HomeMy WebLinkAboutAgreement A-26-024 Amendment I to Agreement No. 21-200.pdf Agreement No. 26-024
Children and Youth System of Care
Memorandum of Understanding
Fresno County Department of Social Services;
Fresno County Department of Behavioral Health;
Fresno County Probation Department;
Fresno County Department of Public Health;
Central Valley Regional Center;
Fresno County Superintendent of Schools;
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VISION
Fresno County youth and their families will receive timely, effective, and collaborative services
that will allow them to be self-sufficient and keep themselves safe, healthy, at home, in school
and/or employed, out of trouble, and economically stable.
MISSION
System partners, bound by this MOU, will work collaboratively to ensure their programs for
youth and families provide services in an integrated, comprehensive, culturally responsive,
evidence-based/best- practice manner, regardless of the agency door by which youth and
families enter. System partners refers collectively to the public agencies, Tribal Governments,
and organizations that collaborate within Fresno County's Children and Youth System of Care
(CYSOC) to serve children, youth, and families. This includes the signatories to this
Memorandum of Understanding (MOU), as well as additional participating entities represented
within the Interagency Leadership Team (ILT), Executive Advisory Committee (EAC), or other
established workgroups supporting the System of Care. This mission includes an awareness of,
and a commitment to, incorporate foster youth experience and voice into county level
collaborations and partnerships that manage or oversee the delivery of services affecting youth
in foster care.
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PURPOSE
The goal of this MOU is to address systemic barriers to the traditional provision of interagency
services. System partners' intent is to maintain an administrative team with collaborative
responsibility for the interrelated child welfare, juvenile justice, Regional Center, education, and
mental health youth services. This MOU seeks to ensure that the system partner's programs
and polices reflect a coordinated, integrated and effective service delivery system for youth and
families.
System partners have been designated by their respective governing bodies to provide
oversight and accountability for state and federally funded programs and services, and to
otherwise act as a coordinating council and planning body related to the programs and services
contained herein.
The system partners agree that consistent inter-agency leadership is essential to successful
collaboration on behalf of youth and families.
The agencies do not delegate their legal authority with respect to any core function or power of
their agency, office, department or position. The system partners are not establishing policies
that are intended to be averse to any relevant agency-wide policies, rules or agreements.
However, the signatories' intent is to fully support the structure and processes contained in this
MOU, and to provide the framework that will guide their operations and the activities, decisions,
and direction of each of their employees regarding youth and family programming. Accordingly,
this MOU should be interpreted in light of this intent and purpose.
This MOU also supports and promotes related agreements and practice approaches used by
members jointly delivering services to children and families. Related MOUs and practice
approaches are referenced throughout this document. The terms "children" and "family" will
refer broadly to young people aged 0 through 21 and their caregivers.
PRINCIPLES
The guiding principles of this collaboration are:
• To pursue authentic Whole Child/Whole Family services through consistent and trust-
based sharing of organizational and personal power.
• To promote and provide services, which encourages families to use their own resources
to resolve problems. Services and supports are outcome-focused, family-centered,
strength- based, trauma-informed, culturally relevant, sexual orientation and gender
inclusive, comprehensive, inclusive, and integrated to the extent possible.
• To identify, develop, and maintain service systems consistent with public/private,
community-based, school-linked and family partnership, which can intervene early or
prevent problems with at-risk youth and families.
• To provide services to youth and families in the least restrictive, least stigmatizing
manner, and in community-based settings, appropriate to meet their identified needs.
• To identify, develop, and monitor coordinated policies, procedures, resources and
implementation practices for the benefit of at-risk youth and families in Fresno County;
and to hold member agencies and their staffs accountable in these efforts.
• To promote and maintain quality services that are family-driven, cost effective, evidence-
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based and appropriate with coordination and collaboration to the extent allowed by law.
• To provide on-going support and direction to each agency and Tribal Government, and
their respective staff in providing services and resources for at-risk youth and families
consistent with the Purpose and Principles, as defined herein.
• To ensure the voices, experiences, and wisdom of foster youth, their families and
caregivers, and Tribal elders are incorporated into the collaborations and partnerships
captured by this MOU.
• To ensure the appropriate utilization of treatment and rehabilitation services for youth
and families in conjunction with appropriate court sanctions, while ensuring the safety of
the community and public-at-large.
• To promote coordinated data collection, prioritized data exchange between the courts
and partners to minimize delays in service delivery, filing of documents, including
electronic filing between the courts, social services agencies, and other key partners and
data tracking that permits them to measure their performance.
Members partner with the following groups and initiatives within the CYSOC to maximize
collective impact and collaborate on efforts:
• Fresno County Comprehensive Prevention Plan Committee
• Fresno County Behavioral Health Board and its subcommittees
• Juvenile Justice Commission
• County Superintendents of Schools Committee
• Court Appointed Special Advocates (CASA)
• Fresno Council on Child Abuse Prevention (FCCAP)
• Health Care Plans/Managed Care Organizations
There will be an effort to utilize standing committees and workgroups from these and other
systemwide efforts to serve as forums for dissemination of information both upward and
downward, and in some cases laterally. These committees/groups may have a standing or ad
hoc position on the ILT and/or EAC agenda(s).
PART ONE - INTERAGENCY LEADERSHIP TEAM
Three closely connected leadership teams and associated processes are in place in Fresno,
which together form a backbone to support the whole child/no wrong door efforts. The structure
is comprised of an Interagency Leadership Team, an Executive Advisory Committee and a
CYSOC Steering Committee.
The Interagency Leadership Team (ILT) serves as the governing and coordinating body of this
collaborative, with the overarching goal to function as a governing body to ensure that
coordinated, timely, and trauma-informed services are provided to children and youth in or at
risk of entry to foster care. The ILT both establishes the MOU and oversees the execution of the
MOU, to meet the overarching goals of a coordinated system of care for foster children, youth,
and families through sharing information, guiding staff, identifying and resolving conflicts, and
leveraging resources to ensure foster children, youth, and their families receive the services
they need to achieve safety, permanency, and well-being.
A. Members —The ILT will consist of the following individuals, or their respective
designees:
• Director of Social Services
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• Director of Behavioral Health
• Director of Public Health
• Chief Probation Officer
• Fresno County Superintendent of Schools
• Executive Director Central Valley Regional Center
• Presiding Juvenile Judge or Designee (Non-Signatory)
In addition to the ILT members, designated other experienced senior managers or staff from the
system partners, or other involved agencies may also attend ILT meetings as regular and
contributing participants, although not as signatories or voting members. Key system partners
may include but are not limited to Big Sandy Rancheria, First Five Commission, Health Care
Plans/Managed Care Organizations administering CalAIM services, youth and caregiver
representation, etc.
In recognition of Tribal sovereignty and in accordance with AB 3176, AB 2083, and related
guidance, the ILT will actively engage with Tribal Governments, including Big Sandy Rancheria,
as invited participants in leadership discussions whenever tribal youth and families may be
impacted. Tribal partners shall be consulted in the development and implementation of system
policies, practices, and Memoranda of Understanding to ensure culturally appropriate, trauma-
informed services. Participation of Tribal representatives in the ILT is intended to strengthen
coordination, reduce service barriers, and affirm the equal partnership of Tribal Governments in
decision-making for tribally involved youth.
ILT Governance Procedures
A. Forum — ILT meetings take place in person or via remote engagement, at a pre
identified time that is agreed upon by all partners.
B. Frequency—The ILT shall meet on a quarterly basis to review the progress and status
of the Executive Advisory Committee and its related work, to discuss current processes,
and identify gaps and barriers. Additional ILT meetings may be scheduled at the
consensus direction of the ILT members.
C. ILT Functions: The ILT shall select co-chairs who will lead the ILT meetings and
process for a one-year period. The Chair will serve as the designated communication
authority when working with requests and correspondence. Each spring, the ILT will
rotate co-chairing responsibilities among partner agencies.
1. ILT members will share responsibility for the necessary Operations and
Administration of the System of Care. These duties may also be rotated every other
year, to ensure consistency and support for the complex tasks inherent within the
role. These duties include capturing agenda and minutes, communicating across the
system partner landscape, and supporting related System of Care events.
2. A shared accessible electronic folder has been created, where all System of Care
documents are housed.
3. Meeting minutes shall be recorded and shared with the participating members and
their requested designees.
4. ILT members will utilize a shared decision-making process for program and service
issues and concerns identified by the system partners.
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Executive Advisory Committee (EAC)
Each system partner has designated senior managers or other appropriate staff to participate in
monthly EAC meetings, where the developmental and adaptive improvements toward whole
child and No Wrong Door care can be pursued. Each EAC meeting typically last 90 minutes,
wherein members will:
A. Receive reports from the Interagency Placement Committee on a quarterly basis and
consider where gaps and needs across the system can be addressed.
B. Receive reports from key community providers on program issues, problems, and
outcomes.
C. Receive and discuss quarterly reports from the county's Health Care Plans/Managed
Care Organizations responsible for CaIAIM's ECM and Community Supports.
D. Review this MOU on an annual basis, to ensure it remains current and is updated in as
timely a manner as possible.
E. Hear reports and consider parallel initiatives which support whole child service
frameworks.
F. Coordinate with School/SELPA leaders to support and align Community School, Social
Emotional Learning and School Wellness programming.
G. Analyze opportunities and projects and make recommendations to the ILT. Provide
recommendations and direction on implementation of policies, procedures, and
programs included under this MOU.
H. Ensure that staff assigned to shared programming are provided the necessary technical
assistance, training, support and resources to ensure mandates are fulfilled.
I. Ensure that staff and programs conform to the shared Purposes and Principles of this
MOU.
J. Review and, as necessary, recommend program direction for applicable community
partners or providers.
K. Agree to work collaboratively to review and discuss provider requests, as well as
system-wide concerns in a timely manner, ensuring all partners are informed, aligned,
and able to coordinate responses.
L. Appoint and support staff to serve as liaisons to various shared projects to ensure full
continuum of care and linkage back to System partner services.
M. Work collaboratively to monitor the Children's Well-Being Continuum and Wraparound
programs.
N. On a quarterly basis at minimum, the EAC will receive information and reports from the
Community Leadership Team (CLT), a cross-system body to guide High Fidelity
Wraparound implementation, to ensure that family, Tribal, and community perspectives
are directly linked to EAC discussions and recommendations to the ILT.
O. Monitor programs for general compliance with statutory and regulatory requirements;
provide guidance and technical assistance to ensure program practice is consistent with
the values and principles of this inter-agency partnership.
P. Work with community agencies to ensure collaborative and integrated strategies are
promoted and utilized, using strength-based, family-focused practice on a systems-wide
basis.
Q. Develop a Dashboard of outcomes to identify and monitor collective impact.
R. Shall serve as a multidisciplinary forum for case consultation prior to requesting
Technical Assistance from the State. Details and procedures for case consultation will
be outlined in an EAC-established Policy and Procedure Guide (PPG).
EAC Membership can include but is not limited to:
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• Department of Social Services (DSS) Representatives
• Department of Behavioral Health (DBH) Representatives
• Department of Public Health (DPH) Representatives
• Probation Representatives
• Central Valley Regional Center (CVRC) Representatives
• Fresno County Superintendent of Schools (FCSS) Representatives
• Big Sandy Representatives
• Health Care Plan/Managed Care Organizations Representatives
• School District Representatives
The EAC will select two co-chairs, who will rotate on an annual basis, the facilitation and
leadership for the EAC and report to the ILT each quarter. The co-chairs will serve on and be
supported by the administrative and operational professionals of the Steering Committee.
Steering Committee
On a rotating basis, the co-chairs of the EAC, along with designated administrative
professionals, participate in a small Steering Committee, which meets for 30 minutes each
month to craft agendas for the ILT and EAC and to otherwise coordinate the functions of the
CYSOC.
PART TWO — INTEGRATED CORE PRACTICE MODEL
This MOU includes a mutual commitment by partners to use the principles, values, and practice
behaviors of the California Integrated Core Practice Model (ICMP) in their programs, processes,
and interactions with youth and families. The ICPM, developed with evidenced informed
learning, and crafted by all child and family serving state departments, is intended to provide
practical guidance and direction to support all Fresno County System of Care partners to
improve delivery of timely, effective, and integrated services to children, youth, and families.
The ICPM is based on four (4) research-based values and twelve (12) guiding principles:
The Four Research-Based Values of the ICPM Model include:
• Parent and Youth Driven
• Community Based and Least Restrictive
• Culturally, Linguistically, and Equity Competent
• Prevention and Early Intervention Focused
The 12 Guiding Principles include:
• Individualized
• Strengths-based
• Trauma Informed
• Persistence
• Team-based
• Family voice and choice
• Natural Supports
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• Collaboration and integration
• Evidence-Based Practice
• Developmentally Appropriate
• Comprehensive Array of Services
• Outcomes-based
To ensure awareness and utilization of the ICPM, a copy of the current ICPM will be distributed
to ILT and EAC members and all system partners. The ICPM values and principles shall be
used in decision-making and integrated, as appropriate, in process and program development.
System partners, as part of the cross-training function outlined in Part 8 below, agree to train
direct service staff members on the principles of ICPM and its implementation with participating
system partners. System partners agree to collaborate in support of these efforts.
PART THREE - INFORMATION AND DATA SHARING
System of Care partners agree, to the fullest extent allowed by law, to share relevant necessary
information in order to conduct treatment, coordinate services and ensure the highest quality of
care is available to youth and caregivers. Partners shall maintain efforts towards the utilization
of a single, uniform Release of Information (ROI) form across all agencies.
System partners acknowledge that Fresno's Child Welfare authority (DSS) is authorized to
disclose information to any Medi-Cal funded system partner for purposes directly related to the
administration of its program [42 United States Code (U.S.C.) § 671(a)(8)(A)]. Medi-Cal funded
providers are likewise authorized to disclose information to DSS for purposes directly related to
the administration of the Medi-Cal program. "Directly related" includes determining the amount
of Medi-Cal assistance and providing services for recipients [42 U.S.C. § 1396(a)(7); 42 C.F.R.
§ 421.302 (2009)].
System partners to this MOU shall be in strict conformance with all applicable Federal and State
of California laws and regulations, including but not limited to Sections 5328, 10850, 827, and
14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of Title
42, Code of Federal Regulations (CFR), Section 56 et seq. of the California Civil Code, Sections
11977 and 11812 of Title 22 of the California Code of Regulations, and the Health Insurance
Portability and Accountability Act (HIPAA), including but not limited to Section 1320 D et seq. of
Title 42, United States Code (USC) and its implementing regulations, including, but not limited
to Title 45, CFR, Sections 142, 160, 162, and 164. The Health Information Technology for
Economic and Clinical Health Act (HITECH) regarding the confidentiality and security of patient
information, and the Genetic Information Nondiscrimination Act (GINA) of 2008 regarding the
confidentiality of genetic information.
System partners agree to evaluate Fresno County's Information Exchange System being
developed to improve care coordination as a potential solution to assist in meeting the goals of
this MOU.
Additionally, Assembly Bill 2083 provides that:
• Members of the ILT may disclose and exchange information with one another that may
be designated as confidential under State law if the member of the team having that
information reasonably believes it is generally relevant to the identification, reduction, or
elimination of barriers to services for, or to placement of, children and youth in foster
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care or to improve provision of those services or those placements. ILT members who
receive disclosed or exchanged information shall only use the information for the
purposes set forth in the preceding sentence.
• Members of the ILT who receive disclosed or exchanged information shall destroy or
return that information once the purposes for which it was disclosed or exchanged are
satisfied. Any information disclosed or exchanged shall be confidential and shall not be
open to public inspection, unless the information is aggregated and de-identified in a
manner that prevents the identification of an individual who is a subject of that
information. Any discussion concerning the disclosed or exchanged information during a
team meeting shall be confidential and shall not be open to public inspection.
• Members of an Interagency Placement Committee (IPC), child abuse multidisciplinary
personnel team, or Child and Family Team (CFT) that is convened for the purpose of
implementing the provisions of this MOU developed pursuant to this subdivision shall
comply with applicable statutory confidentiality provisions for that committee or team.
• Members of teams convened for purposes of implementing this MOU shall comply with
applicable records retention policies for their respective agencies or programs.
PART FOUR—OUTCOMES MONITORING
System partners are committed to development of a System of Care Dashboard, which will
identify key outputs and outcomes whereby the partner's investment in interagency service
delivery can be tracked, monitored, and used to inform leadership decision-making. EAC
members will convene a Dashboard development workgroup, and building on the work of the
FCSOS, under its Transforming Together grant, assign needed analysts or staff to participate in
its development. Once complete, CYSOC Dashboard will be used on a quarterly basis by the
EAC to monitor needs and impact, and as an engagement tool with the Interagency Leadership
Team.
PART FIVE — SCREENING, ASSESSMENT, and ENTRY TO
CARE
Fresno County's CYSOC partnership is based on the awareness that many families have needs
that are often best met by assessment and provision of social, emotional, physical, educational,
and economic services and supports as early as possible, and in settings that support timely
access and continuity of care. This No Wrong Door approach is most often accomplished via
either a readily accessible network of school-based mental health and wellness programs
(where mental health clinicians are placed in every school in the county and where every adult
supports the healthy development and overall well-being of students) and the county's robust
network of community-based providers by ensuring timely referrals as soon as service needs
are identified.
In order to enhance unified service planning, reduce impact on youth and caregivers, and
reduce administrative costs, CYSOC members agree to share and understand standards of
practice and each other's procedures to engage, screen, and assess children, youth and
families at entry to care and while participating in their respective programs. Each partner
agency and Tribal Government uses its own distinct processes and tools to determine eligibility
and need for services, often because of federal, state or local mandates. To the extent
permitted by laws and regulations, members will continue developing shared processes and
tools to screen and assess the service needs of children/youth and their families engaged in
multiple systems, particularly those served by Child Welfare, Probation, Behavioral Health and
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Substance Use Prevention and Treatment teams, as they share responsibility for a population of
children that may be at risk of entry to one another's programs.
Partners agree to share assessment outcomes and processes to facilitate care coordination
through the Child and Family Team process and reduce youth and family impact wherever it is
permissible and legally appropriate.
Children and youth entering the Child Welfare services will be referred to the DBH team for
assessment of mental health needs, within 3 working days of their case being opened, per state
guidance. For most foster youth, the IP-CANS serves as the primary team communication,
assessment and child/family service planning tool. For more information on the requirements for
the administration of the Integrated Practice CANS (IP-CANS) and Child and Family Teams,
please see All County Letter (ACL) 25-10.
Use of the IP-CANS tool is not required for all CYSOC members, such as Education/Schools,
Regional Centers or for some Probation involved youth. CYSOC members may use other
assessments (some mandated) or tools to identify and determine appropriate services and
engage children and families. In all circumstances where children are involved in multiple
agency care, the IP-CANS tool, its use in the Child and Family Team planning process, and any
other assessment information will be shared with CYSOC members and partners to the fullest
extent allowed by law and in accordance with an identified treatment plan.
If a developmental delay or disability is suspected or confirmed, CVRC will be contacted to
determine current status of the child's case. If eligibility has not been previously determined by
CVRC, a referral will need to be made by the referring agency to determine eligibility for
services. For children who have been previously determined eligible for services but, their case
is currently inactive, reactivation will be requested by the referring agency. For children that
have an open case with CVRC, the assigned Service Coordinator will be contacted for
assistance. CVRC uses a variety of assessment tools and reports to determine eligibility.
Records are requested as part of the intake process so as to not duplicate any assessments
previously completed and assist with the eligibility determination process.
PART SIX - CHILD AND FAMILY TEAMING
Child and Family Teaming is the term used to describe the engagement and service planning
process for children and families served by Child Welfare and for foster care involved Probation
and many children in the care of county DBH. Most often, the agency or Tribal Government with
legal jurisdiction convenes the teaming meetings and documents meeting outcomes. In addition
to the members' direct facilitation and delivery of teaming services, DBH and some children on
Probation status obtain facilitation and documentation for teaming and planning meetings
through contracted agencies. CYSOC partners aim to provide a single, unified Child and Family
Teaming (CFT) process via a meeting comprised of the youth, their family/caregiver(s), and
other agency partners and natural supportive relationships relevant to their care. Collaboration
from within the CFT includes family engagement, assessment, service planning, delivery,
coordination, care management, monitoring and adapting services, and transition.
Outside of formal Child and Family Teaming, engagement and planning processes from
member and partner agencies may take different forms, as informed by state expectations or
historical practice. However, to maximize planning and family engagement, a unified, multi-
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disciplinary team will serve each child and family. The most common teaming settings include:
• Children served in education-based services also have a high need for teaming and
coordinated service planning. While each district may use a slightly different approach,
all districts are committed to utilizing a Multi-Tiered System of Supports framework
designed to bring together general and special education supports, with the goal of
providing a comprehensive, proactive, and unified system of education to meet the
needs of, and improve results for, all students. School partnerships with county systems
seek to support the following:
o Ensure participation of an individual from the local educational agency (LEA) who
is knowledgeable about the child and able to provide feedback on significant
relationships that the child may have formed with a teacher, counselor, coach, or
other meaningful person and how changing schools would impact his or her
academic, social, or emotional well-being.
o Facilitate the transfer of educational records for students in foster care who enter
or exit a school within or between LEAs.
o Within one court day of deciding to change a child's placement to a location that
could result in a school change, the placing agency must notify the court, the
child's attorney, and the child's education rights holder or surrogate parent. If a
child who is changing schools has an IEP, the placing agency must give written
notice of the impending change to the current LEA and the receiving Special
Education Local Plan Area (SELPA) at least 10 days in advance. (CRC
5.651(e)(1)(B).
o Facilitate enrollment for students in foster care who enter a school within a LEA.
o Request education records from the school of origin for students in foster care
who enter a school within a LEA.
o Facilitate data sharing consistent with the Family Educational Rights and Privacy
Act (FERPA), California Education Code Sections 49073 et seq., Individuals with
Disabilities Education Act (IDEA), and other privacy laws and policies.
• In accordance with WIC §16501(a)(4)(13)(i)(VII) and related All County Letters (e.g., ACL
20-38 ,ACL 22-73 , and ACL 23-49), Fresno County System of Care partners affirm that
tribal representatives are mandatory participants in Child and Family Team (CFT)
processes for Indian children and youth. This includes timely notification to the Tribe or
Indian custodian when scheduling CFTs, and ensuring their active involvement in case
planning, placement discussions, and service coordination. The CFT must reflect the
principles of the Indian Child Welfare Act (ICWA), including placement preferences,
active efforts, and culturally appropriate engagement.
The inclusion of tribal representatives and elders ensures that child and family teaming
honors tribal sovereignty, cultural traditions, and the unique needs of tribally involved
youth and families. The commitments in this MOU are intended to align with state and
federal requirements while strengthening collaboration between County agencies and
Tribal Governments.
• Foster Care Public Health Nurses (PHNs) assigned to a client will participate in CFTs to
offer available medical information and /or nursing suggestions, as appropriate. If there
are scheduling conflicts (due to multiple CFTs, etc.) the PHN, at a minimum, will
collaborate with the assigned social worker to offer information / suggestions prior to the
CFT so the client's medical history and current medical status can be made available
during the meeting. PHNs will also ensure timely follow-up with the assigned social
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worker to determine if PHN assistance was identified during the meeting.
• Central Valley Regional Center (CVRC) is committed to conjointly participating in
collaborative teaming for foster youth. The assigned service coordinator or designee
shall be the Regional Center's designee to the child's CFT. The CVRC Service
Coordinator will identify funding for, and coordinate services specified in the Individual
Program Plan (IPP) for children ages three (3) and older or Individual Family Service
Plan (IFSP) for infants ages zero (0) to three (3), and that are not provided by DSS, and
as agreed upon by the planning team.
CYSOC members agree to make every effort to invite relevant partner staff to their respective
teaming meetings to engage in teaming and planning, including but not limited to community
contractors, health care plan/managed care organization representatives, school and Regional
Center personnel, or other providers that the family may choose to include.
PART SEVEN - INTERAGENCY PLACEMENT COMMITTEE
Fresno County CYSOC partners have two related interagency service planning venues, which
structurally support the alignment and coordination of care in the next section of this MOU.
The Interagency Placement Committee (IPC) is a multi-agency, multi-disciplinary team that
supports children and youth, including Non-Minor Dependents (NMD), with significant
behavioral, emotional, medical and/or developmental needs through a collaborative review
process whereby a child/youth's treatment and placement needs are determined. The IPC
review process includes consideration of available assessments/evaluations, treatment
information, and other relevant information regarding the child/youth/NMD's history and current
services and needs.
The primary purpose of the IPC is to review and approve the initial treatment of children, youth,
and NMDs within a STRTP, and/or WRAP, consistent with state law (WIC § 4096.5, along with
statutes enacted under CCR (AB 403 & AB 1997). The IPC assessment shall determine or
confirm whether the child meets one of the following criteria:
A. Youth meets the medical necessity criteria for Medi-Cal specialty mental health services.
B. Youth's individual behavior or treatment needs can only be met by the level of care
provided by a STRTP, and/or WRAP, and not a lower level of care.
Each CYSOC partner agency will designate a supervisor, manager or other approved IPC panel
member to participate in IPC.
A. IPC Members —the IPC shall be comprised of representatives from the following:
• DSS
• A licensed mental health professional from DBH
• Probation
• FCSS
• DPH
• CVRC as appropriate
• Health Care Plans/Managed Care Organizations as appropriate
• Tribal representation
B. The IPC meets on a weekly basis in a format agreed upon by attendees.
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C. The cases being reviewed are presented by the relevant Social Worker or Probation
Officer.
D. The IPC shall:
• Review youth and family service plans.
• Review requests for STRTP and/or WRAP placements. Review of these requests
shall include a review of the current services and needs of each client and the
determination of how to meet those needs in the least-restrictive setting.
• If a youth requires placement within an STRTP for longer than six (6) months, the
case is re-presented to IPC for rationale. It will also be presented to the DSS
Deputy Director, who reviews and provides approval.
• A youth's continued participation in the WRAP program is discussed and
determined by the CFT.
• Provide the ILT with quarterly reports to include, but not be limited to, Quality
Improvement on services/systems, need for new or redesigned service delivery,
areas for improvement, and the status of implementation of the California
Integrated Core Practice Model for Children, Youth, and Families.
E. Decisions/recommendations made by the IPC may become the recommendations of the
responsible agency which referred the youth. Any involved staff member associated with
the youth's care who disagrees with the IPC's recommended action may raise an
objection to the recommended action or may advocate for a different action through the
use of the Appeal process, as outlined herein.
IPC Case Specific Appeals:
Appeals of youth/family or case specific IPC recommendations/decisions will be made via the
following process, immediately following the IPC meeting or, if not possible, within two (2)
working days.
• The staff member wishing to appeal the IPC recommendation(s) will notify their
respective Division Chief/Supervisor.
• The staff's Division Manager/Supervisor will forward any questions or subsequent
appeal to the Assistant Probation Chief or the DSS Deputy Director, as appropriate.
• The appropriate Department will proceed through their chain of command up to and
including the Department Head until the concerns have been resolved.
Recommendations from Department Head or designee will be brought back to IPC for
further discussion.
• If necessary, other system partners may be brought into the discussion.
PART EIGHT - ALIGNMENT AND COORDINATION OF
SERVICES
Children and youth with complex challenges and needs typically receive (or are eligible to
receive) services from multiple agencies throughout County's System of Care. Coordination of
services is required to minimize confusion for families and achieve desired outcomes. Care
coordination permits a unifying integration of services among service agencies to support the
child and family. Integration and coordination of services also makes it possible for each agency
and Tribal Government to maximize its resources to serve children, youth, and families through
greater efficiencies.
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The System partners agree to work collaboratively to align timelines for all aspects of care —
from screening and assessment to service delivery. This collaboration shall be implemented and
supported with fidelity to the ICPM and other team-based system planning processes carried
out by the ILT, IPC, and the CFT. Under each of these teams, collaborating agencies are seen
as equal partners and remain well-informed of individual roles and responsibilities. Additionally,
System partners are committed to ensuring that stakeholders important to the child's support
and success are included in the care planning process.
Care planning is meant to be an investigative process that is responsive to the unique
circumstances and needs of each child and family. Alignment and coordination of services
includes the following:
A. Identifying the specific needs and strengths of the child and their family;
B. Identifying services and community supports that the youth and their family require to
address the challenges they face as a result of their needs;
C. Identifying which partner agency, agencies, or Tribal Government can provide these
services and community supports to address the needs of the youth and their family; and
D. Developing a care plan that considers the youth and family's voice and choice and
provides them with realistic supports to address their needs in a timely and appropriate
manner.
The participation of the Local Education Agency (LEA) in teaming, care planning, and services
is crucial for supporting these alignment efforts. CYSOC members will conduct cross-agency
engagement to invite the participation of LEAs and ensure a focus on the following care
processes:
A. Facilitating the prompt transfer of educational records for students in foster care who
enter or exit a school within or between LEAs.
B. Facilitating immediate enrollment for students in foster care who enter a school within a
LEA.
C. Immediately requesting education records from the school of origin for students in foster
care who enter a school within an LEA.
D. Ensuring that students in foster care are promptly enrolled in a LEA's free lunch
program.
E. Ensuring that the school and LEA waive all school fees for students in out-of-home
placement, including but not limited to any general fees, and fees for books, lab work,
participation in in-school or extracurricular activities, and before-school or after-school
programs.
F. Facilitating data sharing with CWS and the Probation Department, consistent with the
Family Educational Rights Act (FERPA), the Individuals with Disabilities Education Act
(IDEA), and other privacy laws and policies.
G. Coordinating necessary transportation for students as described in this MOU, including
through the development of any LEA policies or practices necessary to implement these
procedures.
Coordination with System Partners
Tribal Partnership
Fresno County System of Care partners will collaborate with Tribal Partners in alignment with
the requirements of the Indian Child Welfare Act (ICWA), WIC §16501(a)(4)(B)(i)(VII), and state
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guidance. Coordination shall include, but not be limited to, the following:
• Ensuring that Tribal representatives are notified of, and invited to participate in, Child
and Family Team (CFT) meetings for tribally involved youth;
• Including Tribal representatives in Interagency Placement Committee (IPC) reviews
whenever Indian children are considered for placement, to support culturally appropriate
and least restrictive placement options;
• Engaging Tribal leaders and elders in case planning, service delivery, and transition
discussions to ensure active efforts and placement preferences under ICWA are met;
• Consulting with Tribal representatives in the development of interagency agreements,
service coordination protocols, and culturally responsive supports;
• Affirming Tribal Governments as equal partners in decision-making and honoring their
sovereign authority in all matters affecting tribally involved youth and families.
Fresno County Children's Wellbeing Continuum for Complex Needs Youth
The Fresno County Children's Wellbeing Continuum (CWBC) consists of responsive, front-end
service provision that supports child welfare and behavioral health infrastructures and is
designed to flexibly provide seamless step-up and step-down transition services, ensuring that
children and families receive continuity of service provision even as their needs change over
time.
Because the needs of children and youth in crisis can change rapidly, the Fresno County CWBC
is designed to provide seamless transitions between services and levels of service, with each
service model linking to the others to ensure continuity of care. All services in the Fresno
County CWBC will adhere to the principles of Safety Organized Practice and be built on the
core competencies of trauma-informed and culturally responsive care.
To support and ensure continuity of care, the Fresno County CWBC will be delivered by
community-based providers with the experience and infrastructure to realize the provision of a
multitude of interrelated services and programs, simultaneously. Each agency will provide all the
residential and community-based service components of the Continuum, with one exception:
only one agency will administer mobile response, county-wide. Structuring the Continuum in this
way ensures continuity of care, seamless access to services, fiscal viability and overall program
sustainability, and deep partnership in meeting the complex needs of children and families.
• Crisis Stabilization Center (CSC)
• Psychiatric Health Facility (PHF)
• Mobile Crisis Response
• Super Wrap
• Wraparound
• Children's Crisis Residential Program (CCRP)
• Short Term Residential Therapeutic Program (STRTP)
• Enhanced Intensive Services Foster Care (E-IFSC)
• Emergency Enhanced Intensive Services Foster Care (E-E-IFSC)
• Child Welfare Mental Health (CWMH)
• Family Urgent Response System (FURS)
Community Leadership Team
The Community Leadership Team (CLT) is a cross-system leadership body required under ACL
25-47 and WIC §5851 to guide implementation of California's High Fidelity Wraparound (HFW)
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model, including aftercare services. The CLT brings together empowered leaders from child-
serving agencies, Tribes, community organizations, cultural leaders, families, and youth to
share responsibility for the design, oversight, and fidelity of local HFW programs.
To ensure alignment across Fresno County's System of Care, the CLT will formally connect with
the Executive Advisory Committee (EAC) by bringing forward information, data, and
recommendations. The EAC, in turn, will elevate items requiring policy or system-level decisions
to the Interagency Leadership Team (ILT). This structure ensures that community and family
voice informs planning at every level, while ILT leadership remains accountable for removing
barriers and aligning resources. Engagement between the CLT, EAC, and ILT ensures that
statewide requirements for wraparound are implemented in ways that are meaningful,
sustainable, and responsive to Fresno County youth and families.
PART NINE - STAFF RECRUITMENT, TRAINING, AND
COACHING
CYSOC members commit to trauma-informed care and collaborative work across county
agencies to improve the outcomes for children, youth, families, and communities. To do this,
members acknowledge the value of having highly trained and competent staff teams.
In order to ensure that social workers, probation officers, case managers, clinicians, support and
administrative personnel are fully prepared to deliver the seamless, trauma-informed and
integrated services outlined in this MOU, members agree to coordinate the training and
coaching of staff.
Fresno County CYSOC partners agree to deliver multi-agency training around Child and Family
Teaming, use of the ICPM, and other related System of Care content. Of particular focus for
members is creating a trauma-informed system. Universal Trauma-Informed Care training is
provided across member agencies to develop a foundational understanding of this topic across
various disciplines in the helping profession and all levels of staff.
The system partners are committed to delivery of cross training in key aspects of teaming and
service delivery, including, not limited to:
• Teaming and Engagement based in the Integrated Core Practice Model Guide
• Trauma informed Care and Services
• Motivational Interviewing
• Use of the IP-CANS as the System's primary assessment and teaming tool
• Information privacy and confidentiality practices and policy
Additionally, to align an integrated and whole approach to care, and as a commitment to
sustaining CYSOC workforce cross-training and technical assistance, the EAC will develop a
formal, interagency, multi-year training and technical assistance plan that will support the
alignment of vision and practice by system partners. The training and technical assistance plan
may include, but is not limited to:
• Planning and developing trainings at the system (leadership), supervisory, practice (line
staff), and administrative levels that creates a common language for change.
• Developing and implementing multi-agency training curriculums that align with system
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reform principles and values
• Streamlining and creating continuity in trainings across agencies
• Cross-training agencies and staff in cohorts representing a diverse cross-section of
family, practice, program and system levels
• Developing strategies on how to create new cross-system practices and teamwork
across the system, actionizing the knowledge gained from trainings and integrating it into
practice and policy to improve the quality of care, achieve positive outcomes and cost-
effectiveness, and support lasting system and culture change
• Evaluating the effectiveness of trainings on implementing and improving the CYSOC
The ILT and EAC will work to ensure that the developing partnership supports meaningful
training for each department's affected staff. CYSOC member training funds will be used in the
most flexible manner possible to facilitate this endeavor.
PART TEN - FINANCIAL RESOURCE MANAGEMENT
Notwithstanding the generally categorical nature of each CYSOC department's revenues,
members will inform one another about available funding, including state and federal revenues,
ongoing funding, one-time opportunities, revenue enhancements, Request for Proposals (RFP),
and grant opportunities for programs and services for children and families.
CYSOC members agree to explore and discuss, as appropriate, opportunities for leveraging
one another's revenue and other resources toward the most efficient use of resources and
programming. The monthly EAC agenda will allow for discussion of these opportunities.
Funding opportunities and related budgetary opportunities will be sought and applied for,
planned, monitored and distributed according to joint recommendations of the ILT. Funding
decisions subject to approval by the governing body of each member agency and Tribal
Government will be brought to those governing bodies with a recommendation to approve the
joint recommendations of the EAC, after approval by the ILT.
Paramount to CYSOC's success is the use and maximization of all federal and state allocations
available to support services to Fresno County children and families. Primary to CYSOC
sustainability is the maximization of federal Title IV-E and Medicaid mental health dollars. ILT
members acknowledge the belief and practice of making every effort to identify qualifying
revenue sources for required and/or maximizing available local or state match funds to assure
that a full and complete use of federal and state revenues is accomplished.
The more critical funding streams that CYSOC members will seek to maximize include:
• County General funds (all County agencies)
• Title IV-E Social Services/Foster Care funds (DSS and Probation)
• Title XIX funds (DSS Public Health Nurses)
• Social Services Realignment funds (DSS and Probation)
• Title IV-B funds (DSS and Probation)
• Emergency Assistance Temporary Assistance for Needy Families funds (DSS)
• Juvenile Justice Crime Prevention Act/Youthful Offender Block Grant (Probation)
• Medicaid Mental Health funds (DBH)
• Medi-Cal Realignment funds (DBH)
• Behavioral Health Services Act funds (DBH)
• Mental Health Services Oversight &Accountability Commission grant funds (DBH)
• Substance Abuse and Mental Health Services Administration grant funds (DBH)
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• California Health Facilities Financing Authority grant funds (DBH)
• Medicaid Home and Community-Based Services Waiver funds (CVRC)
• California Department of Education grant funds (SCOE)
• Local Education Agency budgets
• Special Education Local Planning Area funds
• Families First Prevention Services Act funds
• Other local grants and federal financial participation
PART ELEVEN - DISPUTE RESOLUTION PROCESS
While ILT member agencies and leaders may utilize a shared decision-making process for the
programs and services identified by the System partners, challenges and disagreements may
arise. These disagreements are sometimes due to conflicting statutes, regulations, policy,
guidance, or in differing opinions as to what services are needed in a particular case. System
partners will attempt in good faith to resolve any dispute or disagreement arising out of this
MOU, by focusing on the shared vision, values, and practices of the ICPM.
For other types of disputes typically associated with direction, sharing of resources, strategy or
related cross-agency issues, the System partners will seek to settle relevant disputes by
focusing on the shared vision, values, and practices of the ICPM.
Consensus will be the preferable model. However, if consensus cannot be reached, System
partners shall follow an escalation procedure to invite additional discussion, clarification, and
direction from agency directors, Tribal Leaders, and/or State representatives. The level of
escalation needed shall be determined by the nature of the dispute.
PART TWELVE - RESOURCE FAMILIES AND THERAPEUTIC
FOSTER CARE SERVICES
Resource families play a critical role in the life of children when out-of-home placement is
needed to keep the child safe. DSS and Probation make diligent efforts to identify, consider, and
evaluate relatives, family friends, and those closely tied to the family as the primary placement
option.
When placement with a closely tied adult is not an option, the placing agency makes effort to
actively recruit and support resource families so that a child may be provided with a feeling of
safety, permanence, and well-being. Some resource families are identified to provide Intensive
Services Foster Care—an alternative to congregate care placement and a critical resource in
the foster care and behavioral health continuum of care.
While recruitment, retention, and support of all resource families have been viewed as the sole
responsibility of the child welfare and probation systems, other System partners have a parallel
responsibility to support youth in need of safety and resources. The System partners are
committed to practicing collaborative, consistent efforts to recruit, train and support professional
Resource Family caregivers in order to foster safe, permanent, and healthy out-of-home
placement, when necessary.
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PART THIRTEEN - MUTUAL INDEMNIFICATION AND
INSURANCE
Each signatory to this agreement agrees to indemnify, defend and hold the other signatories,
including officials, officers, directors, agents, employees and volunteers, harmless against any
and all losses, claims, expenses (including reasonable attorneys' fees), fines, penalties,
damages, judgments or liabilities, including bodily injury, property damage and death, as a
result of an action brought by a party arising out of this agreement or any breach thereof, but
only to the extent such liabilities have been caused by the negligence, recklessness or willful
misconduct of that signatory with respect to its obligations under this MOU.
In the event of concurrent negligence on the part of signatories, including any of its officials,
officers, directors, agents, employees or volunteers, the liability for any and all such claims,
demands and actions in law or equity for such losses, fines, penalties, forfeitures, costs and
damages shall be apportioned under the State of California's theory of comparative negligence
as presently established or as may be modified hereafter. However, no signatory shall be
indemnified hereunder for any loss, liability, damage, or expense resulting from its own
negligence or willful misconduct.
Required Insurance —Without limiting the indemnification of each signatory as stated herein, it
is understood and agreed that the signatories shall each maintain, at their sole expense,
insurance policies or self-insurance programs including, but not limited to, an insurance pooling
arrangement and/or Joint Powers Agreement to fund their respective liabilities including general
liability, automotive liability, workers' compensation, employers liability, professional liability,
Molestation liability (if required) and cyber liability.
PART FOURTEEN - TERMINATION
This MOU and its agreed upon protocols may be terminated by any System partner upon the
giving of thirty (30) days advance written notice of an intention to terminate to all other System
partners. Written notice of termination given by a System partner to the other System partners
shall only be effective as to the MOU in relation to the System partner giving notice and shall
have no effect on the MOU with respect to all other System partners.
PART FIFTEEN - ELECTRONIC SIGNATURE
Electronic Signatures. The parties agree that this MOU may be executed by electronic signature
as provided in this section.
A. An "electronic signature" means any symbol or process intended by an individual signing
this MOU to represent their signature, including but not limited to (1) a digital signature;
(2) a faxed version of an original handwritten signature; or (3) an electronically scanned
and transmitted (for example by PDF document) version of an original handwritten
signature.
B. Each electronic signature affixed or attached to this MOU (1) is deemed equivalent to a
valid original handwritten signature of the person signing this MOU for all purposes,
including but not limited to evidentiary proof in any administrative or judicial proceeding,
and (2) has the same force and effect as the valid original handwritten signature of that
person.
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C. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2,
Title 2.5, beginning with section 1633.1).
D. Each party using a digital signature represents that it has undertaken and satisfied the
requirements of Government Code section 16.5, subdivision (a), paragraphs (1) through
(5), and agrees that each other party may rely upon that representation.
E. This MOU is not conditioned upon the parties conducting the transactions under it by
electronic means and either party may sign this MOU with an original handwritten
signature.
F. Counterparts. This MOU may be signed in counterparts, each of which is an original,
and all of which together constitute this MOU.
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IN WITNESS WHEREOF, the System partners have executed this Memorandum of
Understanding effective upon execution by all System Partners.
COUNTY OF FRESNO
Garry Bredbfeld, Chairman of the Board
of Supervisors of the County of Fresno
Attest:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By:
Deputy
PLEASE SEE ADDITIONAL SIGNATURE
PAGES ATTACHED
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FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
By:
Print Name: ' j" ' I�-r �G I f% her-
Title: <7wpe r-I jrHe n J e� -4_
Date: 12. 1 • Z
PLEASE SEE ADDITIONAL SIGNATURE
PAGES ATTACHED
21 Paj
CENTRAL VALLEY REGIONAL CENTER
By:
Print Name: z.Gv (.000-
Title: /�G
Date:
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