services and local representatives of each of the following agencies:

1. The local judicial district(s), including probation services;

2. The health department, whether a county, district, or regional health department;

3. The local school district(s);

4. Each comprehensive behavioral health safety net provider as identified by the behavioral health administration;

5. Each behavioral health administrative services organization;

6. The Division of Youth Services;

7. A managed service organization for the provision of treatment of services for alcohol and drug abuse; and,

8. A community domestic abuse program, if representation is available.

C. Counties electing to participate in the MOU may add non-mandatory partners or organizations and are encouraged to include a family member or family advocacy organization, and a youth member or youth advocacy organization.

D. Counties will be provided with guidance/instructions for the completion of the MOU established by the State Department to help in the completion of the MOU process.

E. MOUs must be submitted to the Colorado Department of Human Services on or before May 1st of the fiscal year prior to the MOU agreement year for review and feedback. Completed MOUs, including all signatures, are due on June 30th of the fiscal year prior to the MOU agreement year. Any MOU received after that date will not be accepted and will result in a loss of funding for the next fiscal year.

F. Reviews of each county's MOU will be completed by the State Department and will consist of a review and completion of the MOU review checklist. The review checklist consists of the following areas:

1. A list of mandated partners;

2. MOU deadlines;

3. Oversight group documentation;

4. Target population review;

5. Services provided review;

6. Funding sources review;

7. Reinvestment of funds review;

8. Collaborative Management process review;

9. Confidentiality compliance review; and,

10. Review of required signatures.

G. Each Collaborative Management Program that meets the criteria will receive a signed letter of acceptance from the State Department approving the MOU for the next fiscal year within fifteen (15) days of such approval.

7.303.33Program Components [Rev. eff. 8/1/15]

Each Memorandum of Understanding (MOU) shall contain the following program components.

A. Interagency Oversight Group (IOG)

A system of inter-agency oversight will be developed in the MOU through the creation of an Interagency Oversight Group (IOG). Each IOG must include a local representative of each party to the MOU, each of whom shall be a voting member of the IOG. In addition, the IOG may include advisory members.

1. The MOU shall define the following components of the IOG:

a. Membership requirements;

b. The status of each party as a voting member or advisory member;

c. Procedures for election of officers;

d. Procedures for resolving disputes by a majority vote of voting members; and,

e. Procedures for the development of subcommittee groups.

2. These components shall be maintained in each IOG's by-laws or procedure guide.

3. Process measures shall be identified in the mou annually.

B. Target Population

The CMP target population consists of at-risk children and youth ages birth through twenty one (21) years of age and their families who would benefit from a multi-system approach or integrated service plan as defined in the MOU. Each MOU must include the population that will be served through the designated Individualized Service and Support Team (ISST) or multi-system involved team(s) and CMP prevention programs. Children and youth who are at-risk will be determined in accordance with parties to the MOU.

1. An individualized service and support team (ISST) includes two (2) or more system representatives that are present to assist a child/youth/family with developing an integrated service plan directed by family need. The ISST identifies goals and facilitates collaboration and is a family-driven model for service planning. The child/youth/family members are present at and participating in the development of their plan.

2. CMP prevention programs must demonstrate a multi-systemic approach. Programs must demonstrate in the MOU that multiple disciplines were involved in the development or enhancement of the program or that multiple agencies are involved in the delivery of the service.

3. Programs must demonstrate that the program was developed to reduce bifurcated services aimed at the same outcome and demonstrate, if not provided through CMP, the bifurcated approach would bestow a burden to each of the systems. Each MOU must articulate how the joint approach will benefit children, youth, and/or families in their communities.

C. Elements of Collaborative Management

Each county/region MOU must establish a collaborative management process that addresses:

1. Risk sharing;

2. Resource pooling;

3. Performance expectations;

4. Outcome monitoring; and,

5. Staff training.

The definitions of each for the elements of Collaborative Management shall be maintained by each IOG's by-laws or procedure guide and provided as an appendix to the MOU on an annual basis.

D. Monitoring

The Department will monitor at least one CMP per quarter to ensure implementation of the collaborative management program in accordance with statutes, rules, and the MOU.

1. CMP monitoring will include:

a. A review of the IOG process;

b. A review of the by-laws or procedure guide ensuring it includes the elements required in statute and rule; and,

c. The accuracy and reliability of county-level program data.

2. A review of prevention programs to ensure that each is in compliance with the definitions outlined under target population in the MOU.

3. A review of the data reporting for all program components and expenditure data.

4. Each county/region must enter all participants served through the CMP program's target populations: demographics, services, outcomes, and expenditures in the designated data collection system as determined by the Department, so that it can be tracked and monitored.

7.303.34Reporting [Rev. eff. 8/1/15]

Each IOG must provide an annual report to the State Department that includes:

A. The actual number of children, youth and/or families served through the Individualized Service and Support Team (ISST) or multi-system involved staffingand a description of the recommended services; the outcomes of the services provided, the number, age, race, gender, and, if known, the disability status of the children served; a description of the outcomes for children served; a description of any reduction in duplication or fragmentation of services provided and a description of any significant improvement in outcomes for children, youth and/or families;

B. The actual number of children, youth, and/or families served through the multi-systemic prevention program and the outcomes of the services provided, including a description of any reduction in duplication or fragmentation of services provided and a description of any significant improvement in outcomes for children, youth, and or families;

C. A description of estimated costs of implementing the Collaborative Management Program and any estimated cost-shifting or cost-savings that may have occurred;

D. The number of children and families who were referred to a local Collaborative Management Program and did not receive recommended services, including a description of the services that were recommended but not provided; a description of the barriers to providing such services; and the age, race, gender, and, if known, the disability status of the children;

E. The number of children, by age, served by a local Collaborative Management Program, who were referred by the juvenile justice system (including courts, probation, division of youth services, Colorado Youth Detention Continuum (CYDC), diversion, or law enforcement);

F. The number of children, by age, who were served by a local Collaborative Management Program, who were referred by a county department of human or social services, including referrals through a dependency and neglect case;

G. The number of children, by age, who were served by a local Collaborative Management Program and who identified themselves to the local Collaborative Management Program as:

1. A named victim in a criminal protection order pursuant to Section 18-1-1001 or in a juvenile delinquency or criminal case;

2. A recipient of victim compensation pursuant to Part 4.1 of this title 24; or

3. A protected party in a protection order pursuant to Part 14 of title 13, Section 19-2-707 as it existed prior to its repeal in 2021, or Section 18-1-1001;

H. An accounting of funds that were reinvested in additional services provided to children, youth, and/or families due to cost-savings; and,

I. A description of any identified barriers to provide effective services.

7.303.35Allocation Funding Formula

In order to receive collaborative management program (CMP) funds, the county must implement Collaborative Management components and have a signed Collaborative Management MOU accepted by the Colorado Department of Human Services on or before June 30 of the current fiscal year.

A CMP task group, made up of CMP coordinators, CDHS staff, local IOG members, and CMP state agency stakeholders must be formed to review and make proposed changes to the allocation funding formula. In the event that the CMP taskgroup does not reach an agreement on the allocation formula, the Executive Director of the Department of Human Services shall submit the final proposal for the allocation of moneys to the State Board of Human Services.

7.303.36General Fund Savings and Distribution [Rev. eff. 8/1/15]

County departments must elect to either retain the state general share of the county under-expenditure of the General Fund county child welfare block allocation or participate in surplus distribution for each fiscal year in their MOU. If a county/region chooses to retain the savings realized, they must specify the procedure by which such savings will be reinvested, including to which parties to the MOU such reinvested savings will be available.

The Department, after input from the Child Welfare Allocations Committee, shall develop the method for determining General Fund savings realized as the result of counties' implementation of a collaborative system of management of multi-agency services provided to children and families related to the funding sources specified in an MOU.

7.303.4HUMAN TRAFFICKING

A. In any open Program Area 4, 5 or 6, when the county department of human or social services has reason to believe a child/youth is, or is at risk of being, a victim of human trafficking, the county department shall:

1. screen the child/youth for risk of human trafficking using a state approved human trafficking screen;

2. determine service needs;

3. Document the details of the SCREEN, assessment, and services in the state automated case management system;

4. Report immediately, and no later than twenty-four (24) hours from when the county department becomes aware, to the local law enforcement agency; and,

5. Document the details of the report to law enforcement in the state automated case management system.

B. If a child/youth who is in the legal custody of the county department of human or social services or whom the county department of human or social services has authority for placement is missing, then the county department shall:

1. Report immediately and no later than twenty-four (24) hours from when the county department receives notification that the child/youth is missing, to the local law enforcement agency and to the National Center for Missing and Exploited Children (NCMEC). The county department shall document the details of the reports in the state automated case management system.

2. Make reasonable efforts to locate a child/youth who is missing and document those efforts a minimum of once per month in the state automated case management system:

3. Upon the return of the child/youth, make reasonable efforts to complete the following activities and document those efforts in the state automated case management system:

a. Determine the primary factors that contributed to the child/youth being missing;

b. Determine the child/youth's experiences while missing, including conducting human trafficking screen to determine if the child/youth is a possible human trafficking victim; and,

c. Respond to factors identified in 7.303.4.B.3 (a) AND (b), above, in current and subsequent services.

12 CCR 2509-4-7.303

38 CR 13, July 10, 2015, effective 8/1/2015

38 CR 19, October 10, 2015, effective 11/1/2015

38 CR 23, December 10, 2015, effective 1/1/2016

39 CR 03, February 10, 2016, effective 3/1/2016

39 CR 17, September 10, 2016, effective 10/1/2016

39 CR 23, December 10, 2016, effective 1/1/2017

40 CR 01, January 10, 2017, effective 2/1/2017

40 CR 11, June 10, 2017, effective 7/1/2017

40 CR 17, September 10, 2017, effective 10/1/2017

40 CR 21, November 10, 2017, effective 12/1/2017

41 CR 01, January 10, 2018, effective 2/1/2018

41 CR 21, November 10, 2018, effective 12/1/2018

42 CR 03, February 10, 2019, effective 3/15/2019

42 CR 05, March 10, 2019, effective 3/30/2019

42 CR 15, August 10, 2019, effective 9/1/2019

42 CR 23, December 10, 2019, effective 1/1/2020

43 CR 01, January 10, 2020, effective 1/30/2020

43 CR 09, May 10, 2020, effective 6/1/2020

43 CR 15, August 10, 2020, effective 9/1/2020

43 CR 17, September 10, 2020, effective 9/30/2020

43 CR 21, November 10, 2020, effective 12/1/2020

44 CR 03, February 10, 2021, effective 3/2/2021

44 CR 23, December 10, 2021, effective 12/30/2021

46 CR 03, February 10, 2022, effective 3/2/2023

46 CR 09, May 10, 2023, effective 6/1/2023

46 CR 13, July 10, 2023, effective 7/31/2023

47 CR 11, June 10, 2024, effective 6/30/2024