In 2015, California Assemblymember Mark Stone (D) introduced legislation that launched the state’s Continuum of Care Reform (CCR), an overhaul of the state’s foster care system.
Under 2015’s Assembly Bill (AB) 403, Stone put into place the foundation of the reforms: dramatically scaling back a reliance on group homes as placements for children in the foster care system, and seeking to place more children in the homes of relatives and foster parents.
In addition to reducing the reliance on group care, AB 403 called for better support to relative caregivers, a boost in mental health and other therapeutic services and a focus on making those services available to youth in their home or community.
Last year, new policies associated with CCR began, including the phased transition of group homes into short-term residential treatment programs (STRTPs). A host of implementation issues has also emerged, most notably widespread delays in licensing resource families (as foster families are now called).
As California begins its legislative session, Stone spoke with The Imprint to discuss the state of CCR today and the lessons he’s learned about the process of implementing major system reform.
You’re working on another piece of follow-up legislation to the Continuum of Care Reform (CCR), is that right?
Oh, yes. We’ve done one every year, and we’ll continue. That was a 2015 bill, the Continuum of Care Reform, and each year since then, we’ve done legislation that either adds significant pieces to it or is kind of cleaning up based on what we’ve learned through implementation.
The promise was, if we were going to do a significant reform to the child welfare system and this continuum of care, that we would continue to listen, work with all the stakeholders, and amend the policy based on the implementation and the challenges to implementation.
What I’m trying to get away from is something that government does a lot — they do some big reform, and then stop thinking about it. And 10 or 15 years later, you’re having to reform the reform. Well, if the reform is really going to be a reform, and something as complicated as CCR is, then we should be looking at it every year.
What have the follow-up bills encompassed?
In 2016, the big piece that we put in there was mental health services, trying to put mental health services up front. Normally, mental health’s not billable until there’s an acute problem. Then, the mental health system kicks in and you can bill for it. Well, any child that’s being removed from their home, any child coming into the child welfare system, comes with trauma, comes with mental health needs.
What we’re trying to do — and it’s still not fully implemented and that’s a bit of a frustration, but we’re trying to really push on this — is to ensure that if a kid comes into the system, that they’re being given trauma-informed mental health services up front to the extent they need it.
Now, they may not prove to have acute mental health issues. But why wait until the problem becomes acute? Why not address whatever issues they have as they come into the system?
That to me is much more effective, cost-effective, appropriate for that child, and more humane.
We’re doing another bill this year, it’s a lot of cleanup, it’s kind of not as significant so far in implementation, but my commitment is to continue looking at what needs to be changed every year.
Looking at the overall process of CCR from 2015 until now, what have the biggest achievements been?
I think the biggest success that we’ve had is really changing the reliance on group homes across the state. Because that’s the whole point — changing these group homes into what we call short-term residential treatment programs (STRTPs), and it’s a different licensing for those programs.
They’re going to be receiving kids where they can’t be put out to an individualized placement, there’s work that needs to be done. And this is where as they come in, they ideally get mental health services. They get a lot of attention into trying to address the issues that they have to be able to get them ready for an individualized placement.
In group homes, there are too many instances when kids will just languish. Nobody knows what to do with them. So, they’re stuck in a group home year after year after year when it’s not the best experience for them. And if you talk to kids coming out of foster care, that is one of the things, fairly consistently that they’ll say: “Oh this wasn’t bad, that wasn’t bad, but the group home — oh my gosh.”
There’s a lot of bullying, that’s where a lot of the drug trafficking happens, sex trafficking happens. Kids just get lost.
And what have you seen as the biggest barriers to implementation?
The big challenge, obviously, since we’re getting rid of the group homes, the big challenge that counties are finding is getting those individualized placements. Getting resource families. There still is, in a lot of counties, a lack of individualized placements.
But where that is a challenge because of the circumstances of that child, they’re then put into an STRTP to get the level of services that they need to get them ready for that individualized placement. All of this has to work together. We need the individualized placements, we need the STRTPs licensed, we need to get them the mental health certifications that are necessary.
And that mental health piece has been a bit of a struggle. It’s not where I would like it to be, at this point. It’s been difficult to get the Department of Healthcare Services – who are used to delivering services in a very different model – they’re not used to doing mental health services up front. They’re not used to engaging at this point, and we’re pushing them to do that.
President Trump just signed the Family First Prevention Services Act into law. Several California groups have objected to the bill and are concerned the federal law will jeopardize the CCR process. Do you share that concern?
With this Act, the federal administration is diminishing overall investment in vulnerable communities and is creating conditions where worthwhile programs have to fight amongst themselves for less funding. I remain committed to the Continuum of Care reforms regardless of this new act, but I’m still working with stakeholders to determine how this could hurt kids in California.
I understand that part of the goal of CCR was to redirect cost savings from group homes into other parts of the child welfare system. Does it appear that CCR is on track to actualize those cost savings?
For me, the main goal was not cost savings. And we’ve had to ensure that we have been getting budget allocations out to the counties so that they can be successful. Group homes are often seen as cheaper and easier, but they become cheaper when you just sort of park a kid in a bed and ignore them. That’s the cheapest solution. But that’s what leads to really bad outcomes.
The CCR is meant to be more responsible to the kids, and to outcomes for kids, and it should be working within the allocations that the state gives to counties anyway. But of course, anytime you make a change the counties are all saying, “Oh no, this is so much more expensive.”
We’ve been trying to deal with that and put money on the table where we need to. Because to go out and do these resource family recruitments and retaining resource families, that’s potentially an additional cost. We are asking counties to go do more recruitment. Well, that’s an additional cost.
As the system works, that at some point should not be an additional cost, because they’ve built up enough capacity with the individualized placements, you have enough resource families that you can fill the need in your particular county. But in the short term, this implementation is not necessarily going to be cheaper.
What are the major lessons you’ve learned in trying to legislate this major reform, especially in such a sprawling system as child welfare?
One of the things that I really appreciate is that we’ve done this very closely with the administration. That’s been a tremendous part of the success of these policy areas, and it’s also part of why we can revisit this policy every year.
The more we’re communicating and working together, the better chance we have of getting it right. And the willingness to continue looking at it year after year, and fix implementation challenges along the way — that’s really important.
As we move to a new administration [in California] next year, I really hope we can keep that whole process moving. And even if the new administration wants to do something different with this, that we don’t lose the ground we’ve gained with CCR and continue to look at it and make it OK to continue to look at it.