HomeMy WebLinkAboutAgreement A-11-582-4 with Exceptional Parents Unlimited.pdfAgreement No. 11-582-4
SMART MODEL OF CARE AMENDMENT IV
This SMART MODEL OF CARE AMENDMENT (hereinafter referred to as "Amendment
IV") is made and entered into this lie~ day of \:3"~ 20I5, by and between the
following public and private agencies:
1. County of Fresno, a Political Subdivision of the State of California ("County");
2. Exceptional Parents Unlimited, Inc., a California non-profit corporation ("EPU").
Each of the entities referred to above shall sometimes be referred to as "Agency," and
collectively as the "Agencies."
Whereas, the Agencies and Fresno Unified School District ("FUSD") entered into an Agreement
identified as County Agreement No. A-11-582, effective July I, 20 II, Amendment I to that
Agreement, identified as County Agreement No. A-1I-582-I, effective July I7, 20I2,
Amendment II to that Agreement, identified as County Agreement No. A-II-582-2, effective
September I 0, 20I3, and Amendment III to that Agreement, identified as County Agreement No.
A-11-582-3, effective August 26, 20 I4, collectively referred to as the "Agreement", whereby
Agencies agreed to provide the SMART Model of Care, an integrated system of health and
behavioral health and child welfare, which will ensure access to appropriate early intervention
services for children (0-5 years of age) in Fresno County;
Whereas, FUSD previously provided a ninety (90) day written notification to the Agencies that
terminated its participation in the Agreement on July I, 20I3 in accordance with Section 7.I of
the Agreement;
Whereas, the Agencies now desire to amend the Agreement regarding changes as stated below
and restate the Agreement in its entirety.
Now, therefore, for good and valuable consideration, the receipt and adequacy of which IS
hereby acknowledged, Agencies agree as follows:
I. In accordance with Section 6.0 "Term" of the Agreement, the parties hereto agree to
extend the Agreement into the third year ofthe "Term Extension", beginning July 1, 20I5 and
ending on June 30, 2016.
2. That all references to "Schedule 2.I, Schedule 2.IA, Schedule 2.1B and Schedule 2.IC"
in existing County Agreement Nos. A-11-582, A-11-582-I, A-1I-582-2 and A-11-582-3, as set
forth in Amendment III, shall be changed to read "Schedule 2.1, Schedule 2.IA, Schedule 2.1 B
Schedule 2.I C and Schedule 2.I D", where appropriate, attached hereto and incorporated herein
by reference.
3. That all references to "Schedule 2.5C" in existing County Agreement Nos. A-II-582, A-
11-582-1, A-I1-582-2 and A-1I-582-3, as set forth in Amendment III, shall be changed to read
"Schedule 2.5D", where appropriate, attached hereto and incorporated herein by reference.
Model of Care Amendment IV
4.That all references to "Schedule 8.2,Schedule 8.2.1 A,Schedule 8.2.IB and Schedule
8.2.1C"in existing County Agreement Nos.A-l 1-582,A-l 1-582-1,A-l 1-582-2 and A-l 1-582-
3, as set forth in Amendment III,shall be changed to read "Schedule 8.2.1,Schedule 8.2.1 A,
Schedule 8.2.IB,Schedule 8.2.IC and Schedule 8.2.ID",where appropriate,attached hereto and
incorporated herein by reference.
5.Section 8.2 "Budget"of the Agreement,located on page 10, is deleted in its entirety and
replaced with the following:
"8.2 Budget.Schedule 8.2.1,Schedule 8.2.1A,Schedule 8.2.IB,
Schedule 8.2.IC and Schedule 8.2.ID attached hereto and incorporated herein by this
reference,include the fiscal years 2011-12, 2012-13,2013-14,2014-15 and 2015-16
budgets developed and approved by the planning committee composed of participants
from each of the Agencies.The following and all subsequent budgets will be submitted
for approval by all of the Agencies at least ninety (90)calendar days prior to the
expiration of the prior year's budget."
6.Section 12.15 "Exhibits and Schedules",located on page 15 is deleted in its entirety and
replaced with the following:
"12.15 Exhibits and Schedules.All exhibits and schedules attached to this
Agreement are incorporated herein by this reference and all references herein to
"Agreement"shall mean this Agreement together with all such exhibits and schedules.
Exhibit "A"-Model of Care
Exhibit "B"-Self-Dealing Transaction Disclosure Form
Schedule 2.1 -Agency Participation &Responsibilities FY 2011-12
Schedule 2.1A -Agency Participation &Responsibilities FY 2012-13
Schedule 2.IB -Agency Participation &Responsibilities FY 2013-14
Schedule 2.1C -Agency Participation &Responsibilities FY 2014-15
Schedule 2.ID - Agency Participation &Responsibilities FY 2015-16
Schedule 2.5 -Staffing Model FY 2011-12
Schedule 2.5A -Staffing Model FY 2012-13
Schedule 2.5B -Staffing Model FY 2013-14
Schedule 2.5C -Staffing Model FY 2014-15
Schedule 2.5D-Staffing Model FY 2015-16
Schedule 8.2.1 -Budget Summary FY 2011-12
Schedule 8.2.1A -Budget Summary FY 2012-13
Schedule 8.2.1B -Budget Summary FY 2013-14
Schedule 8.2.1C-Budget Summary FY 2014-15
Schedule 8.2.1D -Budget Summary FY 2015-16"
7. Section 12.17 "Modification",located on page 15 is deleted in its entirety and replaced
with the following:
Model of Care Amendment IV
"12.17 Modification.Any matters of this Agreement may be modified
from time to time by the written consent of all parties without, in any way, affecting the
remainder.Notwithstanding the above, minor changes to addresses or invoices as well as
changes to line items in the budget, attached hereto as Schedule 8.2.1, Schedule 8.2.1A,
Schedule 8.2.IB,Schedule 8.2.IC and Schedule 8.2.ID that do not exceed ten percent
(10%)of the maximum compensation payable, may be made with the written approval of
County's Department of Public Health Director, or designee. Said budget line item
changes shall not result in any change to the maximum compensation amount payable, as
stated herein."
8. That Schedule 2.ID Agency Participation &Responsibilities FY 2015-16, attached
hereto and incorporated herein by reference, shall be added to County Agreement Nos. A-l 1-
582,A-l 1-582-1,A-l 1-582-2 and A-l 1-582-3.
9. That Schedule 2.5D Staffing Model FY 2015-16,attached hereto and incorporated herein
by reference,shall be added to County Agreement Nos. A-l 1-582,A-l 1-582-1,A-l 1-582-2 and
A-l 1-582-3.
10. That Schedule 8.2.ID Budget Summary FY 2015-16, attached hereto and incorporated
herein by reference, shall be added to County Agreement Nos. A-l 1-582, A-l 1-582-1, A-l 1-
582-2 and A-l 1-582-3.
Agencies agree that Amendment IV is sufficient to amend the Agreement and, that upon
execution of Amendment IV, the Agreement and Amendment IV together shall be considered the
Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions,terms,
covenants, conditions and promises contacted in the Agreement and not amended herein shall
remain unchanged and in full force and effect. This Amendment IVshall become effective July
1.2015.
Model of Care Amendment IV
IN WITNESS WHEREOF, the parties hereto have executed this Amendment IV to Agreement
as of the day and year first hereinabove written.
COUNTY OF FRESNO
By:
Date:
BERNICE E. SEIDEL, Clerk,
Board of Supervisors
APPROVED AS TO LEGAL FORM:
DANIEL CEDERBORG, COUNTY COUNSEL
By:
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
By:
Model of Care Amendment IV
4
COUNTY OF FRESNO
REVIEWED AND RECOMMENDED FOR APPROVAL:
By:(\){f)Ovv
David Pomaville,Director
Department of Public Health
Dawan Utecht,Director 7
Department of Behavioral Health
Fund/Subclass:0001/10000
Organization:56201706,56302229
Account:7295
Model of Care Amendment IV
EXCEPTIONAL PARENTS UNLIMITED,INC.
By:%/^6^u y°^Wyy9
Ellen Knapp
Executive Director
Date:*/»/*<•
Mailing Address:
4440 North First Street
Fresno,CA 93726
Phone #:(559)229-2000
Fax #:(559)229-2956
Contact:Ellen Knapp,Executive Director
Model of Care Amendment IV
Model of Care Amendment IV
Exhibit "A"
Model of Care
Putting the Pieces Together
Ensuring Access to Early Interventionfor
High-Risk Children Birth Through Five in Fresno County
The SMART Model of Care
County of Fresno,Department of Public Health
Maternal,Child and Adolescent Health Program
Babies First
iiJFiii
Babies First
And
FIRSTS
Revised July 1,2008
Acknowledgments
The purpose of this report is to describe the outcome of a one (1) year community-based planning
process to develop a Model of Care, ensuring that all high-risk children birth to five years of age in
Fresno County will have full access to early identification,comprehensive assessment, and a full
range of therapeutic services,as mandated by federal and state laws.
The SMART Model of Care has been developed through a formal partnership between First 5 Fresno
County and the County of Fresno, Department of Public Health, Maternal, Child, and Adolescent
Health (MCAH) Program. It has grown into a public-private partnership drawing upon the
experience of all who are involved -from parents of high-risk children to the leaders of Fresno's
institutions and agencies - the County of Fresno, Board of Supervisors; County of Fresno,
Department of Children and Family Services, County of Fresno, Department of Public Health; First
5 Fresno County; Exceptional Parents Unlimited, Inc.; Fresno Unified School District; Fresno
County Office of Education; Central Valley Regional Center; Court-Appointed Special Advocates;
Fresno Metro Ministry; Clovis Unified School District; Fresno County Juvenile Dependency Court;
University of California San Francisco-Fresno Medical Education, Department of Pediatrics; and
the Fresno County Foster Care Oversight Committee. The leadership of these agencies has both
shaped the Model of Care and has committed to provide the necessary resources it requires to be
implemented.This model representsthe work of that dedicated leadership.
This document was prepared by Connie Woodman,RN, PHN, Division Manager,Maternal,Child,
and Adolescent Health,Laurette Misaki,RN,MHN,Perinatal Services Coordinator,and Sandra
Arakelian,Senior Staff Analyst, all with the County of Fresno, Department of Public Health,
Maternal, Child and Adolescent Health Program; and Ira J. Chasnoff, MD, and Richard F.
McGourty,PhD,of Children's Research Triangle,Chicago, Illinois,who were responsible for
facilitating the planning process,recording and developing the community contributions,and
guiding the design of the model.A special thanks goes toNancy Richardson,Chair,Fresno County
Foster Care Oversight Committee in 2003 for sharing The Story of Jose,which inspired us to
persevere;and,to Brittney Di Redo,Health Education Specialist,and Pauline Huynh,MSW,also
with the County of Fresno,Department of Public Health,MCAH,for developing the Community
Resources for High-Risk Children Birth Through Five Years,Fresno2004.
For more information,contact:
Laurie Misaki,RN,MHN
Department of Public Health
Maternal,Child and Adolescent Health Program
1221 Fulton Mall
Fresno,California 93721
Tel:(559)445-7024
lmisaki(g)co.fresno.ca.us
TABLE OF CONTENTS
The Story of Jose 3
What Do We Know?5
What Did We Learn?6
Recommendations 9
The SMART Model of Care for High-Risk Children Birth Through Five Years 10
A Brief Overview 10
Step-by-Step 11
A Community Partnership Has Been Developed 23
Training Plan 26
References 28
Appendices 29
Appendix A:The Planning Process 29
Appendix B:Community Values 35
Appendix C:Terms,Concepts and Organizations:A Reader's Guide 39
Appendix D:Community Resources for High-Risk Children Birth
Through Five Years,Fresno County 2004 42
AppendixE:Exceptional Parents Unlimited,Inc 57
Appendix F:Participants in the Planning Meeting July 2003 60
Appendix G:Individuals and Groups in Town Meetings and
Interviews 62
10
THE STORY OF JOSE
Jose is a child of Fresno County.At first glance his story is one of an unstable home,disordered
parents and, ultimately, his own self-destructiveness.But, on closer inspection,it also is a story of
fragmented services,another child lost in a morass of good intentions but poor follow-up and
communication by those responsible for his safety and well-being.
Kindergarten
•Referred to the school's high-risk program
• Four referrals to Department of Children and Family Services (DCFS):lack of supervision,
hunger,dirty,alleged sexual abuse
•Cigarettes and beer; head lice
•Picked up by police for wandering the streets unsupervised with his eight-year-old
profoundly retarded sister
•Parents referred to counseling,parenting classes
First grade
•Three referrals to DCFS
•Attempted sodomy by older boys
•Mother threatens suicide because her husband was trying to force her to have sex with her
sons
•Mother and children at Marjaree Mason Center briefly;dad picks up sons
• Initial: tests very low academically;severe behavior problems
Second grade
•Fighting,choking,stealing,out of control
•Assessed as age equivalent to 4 years. 3 months
• Mental Health diagnosis:enuresis,conduct disorder, anxiety,possible learning disability.
Request for psychiatric consultation. Dropped due to lack of follow-up
•Referral to DCFS:lack of supervision
Third grade
•Special Day Class
•Brought switchblade knife to school
•Frequent sleeping in class
• Reports of pervasive domestic violence
•Reading at first grade level
•Poor school attendance
11
Fourth grade
• In Resource Specialist Program (RSP) class by parental request
• Testing by California School of Professional Psychology shows skills in lowest 1%of age-
mates:IQ==71.
• Learning disabilities identified in auditory processing, attention, cognitive abilities
• Two referrals to Child Protective Services (CPS):lack of supervision;alleged physical
abuse,possible drug use
Fifth grade
• Special Day Class; requires one-on-one supervision at all times
• Sleeping in school; making serious threats against teachers, classmates
• Weeklycounseling at school; Mental Health assessment pending
•Three referrals to DCFS
•Arrested for stealing forklift
Sixth grade
• Stole father's car;placed on probation
• Slept in every class first day of school
• Out of control, dangerous behaviorat school; frequentsuspensionsand other interventions
•Assaulted a student;arrested;expelled
• Assessed by Mental Health in May,1999
Current Status
• Age 13,first grade level, English emergent
• Expelled from school for fighting
• Poor support by family; no friends
• Sad,depressed, paranoid;has nightmares;wets bed; has insomnia
•Noncompliant with Court Orders
• Gang involved; uses drugs; has tattoos
A review of Jose's case shows that 23 different agencies came into contact with the family over a
seven year period.Jose was identified as having serious behavioral and mental health problems and
was brought to the attention of the right agencies.Several of the agencies were delivering similar
services to multiple members of the family,and in many instances the services for each family
member were being duplicated by several agencies at the same time.We can assume that none of
the agencies set out to miss Jose,and no professional with whom he came in contact was indifferent
to his problems.But the community must ask,"How could so much effort and money yield so little
real help for this young boy?"And,perhaps more importantly,"How can we do better for the Jose's
in our system today and tomorrow?"This is the question the Fresno community asked two years
ago.
12
WHAT DO WE KNOW?
The early years are the most important.
We know this much is true: the first few years of children's lives are vital for their ultimate growth
and development.During this time, the basic difficulties that define life-long mental health,
developmental,and learning problems can begin to emerge.
We also know that a child's development is a dynamic process,involving both social and biological
factors that contribute to success or failure. From day one, the child interacts with the surrounding
environment and seeks the nurturing support that will help him achieve full potential for growth and
development. Thus, behavioral health problems can emerge from a wide variety of biological and
environmental factors. Just as premature birth, prenatal exposure to alcohol or drugs, or poor
maternal nutrition can harm fetal brain development, family violence, substance abuse in the family,
or maternal depression can interfere with the child's brain development after birth. The problems
that emerge as the child enters school leave the child unprepared for learning.
From this perspective,Fresno County certainly is no different from any other community in the
nation. Each year in Fresno County there are children born at risk from multiple biological and
environmental factors that impede their long-term potential for successful growth, development and
learning.
Whoare the high-risk children?
Based on available data,each year in Fresno County:
•1,141 infants (8 % of all newborns) are born with low birthweight or very low birthweight
(California Department of Health Services,2002);
• More than 2,400 infants are admitted to neonatal intensive care units in our community's
hospitals (hospital N1CU admission data, 2002);
•2,031 infants (12.6%)delivered are prenatally exposed to alcohol or illicit drugs (Vega et al,
1993);and,
• 700 children ages birth through five years are placed in foster caredueto abuse and neglect
(County of Fresno,DCFS,2001-2002).This represents a child abuse rate of 68/1,000 and a
rate of 10/1,000 for children birth to five years who are in foster care.
The recent report of California's Task Force on Children with Special Health Care Needs,August
2003,is consistent with the findings in Fresno County.Fresno's children at risk come from every
corner of the County.While the highest rates of identified substance abuse,child abuse and neglect,
and perinatal complications are recognized in children enrolled in Medi-Cal,extensive national
research has shown that these problems exist in all socioeconomic strata.Subsequently,every
hospital,school,and neighborhood in the County has children who are at risk for long-term
developmental and mental health problems.
WHAT DID WE LEARN?
13
Jose's case is a dramatic example of the key difficulty that was uncovered through the one year
planning process for the Model of Care: Fresno County's multi-agency system of identification,
assessment and treatment is failing our very young high-risk children. This fact does not come as a
surpriseto those most familiarwith the high-riskchildren of FresnoCounty;this issuehas beenpart
of the planning discussions from the beginning.(For a description of the planning process,please
see Appendix A.)The situation is made worse, however, by a number of additional challenges
within the community.
THE CHALLENGES FACING FRESNO COUNTY
Fragmentation ofservices
Through the planning process it became clear that Fresno County has a wealth of resources
available, many of which provide services through their mandated responsibility for identifying at-
risk children and providing their assessments, treatment and intervention services.These include:
health care providers,school-based programs,mental health providers and the local Regional
Center.However,though each of these entities has a designated role in the process,not oneof them
is responsible to ensure every child receives a "comprehensive assessment"by qualified
professionals covering the five domains of a child's development:cognitive,physical,
communication, social or emotional, and adaptive. This means assessment and treatment services
for children tend to focus on a specific aspect of a child determined by the type of agency or
provider seeing the child,resulting in partial assessments and service and treatment plans developed
and implemented without a complete picture of the child.
There are several issues contributing to this fragmentation ofservices
• There is no formal effort to identify and monitor high-risk children in Fresno County.
•There is no single site responsible for comprehensive assessment for these children,although a
thorough assessment mustguide effective treatment planning.
•Service delivery,especially treatment,is based on funding streams,so that children at risk for
health and behavioral health problems are referred to a variety of providers through categorical
programs addressing a single need.
•There is no single person or agency that is responsible for ensuring that children and families
have the resources and capabilities to access all needed systems of care.Although treatment
may be available,follow through is poor,and children fail to access services.
• Childrenin avoidant families (substanceabuse, domesticviolence) liveon the periphery of
social,medical,and educational settings so that systems of careneverreachthem until their
complete failure brings them to the attention of the school system or the juvenile justice
system or Child Protective Services (CPS).
Limited eligibility
•Many children have significant developmental deficits,but their scores on standardized tests do
not fall into categories that qualify them for services.These children either continue to be
ignored or are unrecognized as they continue to get worse.Some parents express their frustration
that the only way to get their children services isto step back from them and let them deteriorate
to a level of eligibility.
14
•Children with emotional or mental health problems often have difficulty qualifying for existing
assessment and treatment processes in the County.Thus,an infant or young child with an
attachment disorder or suffering from depression frequently will not qualify for services if
developmental scores fall within the normal range.
• Once a treatment plan is delineated,the complexities of eligibility rules and funding streams
leave many parents perplexed about how to access services.Especially as a child reaches age
three,eligibility for school-based services narrows accessibility further.
Duplication of services
This fragmentation of services frequently is further complicated by duplication of services,
especially in the arena of assessment.Many parents find themselves being referred to a series of
providers, all of whom require their own assessment of the child before treatment services can
begin. There is no guarantee that these duplicative assessments will result in a comprehensive
picture of the child's needs. Parents report that treatment directed by such an assessment falls short
of what the child really needs and exhausts the family's ability to persevere in the treatment process.
Geographic,racial and ethnic diversity
Fresno County is located in the fertile, agricultural region of California known as the San Joaquin
Valley. In 1998, Fresno County grossed over two and a half billion dollars from the production of
over 200 different commercial crops. With a land area of over 6000 square miles and fifteen (15)
incorporated cities, Fresno County encompasses rural, suburban, and urban environments. Fresno
County has experienced double digit unemployment rates for over eight (8) years.
Accordingto the 2000 U.S. Census, Fresno County is the tenth largestcounty in California,with a
population of 799,407.It is a diverse population,with 8.1% of Asian heritage,5.3%African
American,and 44%identifying themselves as Hispanics.Fresno is the 6n largest city in California.
Children under five years of age make up 8.5% of Fresno County's population,and among families
with children under five years,31.7% live below poverty level.English only is spoken in 59%of
households, and 41% of the population speak a language other than English, with 21% having
Spanish as their primary language.
For families living in the more remote rural parts of the County, especially non-English-speaking
monolingual families,assessment and treatment services are particularly difficult to access.Given
the County's geographic breadth and racial and ethnic diversity,outreach to the hard-to-reach
families will require specially designed efforts.In some cases the challenge to engage families in
screening will be to utilize the right communication medium and to gain the endorsement of local
leaders.In other cases, grass roots outreach will be needed.In all cases,though,the guidance of
those who are most familiar with the ethnic, racial and language groupings in the community will be
needed.
15
THE STRENGTHS OF FRESNO COUNTY
Community Leadership
The citizens of Fresno County are ready to take responsibility for their children's welfare. Led by a
coalition of public and private agencies - the County of Fresno, Board of Supervisors;County of
Fresno,Department of Children and Family Services (DCFS),and the County of Fresno,
Department of Public Health (DPH);First 5 Fresno County (First 5);Exceptional Parents
Unlimited,Inc.(EPU);Fresno Unified School District (FUSD); Fresno County Office of Education
(FCOE);Central Valley Regional Center (CVRC);Court-Appointed Special Advocates (CASA);
Fresno Metro Ministry Health Care Roundtable;Clovis Unified School District;Fresno County
Juvenile Dependency Court;the University of California San Francisco-Fresno Medical Education,
Department of Pediatrics;and the Fresno County Foster Care Oversight Committee -the leadership
of these agencies have both shaped the Model of Care and committed the necessary resources it
requires.
Community Values
The very first action of the planning year was to conduct interviews with parents of high-risk
children.From those interviews,individual interviews with community leaders,and a town meeting,
a set of values was formed.Those values have shaped the design of the Model of Care and will
influence the model's implementation;they are the community's guiding hand. The values are
listed here; a fuller explanation of the defining community values can be found in AppendixB.
Values that Shaped the Model of Care's Design
County-wide access and cultural competence
Early intervention
Easy access
Simplicity
Financial sustainability
Not dependent on individuals
Begin with the needs of the children and families
Values that Will Guide the Model of Care's Implementation
Inclusion
Cultural competence
Practicality
Full participation
Respect for evidence-based approaches and tools
Evaluation
Child-centered
Family-focused
16
RECOMMENDATIONS
What emerged from the planning process was a deeper understanding of why and how existing
services fail to meet the needs of so many children and families across the County and how the
community can do better. A set of recommendations represents the response to this deeper
understanding.
I.Establish a Model of Care which includes the following:
a. A systematic, county-wide process for finding children who are at risk for developmental
and mental health problems early enough in their life so that treatment can make a
difference.
•Create public awareness.
• Target community locations where children are served; i.e., newborn nurseries,
pediatricians, child care centers and pre-schools.
b. A universal screening instrument,Ages & Stages Questionnaire (ASQ)and Ages &
Stages Questionnaire:Social-Emotional (ASQ.SE),to be used in all community
locations where children are served.
c. All children birth through five years entering DCFS (through either the Juvenile
Dependency Courtor Voluntary Family Maintenance)are understood to be high riskand
require referral for a comprehensive assessment.
d. A single pointof contact (telephone number)for all providers to call to initiate a referral
for assessment.
e. A single site.The Children's Center,where children can receive a comprehensive,
integrated assessment,a treatment plan, and helpto accessservices.
• Located at Exceptional Parents Unlimited, Inc.
•Co-location of personnel and resources to provide and support direct services to the
children and their families from CVRC,FUSD,DCFS,and E&TA.
• The referral mechanisms and direct support needed to help families access the
treatment services the child needs.
• Createa Family Resource Specialist to ensure families get served.
f.A process to build the County's treatment resources,keeping in mind Fresno County's
geographic sizeand diversity -ethnic,racial,linguistic.
g.A mechanism to link Clovis Unified School District and the Fresno County Office of
Education assessment services with the complementary assessment services at The
Children's Center.
II.Establish the supporting structures needed to initiate,sustain and enrich the Model of Care:
a.An agreement between First 5 and EPU establishing EPU as the site for The Children's
Center,
b.An agreement with County of Fresno,Department of Public Health,Maternal Child and
Adolescent Health Program to coordinate the process whereby high-risk children inthe
community are identified through outreach at the center.
c. A master agreement between those community agencies committing resources to The
Children's Center.
d. A Partners Advisory Committee,comprised of the community agencies,to support The
Children's Center through mutual problem-solving,evaluation and long-term planning.
17
THE SMART MODEL OF CARE FOR HIGH-RISK CHILDREN,
BIRTH THROUGH FIVE YEARS
A Brief Overview
The SMART Model of Care is an integrated system of health and behavioral health which will
ensure access to appropriate early intervention services for children birth through five years in
Fresno County. The three (3) over-arching strategies -community-based identification,center-
based assessment and accessible treatment - are anchored by five (5) core functions:Screening.
decision-Making,Assessment,.Referral,and Treatment.The SMART Model will promote the
earliest identification and intervention for many children who currently are not identified until they
experiencefailure inschool and/or enter thejuvenile justice system.
Community-based identification
The first two (2) functions in the model, Screening and decision-Making are community-based
functions.Children are typically identified by parents,physicians,the child welfare system,child
care providers,preschool programs and the child welfare system.Under the SMART Model it is
proposed the community will adopt a standard screening instrument,Ages &Stages Questionnaire
(ASQ)and the Ages &Stages Questionnaire:Social/Emotional (ASQ-SE),used to screen for
developmental,intellectual,speech,behavioral,and emotional problems.Professionals at sites
where screening occurs will help parents decide which children require a full assessment.A single
phone number will link providers and families with assistance in accessing a comprehensive
assessment.
Center-based assessment
The next two (2)functions,Assessment,and i?eferral for Treatment will be centralized in a new
Children's Center. TheChildren 'sCenter will be characterized by:
•Multidisciplinary staffing with co-location of existing assessment and eligibility
determination resources provided through EPU's Child Development Services,Central
Valley Regional Center,Fresno County Department of Children and Family Services-
Children's Mental Health, Fresno Unified School District's Preschool Assessment Team,
Fresno County Department of Employment and Temporary Assistance's Eligibility Services.
• A family-based approach with the center's primary responsibility being to assess the child
within the context of the family.
• A Family Resource Specialist assigned to each child/family at entry phone call who assists
and advocates for the child throughout assessment, referral and treatment.
•Comprehensive assessment and treatment plan(s)based on the needs of the child and not
driven byeligibilitycriteriafor categorical assessment/treatment.
Accessible treatment
With the treatment plan in hand,the Family Resource Specialist at The Children's Center will work
with the family and the appropriate agencies involved to find and access all needed services within
the family's geographic region of the County.In some cases treatment may occur at the center until
appropriate services can be established in underserved areas of the County.The Family Resource
Specialist also will serve as a service coordinator to ensure access for the family and to provide
feedback to the team at the center. Each child will return to the center for follow up evaluation as
indicated by the child's clinical course.
THE SMART MODEL:STEP BY STEP1
The SMART Model of Carefor High-Risk Children targets all children birth through five years for
screening and identifies and tracks the high-risk child through a progressive series of evaluations
culminating in intervention and treatment that focuses on the needs of the child and his or her
family.
Screen Identify all children birth through five years in Fresno County who
are at risk for behavioral,developmental,social/emotional,sensory,
or dyadic relationship problems by screening all young children with
a universal screening instrument,the Ages & Stages Questionnaire.
decision Making Pediatricians,Public Health Nurses,Infant Mental Health Specialists
and other trained professionals assist in making decisions as to which
children require a full assessment for health and behavioral health
problems.
Assess The child undergoes an appropriate family-based, multidisciplinary
assessment that results in a long-term treatment plan.
Refer A "warm hand-off referral system provides all children and families
a level of follow through that ensures access to services.
Treat Based on the assessment and treatment plan, all at-risk children
receive child-centered,family-focused interventions and treatment
that incorporates and respects the cultural and linguistic strengths of
the family.
Screening
The screening process is the first step and the core element around which the integrated Model of
Care is built.Screening asks."Who isat risk?"The goal of screening isto encompass all children in
the community,identifying those who are at risk for a wide array of behavioral health problems that
may range from developmental delays to reactive attachment disorder.The difficulty with screening
lies in the many ways in which children at risk can present.In addition,most children with behavioral
health problems "look normal";there are no clear physical signs that can draw attention to the child.
Thus, as the model is designed,it is important that all children in the County be included in a
universal screening process,guaranteeing that at some point in the early years of life,every child in
Fresno County will be screened for behavioral health risks.
How will children be screened?
To be effective we must utilizea screening instrument that is sensitive to the child's age, is proven by
A guide to terms and concepts presented inthe document canbe found in Appendix C.
19
research to effectively and efficiently identify children at risk,and can screen for all aspects of
behavioral health functioning:
development (cognitive, motor, speech, language);
behavior;
social/emotional adaptation;
sensory integration;
dyadic relationship.
There are a variety of screening instruments available for young children.However,most screen for
only one or two areas of behavioral health,and many are limited to specific age groups within the
birth to five years span.The Ages &Stages Questionnaires (ASQ)(Squires,Potter,and Bricker
1999)and its accompanying Ages &Stages Questionnaires:Social-Emotional (ASQ:SE)(Squires,
Bricker and Twombly,2002)were developed to assist in identifying and monitoring children with
developmental delays and social-emotional difficulties from four months to five years of age.The
ASQ system,made up of nineteen developmental and eight social-emotional questionnaires that are
administered sequentially across the targeted age span,represents a novel approach to screening
because the questionnaires are designed to be completed by the parents or caregivers of young
children, rather than by trained professionals.
The ASQ has undergone extensive research and exhibits a high level of sensitivity and specificity.
Its findings concur closely with more extensive developmental and infant and child behavior
assessments,and over referral and under referral rates are well within the accepted norm -12%and
4%. respectively- for the developmentalcomponent.
In sum,the ASQ presents many advantages for its use as a universal screening instrument for
children in Fresno County:
• Itscreens for all keybehavioralhealthdomains byage.
•It allows for repeated measures,so that a child can be screened several times on a regular
basis across thespanof years and ina variety of settings.
•It is completed by the parent so requires no special training for its administration,making
it easily accommodated in pediatric offices as well as in day care centers.
•It takes only about 15 minutes to complete,eliminating any burden for the provider and
minimizing the time required for the parent.
•It is easily scored,providing simple guidelines defining risk or no risk.
•It is available in English,Spanish,and Vietnamese and has been validated across a wide
range of socioeconomic populations.
•It can be purchased for a one-time fee of$1,600 for unlimited use across the County.
•Time for administering,scoring and interpreting the instrument is reimbursable through
Medicaid in some states,although this isnotthecase throughout California.
•The results include suggested activities which can serve as a basis of early intervention and
parent education in primary care and pediatric offices.
Who will do the screening?
The ASQ is designed to be completed by the child's parent or caretaker.The completed form is
scored by a trained person at the screening site.Parents who require assistance in completing the
20
ASQ will be helped by a person at the screening site. The use of the ASQ by physicians will be
encouraged.However, other methods of screening will be recognized in the Model of Care.
Aside from physicians'offices and other health care sites,children will be screened in "community
touch points,"places in the community where children can be found along with the professionals
who are looking after them -Child Protective Services,child care, Head Start and Early Head Start,
and preschool settings. First 5 Fresno County has made a commitment to supporting and enhancing
the quality of child care services in the County, and is funding training and supporting child care
providers through the LEADS project and Child Care Health Linkages, which will fully interface
with the Model of Care.
Child Protective Services:All children birth to five years of age entering DCFS,whether through
dependency court or voluntary family maintenance will be screened with the ASQ.The screens are
all reviewed by the children's mental health specialist with the case worker to ensure the child is
referred for further assessment,aware that all children entering DCFS are indeed "at-risk"due to life
circumstances and will benefit from a comprehensive assessment.
Child Care Centers:Child care centers are widely distributed throughout the County and represent
an opportunityto screen children who are seen regularlyat these locations.There are four types of
child care, and the number of each type has importance for how the implementation of the model
will take place.
Type of Child Care Number of Providers Children Served/Provider
License Exempt Child Care
Centers
42 Less than 50
Licensed Child Care 279 30-200
Licensed Family Child Care
Homes
1,145 6-12
Licensed Exempt Providers
(known)
14 1 -2
Total 1,480
Source:Children 's Services Network
License Exempt Child Care:The License Exempt ChildCare programs are primarily school-based
programs for adolescent mothers but also include child care at Spirit of Woman,PATHS and M'ella
House.All these programs are "license exempt"because the parent is on-site.These child care
programs are especially attractive for screening because the children are"at-risk."
LicensedChildCare:These are commercial child care providers, and the range in size is
considerable- from as small as thirtychildren to as largeastwo hundred. The numberof child care
providers in any one location ranges accordingly.Typically,the senior-most individuals are
experienced and trained,and it is these people who would handle the screening and decision-maker
roles. It is not unusualto see a highturnover rate amongthe lowerlevelstaff in largechild care
centers.
Licensed Family Child Care Homes:Licensed Family Child Careis offered in local neighborhoods
21
in the homes of the child care providers. The number of children being cared for in any particular
site is low (6-12)but the number of these providers is high - 1,145. It is no surprise that the
experience and formal training of these providers, and,consequently,the quality of the child care
that is provided,varies quite a bit.
License Exempt Providers:License Exempt Providers are family members who care for one or two
children. They represent a small fraction of the child care providers who are known to the Children
Services Network.Training can be offered to these providers by inviting them to training events
held for the other groups.
Early Head Start,Head Start and Preschool settings:Early Head Start, Head Start, and preschool
settings are a natural fit for screening and have the further advantage of being long-established parts
of the community. Head Start currently serves approximately 2,800 children throughout Fresno
County in over 35 centers and 19 Home Base areas.
To avoid over-screening, especially in the start-up period, guidelines will be needed.
Stage Screening Guidelines
Year One Each child entering DCFS, children graduating from the neonatal
intensive care units, children in physician offices, children in pre-school
programs,and children in Head Start and EarlyHead Startwill be
screened in accordance with the ASQ manual - every two months for
children up to 24 months, every three months for children from 24
months to 36 months, and every four months for children from 36 months
to 60 months.
Subsequent
Years
Above screeningguidelineswill continue. Inaddition,children in child
care will be screened according to the ASQ manual.
Children who have been previously screened for a full year and were
negative on all screens,will be screened once ineach subsequent year,
and if that screen is negative,they will not be screenedagainthat year.
Children who screened positive and received an assessment do not
receive further screening.
Special outreach:Special outreach is needed to contact many children in the County who are
otherwise hard to reach. This would include children of migrant workers, ethnic groups who are not
connected to traditional community organizations,children whose families are marginalized by
virtue of poverty or language barriers,and children of law-breaking parents who prefer to shield
their family from any type of scrutiny.While finding these children is clearly mandated under Title
14,Chapter5.e.,it doesnotoperateina formal waywithin Fresno County.
To reach these children,each group will require specific planning.Working with local leaders is
key to this planning as well as collaboration with existing groups (e.g.,Khmer Society)to help
22
design strategies for establishing a sense of trust between the Model of Care and the community's
parents.The use of a Promotora model of door-to-door outreach may be a good fit for some
communities.Public awareness efforts will focus on developing a partnership that can bring
families into the services they need. The SMART Model of Care will benefit from First 5's Better
Baby Care initiative, in particular the public awareness campaign that will include paid media
coverage and other outreach strategies.
decision-Making
"decision-Making,"the second step in the Model of Care, is intended to decide whether the child
needs a full assessment or not. The Model of Care aims to screen every child birth through five
years in Fresno County;naturally,there isa challenge to be met when screening such a large number
of children.Fortunately,the ASQ provides clear guidelinesto help determinewhich childrenshould
be sent on for an assessment and which children require routine monitoring. Children in the County
of Fresno,Department of Children and Family Services,Voluntary Family Maintenance program,
andthose enteringthe fostercare systemwill all be referredfor a comprehensive assessment.
Who decides which children will be assessed?
Like any effective screening tool,the ASQ will over-identify children as needing further assessment.
For those children seenina physician's office,the physician will decide ifan assessment is needed.
The physician may or may not use Ages &Stages.Within pediatricians'and other primary health
care providers'offices who choose to use Ages &Stages,the physician,medical assistant,nurse,or
other professional will review the results of the Ages &Stages with the parent.Ifit is determined
that the child is at a level of risk but does not need a full assessment,the health care provider will
talk with the parents about his orher concerns,offer suggestions for primary prevention and,if they
choose,continue monitoring the child through the repeated administrations ofthe Ages &Stages.
Infant Mental Health Specialists and other licensed health care and mental health care providers also
will exercise discretion over how the results of the ASQ are interpreted. Providers in child care and
early education settings will be supported in assessment and decision-making by Public Health
Nurses assigned to the various programs.The Fresno County Department of Community Health
plans to replicate a national evidence-based child care consultant model,the Child Care Health
Linkages Program.Through this program.Public Health Nurses will provide training and
education to child care providers on health and safety issues surrounding young children enrolled in
child care facilities.It is proposed the nurses will augment and enhance screening,assessment,and
referral and linkage services for families with children identified as being at risk for behavioral
health problems.The Public Health Nurses also will provide consultation and assistance to other
child care specialists by assisting with screening,referring,and linking children and their families to
appropriate health services,including specialty services.As noted earlier,all children entering
DCFS care are considered at high risk due to life circumstances;consequently,all DCFS children
birth to five years will be referred for further assessment.The ASQ information obtained by DCFS
staff will accompany the children.
23
Location of decision-Making Person Who Decides to Send the Child
for Further Assessment
Physician's Office Physician,Nurse
Child Care Center director,teacher,qualified staff, or Public Health
Nurse
Head Start and Earlv Head Start Director,qualified staff
Special Outreach Public Health Nurses and other professionals in early
childhood education
Foster Care/Voluntary Family
Maintenance
Automatic referral by caseworker
The decision-making step follows screening and precedes assessment. Once a decision is made to
refer for further assessment,the decision is discussed with the parent or primary caretaker and
permission is obtained to call a dedicated phone number which will be staffed bya Family Resource
Specialist at The Children's Center.Through the conversation and based on the ASQ,the referral
for assessment will be made to The Children 's Center.
The need for a dedicated phone number is dictated by the need to provide the community's
physicians,Public Health Nurses,and DCFS children's mental health specialists a simple method to
refer children and their families to The Children's Center for initial assessment.The dedicated
number will be more than the exchange of information about where and when the child will be
assessed.The Family Resource Specialist will help the family arrange for their child's assessment
appointment,will secure transportation and child care if they are needed,and will follow up to make
sure the child is seen for assessment as planned (including interpreter services,if required).If the
family fails to attend the assessment appointment,the referring physician,public health nurse or
other professional will be informed.
Assessment
Those children referred to The Children's Center because of recognized behavioral health risk will
undergo a comprehensive assessment of the child's cognitive,medical,behavioral,social,
educational,and emotional development as well as parental functioning.The task of assessment is
to define the specific strengths and concerns ofa targeted child,resulting in a comprehensive child-
centered,family-focused treatment plan that will address all aspects of the child's needs.
The SMART Model of Care asserts the need for a shared understanding among the community's
professionals regarding what constitutes a comprehensive assessment.This shared understanding
becomes, ineffect, a community standard that will have several benefits:
1.Comprehensive assessments secure appropriate treatment forthe child.
2.Comprehensive assessments save money by avoiding multiple assessments.
3.Receiving a comprehensive assessment at a single site reduces the strain on families who in
the past have had to go to multiple sites to receive all the assessment components their child
needs.
24
4.Having a community standard for assessment facilitates communication among
professionals which,inturn,servesthe best interests ofthe child.
Where will the assessment be performed?
The assessment will be performed at The Children's Center.It will be centrally located within the
Fresno metropolitan area and will operate on a five days a week schedule.A central location is
necessary to support the comprehensive nature of the assessment.While it will place a demand on
some families to travel to The Children's Center,it is a one-time visit,and the benefits of having the
child seen by all the specialists is viewed as worth the difficulty.For those families in need of
special travel arrangements,transportation will be provided.
How will the assessment be done?
As a child enters The Children's Center,he or she will be evaluated by an intake worker from
Central Valley Regional Center to determine funding eligibility.A developmental pediatrician will
assess the child's physical health through reviewing the child's health history and conducting a full
physical examination,including neurodevelopmental.Following the pediatrician's evaluation,the
child will be seen by an Infant Mental Health Specialist or Clinical Psychologist,depending on the
age of the child,as well as Occupational/Physical/Speech and Language Therapists as determined by-
need. A school assessment team will evaluate the child's learning-related behaviors and
development as appropriate.The specific assessment and evaluation instruments will be determined
by the clinical presentation of the child.However,in one day's time,the child and his or her family
will undergo comprehensive assessment by a full range of professionals -including personnel from
Central Valley Regional Center,DCFS,Children's Mental Health,and Fresno Unified School
District - in a single setting.
Such a comprehensive approach to assessment guides our philosophy fox family-focused treatment
planning and treatment.A family-focused approach integrates the parent into the decision making
process for the child.Each team member has a basic theoretical knowledge of the roles,
responsibilities and intervention techniques of each of the other professionals and is able to
incorporate treatment aspects of other members'disciplines into the intervention program.The
parents serve as the primary teachers and caregivers in the treatment planning and intervention
program.Most importantly,the family serves as the central force in goal setting and decision
making.This approach reduces conflict by eliminating mixed messages communicated to the
parents,enhances communication among team members and maintains the parents'role in guiding
the program planning and therapeutic interventions.This model is applied to the child's primary
caretaker,whether it is biologic,adoptive or foster parent.Thus,the model adapts to the child's
varying placements if he or she is in the child welfare system and allows for long term support and
follow-up once permanency placement is decided.
The family-focused approach replaces the medical Model of Care which places the physician in the
center of the decision-making process and requires all consultants to feed information into the
physician.Within a classic medical model approach,each of the team members has a defined role
and provides specific interventions based on his or her own medical,educational,or psychosocial
expertise.Rarely is there sufficient communication between disciplines,and responsibility for
integrating information and ideas falls to the physician.The child's family will be involved in goal
25
setting;however,at this point in the process,the child is primarily a recipient of the advice and
recommendations offered by the multidisciplinary members.
Following assessment ofthe child,in keeping with the family-focused model,the participating team
members will meet with the family to provide immediate feedback.Preliminary recommendations
will be discussed.A written report will then be prepared.The clinical psychologist will lead the
report writing process,and each of the team members will add his or her component.Once the
report is ready (within six weeks of the assessment visit),all professionals who evaluated the child,
all agencies working with the child and family,and the family will meet asa family-focused team to
finalize a treatment plan that addresses all aspects of the child's problems and strengths.The
Family Resource Specialist from The Children's Center will attend the meeting.The role of the
Family Resource Specialist is to make sure the family understands all information being presented
andto serveas an advocate for the family as they secure services for their child.The treatment plan
that is finalized at this meeting will then guide the child's and family's short-term and long-term
interventions.
Following the family-focused meeting,The Children's Center team prepares a report on the child's
assessment.This report brings together all pertinent aspects of the child's medical and
developmental history,describes the results of the health,behavioral health,and education
evaluations;summarizes current challenges and strengths in the child's life;and presents a
comprehensive list of recommendations that encompasses home-,school-,and agency-based
interventions.
26
1.All children birth through five years are screened using ASQ and ASQ:SE.
2.Some children will screen positive.This means that the child is at risk.Children who
screen positive but who do not need further assessment will be monitored and re-
screencd.
3.Some children will screen negative. They will be followed by their pediatrician,
school,day care center or other setting with the option to re-screen as dictated by the
Ages &Stages.
4.A decision is made about further assessment.Parents of children whose screen
indicates areas of lagging growth are given a primary'intervention -they arc educated
about the concerns and given guidelines for early intervention.Public Health Nurses.
child development/early intervention specialists and the Family Resource Specialist at
Hie Children's Center will be available to support child care providers in the decision
making process.
5.Physicians, Public Health Nurses. Infant Mental Health Specialists and others in the
community who wish to refer a child for assessment will have a single point of contact
to facilitate the linkage and to ensure that the child and family get the assessment.
6.The family-focused assessment is conducted and a report is written defining a
comprehensive immediate and long-tenn treatment plan for the child and family.
Referral
The basic philosophy of the referral system is the "warm handoff." A "warm handoff is a referral
mechanism that is built upon a respect for human values. That is, we recognize that each child and
family is unique, and parents and caretakers will require sensitive support as their child is
recognized as being "high risk" and moved through the system to intervention and treatment
services. This is where the strengths provided by a family's culture, values and language can
support the family as it faces the normal anxieties and fears that accompanyseeking treatmentfor a
high-risk child.
27
Who will be referred?
The immediate focus of the referral is the child,who is at the center of all decisions and planning.
However, if necessary, other family members may be referred for appropriate assessment and
treatment, especially if there is a need for substance abuse or mental health treatment services.
How will the referral be accomplished?
A referral in the Model of Care requires an up-to-date understanding of the treatment resources in
the community and careful attention to the process of making the referral itself,especially follow-
up.
The MCAH Division performed an audit of existingtreatment resources in the community in 2004
(AppendixD).
The referral mechanism
As the child's assessment is completed, a family-focused meeting will be held with the child's
family.At that time,the family will be presented with the recommendations for the child's
interventions and treatment and referrals to specific resources. For many families that will be
sufficient,but for some,especially those who are less familiar with the system,additional support
may be required.For example,a family may not be aware of home-based early intervention services
available in the community.The Family Resource Specialist will make the telephone call to the
early intervention team,setan appointment time,and follow up to make sure the appointment was
kept.This is a concrete component of a "warm handoff in that families are provided not only
information as to what treatment is needed but also where to find that treatment and how to access
it.
This additional support is provided through systematic follow-up procedures.Each child's referral
will be followed by a phone call to the provider to determine if the child has gained access to the
recommended treatment services. Ifthe child has not gained access, the Family Resource Specialist
at The Children's Center will be responsible for re-establishing connections with thechild's family
and making a new referral.
Who will facilitate the referral?
A Family Resource Specialist working at The Children's Center will handle the referral process.In
addition to having a working knowledge of the treatment resources in the County,the Family
Resource Specialist will need to adjust the referral process to fit with the culture of the child/family
being served.Although any language needs will be met through the use of interpreters when
necessary,the goal will be to have staff that represent the linguistic,ethnic,and racial diversity of
the community to the extent possible.
Selection of the treatment and intervention resources for the family will be based on the
recommendations in the assessment report matched to what treatment is most conveniently available
to the family.The Family Resource Specialists will be responsible for continuous updating of the
treatment resource information and will make the appointments for the family at the treatment
facilities.
28
Treatment
Treatmentthroughthe Modelof Care isdefined as those medical/social/interventions that foster
growth and development ofthe child,helping him to reach his full potential.Specifically,within
the Model of Care,treatment and intervention will include case management,health care, physical
therapy,occupational therapy,sensory integration,speech and language,family support,dyadic
therapy,psycho-education groups forthe parents,and linked substance abuse and mental health
treatment,as needed,for all family members.
Treatment will be child-centered in that all decisions and planning will be dictated by the best
interests of the child.Implementation of treatmentwill be family-focused,depending on the family
as the primary provider of interventions.In this way,the richness and strengths of the family's
cultureand backgroundcan be a core componentof intervention.
Where will treatment occur?
Treatment will be provided in accordance with the individualized treatment plan.The family will
have the option of continuing to come to The Children 's Center or receiving treatment at a site
within their own neighborhood or community.As noted in Appendix D,there are a wide variety of
treatment sites available in the County,but capacity and geographic distribution do not meet the
projected need.Clearly,treatment quality and capacity for underserved areas of Fresno
County need to be studied further.In the near term,however,some parts of the County will lack
adequate treatment capabilities;thus,in those areas,transportation will need to be provided.
How will treatment occur?
Specific treatment services for each child will vary according to the child's behavioral health
problems and deficits.The Family Resource Specialist will oversee the family,coordinating services
and, inthe caseof children involved with DCFS,workwith the designated DCFS case manager.As
the child receives services,the family will always be instructed asto the purpose and methods of the
specific form of therapy.Each family will be guided in instituting similar interventions in the home.
Teaching a family how to do the exercises associated with occupational therapy or physical therapy
or guiding the family in behavioral management strategies that coincide with the approaches used by
the therapy professional ensures a continuity of care for the child.
29
Assessment Through Treatment
Flow Chart
CVRC,
Monitor Schools^
7.The child and the family are directed to treatment resources that are called for
by the assessment-based treatment plan.
8.Children and their families who are assessed and referred to treatment are
followed to assure that they actually get to the treatment resources they need.
9.Treatment resources are provided throughout the County,taking into account
the language and cultures of those who are served.
10.Children birth through two, that is newborns and children up to age 3 years 0
months, are served through programs such as Early Head Start and other
community-based providers.
11.Children birth through five years may be treated at The Children'sCenter and
other community-based providers.
12.Children from age three years through age five years receive services through
the schools based on an assessment from The Children 's Center or CVRC
and/or in collaboration with TheChildren 'sCenter,CVRC,and other
providers.
30
A COMMUNITY PARTNERSHIP HAS BEEN DEVELOPED
The SMART Model of Care is built upon a partnership of public and private agencies that are
committed to the welfare of children:
o Central Valley Regional Center
o Clovis Unified School District
o County of Fresno,Auditor-Controller/Treasurer-Tax Collector
o County of Fresno, Board of Supervisors
o County of Fresno,Department of Children and Family Services
o County of Fresno,Department of Employment and Temporary Assistance
o Countyof Fresno,Department of Public Health
o Court Appointed Special Advocates
o Exceptional Parents Unlimited, Inc.
o First 5 Fresno County
o FresnoCounty FosterCare OversightCommittee
o Fresno County Juvenile Dependency Court
o Fresno County Office of Education
o Fresno Metro Ministry Health Care Roundtable
o Fresno Unified School District
o University of California San Francisco-Fresno Medical Education,Department of Pediatrics
The Model of Care partnership has been formed by a shared vision and is held in place by a set of
contractual relationships.Each agency has unique responsibilities to high-risk children,but no one
entity has responsibility to ensure a comprehensive approach to assessment and treatment planning.
Thus,the model incorporates all resources into a continuum of services,accruing benefits to the
partners as well as to the child and family.Each partner will enhance the work of all others,
providing value-added resources without increasing budgetary demands.
The Partners'Roles
The partners for the Model of Care have invited Exceptional Parents Unlimited (EPU),a 501(c)(3)
not-for-profit agency,to serve as the lead agency in the model for the purpose of establishing The
Children's Center.EPU was asked to serve as the lead agency because it holds a unique place in
the community.The organization has already created programs that support the concept ofa family-
focused approach and serves as a center for high-risk children who are targeted through the Model
of Care,including housing the developmental pediatricians previously located at Children's
Hospital Central California.Thus,many of the resources currently in place are natural linkages to
provide comprehensive assessment and treatment for high-risk children in the community,as
described in the Model of Care.For more information regarding EPU's background and services,
please see Appendix E.
As demonstrated in the following two tables,each of the partners in the Model of Care also has
committed to specific roles and responsibilities within the overall Model of Care.
31
Community-Based Screening and decision-Making:Identifying the Child At Risk
Agency
First 5 Fresno County
Exceptional Parents Unlimited, Inc.
County of Fresno, Departmentof Children
and Family Services
County of Fresno. Department of Public
Health,Maternal,Child and Adolescent
Health Program
Central Valley Regional Center
Fresno Unified School District
Function
Support screening and decision-making in
child care facilities across the County
throughthe LEADSprojectand Child Care
Health Linkages.
Accept all referrals into The Children's
Center:provide intake services.
Screen all children birth to five years
entering DCFS; link referral to court
mandates as appropriate:support access to
The Children's Center.
Coordinate the Model of Care's
community outreach, screening, decision-
Making; conduct screening of high-risk
newborns and children birth to five years;
support access to The Children's Center.
Screen all children seeking services
through CVRC; assess all childrenentering
The Children's Center for funding
eligibility; support access to The
Children's Center.
Screen all children in preschool programs;
support access to The Children's Center.
Committed Resources
Funding support for LEADS and Child
Care Health Linkages.
Overall fiscal and administrative
management by EPU Board of Directors.
Program staff to use the ASQ to screen and
refer all children entering DCFS.
Public Health Nurses to support screening
and decision-Making.
Refer all children at risk for emotional and
mental health problems to The Children 's
Center.
Screen children enrolled in preschool
programs with the ASQ.
32
Center-Based Assessment,Referral,and Treatment Access
Agency
Exceptional Parents Unlimited, Inc.
Countyof Fresno,Departmentof Public
Health.Maternal,Child and Adolescent
Health Program/EPU Subcontract
County of Fresno, Department of Children
and Familv Services
Central Valley Regional Center
Fresno Unified School District
County of Fresno, Department of
Employment and TemporaryAssistance
Countyof Fresno,Auditor-Controller/
Treasurer-Tax Collector
First 5 Fresno County
Function
Partnership Lead Agency;conveneraroundthe Modelof
Care; health evaluation;review existing medical records;
medical,neurodevelopmental,vision and hearing,
psychosocial, OT, PT, speech and language; program
administration;make available existing family resources.
Outreach and access;case management/care
coordination; transportation; linkage to treatment and
intervention; resource development (financial).
Mental health evaluation:mental health treatment (dyadic
therapy); linkage to Dependency Court.
Eligibilityfor services for birth throughtwo at EarlyStart
and for continuing Regional Center eligibility at three
through five; psychological services.
Psycho-educational assessment foreligibilityfor special
education preschoolservices(three through fiveyears);
speech and language evaluation for eligibility for special
education preschool services (three through five years).
Access to entitlement programs; i.e.,Medi-Cal,Healthy
Families liaison, food stamps,CalWORKS,SSI
liaison/advocacy; emergency housing.
Financial; billing for DCFS services provided at the
center; accounting; revenue maximization.
Co-funder for planning; potential funder for partnership.
33
TRAINING PLAN
Training is essential for the success ofthe SMART Model ofCare
The training plan for the SMART Model of Care must address the needs ofa wide constituency,
ranging from the public whose support we seek to the primary providers of early intervention
services for the children and families:
Community at large
The Children's Center staff
Model of Care partners
Pediatricians,pediatric nurse practitioners,and other health care providers
Child care providers
Public Health Nurses
School personnel, administrators
DCFS personnel,case workers,social workers,administrative staff
Head Start and Early Head Start providers
Community-based treatment providers
Learning objectives
The overall purpose ofthe training istwo fold:
1)to obtain "buy in"from the community and the agencies across the County with a
commitment tothe policies,procedures,and timelines,and
2)to enhance the quality of services through skill-building and knowledge
development.
The specific learning objectives for each targeted group will vary according to need.In addition,
the level of the technical discussion will be geared toward the audience's background and interests.
Training should be selected from the following learning topics:
A.Recognition of behavioral health risk in young children.
•How do you recognize a child at risk for long-term behavioral health problems,
especially through administration ofthe Ages &Stages Questionnaire?
B.Child development
•What are the key developmental milestones that a child must achieve from birth
through fiveyears ofage9
C. Infants" and children's mental health
•How do infants birth through two years of age manifest mental health
problems?
D.Substance use in pregnancy
•How does prenatal and/or postnatal exposure to alcohol,tobacco,and illicit
drugs affect the child's long-term growth,development,behavior,and
learning?
E.Maternal depression in and around the perinatal period
•How do depression and other mental health conditions affect the child's long-
26
34
G.
H.
term growth,development,behaviorand learning?
Family violence
•How does violence in the home affect the child's long-term growth,
development, behavior, and learning?
General treatment approaches for behavioral health problems in young children:
Primary providers
•What early intervention strategies canbeusedina primary health careorchild
caresettingto address behavioral healthproblems inayoung child9
Specific treatment approaches for behavioral health problems in young children:
Community treatment providers
•What evidence-based practices have been shown to successfully address the
needs ofvoung children with behavioral health problems?
The community and the SMART Model of Care for High-Risk Children
•What is the SMART Model of Care,how does it work,and what is the role of
each of the agencies andprofessionalsacross Fresno County?
The topics to be addressed with each audience will be distributed as noted in the following chart.
For example,for the community,topics A, G,and I will be presented ina single session.Other
audiences,such as DCFS,will require several sessionsto coverall topics.Finally,thereare some
topics that will always be presented together,such as topics D,E and F,since these issues often are
co-occurring in a family.
Learning Objectives to be At dressed
Group A B C D E F G H I
Community X X X
Model of Care Partners X X X X X X X X
Physicians X X X X X X X X
Child care providers X X X
Public health nurses X X X X X X X X
DCFS X X X X X X X X
Head Start X X X
Treatment providers X X X X X X X X
Education X X X X X X X
35
REFERENCES
Individuals With Disabilities Education Act.20 U.S.C.,Section 1431,Part C.
McGourty RFandChasnoff IJ.Power Beyond Measure.NTI Publishing.Chicago.2003.
Rudolph,Linda MD and Rothman King Sharon MSW.Report of the Task Force on Children
With Special Health Care Needs.Medi-Cal Managed Care Division of the California Department
of Health Services.August 2003.
Squires J.Potter L,Bricker D.The ASQ User's Guide for the Ages &Stages Questionnaires:A
Parent-Completed,Child-Monitoring System.Paul H.Brookes Publishing Co:Baltimore,1999.
Squires J,Bricker D,Twombly E.The ASQ.SE User's Guide for the Ages &Stages
Questionnaires:Social-Emotional.Paul H. Brookes Publishing Co:Baltimore,2002.
36
Appendix A
The Planning Process
37
THE PLANNING PROCESS
Babies First,a program of the County of Fresno,Department of Public Health/Maternal,Child and
Adolescent Health Program,has led the effort to develop a Model of Care for high-risk children in
Fresno County.Funded in part by the U.S.Department of Health and Human Services,Maternal
and Child Health Bureau,the goal of Babies First isto reduce infant mortality rates among high-
risk populations and improve perinatal outcomes by replicating intervention models that were
developed during the demonstration phase of the federal Healthy Start Initiative in 1992-1997.
Implemented in 1997.in its first four years,Babies First reduced infant mortality in 18 contiguous
census tracts within the south-central area of the Fresno metropolitan area from an initial infant
mortality rate of 13.3 deaths per 1,000 live births in 1991-93 (twice the state average)to 8.9.Since
June 2001,the project has expanded to include 29 census tracts (20 new ones)having an infant
mortality rate of 12.4 deaths per 1,000 live births in 1996-98.Half of the original census tracts
were eliminated from the project because their infant mortality rate was below 12.4.
Responding to the issues facing children and families in Fresno County,Babies First organized a
team of community professionals in October 1999,to develop a strategic plan for promoting the
early identification and treatment of women using drugs or alcohol during pregnancy.The team
organized by Babies First reflected a public-private partnership and crossed organizational and
professional boundaries bringing together representatives from County of Fresno,Department of
Children and Family Services and the County of Fresno,Department of Public Health,Maternal.
Child and Adolescent Health Program,pediatricians,obstetricians,as well as professionals in
hospital administration,mental health,substance abuse treatment and child protection.
As the plan has been implemented,women are screened for alcohol and other drug use during
pregnancy.Of the 5,613 women screened in 2003,it was found that 22%are at risk for drug use
and 10%were actively using drugs or alcohol.
As a result of the emerging information and the documented need for services,outpatient and
residential treatment programs for pregnant and parenting women and their children have been
funded by a consortium of County agencies.These programs currently are providing treatment to
over 300 women and their children per year.In addition,over 6,000 pregnant women peryearare
being screened for risk and receiving substance abuse prevention information and interventions
within the context of their prenatal care and through public health nurse home visiting services.
Out of these efforts,a second group of community professionals met in February 2002,to examine
issues of risk for children in Fresno County.This group represented a wide range of disciplines,
agencies, and institutions:
•Program Manager for Legal and Interagency Services,Fresno Unified School District,
Special Education
•Two Judges,Fresno County Juvenile Dependency Court
•Fresno County Human Services System,Alcohol and Drug Programs Administration
38
•Two Public Health Nurses,County of Fresno,Department of Public Health,Child Health
and Disability Prevention Program and County of Fresno,Department of Children and
Family Services Foster Care Program
•Program Manager,Perinatal Addiction Treatment and Health Services Program (PATHS),
County of Fresno.Department of Behavioral Health
•Perinatal Services Coordinator,County of Fresno,Department of Public Health Maternal,
Child and Adolescent Health Program
•Fresno County Juvenile Dependency and Delinquency Court Administrator
•Program Manager,County of Fresno,Department of Children and Family Services
•Neonatologist,Children's Hospital Central California,St.Agnes.Kaiser,Community
Medical Centers
•Associate Professor,University of California San Francisco,School of Medicine at Fresno,
Department of Pediatrics and University Medical Center
•Private Pediatrician
•Director of the Developmental and Behavioral Pediatrics Department,Children's Hospital
Central California
•Director of Maternal and Child Services,Community Medical Centers-Fresno and
University Medical Center
•Division Manager,County of Fresno,Department of Public Health,Maternal,Child and
Adolescent Health Program
•Director,County of Fresno,Department of Children and Family Services
The core strategy was determined to be the development of a comprehensive Early Childhood
Assessment and Treatment Center.As a next step,this team of professionals came together to
develop a planning proposal,and in April 2003,First 5 Fresno funded Babies First to develop a
plan that would establish a Model of Care for high-risk children in Fresno County.
The overall aim of the plan is to create a linked,integrated Model of Care for these children,
anchored by a core group of community service and policy professionals.The planning process
was derived from First 5's strategic guidelines (2003):
Strategic Result:Improve systems for families so services are integrated,accessible,
culturally appropriate andof high quality.
Goal:An integrated service delivery system provides care for infants,young
children and their families throughout Fresno County.
Objective 1:Increase the knowledge of needs and gaps in service.
Outcome la.Identify existing resources,services and programs in community
areas in order to determine service gaps.
Objective 2:Increase level of integration among service providers serving children and
families in Fresno County.
Outcome 2a.Improve communication among service providers to achieve higher
levels of service integration.
Outcome 2b.Increase cross referral systems among services provided to children
and families in Fresno County.
39
Outcome 2c.Increase formal collaboration among all appropriate service
providers,thereby decreasing duplication and enhancing integrated
services.
The first step in the planning process was to conduct a town meeting and a series of focus groups
to develop an overarching vision for serving young children in Fresno County and to gather core
information regarding programs and services currently available in the County.This process of
listening to the community identified a basic vision and a set of values (Appendix B)that have
been used to guide the development of the Model of Care.In addition,a resource list of all
programs that serve children in Fresno County was developed (Appendix D).This listing includes
the following information:
p Nameof agencyand contact information
•Eligibility requirements
a Services that are provided
•The number of children served
a Staff qualifications
•How long the agency has been established (experience)
•Funding source(s)
Sixty-six agencies of all kinds are described.Of the 66,ten are Head Start centers,six are listed as
heavily focused on the foster care population,and eight are regional mental health clinics.While
there are some information gaps,the document offers a picture of the resources available within
the County.Here are some observations about that picture:
1.Exceptional Parents Unlimited (EPU),the Lori-Ann Infant Program and,in the private
sector,the Sullivan Center,are well-established and have a range and depth of resources.
2.The Sequoia Community Health Foundation is similarly well-established,sees a high
volume of children and could serve as an effective screening location.
3.The Head Start centers are established points of contact and have locations throughout the
County.
4.The Southeast Asian communities (Khmer,Lao,and Hmong)have points of contact in the
County that may be developed into sites for screening.
5.The school districts focus most of their resources on children in kindergarten and up.The
four and five year olds in preschool receive special education services.However,many
children do not qualify for the services and so are left undetected and unserved until the
academic challenges of first and second grade set them on a road to failure.
6.While at first glance the County appears to have a wealth of resources,the fact is otherwise
for the population of children birth through five years who are at risk for developmental,
behavioral and emotional disorders.There are several reasons for this.First among them
is the access problems encountered by children with behavioral and emotional disorders.
Many of the services that are offered are provided for children with developmental
problems.Children with behavioral and/or emotional disorders are not eligible.
7.Children ages three,four,and five years have fewer services available to them than
children birth through two years.Federal guidelines for eligibility for early intervention
services for children birth through two years include a category for those who are at risk
for a developmental,behavioral,or emotional disorder.When a child moves beyond this
40
age group,the at-risk criterion no longer is in effect.As a result,many children become
ineligible because their disabilities,while serious,do not meet criteria for learning
disabilities or other difficulties that affect learning required by the schools or medical
problems such as a diagnosis of cerebral palsy,epilepsy,autism,mental retardation
required by Central Valley Regional Center.
8.The vast majority of services are located in metropolitan Fresno,creating an access barrier
for children and their families in outlying areas. The Head Start centers constitute an
exception to this pattern but they do not offer early intervention services for children birth
through five years with behavioral and/or emotional disorders.There are a few
organizations offering services in some of the more remote areas of the County,but the
overall picture isoneof sparse resources outside the Fresno metropolitan area.
9.Most service providers are well-linked to the agencies from which they receive referrals.
However,as an overall system,the agencies listed form a set of islands with limited
linkage between themselves and the other services in the community.
In summary,the overall picture is very mixed.Some children birth through five years are well-
served by a limited number of agencies.However,far more children struggle to get what they
need,and even more never have their needs recognized or adequately diagnosed.Efforts to move
screening beyond the Fresno metropolitan area and into the larger County community will depend
on collaborating with pediatricians,day care centers and special outreach initiatives for those who
might otherwise not be screened.Establishing a referral system that can effectively link existing
services is more a training and communication challenge than a technical challenge.
With this information in hand,a three-day meeting of community leaders was held (see Appendix
F for the list of participants)to address core issues that would shape the design of the integrated
Model of Care.In addition,a series of individual interviews were conducted with leaders from
throughout the community (Appendix G).The initial draft of the model was prepared based on
outcomes from the meetings and interviews,and the team of community leaders reviewed the draft
in October 2004.In a second town meeting,the model was presented to the community,and
feedback obtained in that meeting guided further revisions.
As the Model of Care entered its final phase of development each organization was briefed,and,in
certain cases,a formal expression of approval was issued.
Oct.14,2003
Nov.19,2003
Nov.20,2003
Jan.13.2004
Jan.14,2004
Jan.22,2004
Feb.3,2004
Fresno County Interagency Council for Children and Families briefing
Fresno County Mental Health Advisory Board briefin
Fresno Metro Ministry Health Care Roundtable briefing
The County of Fresno,Board of Supervisors issues an administrative
directive in support of the Model of Care.
The Fresno Unified School District Board indicates its support for the
Model of Care.
Fresno School Superintendents'briefing
Foster Care Oversight Committee briefing
March 15,2004 The partners commit their resources to the Model of Care
In short,a wide array of public and private citizens and agencies have come together to build an
41
infrastructure that will assure that all children birth through five years in Fresno County will have
access to the health and mental health services they require to reach their full potential.
42
Appendix B
Community Values
43
Community Values
In April, May, and October of 2003, two town meetings and a series of parent meetings and
individual interviews were conducted with community members from a wide variety of
backgrounds,disciplines and interests. These meetings produced a set of values: values that guide
the design and the implementation of the model.
Values that Guide the Design of the Model of Care
Value Commentary
County-wide access and
cultural competence
The Model of Care will respond to the needs of children
birth through five years in Fresno County.
The Fresno metropolitan area is where most services are
located.However,the County has several smaller
communities of some size and numerous rural communities
that are small and quite remote from the Fresno
metropolitan area. This will require providing services in a
manner that goes beyond traveling clinics and working with
local community leaders to market the services. Issues of
culture and language will need to be taken into account.
Early intervention Early intervention can accomplish more for the child than
services that are delayed.
An emphasis has been placed on screening because effective
screening isthe best wayto find children at risk early in life.
Easy access Barriers to access -distance,language, gaps in cultural
understanding, administrative procedures, and scheduling
will be overcome.
Simplicity If the Model of Care is to be useful,it will need to be
structurally and operationally simple.
Financial sustainability The Model of Care must be financially sustainable over
time.
Some one-time costs can be supported through special
allocations, but the operating budget for the Model of Care
must be supported by a reliable and diverse pool of
resources.
44
Not dependent on
individuals
The Model of Care cannot depend on individuals.
To sustain the Model of Care,knowledge must reside in
organizations,and key individuals must have back-ups who
can step in if a single person falls ill,moves or changes
position. In the beginning the system will depend on key
individuals but the goal will be to create a Model of Care
that can withstand normal change.
Begin with the needs of
the children and families
The starting point for the planning process will be the needs
of children and their families and not financial or human
resource limitations.
The planning cannot ignore the real limitations that limited
resources impose. Rather, the process will start with the
needs of the children and their families and then ask how
existing monies and personnel can be aligned to meet those
needs.
45
Values that Guide the Implementation of the Model of Care
Value Commentary
Inclusion The ongoing development of the Model of Care will seek to
understand the perspective of all communities within the
County.The evaluation process will be used to secure the
perspective of those served by the model.
Cultural competence Both the design of services and the delivery of services
require attention to the uniqueness of each ethnic/racial
group within the County. This has implications for
achieving access to services and for the preparation of the
professionals who will provide the services.
Practicality The plan will be action-oriented and will include a staged
implementation plan.
Full participation The children of the County are the responsibility of all.
Organizational boundaries and rigid funding streams that
interfere with the delivery of service to children and their
families will be challenged.
Respect for evidence-
based approaches and
tools
The choice of what approach to adopt or what screening tool
should be used will be driven by a combination of scientific
information and local experience.
Evaluation The Model of Care will undergo ongoing evaluation and
revision; a rigorous evaluation of both process and outcomes
will be necessary.
Child-centered All decisions are made in the best interests of the child.
Family-focused The family is at the heart of intervention for the child and is
the primary treatment provider and first teacher. The Model
of Care is not a medical model but one in which all
disciplines have input and the family is at the center of
decision-Making.
46
Appendix C
Terms,Concepts and Organizations:A Reader's Guide
47
Terms,Concepts and Organizations:A Readers Guide
Fresno County is a geographically large and culturally diverse community.That is a blessing in
most respects and a challenge in others. One challenge is just to understand all that goes on and
who is involved. Few people can know everything there is to know about the County, especially
when it comes to the world of health care and behavioral health care and the public and private
institutions that provide these services. As this plan took shape, it became apparent that there was
a need for a guide that would provide definition for many of the terms,concepts and organizations
referred to in this document.
Accessibility Ease of obtaining services, measured by addressing geographic, travel,
and other barriers. For example,children who cannot get to the
treatment they need are facing an issue of accessibility.
Behavioral Health A broad term that recognizes the interaction of biology and
environment in producing a child's observable behaviors. This term
usually encompasses cognitive and motor development,social and
emotional health,and mental health.
Brain-based
development and
behavior
Recognition of the multiple factors in the prenatal and infancy period
that affect growth,structure,and function of the brain.
Child-centered A value of the Model of Care that demands all decisions are made in
the best interest of the child.
Culturally competent
services
A value that notes the necessity to develop programs that build on the
strengths of the family as expressed through history, language, race,
ethnicity, and culture. This has implications for access to services and
the preparation of professionals who will provide the services.
CVRC The Central Valley Regional Center is a private, nonprofit corporation,
funded bythe state of California to provide services to persons with
developmental disabilities.
Developmental
Disabilities
Delays in motor, language, and cognitive development that impedea
child's ability to function fully.
Early Intervention Providing services to the child at as young an age as possible has been
shown to have positive effects on the child's long-term outcome. For
young children, early intervention services can cover a wide range of
disciplines and approaches: physical therapy, occupational therapy,
sensory integration, speech and language,developmental therapy,
dyadic therapy (often referred to as "treatment").
48
Parent education as
an intervention
Many young children's developmental or behavioral difficulties are
simply extremes on the range of "'normal."In these cases,instructions
given to the parents/caregivers regarding normal child development and
behavior can promote the child's development along a more positive
trajectory.Information and anticipatory guidance are the foundation for
all interventions for young children and can be utilized as a primary
step in the SMART Model of Care.
Risk Factors that influence poor outcome of the child from a health or
behavioral health perspective.
SMART SMART is an acronym that stands for Screening,decision-Making,
Assessment,Referral and Treatment.The Model of Care has come to
be referred to as the SMART Model of Care.
The Children's Center A single site for assessment and some treatment services to be
developed for children birth through five and families living in Fresno
County.
Target population All children birth through five years of age living in Fresno County.
Touch points In the Model of Care,the "narrow gates"in the community where
children gather and can be screened for developmental or behavioral
health problems -pediatricians'offices, day care centers and child
welfare.
Family-focused An assessment and treatment model that puts the family at the center of
the decision-Making process and requires all disciplines to
communicate across boundaries and jurisdictions.
0-2 (birth through
two)
The traditional approach to children's development is divided into two
categories,the first of which is 0 through 2: a child from birth through
the date the child reaches his or her third birthday.Services for this
population of children are paid for through early intervention monies
drawn down from the federal level.
3-5 (three through
five)
This is the second category of young children who are three years, zero
months through five years, that is until their sixth birthday.Services
for these children are paid for through school-based special education
funding.
49
Appendix D
Community Resources for High-Risk Children Birth
Through Five Years
Fresno County 2004
50
Community Resources for High-Risk Children Birth Through Five Years
Fresno County 2004
Fresno County:Medical Resources
Agency/Contact Eligibility Services Number Served Staff Experience Funding
Source
California Hawaii Elks Children,Birth-21 Home-based occupational 67 served MA Since 1950 Elks members
Major Project,Inc.
5450 Hast Lamona Ave.
years;written
prescription from
and physical therapy
Fresno,CA 93727 physician
(559)255-4531
Central Valley Regional Part C eligibility.Diagnosis,evaluation,1,200 served in six AA,BA,Since 1970 California Dept.
Center
4615N.Martv
Birth-3 years case management,service
coordination
county region MA,MSW
and PhD
of
Developmental
Fresno,CA 93722 Services
(559)276-4300
Children's Clinic IMC Children followed Behavioral consultation No data available MD,FNP,No data Medi-Cal;
445 S.Cedar Ave.in Children's and treatment LCSW available EPSDT for
Fresno,CA 93702 Clinic at UMC children who do
(559)459-4041 not qualify for
Medi-Cal;
Medically
Indigent
Services
Program
Community Medical Children,Birth-3 Preventative case 10 cases per month MD,3 year grant First 5 Fresno
Center Healthy Steps for
Young Children
years identified at
UMCOB.NB
management,well-child
visits,home visits and
served on first-come,
first-served basis
LCSW,
Healthv
beg 2003 County
445 S.Cedar Ave.
Fresno,CA 93702
Nursery or
Children's Clinic
parent groups Steps
Specialist
(559)459-4300
Comprehensive Youth
Services
3795 E.Shields
Fresno,CA 93726
Children,Birth-5
years referred by
CPS.Infant Mental
Health
Therapeutic,supervised
visits with non-custodial
parent/guardian and
parent education
220 children within
two years
LCSW,
MFT,
MSW
Since 1974 First 5 Fresno
County
(559)229-3561
51
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Exceptional Parents Children,ages Early intervention 4,800 children served RN.OPT,Since 1977 Infant Mental
Unlimited,Inc.Birth-3 years services,including direct per year RT Health
4440 North First therapy,group,child and
Fresno,CA 93726 family support and
(559)229-2000 education
County of Fresno,DSM-IV criteria Evaluation,assessment,No data available MA,MSW,Since 2001 Infant Mental
Department of Children for significant treatment LMFT,Health
and Family Services mental health LCSW,
(DCFS),Children's problems to meet
Ph.D.,MD
Mental Health criteria for medical
3133 N.Millbrook necessity;financial
Fresno,CA 93703 criteria for
(559)453-8918 medically indigent;
can qualify through
EPSDT if don't
meet DSM-IV
criteria
County of Fresno,Children,ages Trained clinicians to Majority of trained Ph.D.No data First 5 Fresno
Department of Children Birth-3 years provide IMH services.IMH workers are LMFT,and available County;County
and Family Services Psychologist co-located at working in LCSW of Fresno;and
(DCFS),Infant Mental CVRC to provide dependency court Medi-Cal
Health Services consultation to staff and cases,so few services
2011 Fresno Street facilitate service access to available in agencies
Suite 3 mental health;no funding
Fresno,CA 93721 for services other than
(559)453-8403 Medi-Cal.
Fresno Scottish Rite Language and Clinical services to Approx.40 Speech/Since 1991 Scottish Rite
Childhood Language learning disabled children with speech,Language Members
Disorders Clinic language and learning Pathologist
1435 L Street 18 months to 18 disorders (i.e.,aphasia and
Fresno,CA 93721 years and dyslexia);students
(559)498-8393 does not serve children
with CP,Autism,or
hearing-impaired.
earning
degree
52
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Fresno Unified School Income restricted.On-site physical exam.No data available RNs Since 2002 First 5 Fresno
District (Parent Mobile
Program)
3058 N.Millbrook Fresno
Birth-5 years TB testing and
immunization
County and
School District
CA 93703
(559)248-7383
Sequoia Community 6 months to 5 This project will increase 5,000 children/ year MD,RNs Since 1978 First 5 Fresno
Health Foundation,Inc.
"Share a Book,Share a
years;
no income
the number of children
that are screened for
County
Dream''
2790 S.Elm
restrictions but
primarily low-
probable developmental
delays.
Fresno,CA 93706
(559)442-7900
income population
served
Spirit of Woman
1331 E.San Bruno
Fresno,CA 93710
Women,women
with young
children,and
Inpatient/outpatient drug
treatment facility.Family
therapy,relationship
No data available RNs,MA
level
clinicians
Since 2000 First 5 Fresno
County
(559)244-4353 pregnant women
who are having a
drug/alcohol
problem
therapy to help young
mothers bond with their
children,and individual
therapy.Children 0-5
receive services with their
mothers.The inpatient
service period is 6 months
and the outpatient service
is 6 months after that.
Stone Soup For high-risk Preschool,parenting No data available Volunteers Since 1992 First 5 Fresno
1345 E.Bulldog
Lane,Suite 4
Hmong community class. The program offers
home visit bv RN for
profess-
sionals,i.e.,
County
Fresno,CA 93710 high-risk families and nurses.
(559)224-7613 their children.teachers
Sullivan Center for Fee for service;Evaluation,assessment.500 children MD,PhD No data Private Pay
Children Medi-Cal not individual and dyadic available
3443 W.Shaw Ave
Fresno,CA 93711
accepted therapy,forensic services
(559)271-1186
53
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
United Cerebral Palsy of
Central California
4224 North Cedar
Fresno,CA 93726
(559)221-8272
Children with
developmental
disabilities
Developmental therapy,
respite care
Center that serves
children is NOT in
Fresno County-ALL
children referred to
EPU
No data
available
Since 1954 CVRC;
Fundraisers
West Fresno Crisis
Center
838 O Street
Firebaugh,CA 93622
(559)934-0915
Victims of child
abuse and their
families
Expansion of current
child abuse services to
more residents in rural
west Fresno
No data available MA,B.S.Since 1977 State of CA;
County of
Fresno
54
Fresno County:Educational Resources
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
California Health Any providers Provide technical assistance No data available Experienced Since 1998 First 5 Fresno
Collaborative who are funded and train providers about public health County
1625 E.Shaw,Suite 155 through Prop.10 secondhand smoking so that workers
Fresno.CA 93710 they can educate the parents
(559)221-6315 they work with about the
effect of secondhand
smoking.
Centro La Familia Court-referred or Child abuse prevention,No data available Master level Since 1976 First 5 Fresno
CAPP self-referred marital counseling,clinicians,BA County;
2014 Tulare St,Suitel 11 families parenting classes and anger and volunteers State funding
Fresno,CA 93721 management classes.through
(559)237-8530 Women's support group for
women with young
children.
County of
Fresno;United
Way;and the
California
Endowment
Children's Services All income levels Help parents to locate No data available AA,BA and Since 1976 95%of
Network quality child care providers MA funding is
5030 E.University in the community.Parent from Dept.of
Fresno,CA 93727 education,subsidized child Education and
(559)456-1100 care,and community
outreach.LEADS program
to train/improve quality of
child care.
First 5 Fresno
County
Clovis Adult Education,Must be from Preschool education.Program has Teachers with Since 1993 First 5 Fresno
Even Start Hmong Parent classes:parents helped 60 credentials and County
1452 David E.Cook Way community.learn how to be their families so far pre-school
Clovis,CA 93611 Parents must children's first teachers.teachers
(559)327-2818 attend parent
classes daily in
order for their
children to qualify
for preschool.
55
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Clovis Unified Part C eligibility.Family Resource Center,65 children PNP,Since 1960 Federal and
1450 E.Herndon Birth-3 years.PT, OT,speech,special ed.psychologists,state funding
Clovis,CA 93611 Contracted by home visits,play groups.teachers,vision
(559)327-9000 regional center for
children and
special education
full inclusion preschool for
special needs
impaired,and
hearing
impaired
Comprehensive Youth Individual,group School Readiness Projects No data available BA,MSW,No data First 5 Fresno
Services and family therapy incorporating the five psychologists available County
Burroughs Elementary elements for child
3755 E.Shields development
Mayfair Elementary
3759 E.Shields
(559)229-3561
Frente Indigena Spanish-speaking Health education No data available BA and leaders Since 1993 Ford
Oaxaqueno families workshops for parents and in the Foundation
2014 Tulare St.,Suite 223 children community
Fresno,CA 93721
(559)499-1178
Fresno Center for New Hmong Provide an awareness about Goal is to have BA Since 1995 First 5 Fresno
Americans community quality and culturally 15-20 licensed County;
4879 E. Kings Canyon appropriate child care;child care funded for 3
Road assist Hmong families to
providers in 2004 years
Fresno,CA 93727 become licensed child care
(559)255-8395 providers.
Fresno County Office of Part C eligibility,Home-based speech,OT.60 open cases at Teachers w/Since 2000 Federal and
Education Infant Birth-3 years;PT, special education one time;no credentials.some state
Program 50%delay in one waiting list Speech and OT funding
1111 Van Ness 6lh Fl developmental therapists (MA
Fresno,CA 93721 area;rural,not
involved in FUSD
special education;
local planning
areas
level),AA and
RN
56
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Fresno County Migrant Migrant children Child care,English classes April-Oct every AS,BA and Since 1970 State-funded
Education Day Care 0-5 years and their for parents year; 76 migrant RN through the
(Proteus)parents children.Department of
8800 S.Academy St.Education
Parlier,CA 93648
(559)646-2735
Fresno Unified Birth-3 years and Early intervention services 500 students Teachers,RN,Since 2000 First 5 Fresno
1301 M Street 3-5 years,infant such as home visit,group PUN,School County
Fresno,CA 93721 and children with services,and family-Psychologist
(559)457-3000 disabilities involvement activities.
School readiness projects at
Lowell and Homan
Speech
Therapist
1-5 Social Services Low-income Child care 250 children at Licensed child-Since 1997 CA Dept.of
4762 W.Jennifer,Suite
102
Fresno,CA 93722
families one time care teacher.Education
(559)275-7132
Kings Canyon Unified Birth-3 years,Part Home-based and center-50 children at Nurse,speech.Since 2002 First 5 Fresno
TIPS Program C +educational based for parent education;one time teachers,OT,County
1221 E.Duff services EPU provides direct bilingual
Reedley,CA 93654 services assistance
(559)637-1434
Khmer Society of Fresno Low-income,Home-based,school 30 families Home visitors Funded in First 5 Fresno
Cambodian Community-Cambodian readiness program for 2003;2-year County
based ECE Project families w/children and their families grant
4729 E.Kings Canyon,children 0-5 years
Ste 114
Fresno.CA 93702
(559)252-0474
Lao Family Community Southeast Asian Parent workshop;provide No data available AA,Child Since 2000 First 5 Fresno
of Fresno Inc.parents with nutritional and health Development County
4903 E. Kings Canyon,children 0-5 years information Education
Ste 281 Certificate
Fresno,CA 93727
(559)453-9775
57
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Lori-Ann Infant
Program
67 E.Ashlan
Fresno,CA 93704
(559)248-7236
Birth-3 years,Part
C eligible
F2arly intervention services,
home-and center-based
145 families MA,PHN,
Speech
Language
Therapists
Since 1960 Sate of CA,
CVRC
Marjaree Mason Center
1600 M street
Fresno,CA 93721
(559)244-5777
Children and their
parents who are
victims of
domestic violence
Emergency residential up to
six months for children and
adults who are victims of
domestic violence
Data not
available
BA or AA Since 1980 First 5 Fresno
County;City
of Fresno;
County of
Fresno;and
federal funds
Parlier Unified
Fair Chance
900 Newmark Ave
Parlier,CA 93648
(559)646-3854
High school
students with a
child or children
Child Daycare 9-11 children BA Since 2001 First 5 Fresno
County
Radio Bilingue
5005 E.Belmont
Fresno,CA 93727
(559)455-5745
Anyone who has
access to a radio
Health education services to
Spanish-speaking parents
No data available Second year of
college
Since 2000 First 5 Fresno
County
Raisin City School
District
PARC Center
6425 W.Bowles Ave
Raisin City, CA 93652
(559)233-0128
Low-income farm
labor families
Child care for rural and
farm labor families
13-20 children BA Since 2002 First 5 Fresno
County
Selma Unified
Parents as Teachers
Project
3036 Thompson Ave
Selma,CA 93662
(559)898-6700
Birth-5 years.
Selma and
surrounding areas
In-home services,school
readiness,parent education
on child development and
brain development,group
sessions,Ages &Stages
(assess and refer)
31 families LVN,certified
parent
educators
No data
available
First 5 Fresno
County
58
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Supportive Services
2455 W.Shaw
Suite 102
Fresno,CA 93711
(559)230-2030
Families with
children at risk
due to family
problems
Respite child care Currently serving
over 6,000
children
MA,BA,AA,
HS diploma
Since 1977 CA Dept.of
Education and
CalWORKS
Washington Colony
Preschool
130 E.Lincoln
Fresno,CA 93706
(559)233-0706
3 years,9 months
through
Kindergarten age
Several key projects that
will enable young children
to fully participate in
enriched learning
48 children BA Since 2002 First 5 Fresno
County
59
Fresno Countv:Head Start Centers
Agency/Contact Eligibility Services Number Served Staff Experience
Biola Migrant Head Low-income migrant Health,dental 25 students AA degree Since 1995
Start Center children,ages 2-6 screening,mental health
5022 Madera Ave years services,education,
Kerman,CA 93630 nutrition,social services
(559)843-2880
Fircbaugh Migrant Low-income migrant Health,dental 40 students AA,Early Since 1984
Head Start Center children screening,mental health Child
1777 Thomas Conboy services,education.Development
Firebaugh,CA 93622 nutrition,social services Units,Master
(559)659-1576 teacher
Five Points Migrant Low-income migrant Health,dental 40 students AA degree,Since 1993
Head Start Center children screening,mental health Early Child
18849 West Excelsior services,education,Development
PO Box 726 nutrition,social services units
Five Points,CA 93624
(559)884-2363
Fresno County EOC Low-income children Health,dental 3,000 children BA,AA Since 1965
Head Start and Early in certain census screening,mental health
Head Start tracts services,education,
1920 Mariposa Mall nutrition,social services
Suite 200
Fresno,CA 93721
(559)263-1200
Fresno Migrant Head Low-income migrant Fiealth,dental 425 each season AA,AS,BA Since 1965
Start Center children screening,mental health
(Sept-Nov)
4221 West Sierra services,education,
Madre#109 nutrition,social services
Fresno,CA 93722
(559)277-8641
Huron Migrant Head Low-income migrant Health,dental 40 students AA,GED,HS No data available
Start Center children screening,mental health andBA
16805 'A Fifth Street services,education,
PO Box 385 nutrition,social services
Huron,CA 93234
(559)945-2441
60
Agency/Contact Eligibility Services Number Served Staff Experience
Mendota Migrant Low-income migrant Health,dental 40 students at each AA,GRE,HS No data available
Head Start Center children,age 2 Vi to 5
screening,mental health
season andBA
435 Sorensen years services,education.
Mendota,CA 93640 nutrition,social services
(559)655-3087
Orange Cove Low-income migrant Health,dental 40 students at each AA,GRE,HS No data available
Migrant Head Start children screening,mental health season and BA
863 Eleventh Street services,education.
Orange Cove,CA nutrition,social services
93646
(559)626-7199
Parlier Migrant Head Low-income migrant Health,dental 40 students at each AA,GRE,HS No data available
Start Center children screening,mental health season and BA
900 Newmark Ave services,education,
Parlier,CA 93648 nutrition,social services
(559)646-0151
Selma Migrant Head Low-income migrant Health,dental 40 students at each AA,GRE,HS No data available
Start Center children,age 2 Vi to 5
screening,mental health season andBA
12898 S.Fowler Ave years services,education,
Selma,CA 93662 nutrition,social services
(559)896-4073
Fresno Unified 3 years, 9 months Educational and speech 1,610 students in AA,No data available
Preschool Program through Kindergarten assessment,parenting entire district Psychologist,
2309 Tulare St.age classes Speech
Fresno,CA 93721 Therapist
1(559)457-3685
61
A.Fresno Countv:Foster Care Agencies
Agency/Contact Eligibility Services Number Served Staff Experience Funding
source
Aspira Foster Family Agency Any foster family Foster care,No data available Ph.D,MSW.Since 1976,State;
1320 E.Shaw,Suite 140 needing services;adoption,intensive LCSW or Fresno Countv of
Fresno,CA 93710 referred by the treatment,Regional MFT intern,since 1989 Fresno;and
(559)222-4969 County of Fresno
and Probation
Center vendorized,
therapeutic behavior
services
BA Medi-Cal
Families First Foster care,others Therapeutic 1,800 children in LCSW,Data not County and
2135 Fresno St.in community.behavioral services,mental health and bachelors available State
Fresno,CA 93721 more seriously ill home-based services.foster care have level funding
(559)244-5880 children,Infant
Mental Health
behavioral
modification
been served.
Currently 200 are
being served
Foster Friends Any foster family Counseling,No data available LMFT,Since 1991 No data
(Family Communication needing services psychological testing Ph.D,available
Center)and evaluations LCSW,and
1039 U St.LMFT and
Fresno.CA 93721 MSW
(559)237-8304 Interns.
Genesis,Inc.Any foster family Foster care,group 12 bed facility;9 BA Since 1989 Non-profit
7475 N.Palm Ave.needing services home,adoption infant-toddler
Fresno.CA 93711 beds
(559)439-5437
Proteus Foster Family Agency Any foster family Individual and family Approx.50 MFT,LCSW Since 1997 County
265 N.Van Ness needing services;counseling
Fresno,CA 93701 targets rural
(559)499-2535 Spanish-speaking
population
Quality Group Homes Any foster family Foster care and Approx.75;BSW,MSW,No data Federal,
4928 E.Clinton Way, Ste. 108 needing services intensive foster care 20 group homes contracted available State,and
Fresno,CA 93727 to include mental Psychologist County
(559)252-6844 health treatment
services
funded
62
B.Fresno County:Mental Health Services/Regional Clinics
Agency/Contact Eligibility Services Number Served Staff Funding
source
Coalinga Health Center Children and their Family therapy.No data available Child Medi-Cal and
311 Coalinga Plaza families;must meet individual therapy and Psychiatrists,sliding scale
Coalinga,CA 93210 the DSM-IV medical case management.LCSWs,for uncovered
(559)935-2058 necessity Children are seen with
their parents.
LMFTs and
BAorBSW
case managers
individuals
Fresno County Youth Children from 4 Assessment,therapeutic No data available LCSW,master Medi-Cal
Services (CCAIR Center)years and their interventions,family level RNs,
3133 N.Millbrook Street families with urgent meetings,treatment LVNs and
Fresno,CA 93703 psychiatric issues planning,follow-up LMFT
(559)453-8918 support and services in
case of hospitalization
Firebaugh Health Children and their Family therapy.No data available Child Medi-Cal and
Center families;must meet individual therapy and Psychiatrists,sliding scale
1133 P Street the DSM-IV medical case management.LCSWs,for uncovered
Firebaugh,CA 93622 necessity Children are seen with LMFTs and individuals
(559)488-3927 their parents.BAorBSW
case managers
Huron United Health Children and their Family therapy,No data available Child Medi-Cal and
Center families;must meet individual therapy and Psychiatrists,sliding scale
36678 S.Lassen Ave.#1 the DSM-IV medical case management.LCSWs,for uncovered
Huron,CA 93224 necessity Children are seen with LMFTs and individuals
(559)945-2826 their parents.BAorBSW
case managers
63
Agency/Contact Eligibility Services Number Served Staff Funding
source
Kerman Children and their Family therapy.No data available Child Medi-Cal and
275 S.Madera Ave.families;must meet individual therapy and Psychiatrists,sliding scale
#400 the DSM-IV medical case management.LCSWs,for uncovered
Kerman,CA 93630 necessity Children are seen with LMFTs and individuals
(559)846-7500 their parents.BAorBSW
case managers
Pinedale Children and their Family therapy.No data available Child Medi-Cal and
28 E.Minarets families;must meet individual therapy and Psychiatrists,sliding scale
Pinedale,CA 93650 the DSM-IV medical case management.LCSWs,for uncovered
(559)436-0482 necessity Children are seen with
their parents.
LMFTs and
BA or BSW
case managers
individuals
Sanger Children and their Family therapy,No data available Child Medi-Cal and
225 Academy families;must meet individual therapy and Psychiatrists,sliding scale
Sanger,CA 93657 the DSM-IV medical case management.LCSWs,for uncovered
(559)875-7705 necessity Children are seen with
their parents.
LMFTs and
BAorBSW
case managers
individuals
Selma Children and their Family therapy.No data available Child Medi-Cal and
3800 Mc Call Ave families;must meet individual therapy and Psychiatrists,sliding scale
Selma,CA 93662 the DSM-IV medical case management.LCSWs,for uncovered
(559)898-5290 necessity Children are seen with
their parents.
LMFTs and
BA or BSW
case managers
individuals
64
Appendix E
Exceptional Parents Unlimited,Inc.
65
Exceptional Parents Unlimited,Inc.
Exceptional Parents Unlimited,Inc.(EPU) was established in 1976 as a resource for parents who
had given birth to infants with disabilities.The initial focus of the program was to provide
support, information, advocacy and assistance to parents in accessing services for their infants
and children. Over the past 27 years, services have expanded as the needs of children and
families have been recognized from input received by the parents being served. In 1979 an early
intervention program, the Infant-Family Program, was established to serve infants with
disabilities and their families through specialized therapeutic interventions provided by a multi-
disciplinary team of professionals, each of whom brought unique expertise to the team. The
Infant-Family Mental Health component of this program has recently been expanded through the
addition of a Licensed Clinical Psychologist who has extensive training and experience in Infant-
Family Mental Health. This addition will enable EPU to meet the increasingly complex needs of
families in which there are parental mental health issues, parents with developmental disabilities,
and families in which there are grief and attachment challenges presented by the presence of a
child with a disability.
In 1992,in response to the large number of infants who were being served in the early
intervention program who had been prenatally exposed to alcohol and other drugs, an intensive
program was created called "Learning About Parenting"(LAP).The LAP program provides a
wide range of services to addressthe substance abuse issues of parents,the developmental needs
of infants and children, and to provide intensive parenting through formal classes and intensive
home visitation. The LAP program serves the whole family as a unit and the unique needs of
each family member as individuals.As the LAP program has progressed,the clientele has
expanded to include parents who are involved with the County of Fresno,Department of
Children and Family Services system through Voluntary Family Maintenance.Oneofthe unique
programs included under the umbrella of the LAP program is a Fatherhood program which is
coordinated by a masters level counselor who is bilingual (English/Spanish).Many services are
offered to fathers through this program including a 14-week "Nurturing Fathers Journal"
program,anger management,camping and fishing programs,and other classes ranging from
father/child playgroups to teaching fathers howto prepare a Thanksgiving Turkey!
The LAP program has been a collaborative partner in the CHAT program (Child Abuse
Treatment)through the Office of Criminal Justice Planning.In this program therapeutic
interventions are provided by a mental health clinician (LCSW)to children who have been
victims of abuse and their non-offending parent. The focus of this program has been children
from birth to five years of age and those with disabilities.
Since 1996,Exceptional Parents Unlimited,Inc.has served as Central California's Parent
Training and Information Center (PTI).The Central California PTI at EPU is one of 105 centers
funded by the U.S.Department of Education as part of the Individuals with Disabilities
Education Act (IDEA).The PTI at EPU serves families of children from birth to 22 years of age
with disabilities and other special needs in a sparsely populated,rural,and ethnically/culturally
diverse ten county region in Central California.As a leader in this field,EPU has taken a role in
66
building local capacities and has created a culturally and linguistically responsive network of
services through established collaborative partnerships with Family Resource Centers (FRC),
funded by California's Early Start,throughout the ten county region. The capacity building work
with these FRCs has included providing formal training and technical assistance,as well as
funding to expand the services the FRCs are able to provide in their local communities.Both the
PTI and the partnering FRCs are staffed primarily by parents and close family members of
children with disabilities and other special needs who represent diverse cultural and ethnic
groups and whose children have a wide range of special needs.EPU also works closely with
school districts and SELPAs (Special Education Local Planning Areas)and provides community-
based services to ensure that the parent voice is heard at all levels of decision making regarding
the needs of children with special needs and that the cultural and linguistic backgrounds of
children and families are respected and services provided accordingly.
In 2003,EPU entered into an agreement with First 5 Fresno County to retain two developmental
pediatricians previously located at Central California Children's Hospital,when the hospital
eliminated those services in April 2003. Since they are the only subspecialists in developmental
pediatrics in Central California,EPU uses funds from First 5 to contract with the pediatricians to
provide developmental services to referred children,birth through five years of age residing
within Fresno Countv.
67
Appendix F
Participants in Planning Meeting
July 2003
68
Participants in Planning Meeting (July 2003)
Susan Anderson
Carol Bence
Edgar Castillo,MD
Debbie Davis
Cathy Drusen
Sandy Fabry
Steve Gordon
Marion Karian
Brian Mimura
Laurie Misaki
Bjorn Nilson,MD
Don Pierce
Laurie Primavera
Nancy Richardson
Kendra Rogers
David Snyder,MD
Susan Snyder
Connie Woodman
Ira J.Chasnoff,MD
Richard F.McGourty,PhD
Supervisor District 2,County of Fresno, Board of Supervisors
Assistant Director,Special Education,Clovis Unified School
District
Chief Child Psychiatrist,County of Fresno,Department of
Children and Family Services
Program Manager.Special Education,Fresno Office of Education
Division Manager,County of Fresno,Department of Public Flealth.
Nursing Outreach Services
Program Specialist,Special Education,Fresno Unified School
District
Executive Director,First 5 Fresno County
Executive Director,Exceptional Parents Unlimited,Inc.
Director of Planning and Evaluation,First 5 Fresno County
Perinatal Services Coordinator,County of Fresno,Department of
Public Health,Maternal,Child and Adolescent Health Program
Chair,University of California San Francisco-Fresno Medical
Education Department of Pediatrics
Interim Director,Fresno County Human Services
Health Care Project Coordinator,Fresno Metro Ministry
Chair, Fresno County Foster Care Oversight Committee
Program Development Director,First 5 Fresno County
Child Development Services, Exceptional Parents Unlimited
Program Manager,Central Valley Regional Center
Division Manager, County of Fresno, Department of Public Health,
Maternal,Child and Adolescent Health Program
Children's Research Triangle
Children's Research Triangle
69
Appendix G
Individuals and Groups in Town Meetings
and Interviews
70
Individuals and Groups for Town Meetings and Interviews
Parent Meetings
Parent meetings were conducted in English and Spanish at the offices of Exceptional Parents
Unlimited,Inc.All parents had a special needs child;three of the parents were from the City of
Fresno, and there was one parent from each of the following communities:Coalinga,Firebaugh,
Reedley, Clovis, Selma, and Parlier. One parent was Caucasian,two were African American,
four were Hispanic, one was Native American, and one was Asian American. The children had a
wide range of disabilities:autism, Pervasive Developmental Delay, Attention Deficit
Hyperactivity Disorder, Fetal Alcohol Syndrome,congenital heart disease, schizophrenia,
cerebral palsy, Down Syndrome,Bipolar Disorder,and Trisomy 18.
Town Meetings
Two Town Meetings were convened (April and October 2003), each attracting well over 100
people from across Fresno County. There was representation from every major health agency in
the County, several private agencies, the schools, and parents and other concerned individuals
from many communities outside the City of Fresno.
Individual Interviews
Interviews were conducted with a wide range of individuals from the public, private, business,
and political arenas:
Supervisor District 2, County of Fresno, Board of Supervisors
Former Chairman,County of Fresno,Board of Supervisors
Judge, Fresno County Juvenile Dependency Court
Chief Child Psychiatrist, County of Fresno, Department of Children and
Family Services,Children's Mental Health
Coordinator,Interagency Council for Children and Families
Former Director,Fresno County Human Services
Children's Services Network
Executive Director,Stone Soup
Child Flealth and Disabilities Coordinator,Fresno County Economic
Opportunities Commission Early Head Start
Community Relations,Health Net
Program Manager, Fresno County Office of Education
Executive Director,Khmer Society
Commissioner,First 5 Fresno County; Board Member, Fresno Unified
School District
Assistant Executive Director,Fresno County Economic Opportunities
Commission,Child Education and Development
Chair, University of California San Francisco- Fresno Medical Education
Department of Pediatrics
Managing Partner,Rios Company
Executive Director, Fresno County Economic Opportunities Commission
Commissioner,First 5 Fresno County; Board Member, Fresno County
Mental Health Advisory Board
Susan Anderson
Juan Arambula
Dennis Caeton
Edgar Castillo,MD
Lilia Chavez
David Dent
Gayle Duffy
Kathy Garabed
Lisa Gartin
Lupe Gonzales
David Halpern
Tia Lamb
Luisa Medina
Naomi Mizumoto
Bjorn Nilson,MD
Samuel Norman
Roger Palamino
Lee Ann Parry
71
Don Pierce
Steve Price,PhD
Laurie Primavera
Audrey Riley
Nancy Richardson
David Riester
Angie Rios
Kathleen Shivaprasad
Bob Silveira
Martin Suits
Peter Vang
Gary Zomalt
Interim Director,Fresno County Human Services
School Development Center,California State University-Fresno
Health Care Project Coordinator,Fresno Metro Ministry
Executive Director,Spirit of Woman
Chair,Fresno County Foster Care Oversight Committee
Director,Central Valley Regional Center
Owner,Rios Company
Program Manager, Early Head Start, Fresno County Economic
Opportunities Commission
Director of Finance,Fresno County Human Services
Judge, Fresno County Juvenile Dependency Court
Refugee Community Liaison, Fresno County Human Services
Director, County of Fresno, Department of Children and Family Services
72
Exhibit "B"
Self-Dealing Transaction Disclosure Form
Model of Care Amendment IV
73
Exhibit B
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"),must
disclose any self-dealing transactions that they are a party to while providing goods,performing
services,or both for the County.A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in whichone
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name, job title (ifapplicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe indetail the nature of the self-dealing transaction that isbeing disclosed to the
County. At a minimum,include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4)Describe in detail whythe self-dealingtransaction isappropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed bythe board member that isinvolvedinthe self-dealing transaction
described in Sections (3)and (4).
74
Exhibit B
(1)Company Board Member Information:
Name:Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure (Pleasedescribe the nature ofthe self-dealingtransaction you are a partyto):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5)Authorized Signature
Signature:Date:
75
Schedule 2.1
Agency Participation &Responsibilities FY 2011-12
Model of Care Amendment IV
76
Schedule 2.1
Model of Care Agreement
Agency Participation & Responsibilities
County of Fresno,Department of Behavioral Health
Address for Notices:
County of Fresno
Donna Taylor,RN,Director
Department of Behavioral Health
3133 N.Millbrook
Fresno,CA 93703
Committed Resources:
County agrees to pay to EPU and EPU agrees to receive compensation based on actual
expenditures incurred by EPU under this Agreement.Payments shall be made by County in
arrears,for services provided during the preceding month,within forty-five (45)days after the
date of receipt of itemized invoice.Payments shall be made after receipt and verification of
actual expenditures incurred by EPU in the performance of this Agreement and shall be
documented to County on a monthly basis by the 15th day of the month following the month of
said expenditures.In no event shall compensation under this agreement exceed Nine Thousand
Twenty Six No/100 Dollars ($9,026.00)for the period July 1,2011 through June 30,2012.
Additional resources that County may provide includes:laptops or computer equipment and
other suchequipmentrequired to performspecificduties.
Committed Personnel:
County agrees to supply the following personnel in accordance with the Staffing model.
Schedule 2.5:
Job Title:Infant Mental Health Clinician FTE Equivalents 1.0
Data Reporting Requirements:
Co-located agencies will collect and report to EPU data that is not collected elsewhere on
children their staff assess at the Center. This includes but is not limited to the number of children
assessed by their agency only.
77
Schedule 2.1
Model of Care Agreement
Agency Participation &Responsibilities
Fresno Unified School District (FUSD)
Address for Notices:
Maria Maldonado,Assistant Superintendent
FUSD English Learner Services
2348 Mariposa Mall
Fresno,CA 93721
Committed Resources:
Annual contribution of Twenty Four Thousand One Hundred Forty Five and No/100 Dollars
($24,145.00)forthe period July 1,2011 through June 30,2012 to be paid to EPU during the first
month of said period.
Additional resources that FUSD may provide includes:laptops or computer equipment and other
suchequipmentrequiredto performspecificduties.
Committed Personnel:
FUSD agrees to supply the following personnel in accordance with the Staffing Model,
Schedule 2.5:
Job Title Pre K Teacher FTE Equivalents 1.0
Job Title 3 Vz hour Instructional Aide FTE Equivalents 0.44
Job Title Secretary FTE Equivalents 0.4
Data Reporting Requirements:
FUSD will report to EPU data that is collected on children who receive intervention services at
EPU by FUSD staff as well as for those children who have been referred through the one-call
line and receive services through FUSD.
78
Schedule 2.1
Model of Care Agreement
Agency Participation & Responsibilities
County of Fresno,Department of Public Health (DPH)
Maternal,Child and Adolescent Health (MCAH)Program
Address for Notices:
County of Fresno
Edward L.Moreno,M.D.,M.P.H.
Director-Health Officer,
Department of Public Health
1221 Fulton Mall
Fresno,CA 93721
Committed Resources:
The parties understand that the County's commitment to pay EPU the monies is contingent upon
two events.First,it is contingent on the County's receipt of the money from the Children and
Families Commission of Fresno County("First Five") under its agreement for the funding of the
Assessment Center.Second,it is contingent on the County's ability to usethe monies received
from First Five to leverage additional federal funds.To the extent that either or both of these
contingencies are reduced,the County's duty to pay EPU the monies,described in the following
paragraphs,is correspondingly reduced.
For the period July 1,2011 through June 30,2012,County agrees to pay to EPU and EPU agrees
to receive compensation based on actual expenditures incurred by EPU under this Agreement.
Payments shall be made by County in arrears,for services provided during the preceding month,
within forty-five (45)days after the date of receipt of itemized invoice.Payments shall be made
after receipt and verification of actual expenditures incurred by EPU in the performance of this
Agreement and shall be documented to County on a monthly basis by the 15th day of the month
following the month of said expenditures.In no event shall compensation under this agreement
exceed One Million One Hundred and Thirty Seven Thousand Seven Hundred Sixty One and
No/100 Dollars ($1,137,761.00)forthe period July 1,2011 through June 30,2012.
Additional resources that County may provide include:laptops or computer equipment and other
such equipment required to perform specific duties.
The California Department of Public Health (CDPH)Maternal,Child and Adolescent Health
(MCAH)Program requires all personnel that are funded by Federal Title XIX funds to time
study at least once per quarter.Therefore,in order to be entitled to receive these federal
matching funds,EPU will need to prepare and provide to the County the appropriate time
studies.Additional information regarding time studying will be provided to EPU by the CDPH
79
MCAH Program and/or designees of the County of Fresno,Department of Public Health's
MCAH Program.
EPU agrees to maintain and preserve,until three (3)years after termination of the County's
MCAH Allocation Funding Agreements with the California Department of Public Health
(CDPH)Maternal,Child and Adolescent Health (MCAH)Program -Agreement Numbers
200910,201010and 201110 and final payment from the California Department of Public Health
Maternal, Child and Adolescent Health Program, to permit the CDPH MCAH Program or any
duly authorized representative,to have access to,examine or audit any pertinent books,
documents and records related to this subcontract and allow interviews of any employees who
might reasonably have information related to such records.
80
Schedule 2.1A
Agency Participation &Responsibilities FY 2012-13
Model of Care Amendment IV
81
Schedule 2.1A
Model of Care Agreement
Agency Participation &Responsibilities
FY 2012-13
County of Fresno,Department of Behavioral Health
Address for Notices:
County of Fresno
Donna Taylor,RN,Director
Department of Behavioral Health
3133 N.Millbrook
Fresno,CA 93703
Committed Resources:
County agrees to pay to EPU and EPU agrees to receive compensation based on actual
expenditures incurred by EPU under this Agreement.Payments shall be made by County
in arrears,for services providedduring the preceding month,within forty-five (45) days
after the date of receipt of itemized invoice.Payments shall be made after receipt and
verification of actual expenditures incurred by EPU in the performance of this Agreement
and shall be documented to County on a monthly basis by the 15th day of the month
following the month of said expenditures.In no event shall compensation under this
agreement exceed Nine Thousand and Five No/100 Dollars ($9,005.00)for the period
July 1, 2012 through June 30, 2013.
Additional resources that County may provide includes: laptops or computer equipment
andother such equipment required to performspecific duties.
Committed Personnel:
County agrees to supply the following personnel in accordance with the Staffing model,
Schedule 2.5A:
Job Title: InfantMental HealthClinician | FTE Equivalents 1.0
Data Reporting Requirements:
Co-located agencies will collect and report to EPU datathatis not collected elsewhere on
children their staff assess at the Center.This includes but is not limited to the number of
children assessed by their agency only.
82
Schedule 2.1A
Model of Care Agreement
Agency Participation &Responsibilities
FY 2012-13
Fresno Unified School District (FUSD)
Address for Notices:
Maria Maldonado,Assistant Superintendent
FUSD English Learner Services
2348 Mariposa Mall Street
Fresno,CA 93721
Committed Resources:
Annual contribution of Twenty Five Thousand Five Hundred Seventy Four and No/100
Dollars ($25,574.00)for the period July 1,2012 through June 30, 2013 to be paid to EPU
during the first month of said period.
Additional resources that FUSD may provide includes:laptops or computer equipment
and other such equipment required to perform specific duties.
Committed Personnel:
FUSD agrees to supply the following personnel in accordance with the Staffing Model,
Schedule 2.5A:
Job Title:Teacher on Special Assignment
PreK
FTE Equivalents 1.0
Job Title:Social Worker FTE Equivalents 1.0
Job Title:3 Vi hour Instructional Aide FTE Equivalents 0.44
Job Title:Secretary FTE Equivalents 0.4
Data Reporting Requirements:
FUSD will report to EPU data that is collected on children who receive intervention
services at EPU by FUSD staff as well as for those children who have been referred
through the one-call line and receive services through FUSD.
83
Schedule 2.1A
Model of Care Agreement
Agency Participation &Responsibilities
FY 2012-13
County of Fresno,Department of Public Health (DPH)
Maternal,Child and Adolescent Health (MCAH)Program
Address for Notices:
County of Fresno
Edward L.Moreno,M.D.,M.P.H.
Director-Health Officer,
Department of Public Health
1221 Fulton Mall
Fresno,CA 93721
Committed Resources:
The parties understand that the County's commitment to pay EPU the monies is
contingent upon two events. First, it is contingent on the County's receipt of the money
from the Children and Families Commission of Fresno County ("First Five")under its
agreement for the funding of the Assessment Center. Second, it is contingent on the
County's ability to use the monies received from First Five to leverage additional federal
funds. To the extent that either or both of these contingencies are reduced,the County's
duty to pay EPU the monies, described in the following paragraphs, is correspondingly
reduced.
For the period July 1,2012 through June 30, 2013, County agrees to pay to EPU and EPU
agrees to receive compensation based on actual expenditures incurred by EPU under this
Agreement.Payments shall be made by County in arrears, for services provided during
the preceding month, within forty-five (45) days after the date of receipt of itemized
invoice. Payments shall be made after receipt and verification of actual expenditures
incurred by EPU in the performance of this Agreement and shall be documented to
County on a monthly basis by the 15th day of the month following the month of said
expenditures. In no event shall compensation under this agreement exceed One Million
One Hundred and Thirty Seven Thousand Seven Hundred Sixty One and No/100 Dollars
($1,137,761.00)for the period July 1, 2012 through June 30, 2013.
Additional resources that County may provide include: laptops or computer equipment
and other such equipment required to perform specific duties.
The California Department of Public Health (CDPH) Maternal, Child and Adolescent
Health (MCAH) Program requires all personnel that are funded by Federal Title XIX
funds to time study at least once per quarter. Therefore, in order to be entitled to receive
84
these federal matching funds, EPU will need to prepare and provide to the County the
appropriate time studies.Additional information regarding time studying will be
provided to EPU by the CDPH MCAH Program and/or designees of the County of
Fresno,Department of Public Health's MCAH Program.
EPU agrees to maintain and preserve,until three (3)years after termination of the
County's MCAH Allocation Funding Agreements with the California Department of
Public Health (CDPH)Maternal,Child and Adolescent Health (MCAH)Program -
Agreement Numbers 200910,201010 and 201110 and final payment from the California
Department of Public Health Maternal,Child and Adolescent Health Program,to permit
the CDPH MCAH Program or any duly authorized representative,to have access to,
examine or audit any pertinent books,documents and records related to this subcontract
and allow interviews of any employees who might reasonably have information related to
such records.
85
Schedule 2.1B
Agency Participation &Responsibilities FY 2013-14
Model of Care Amendment IV
86
Schedule 2.1B
Model of Care Agreement
Agency Participation &Responsibilities
FY 2013-14
County of Fresno,Department of Behavioral Health
Address for Notices:
County of Fresno
Dawan Utecht,Director
Department of Behavioral Health
3133 N.Millbrook
Fresno,CA 93703
Committed Resources:
County agrees to pay to EPU and EPU agrees to receive compensation based on actual
expenditures incurred by EPU under this Agreement. Payments shall be made by County
in arrears, for services provided during the preceding month, within forty-five (45) days
after the date of receipt of itemized invoice. Payments shall be made after receipt and
verification of actual expenditures incurred by EPU in the performance of this Agreement
and shall be documented to County on a monthly basis by the 15lh day of the month
following the month of said expenditures. In no event shall compensation under this
agreement exceed Ten Thousand Two Hundred Seventy Seven and No/100 Dollars
($10,277.00)for the period July 1,2013 through June 30, 2014
Additional resources that County may provide includes: laptops or computer equipment
and other such equipment required to perform specific duties.
Committed Personnel:
Countyagrees to supply the following personnel in accordance with the Staffing model,
Schedule 2.5B:
Job Title: Infant Mental Health Clinician | FTE Equivalents 1.0
Data Reporting Requirements:
Co-locatedagencies will collect and report to EPU data that is not collectedelsewhereon
children their staff assess at the Center.This includes but is not limited to the number of
children assessed by their agency only.
87
Schedule 2.1B
Model of Care Agreement
Agency Participation &Responsibilities
FY 2013-14
County of Fresno,Department of Public Health (DPH)
Maternal,Child and Adolescent Health (MCAH)Program
Address for Notices:
County of Fresno
David Pomaville,M.B.A.,R.E.H.S.
Interim Director,
Department of Public Health
1221 Fulton Mall
Fresno,CA 93721
Committed Resources:
The parties understand that the County's commitment to pay EPU the monies is
contingent upon two events. First, it is contingent on the County's receipt of the money
from the Children and Families Commission of Fresno County ("First Five")under its
agreement for the funding of the Assessment Center. Second, it is contingent on the
County's ability to use the monies received from First Five to leverage additional federal
funds. To the extent that either or both of these contingencies are reduced,the County's
duty to pay EPU the monies, described in the following paragraphs, is correspondingly
reduced.
For the period July 1,2013 through June 30, 2014, County agrees to pay to EPU and EPU
agrees to receive compensation basedon actual expenditures incurred by EPU underthis
Agreement.Payments shall be made by County in arrears,for services provided during
the preceding month,within forty-five (45) days after the date of receipt of itemized
invoice.Payments shall be made after receipt and verification of actual expenditures
incurred by EPU in the performance of this Agreement and shall be documented to
County on a monthly basis by the 15th day of the month following the month of said
expenditures.In no event shall compensation under this agreement exceed Eight
Hundred Seventy Thousand Seven Hundred Fifty Eight and No/100 Dollars
($870,758.00) for the period July 1,2013 through June 30, 2014.
Additional resources that County may provide include: laptops or computer equipment
and other such equipment required to perform specific duties.
The California Department of Public Health (CDPH) Maternal, Child and Adolescent
Health (MCAH) Program requires all personnel that are funded by Federal Title XIX
funds to time studyat least once per quarter.Therefore,in orderto be entitledto receive
these federal matching funds,EPU will need to prepare and provide to the County the
appropriate time studies.Additional information regarding time studying will be
provided to EPU by the CDPH MCAH Program and/or designees of the County of
Fresno,Department of Public Health's MCAH Program.
EPU agrees to maintain and preserve,until three (3) years after termination of the
County's MCAH Allocation Funding Agreements with the California Department of
Public Health (CDPH)Maternal,Child and Adolescent Health (MCAH)Program -
Agreement Numbers 201010,201110 and 201210 and final payment from the California
Department of Public Health Maternal,Child and Adolescent Health Program,to permit
the CDPH MCAH Program or any duly authorized representative,to have access to,
examine or audit any pertinent books,documents and records related to this subcontract
and allow interviews of any employees who might reasonably have information related to
such records.
89
Schedule 2.1C
Agency Participation &Responsibilities FY 2014-15
Model of Care Amendment IV
90
Schedule 2.1C
Model of Care Agreement
Agency Participation &Responsibilities
FY 2014-15
County of Fresno,Department of Behavioral Health
Address for Notices:
County of Fresno
Dawan Utecht,Director
Department of Behavioral Health
3133 N.Millbrook
Fresno,CA 93703
Committed Resources:
County agrees to pay to EPU and EPU agrees to receive compensation based on actual
expenditures incurred by EPU under this Agreement. Payments shall be made by County
in arrears, for services provided during the preceding month, within forty-five (45) days
after the date of receipt of itemized invoice. Payments shall be made after receipt and
verification of actual expenditures incurred by EPU in the performance of this Agreement
and shall be documented to County on a monthly basis by the 15l day of the month
following the month of said expenditures. In no event shall compensation under this
agreement exceed Ten Thousand Two Hundred Seventy Six and No/100 Dollars
($10,276.00)for the period July 1,2014 through June 30, 2015.
Additional resources that County may provide includes: laptops or computer equipment
and other such equipment required to perform specific duties.
Committed Personnel:
County agrees to supply the following personnel in accordance with the Staffing model,
Schedule 2.5C:
Job Title: Infant Mental Health Clinician | FTE Equivalents 1.0
Data Reporting Requirements:
Co-located agencies will collect and report to EPU data that is not collected elsewhereon
children their staff assess at the Center.This includes but is not limited to the number of
children assessed by their agency only.
91
Schedule 2.1C
Model of Care Agreement
Agency Participation &Responsibilities
FY 2014-15
County of Fresno,Department of Public Health (DPH)
Maternal,Child and Adolescent Health (MCAH)Program
Address for Notices:
County of Fresno
David Pomaville,Director
Department of Public Health
1221 Fulton Mall
Fresno,CA 93721
Committed Resources:
The parties understand that the County's commitment to pay EPU the monies is
contingent upon two events. First, it is contingent on the County's receipt of the money
from the Children and Families Commission of Fresno County ("First Five")under its
agreement for the funding of the Assessment Center. Second, it is contingent on the
County's ability to use the monies receivedfrom First Five to leverage additional federal
funds. To the extent that either or both of these contingencies are reduced,the County's
duty to pay EPU the monies,described in the following paragraphs,is correspondingly
reduced.
FortheperiodJuly 1,2014 through June 30,2015,Countyagreesto paytoEPUandEPU
agrees to receive compensation based on actual expenditures incurred by EPU under this
Agreement.Payments shall be made by County in arrears,for services provided during
the preceding month,within forty-five (45)days after the date of receipt of itemized
invoice.Payments shall be made after receipt and verification of actual expenditures
incurred by EPU in the performance of this Agreement and shall be documented to
County on a monthly basis by the 15lh day of the month following the month of said
expenditures.In no event shall compensation under this agreement exceed Eight
Hundred Seventy Thousand Seven Hundred Sixtyand No/100 Dollars ($870,760.00)for
the period July 1,2014 through June 30.2015.
Additional resources that County may provide include: laptops or computer equipment
and other such equipment required to perform specific duties.
The California Department of Public Health (CDPH)Maternal,Child and Adolescent
Health (MCAH)Program requires all personnel that are funded by Federal Title XIX
funds to time study at leastonceper quarter.Therefore,inorderto be entitled to receive
these federal matching funds,EPU will need to prepare and provide to the County the
92
appropriate time studies.Additional information regarding time studying will be
provided to EPU by the CDPH MCAH Program and/or designees of the County of
Fresno,Department of Public Health's MCAH Program.
EPU agrees to maintain and preserve, until three (3) years after termination of the
County's MCAH Allocation Funding Agreements with the California Department of
Public Health (CDPH)Maternal,Child and Adolescent Health (MCAH)Program -
Agreement Numbers 200910,201010,201110,201210 and 201310 - and final payment
from the California Department of Public Health Maternal,Child and Adolescent Health
Program, to permit the CDPH MCAH Program or any duly authorized representative,to
have access to,examine or audit any pertinent books,documents and records related to
this subcontract and allow interviews of any employees who might reasonably have
information related to such records.
93
Schedule 2.1D
Agency Participation &Responsibilities FY 2015-16
Model of Care Amendment IV
94
Schedule 2.1D
Model of Care Agreement
Agency Participation &Responsibilities
FY 2015-16
County of Fresno,Department of Behavioral Health
Address for Notices:
County of Fresno
Dawan Utecht,Director
Department of Behavioral Health
4441 E.Kings Canyon
Fresno,CA 93702
Committed Resources:
County agrees to pay to EPU and EPU agrees to receive compensation based on actual
expenditures incurred by EPU under this Agreement.Payments shall be made by County
in arrears,for services provided during the preceding month,within forty-five (45) days
after the date of receipt of itemized invoice. Payments shall be made after receipt and
verification of actual expenditures incurred by EPU in the performance of this Agreement
and shall be documented to County on a monthly basis by the 15*day of the month
following the month of said expenditures. In no event shall compensation under this
agreement exceed Nine Thousand Seven Hundred Thirty Eight and No/100 Dollars
($9,738.00)for the period July 1,2015 through June 30,2016
Additional resources that County may provide includes: laptops or computer equipment
and other such equipment required to perform specific duties.
Committed Personnel:
County agrees to supply the following personnel in accordance with the Staffing model,
Schedule 2.5D:
Job Title: Infant Mental Health Clinician | FTE Equivalents 1.0
Data Reporting Requirements:
Co-located agencies will collect and report to EPU data that is not collected elsewhere on
children their staff assess at the Center.This includes but is not limited to the number of
children assessed by their agency only.
95
Schedule 2.1D
Model of Care Agreement
Agency Participation &Responsibilities
FY 2015-16
County of Fresno,Department of Public Health (DPH)
Maternal,Child and Adolescent Health (MCAH)Program
Address for Notices:
County of Fresno
David Pomaville,Director
Department of Public Health
1221 Fulton Mall
Fresno,CA 93721
Committed Resources:
The parties understand that the County's commitment to pay EPU the monies is
contingent upon two events. First, it is contingent on the County's receipt of the money
from the Children and Families Commission of Fresno County ("First Five")under its
agreement for the funding of the Assessment Center. Second, it is contingent on the
County's ability to use the monies received from First Five to leverage additional federal
funds. To the extent that either or both of these contingencies are reduced,the County's
duty to pay EPU the monies, described in the following paragraphs, is correspondingly
reduced.
For the period July 1,2015 through June 30, 2016, County agrees to pay to EPU and EPU
agreesto receive compensation basedon actual expenditures incurred by EPU underthis
Agreement.Payments shall be made by County in arrears, for services provided during
the preceding month, within forty-five (45) days after the date of receipt of itemized
invoice.Payments shall be made after receipt and verification of actual expenditures
incurred by EPU in the performance of this Agreement and shall be documented to
County on a monthly basis by the 15th day of the month following the month of said
expenditures.In no event shall compensation under this agreement exceed Eight
Hundred Seventy Thousand Seven Hundred Fifty Nine and No/100 Dollars
($870,759.00) for the period July 1,2015 through June 30,2016.
Additional resources that County may provide include: laptops or computer equipment
and other such equipment required to perform specific duties.
The California Department of Public Health (CDPH) Maternal, Child and Adolescent
Health (MCAH) Program requires all personnel that are funded by Federal Title XIX
funds to time studyat leastonce per quarter.Therefore,in orderto be entitledto receive
these federal matching funds,EPU will need to prepare and provide to the County the
96
appropriate time studies.Additional information regarding time studying will be
provided to EPU by the CDPH MCAH Program and/or designees of the County of
Fresno,Department of Public Health's MCAH Program.
EPU agrees to maintain and preserve,until three (3) years after termination of the
County's MCAH Allocation Funding Agreements with the California Department of
Public Flealth (CDPH)Maternal,Child and Adolescent Flealth (MCAH)Program -
Agreement Numbers 201110,201210,201310 and 201410 - and final payment from the
California Department of Public Health Maternal,Child and Adolescent Health Program,
to permit the CDPH MCAH Program or any duly authorized representative,to have
access to,examine or audit any pertinent books,documents and records related to this
subcontract and allow interviews of any employees who might reasonably have
information related to such records.
97
Schedule 2.5
Staffing Model FY 2011-12
Model of Care Amendment IV
98
EPU ASSESSMENT CENTER FOR CHILDREN STAFFING CHART
FY 2011-2012 Schedule 2.5
Medical Director
David Snyder, MD
(0'8)
Licensed Psychologist
(0.5)
DBH
Department of Behavioral Health
EPU Administration
Exceptional Parents Unlimited
EPU /First 5
Exceptional Parents Unlimited
EPU/Ml ISA*
Exceptional Parents Unlimited
*MI ISA—not included
in Master Agreement
July 20,20 11
Executive Directoi
Marion Karian
Daryl Hitchcock,PhD
(0.9)and(0.1MHSA*)
Mental Health Clinician (Senior)
(0.8)and (0.2MHSA*)
Mental Health Clin./Psvch.
(1.7)
Mental Health Clinician
(0.5)
Speech Pathologist
(0.5)
Occupational Therapist
(1.0)
Mental Health Clinician*
(2.3)
Family Education Specialist*
(4.0)
Infant Mental Health Clinician
(1.0)
Development &Evaluation (0.25)
Barbara Swan
(1.0)
(2.0)
Administrative Assistant *
(0.5)
(12.0)
(0.5)and(0.5MHSA*)
(2.0)and(1.0MHSA*)
Family Resource Specialist
(10)
Program Assistant
(1.0)
Partner Oversite Committee MoCPOC
CCCI Central California Children's Institute
CIICC Children's Hospital Central California
CVRC Central Valley Regional Center
DBH Department of Behavioral Health
DPH Department of Public Health
DSS Department of Social Services
KMQ families First
FPU Fxceptional Parents Unlimited
First 5 Fresno Countv
FUSD Fresno Unified School District
MMC Marjaree Mason Center
WestCare
Cassandra Joubert
Kristine Anbiy
Tom Keenen
Donna Taylor
Ed Moreno,MD
Judy Lemos
Marilyn Bamford
AIavion Karian
Kendra Rogers
Deanna Mathies
Pamela Kallsen
Lynn Pimentel
99
Schedule 2.5A
Staffing Model FY 2012-13
Model of Care Amendment IV
100
Developmental &
Behavioral Pediatrician
(0.8)
Licensed Psychologist
(.25)
DBH
Department of Behavioral Health
EPU Administration
Exceptional Parents Unlimited
EPU/ First 5
Exceptional Parents Unlimited
EPU/MHSA*
Exceptional Parents Unlimited
Mental Health Services Act
*MHSA—not included in
Master Agreement
April 25.2012
EPU ASSESSMENT CENTER FOR CHILDREN STAFFING CHART
FY 2012-2013 Schedule 2.5A
Executive Director
Marion Karian
Daryl Hitchcock,PhD
(0.9)and (0.1 MHSA*)
Mental Health Clinician (Senior)
(0.8)and (0.2 MHSA*)
Mental Health Clinician
(1.8)
Speech Pathologist
(0.5)
Occupational Therapist
(1.0)
Mental Health Clinician*
(2.3)
Family Education Specialist*
(4.0)
Infant Mental Health Clinician
(1.0)
(11.15)
(3.0)and (1.0 MHSA*)
Family Resource Specialist
(10)
(1.45)
Administrative Assistant *
(0.5)
(0.5)and (0.5 MHSA*)
Partner Oversite Committee MoCPOC
CCCI Central California Children's Institute Cassandra Joubert
CHCC Children's Hospital Central California Kristine Aubry
CVRC Central Valley Regional Center Tom Keenen
DBH Department of Behavioral Health Donna Taylor
DPH Department of Public Health Ed Moreno,MD
DSS Department of Social Services Howard Himes
EMQ Families First Marilyn Bamford
EPU Exceptional Parents Unlimited Marion Karian
First 5 Fresno County Kendra Rogers
FUSD Fresno Unified School District Deanna Mathies
MMC Marjaree Mason Center Pamela Kailsen
WestCare Lynn Pimentel
_.
Schedule 2.5B
Staffing Model FY 2013-14
Model of Care Amendment IV
102
Developmental &
Behavioral Pediatrician
(0.6)
DBH
Department of Behavioral Health
EPU Administration
Exceptional Parents Unlimited
EPU/ First 5
Exceptional Parents Unlimited
EPU/MHSA*
Exceptional Parents Unlimited
Mental Health Services Act
*MHSA—not included in
Master Agreement
May 16.2013
EPU ASSESSMENT CENTER FOR CHILDREN STAFFING CHART
FY 2013-2014
Executive Director
Marion Karian
Daryl Hitchcock,PhD
(0.8)and (0.2 MHSA*)
Mental Health Clinician (Senior)
(0.8)and (0.2 MHSA*)
Mental Health Clinician
(0.8)
Speech Pathologist
(0.38)
Occupational Therapist
(10)
Mental Health Clinician*
(1.7)
Family Education Specialist*
(4.25)
I
Barbara Swan
(0.9)and (.10 MHSA)
(6.4)
(1.0)
(2.5)and (1.5 MHSA*)
Family Resource Specialist
(.5)and (1.0 MHSA)
Schedule 2.5B
Children's Center
(1.3)
Administrative Assistant *
(0.7)
(0.25)and (0.75 MHSA*)
Infant Mental Health Clinician
(10)
Partner Oversight Committee MoCPOC
CCCI Central California Children's Institute
CHCC Children's Hospital Central California
CVRC Central Valley Regional Center
DBH Department of Behavioral Health
DPH Department of Public Health
DSS Department of Social Services
EMQ Families First
EPU Exceptional Parents Unlimited
First 5 Fresno County
FUSD Fresno Unified School District
MMC Marjoree Mason Center
WestCare
Cassandra Joubert
Kristine Aubry
Tom Keenen
Dawan Utecht
David Pomaville
Howard Himes
Marilyn Bamford
Marion Karian
Kendra Rogers
Deanna Mathies
Pamela Kails en
Lynn Pimentel
=ms
Schedule 2.5C
Staffing Model FY 2014-15
Model of Care Amendment IV
104
Developmental &
Behavioral Pediatrician
(0.6)
Mental Health Clinician
(0.25)
DBH
Department of Behavioral Health
EPU Administration
Exceptional Parents Unlimited
EPU/ First 5
Exceptional Parents Unlimited
EPU /MHSA*
Exceptional Parents Unlimited
Mental Health Services Act
*MHSA—not included in
Master Agreement
May 23,2014
EPU ASSESSMENT CENTER FOR CHILDREN STAFFING CHART
FY 2014-15
Executive Director
Marion Karian
Daryl Hitchcock,PhD
(0.8)and (0.2 MHSA*}
Mental Health Clinician (Senior)
(0.6)and (0.4 MHSA*)
Mental Health Clinician
(0.9)
Speech Pathologist
(0.4)
Occupational Therapist
(1.0)
Mental Health Clinician*
(2.1)
Family Education Specialist*
(3.25)
Barbara Swan
(0.9)and (.10 MHSA*)
4 ~
(6.3)
(0.95)
(2.5)and (1.5 MHSA*)
Family Resource Specialist
(0.5)and (1.0 MHSA*)
Schedule 2.5C
V 'EDI I
Children's Center
(1.3)
Administrative Assistant *
(0.7)
(0.25)and (0.75 MHSA*)
Infant Mental Health Clinician
(1.0)
Partner Oversight Committee MoCPOC
CCCI Central California Children's Institute
CHCC Children's Hospital Central California
CVRC Central Valley Regional Center
DBH Department of Behavioral Health
DPH Department of Public Health
DSS Department of Social Services (Interim)
EMQ Families First
EPU Exceptional Parents Unlimited
First 5 Fresno County
FUSD Fresno Unified School District
MMC Marjoree Mason Center
WestCare
Cassandra Joubert
Kristine Aubry
Tom Keenen
Dawan Utecht
David Pomaville
Judy Lemos
Marilyn Bamford
Marion Karian
Kendra Rogers
Deanna Mathies
Genelle Taylor Kumpe
Lynn Pimentel
1C:5
Schedule 2.5D
Staffing Model FY 2015-16
Model of Care Amendment IV
106
Mental Health Clinician
(0.30 F5)&(0.10 MHSA*)
contract
DBH
Department of Behavioral Health
EPU Administration
Exceptional Parents Unlimited
EPU/ First 5
Exceptional Parents Unlimited
EPU /MHSA*
Exceptional Parents Unlimited
Mental Health Services Act
EPU/Other
*MHSA—not included in
Master Agreement
April?,2015
EPU ASSESSMENT CENTER FOR CHILDREN STAFFING CHART
FY 2015-2016
Schedule 2.5D
Executive Director
Ellen Knapp
EpHi
Daryl Hitchcock,PhD
(0.8 F5/MCAH) &(0.2 MHSA*)
T
Mental Health Clinician (Senior)
(0.6 F5) &(0.4 MHSA*)
Mental Health Clinician
(.90) & (1.0 Open)
Speech Pathologist
(0.75)
Occupational Therapist
(1.0 Open)
Mental Health Clinician*
(1.7)
Children's Services Coordinator/MHSA*
(3.05)& (.30 Open)
Infant Mental Health Clinician
(1.0)
Barbara Swan
(0.8 F5/MCAH) & (.10 MHSA*)
(0.950 MCAH) & (.05 MHSA*)
(1.95 MCAH) & (1.0 EPU other)
(5.31)(0.70 Open)
(0.95)
(2.60 F5/MCAH) & (1.4 MHSA*)
Family Resource Specialist
(0.5 F5) &(0.75 MHSA*)
Children's Center
(1.3)
Administrative Assistant *
(0.7)
(0.25 F5/MCAH)& (0.75 MHSA*)
SMART Model of Care Leadership Team
CASA Court Appointed Special Advocates OPEN
VCH Valley Children's Hospital Kristine Aubry
CVRC Central Valley Regional Center Heather F/ores/Rachel Hagans
DBH Department of Behavioral Health Susan Holt
DPH Department of Public Health Rose Mary Garrone
DSS Department of Social Services Tricia Gonzalez
EPU Exceptional Parents Unlimited Ellen Knapp
FCOE Fresno County Office of Education Lupe Jaime
First 5 Fresno County Lilith Assadourian
FUSD Fresno Unified School District Deanna Mathies/Wilma Hashimoto
MMC Marjoree Mason Center Genelle Taylor Kumpe 1Q7
Community Rep Marion Karian
Schedule 8.2.1
Budget Summary FY 2011-12
Model of Care Amendment IV
108
Assessment Center for Children
Model of Care Budget Summary
FY 11-12
EXPENSES:
Annual
Budget
MCAH/EPU/
DBH FUSD FIRST 5 FIRST 5
Personnel Expenses $1,816,326 $116,450 $138,176 $844,547 $717,153
Facilities Cost $217,557 $5,975 $17,727 $115,901 $77,954
Operational Supplies $41,500 $1,106 $2,035 $20,128 $18,231
TrainingfTravel/Transportation $27,600 $17,520 $10,080
Insurance &Audit $10,000 $299 $550 $5,440 $3,711
Program Supplies $12,500 $12,500
Professional Services $141,250 $678 $1,246 $12,322 $127,004
Capital &Equipment $6,000 $6,000
EPU Indirect Cost $241,454 $968 $2,587 $121,903 $115,996
County Indirect Cost $126,613 $45,342 $81,271
TOTAL EXPENSE $2,640,800 $170,818 $162,321 $1,219,032 $1,088,629
REVENUE:
Central Valley Regional Center
First-Five Commission (30%of MCAH)
$365,710 $365,710
First-Five Commission (50%of remaining 70%)$426,661 $426,661
First-Five Commission $1,088,629 $1,088,629
Fresno Unified School District $162,321 $162,321
State MCAH (50%of remaining 70%)$426,661 $426,661
Short Doyle Medical $69,870 $69,870
Projected EPSDT $46,580 $46,580
M H Realignment $47,381 $47,381
Other Revenue $6,987 $6,987
TOTAL REVENUE $2,640,800 $170,818 $162,321 $1,219,032 $1,088,629
Note:Shaded amounts represent costs paid through EPU
Schedule 8.2.1
109
Schedule 8.2.1A
Budget Summary 2012-13
Model of Care Amendment IV
110
Assessment Center for Children
Model of Care Budget Summary
FY 2012-13
EXPENSES:
Annual
Budget
MCAH/EPU/
DBH FUSD FIRST 5 FIRST 5
Personnel Expenses $1,863,820 $116,450 $228,255 $856,277 $662,838
Facilities Cost $201,800 $6,135 $17,423 $111,372 $66,870
Operational Supplies $32,320 $907 $2,575 $16,456 $12,382
Training/Travel/Transportation $19,300 $0 $0 $13,670 $5,630
Insurance &Audit $15,100 $319 $907 $7,819 $6,055
Program Supplies $9,000 $0 $0 $0 $9,000
Professional Services $140,750 $679 $1,930 $10,265 $127,876
Capital &Equipment $0 $0
EPU Indirect Cost $232,485 $965 $2,740 $121,902 $106,878
County Indirect Cost $126,605 $45,336 $0 $81,269
TOTAL EXPENSE $2,641,180 $170,791 $253,830 $1,219,030 $997,529
REVENUE:
Central Valley Regional Center $0
First-Five Commission (30%of MCAH)
$365,709 $365,709
First-Five Commission (50%of remaining 70%)$426,661 $426,661
First-Five Commission $997,529 $997,529
Fresno Unified School District $253,830 $253,830
State MCAH (50% of remaining 70%)$426,660 $426,660
Short Doyle Medical $69,870 $69,870
Projected EPSDT $46,580 $46,580
M H Realignment $47,354 $47,354
Other Revenue $6,987 $6,987
TOTAL REVENUE $2,641,180 $170,791 $253,830 $1,219,030 $997,529
Note:Shaded amounts represent costs paid through EPU
Schedule 8.2.1A
111
Schedule 8.2.1B
Budget Summary FY 2013-14
Model of Care Amendment IV
112
Assessment Center for Children
Model of Care Budget Summary
FY 2013-14
EXPENSES:
Annual
Budget
Fresno County County MCAH/EPU/
DBH FIRST 5 FIRST 5
Personnel Expenses $1,266,297 $116,450 $640,301 $509,546
Facilities Cost $145,060 $6,722 $88,864 $49,474
Operational Supplies $28,201 $1,284 $16,970 $9,947
Training/Travel/Transportation $10,000 $0 $9,130 $870
Insurance &Audit $11,600 $324 $6,313 $4,963
Program Supplies $7,000 $0 $0 $7,000
Professional Services $84,050 $765 $9,005 $74,280
EPU Indirect Cost $186,648 $1,182 $100,176 $85,290
County Indirect Cost $62,729 $8,788 $53,941
TOTAL EXPENSE $1,801,585 $135,515 $924,700 $741,370
REVENUE:
First-Five Commission $1,342,425 $601,055 $741,370
State MCAH $323,645 $323,645
Short Doyle Medical $69,870 $69,870
Projected EPSDT $46,580 $46,580
M H Realignment $12,078 $12,078
Other Revenue $6,987 $6,987
TOTAL REVENUE $1,801,585 $135,515 $924,700 $741,370
Note:Shaded amounts represent costs paid through EPU
Schedule 8.2.IB 113
Schedule 8.2.1C
Budget Summary FY 2014-15
Model of Care Amendment IV
114
Assessment Center for Children
Model of Care Budget Summary
FY 2014-15
EXPENSES:
Annual
Budget
MCAH/EPU/
DBH FIRST 5 FIRST 5
Personnel Expenses $1,287,455 $134,805 $635,130 $517,520
Facilities Cost $153,480 $7,122 $91,518 $54,840
Operational Supplies $29,720 $1,356 $17,423 $10,941
TrainingfTravel/Transportation $11,100 $0 $9,480 $1,620
Insurance &Audit $13,860 $616 $8,266 $4,978
Program Supplies $7,000 $0 $0 $7,000
Professional Services $76,355 $0 $8,766 $67,589
Capital &Equipment $0 $0
EPU Indirect Cost $187,741 $1,182 $100,177 $86,382
County Indirect Cost $64,014 $10,074 $53,940
TOTAL EXPENSE $1,830,725 $155,155 $924,700 $750,870
REVENUE:
First-Five Commission (30%of MCAH)
First-Five Commission (50%of remaining 70%)
First-Five Commission
State MCAH (50% of remaining 70%)
Short Doyle Medical
Projected EPSDT
M H Realignment
Other Revenue
$277,410
$323,645
$750,870
$323,645
$44,548
$35,639
$74,968
$0
$44,548
$35,639
$74,968
$0
$277,410
$323,645
$323,645
$750,870
TOTAL REVENUE $1,830,725 $155,155 $924,700 $750,870
Note:Shaded amounts represent costs paid through EPU
Schedule 8.2.1C
115
Schedule 8.2.1D
Budget Summary FY 2015-16
Model of Care Amendment IV
116
Assessment Center for Children
Model of Care Budget Summary
FY 2015-16
EXPENSES:
Annual
Budget
MCAH/EPU/
DBH FIRST 5 FIRST 5
Personnel Expenses $1,316,359 $123,184 $644,234 $548,941
Facilities Cost $152,380 $6,713 $87,266 $58,401
Operational Supplies $30,220 $1,288 $16,733 $12,199
Training/Travel/Transportation $8,800 $0 $6,880 $1,920
Insurance &Audit $14,000 $617 $8,017 $5,366
Program Supplies $7,000 $0 $0 $7,000
Professional Services $28,400 $0 $7,452 $20,948
Capital &Equipment $1,475 $1,475
EPU Indirect Cost $186,417 $1,120 $100,177 $85,120
County Indirect Cost $63,166 $9,225 $53,941
TOTAL EXPENSE $1,808,217 $142,147 $924,700 $741,370
REVENUE:
First-Five Commission (30%of MCAH)
First-Five Commission (50% of remaining 70%)
First-Five Commission
State MCAH (50% of remaining 70%)
Short Doyle Medical
Projected EPSDT
M H Realignment
Other Revenue
$277,410
$323,645
$741,370
$323,645
$73,910
$49,274
$11,572
$7,391
$73,910
$49,274
$11,572
$7,391
$277,410
$323,645
$323,645
$741,370
TOTAL REVENUE $1,808,217 $142,147 $924,700 $741,370
Note:Shaded amounts represent costs paid through EPU
117
Schedule 8.2.1D