Assessment and Referral

County of Los Angeles Community Assessment Service Center

Overview

Program/Practice Name: County of Los Angeles Community Assessment Service Center (CASC)

Agency Name: County of Los Angeles, Department of Public Health, Substance Abuse Prevention and Control, Adult Treatment and Recovery Services Division

Contact Information: Linda G. Dyer Health Analyst Adult Treatment and Recovery Services Division Substance Abuse Prevention and Control 1000 S. Fremont Avenue, Bldg. A-9 East, 3rd Floor Alhambra, CA 91803 Phone: (626) 299-4109 Fax: (626) 458-6823 ldyer@ph.lacounty.gov

Type of Program/Practice: CASC serves as an entry point for any Los Angeles County citizen seeking alcohol and other drug treatment and recovery services. CASC connects CalWorks1 clients identified with mental health, substance abuse, and similar issues with treatment, and coordinates other specialized supportive service referrals for clients with Greater Avenues of Independence (GAIN), the initial program point of contact for TANF in the Department of Public Social Service (DPSS).

1 CalWorks is the name used for California programs that include Temporary Assistance for Needy Families (TANF) Welfare to Work programs.

Description

Program/Practice Description: The CASC system is composed of eight contracted community-based organizations located throughout Los Angeles County's eight Service Planning Areas. Twenty service center sites are located throughout Los Angeles County. Some sites are co-located in behavioral health treatment centers and others are free-standing community sites where services are coordinated with the local DPSS GAIN office.

CASC works closely with a network of contracted alcohol and other drug treatment agencies, mental health providers, domestic violence agencies, and other community-based organizations providing substance abuse assessments, information, and referrals to a wide variety of supportive services. CASC ancillary referrals include job development, literacy training, and temporary housing, as well as referrals to food banks, health care, and other needed services.

Background/Program History: CASC began in 1997 prior to the inception of CalWorks (1998). The program was designed by a steering committee composed of DPSS representatives, county-based treatment providers, and advocates. GAIN service workers now also participate on the steering committee. The steering committee continues to be actively involved in the program by meeting quarterly to revise CASC program policies and procedures.

Innovations and Results: CASC serves as the liaison between the GAIN (TANF) client and provider. CASC workers must be able to determine if the provider is licensed and assess the quality of the care provided. A well-trained CASC worker also must be able to create a confidential setting for clients, correctly identify the client's service needs, and connect the client to appropriate mental health or substance abuse services. CASC clients can receive a referral to treatment at their initial intake/assessment before leaving the CASC office, thus "catching" the client at the point of highest motivation for change. CASC staff are trained in motivational interviewing techniques.

Operations: CASC is intended to operate on a large scale, specifically within the context of a large county or State-based social services system. To be implemented successfully, a network of treatment providers (substance abuse, mental health) must be available, licensed and/or certified, and able to comply with the requirements of the CASC model. These providers and their office staff should be culturally and linguistically competent.

Funding: Resources for the program are provided directly from State CalWorks allocations.

Staffing: CASC offices operate in two distinct types of settings: within a behavioral health treatment center, where clients receive both CASC assessments, treatment, and support services; or in an independent community-based site where both assessments are performed and treatment and services are coordinated between the treatment provider and the DPSS GAIN office. In addition to the CASC program director, there are four key staff positions: CASC advocate, CASC assessor, peer advocate, and community specialist.

Additional Information: To ensure standardization and continuity of diagnoses, CASC staff are trained to use the Addiction Severity Index (ASI). CASC employs a database tracking system, which can track clients across the county system and, through a review process, verify client engagement in treatment and match clients to the most appropriate treatment available.

Implementation

Tips to Implementation:The CASC model provides flexibility in a large social service agency setting to address client needs as well as the program implementation needs of a large county-based system. The balance between systems needs and individual client needs is at the heart of this program. Implementation of new program services is facilitated through this model.

Keys to Success: CASC attributes its success to several mechanisms:

  • Developing strong relationships of trust among CASC, DPSS, and community providers through cross-agency and provider training.
  • Standardization/continuity in diagnosis and treatment through the use of ASI. All CASC staff are certified in using ASI through training provided by the University of California, Los Angeles, which ensures consistency in the application of services across all CASC sites.
  • Centralized reporting of aggregate data, providing the capacity to make data-driven decisions and inform program and policy.
  • Transparency of the CASC/GAIN system to the client.

Successes: CASC benefits from significant administrative support from DPSS and GAIN staff and community-based providers, thus ensuring clients are able to successfully engage in treatment and fully benefit from the program's employment supports.

Challenges: Challenges include dealing with staff turnover, principally at the DPSS GAIN office, which results in additional need for training, and distributing treatment services equitably across community providers.

Tools

The following tools are associated with County of Los Angeles Community Assessment Service Center. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Administrative Resources

Includes CalWorks Supportive Services flow chart, job descriptions for key CASC positions, prototypes, new application orientation talking points, sample presentation schedules, and policies/procedures for implementing this type of program

Assessment tool used by CASC staff

Assessment tool used by CASC staff

VR Reach-Up Program

Overview

Program/Practice Name: VR Reach-Up Program

Agency Name: Vermont Division of Vocational Rehabilitation

Contact Information:

Karen Blake-Orne VR Reach-Up Vocational Rehabilitation 63 Professional Drive Morrisville, VT 05661-9724 (802) 888-1312 Karen.Blake-Orne@ahs.state.vt.us

Type of Program/Practice: VR Reach-Up is a special program that provides vocational counseling, case management, support services, and job search/placement assistance to all TANF participants in Vermont who possess a significant disability-related barrier to employment.

Description

Program/Practice Description: Since 2001, Vocational Rehabilitation (VR) Vermont has worked with the Department for Children and Families (DCF) to help Temporary Assistance for Needy Families (TANF)1 recipients who have been identified as having a disability that is a barrier to employment. These recipients are referred by DCF to VR for services. They are provided with a specialized VR counselor who also serves as the TANF Reach-Up case manager. This means a single counselor provides all services, thus blending the resources of both VR and DCF to provide vocational services and case management.

VR Reach-Up clients are parents who are experiencing a disability that affects their ability to obtain or keep a job. Disabilities, often trauma based, include depression, posttraumatic stress disorder, anxiety disorders, substance abuse, bipolar disorder, and other personality disorders. The current program is the result of multiple years of learning about ways to assist TANF recipients stabilize their lives and obtain meaningful employment.

Innovations and Results: There have been two initiatives in the last two years that have significantly altered the way the VR Reach-Up program is administered. The Teaming initiative was introduced by the DCF Reach-Up Director as a way to provide services to families in a way that appeared seamless for customers and made the best use of an integrate team comprised of five partners including VR. The Creative Workforce Solutions (CWS) initiative was introduced by the VR Director as a vehicle to provide coordinated and collaborative employer outreach across the agency which builds on the Dual Customer approach. The Dual Customers are those seeking employment and the potential employer. In order to assist people who are faced with significant challenges in obtaining employment, both employers and job seekers need to be provided support. The VR Reach-Up program is now more integrated into the overall DCF Reach-Up team at local and statewide levels. The services to DCF customers through the VR Reach-Up grant have increased as a result of Teaming in combination with CWS. The model for progressive employment supported through the CWS initiative is also a good match for the VR Reach-Up program as it allows participants to engage in short, time-limited activities that relate to employment and gradually build and increase over a short period of time to result in competitive employment. Trial work experiences that are time-limited and well organized have resulted in employers who previously stated they had no openings offering employment to a person who has been made visible to them through a work experience.

Individual-level innovations. VR Reach-Up focuses on three concepts that underlie the supported employment model: treatment addressing the identified disability, individualized support, and tailored employment experiences. VR has a wealth of resources that can be provided, including a job developer, job coach, home visits, and various assistive technologies. This results in stability and increased likelihood that VR Reach-Up customers maintain stable employment.

Systems-level innovation. VR Reach-Up uses cross-agency integration to reduce boundaries and facilitate partnering and relationship building with DCF Reach-Up staff. This includes cross-agency training and full participation in the Reach-Up Teaming Initiative as well as the Creative Workforce Solutions initiative which contribute to improved communication and collaboration around staff and customers.

New model. VR Reach-Up is in a developmental phase as the program adjusts to the many changes brought by the Teaming and CWS initiatives. Staff no longer have capped caseloads and exist in their own silo connected only by the referrals they receive. VR Reach-Up Counselors are now expected to participate in multiple levels of the DCF Reach-Up process based on local teaming plans facilitated by the DCF local leadership and a statewide partnership. Depending on the expertise of the counselors, they may offer additional assessments and consultation to other team members who are also serving customers with disabilities. This assists the teams in serving customers with disabilities more adequately as the number who potentially qualify for VR services exceed the VR capacity that exists for the program. Designated employment staff still work directly with VR Reach-Up Counselors customers to facilitate work experiences and training, but are now part of a CWS Employment Team which provides them with additional support in the employment realm by increasing business contacts and relationships that benefit all staff and programs.

Operations: Reach-Up Teams follow a structure of Orientation, Assessment, Assignment, and services through sub-teams, one of which is the VR Team. This VR Team includes the VR Reach-Up Counselor and often 1-2 additional DCF Reach-Up Case Managers. This structure allows customers with disabilities to be flagged early on in the initial assessment process and potentially assigned directly to the VR Team for more assessment and service. Other customers who are initially assigned to the Resource or Employment Teams for service may also be referred to the VR Team when a disability issue comes to the surface. This is done by bringing the case back to the Assignment meeting/Team with medical evidence or anecdotal evidence of the need for assessment or service by the VR Team. When possible, meetings are held to transition the customer from the referring team to the staff on the VR Team. The VR Reach-Up Counselor may take the case based on the extent of the disabling condition, their caseload size, or may not take the case but will be available to the DCF Reach-Up Case Managers for consultation and support. Additionally when a customer transitions from one of the case managers on the VR Team to the VR Reach-Up Counselor, a "hand-off meeting" is held whenever possible with the VR Counselor, the customer, and the Case Manager.

Funding: The DCF Economic Services Division provides $1.7 million per year to VR to provide vocational rehabilitation services to individuals on TANF who have a disability. VR contributes additional funding to support disability-related services. Additional funds from Economic Services Division  to VR for employment services and social security disability application assistance bring this grant to a total of $4 million per year.

Staffing: VR Reach-Up has 10.5 full-time employees working in VR and additional employment training specialists. VR Reach-Up staff can provide mental health/substance abuse referrals plus vocational services. Because the VR Reach-Up counselor is the TANF case manager for their customers with disabilities, counselors have a complete understanding of both the Reach-Up program and VR in its entirety.

Additional Information: Progressive employment, as an approach to obtaining competitive employment through progressive steps, has been very successful for those contemplating employment. The participants who do not believe they can obtain employment may do well with exploring interests, going on informational interviews, attending a company tour, engaging in a one-day job shadow, and then taking part in a part-time placement with an employer. VR Reach-Up offers intensive support to employers and Reach-Up participants during trial work experience. As part of the CWS collaborative, VR Reach-Up employment staff assures employers that they are under no obligation as a result of a work placement, and the employment staff engages in regular monitoring with the employer to ensure a positive work experience for both the VR Reach-Up customer and the employer. The employment staff offer support to employers in cases when participants do not follow through in order to maintain the relationship with the employer for a future placement. Participants are encouraged to follow through with their placements by receiving a small monetary training off-set that defrays the cost of being at work. This incentive has prompted individuals to follow through with their placements and the employer has then offered them competitive employment.

1 Reach-Up is the TANF program in Vermont.

Implementation

Tips to Implementation: VR Reach-Up follows a supported employment model which has its origins in working with developmentally disabled populations. The VR agency is a customer-focused organization using data-driven decision-making. VR Reach-Up employment staff operate with the freedom and flexibility to provide a wide range of resources to their Reach-Up clients. Modification of the work requirement (for TANF clients) is a central concept to the VR approach. Instead of the perception that TANF participants are being deferred (stopping the clock and thus relieving individual responsibility for complying with the TANF timeline for employment), VR Reach-Up describes its process as a modification and/or gradual increase in work participation. The concept of modification has implications for participants (they are still responsible) and for VR Reach-Up staff (they are always looking for a person's highest level of ability versus their disability).

From a more macro standpoint, partnering in a collaborative way with DCF Economic Services Division and other partners both at the State and local levels is valuable and requires effort. The complexity of the Teaming initiative and the CWS initiative have required all of the partners to work toward creation of a shared mission where the greater good of the partnership takes precedence over individual’s holding tightly to their individual program stance. The resulting leadership structure is that of a matrix wherein there exist direct supervisors, local supervisors, and programmatic supervisors. Negotiating these roles and boundaries takes time and development of trust. Shared projects have helped this trust grow to support the matrix model of leadership. While one of the most complex types of management, matrix leadership has the potential to offer the richest and most productive collaboration between multiple partners. Leadership training is essential to ensure all partners can increase their ability to give and receive feedback as well as create agreements that support healthy boundaries for partners and their staff.

Keys to Success: In addition, the success of VR Reach-Up can be attributed to several other factors. VR Reach-Up staff members have master's level training and some have prior experience with TANF, having worked for the Economic Services Division. They are trained to be flexible and customer service oriented by providing individualized services to clients. The wealth of employment resources and access to mental health/substance abuse treatment also contribute to the effectiveness of their work with TANF clients. VR Reach-Up's Management staffs' close relationship with DCF-ESD Management staff has also been a key to an ongoing, healthy partnership that honors the important work we are doing with an underserved population.

Successes: Successes include integrating VR Reach-Up into the Teaming initiative and increasing collaboration of the employment staff dedicated to Reach-Up through the CWS initiative; consistently engaging a hard to serve population in mental health and substance abuse treatment with successful results; continuing to assist between 40 to 65 individuals in obtaining competitive employment per year even during the economic recession; and assisting 100-115 individuals per year to obtain SSI/SSDI benefits so they are served by the appropriate poverty program.

Challenges: Challenges include creating movement with passive clients who can have just enough engagement but no positive accomplishments; supporting individuals who often have deep trauma resulting in fear and depression; operating despite limited resources in a rural State where adequate housing and transportation is difficult to find; and maintaining hopefulness in staff even while they serve a high-needs population that is slow to move toward employment.

Other Lessons Learned: VR Reach-Up Counselors have developed expertise in documenting functional capacity that supports participants' applications for Supplemental Security Income and Social Security Disability Income benefits for eligible Reach-Up clients and their families. Increased assessment up front for more appropriate plan development has also been helpful in reducing long-term reliance on Reach Up.

Tools

The following tools are associated with VR Reach-Up Program. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Disability Screening Form for Referral to Division of Vocational Rehabilitation

This form is used in some districts to help case managers identify appropriate cross team referrals, i.e., referrals from the Resource Team to the VR Team.

Explaining Services Checklist

A document that offers explanation of the process and obtains a participant's signature so that the VR Reach-Up Counselor can refer to that document when the participant is not complying with the program.

Reach-Up Spending Limits and Support Services Matrix

Work First New Jersey Substance Abuse Initiative

Overview

Program/Practice Name: Work First New Jersey Substance Abuse Initiative/Behavioral Health Initiative (WFNJ–SAI/BHI)

Agency Name: National Council on Alcoholism and Drug Dependence - New Jersey (NCADD–NJ)

Contact Information: Annette Riordan, Psy.D. Coordinator of Transitional Services Unit New Jersey Department of Human Services, Division of Family Development (NJDHS-DFD) 6 Quakerbridge Plaza, P.O. Box 716 Hamilton, NJ 08619 Fax: 609-631-4541

Type of Program/Practice: The WFNJ–SAI/BHI program is based on managed care principles. SAI/BHI provides independent assessment and case management to augment treatment, a continuum of services, and fee-for-service reimbursement to treatment providers. Care coordinators work to provide coordinated care to TANF participants with substance abuse and/or mental health disorders. The primary goals of the program are to treat substance abuse and/or mental health as barriers to employment, ensure uniform assessment, decrease fragmentation of treatment services among providers offering various levels of care, and maintain and utilize a continuum of treatment services integrated with work activities. Clients unable to work due to severe and persistent mental illness (SPMI) are medically deferred from work activities and assisted in applying for Supplemental Security Income (SSI).

Description

Program/Practice Description: The New Jersey Department of Human Services, Division of Family Development's WFNJ–SAI/BHI program co–locates licensed clinicians (i.e., care coordinators) in the 21 county welfare offices in New Jersey to provide comprehensive co–occurring assessment and case management services to welfare recipients whose substance and/or mental health problems interfere with their ability to get or keep a job. These services include scheduling referrals, conducting assessments, arranging patient placements, developing service plans, conducting clinical service reviews, requesting welfare transportation and childcare supports for clients, and tracking client treatment participation and utilization management. The program adheres to a philosophy of client–centered treatment that informs all clinical service decisions. Specifically, care coordinators assess clients and arrange placement in one or more levels of care according to the client's diagnosis and integrate service planning with social services and work activities. WFNJ–SAI/BHI offers a continuum of treatment options to clients with substance abuse, mental health and co–occurring disorders.

Background/Program History: In 1998, the National Council on Alcoholism and Drug Dependence - New Jersey (NCADD–NJ) was contracted by NJDHS–DFD to provide substance abuse services for welfare clients in all 21 counties. From 1999 through 2003, as part of a randomized research evaluation project, two counties offered both Intensive Case Management (ICM) and Care Coordination services to Temporary Assistance for Needy Families (TANF) clients. The outcomes of the research evaluation indicated that ICM was more effective in reducing substance abuse as a barrier to employment for the hard–to–serve clients. Based on those findings, DFD expanded ICM to 14 counties with the largest TANF and child welfare populations. Lessons learned from the research evaluation include: (a) the importance of community stakeholders' input when designing service delivery systems; (b) the value of cross–systems coordination to develop integrated service plans; (c) establishing a lead agency responsible for overseeing and managing care; and (d) significantly expanding treatment capacity to meet clients' multiple service needs. In 2009, due to the increasing number of clients with co–occurring substance abuse and mental health disorders, WFNJ–SAI implemented the Behavioral Health Initiative. SAI/BHI serves WFNJ (TANF) participants with substance abuse and/or mental health disorders.

Innovations and Results: WFNJ–SAI employs an online case management and care coordination system to track clients from initial referral through successful completion of services, along with any potential future need for follow–up treatment. The state–of–the–art case management system was designed from the ground up with considerable input from frontline workers resulting in minimal operating system changes and extensive quality assurance reporting mechanisms to ensure efficient and responsive quality service delivery. With care coordinators embedded in welfare agencies throughout the counties, along with strong collaboration with Division of Youth and Family Services and the WFNJ–SAI provider network, the program is able to address the multitude of needs that clients present with, integrate treatment services delivery, and coordinate cross–agency networking. Frequent drug screening and the use of a voucher incentive system tied to continued successful substance–free functioning enable care coordinators to better monitor treatment progress and be more responsive to client needs for more or less intensive substance abuse treatment. Additionally, these measures provide feedback to WFNJ about client progress toward employability or maintaining employment.

Implementation

Support Services Available:

  • Onsite service delivery at county welfare offices
  • Comprehensive substance abuse assessment
  • Multi-agency collaborative service planning and treatment
  • Child support services
  • Intensive case management and care coordination
  • Welfare transportation
  • Referrals to self-help groups, legal services, and medical services

Tools

The following tools are associated with Works First New Jersey Substance Abuse.