The purpose of this memo is to transmit Successful Families policy changes and provide implementation instruction for the changes. These changes will be effective July 1, 2007 and will be incorporated into a future KEESM revision.

Background Information:

Reauthorization of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was implemented in October 2006. Reauthorization changed the way substance abuse treatment was defined as work participation. Prior to reauthorization, Kansas counted substance abuse treatment for an unlimited period of time as meeting the work requirements. That is no longer possible under the new guidelines. Job search and job readiness activities are limited to four consecutive weeks within the fiscal year or 6 non-consecutive weeks within the fiscal year. To continue to address the needs of persons receiving TAF benefits while engaged in treatment for substance abuse, EES and AAPS have developed a plan that will focus TAF funding on meeting a TAF customer’s need of obtaining treatment for substance abuse while fulfilling the primary hours of work participation.

Specific Policy Changes Necessary to Address Individual Client Needs and Meet the Federal Participation Requirements:

KEESM 3330.1 Alcohol and Other Drug Assessment and Treatment (AOD):

The SASSI test must be administered during the SRS assessment process. The Solutions Recovery Care Coordination (SRCC) manager will provide feedback to the EES case manager on the clinical interpretations.

For those individuals who are not initially identified as in need of services, on-going screening will be provided by the EES case manager. If the client meets at least one of the following criteria during the current period of participation, the EES case manager will refer the client to the SRCC manager via the SRS/RADAC case manager turnaround form:

1. Two or more affirmative indications from administering the CAGE or indications from the SASSI and/or the Self Assessment Form.
   
   
2. Well-documented incidence of intoxication while in the SRS office.
   
   
3. Dismissal from employment or any work program activity for substance abuse related causes.
   
   
4. Any substance abuse related legal problems that carry current consequences (i.e., probation, diversion, loss of license, etc)
   
   
5. Client admission or medical diagnosis that an alcohol and/or drug related problem with abuse or dependency exists.
   
   
6. Repeated failures of not showing for appointments or not following through with assignments.

Decisions to not refer clients to the SRCC manager when one of the above criteria is met need to be clearly documented in the case record.

EES case managers can mandate TAF recipients, who are without medical coverage, to participate in substance abuse treatment activities. EES case managers are responsible for assisting those individuals in obtaining Medicaid. If the customer does not cooperate in obtaining medical coverage, the EES case manager will determine if a Work Program failure has occurred and a Work Program penalty would be established.

Once referred, if a TAF individual refuses to participate in SRCC manager recommended substance abuse treatment or follow through on the SRCC plan, the EES case manager will determine if a Work Program failure has occurred and a work program penalty would be established. It is recommended that a multi-disciplinary team, including the SRCC manager, discuss the situation and review the options with the TAF individual before a penalty is applied. NOTE: This policy is effective statewide beginning July 1, 2007.

The Solutions Recovery Care Coordination (SRCC) System combines the services of the Solutions case manager and the RADAC TAF assessors into a seamless delivery of person centered recovery care coordination that will be matched to the needs of the individual TAF customer. The system for coordination will provide screening, assessment, multi-disciplinary care management, and individualized care coordination to TAF customers with substance abuse problems. The SRCC managers and the treatment providers will document the activities that fulfill the primary work requirements to the EES case manager. This will include the customer’s progress toward self-sufficiency in reaching recovery goals.

This plan will include the following work activities within a treatment or substance abuse service setting:

• Peer Support Coach - Examples include assisting in group sessions; assisting in development and delivery of educational lecture; tutoring of other treatment participants in preparing assignments; and reading required assignments to treatment participants with poor reading skills. (Work Experience)
  
  
• Recovery Support Volunteer - Examples include transportation of others to necessary appointments; providing office or data support; developing or distributing flyers or newsletters; residential monitor; organizing/leading or participating in a volunteer activity related to improving the health and well-being of others.(Community Service)
  
  
• Recovery Coach - This is a community based barrier remover who attempts to engage and help addicts or alcoholics stay connected and supported within the recovering community. The recovery coach will fill the gap between the indigenous recovering community and local treatment institutions. (Subsidized or unsubsidized employment)

NOTE: See 3310.8 for consideration of short-term substance abuse treatment as a Job Readiness work component.

Implementation:

Beginning July 1, 2007 transition to the SRCC model will begin in three service centers: Kansas City, Wichita and Topeka. The Southeast, South Central and West regions and the remaining service centers within the Kansas City Metro and Northeast regions will transition to this model by the end of December 2007.

A attached timeline has been developed to assist regions in meeting the implementation deadline.

Regional teams of treatment providers, SRCC Managers, Community Collaboration, and SRS regional staff are to work together to plan the transition to the SRCC model within the Region. The SRCC contractor will be responsible for establishing this regional team. At a minimum, the following needs to be addressed in the plan:

• Provisions for work program group orientations whenever possible and to include SRCC managers in these orientations.
  
  
• Training plan for SRS staff and treatment provider staff including use of web-based training and the SRCC video.
  
  
• SASSI testing for new TAF recipients. Such testing will continue to be completed after July 1 and SRCC managers and EES case managers will need to coordinate this process. Wherever possible, SRCC will deliver the SASSI testing. In rural communities, the process may need to be modified. SRCC managers will score and interpret the SASSI. When TAF customers are referred for SRCC, a copy of the Self Assessment Form or Work Readiness Screening Form should also be shared with SRCC.
  
  
• Procedure to establish multi-disciplinary team meetings to occur at admission to treatment, pre-discharge, transfers between treatment services and as needed. The purpose of the multi-disciplinary team meeting is to provide regular communication between members, aid in barrier reduction, problem solve and ensure compliance to TAF and other programs. At a minimum, the SRCC manager, treatment provider and customer will be present. Other partners, such as the TAF case manager, will be invited and encouraged to attend as schedules permit.
  
  
• Development of a list of treatment providers within the region.
  
  
• Establishment of Work Experience and Community Service site agreements with the treatment providers. Treatment providers will need to complete the site agreement process. The ES 4104 and the ES 4105 should be in place by December 31, 2007. The SRCC managers play a vital role in connecting the treatment provider staff with SRS staff.
  
  NOTE: Treatment providers should only be required to complete one site agreement even if services are provided to more than one SRS Service Center.
  
• Review of the status of current AOD customers. Use of a multi-disciplinary team (including the SRCC managers, treatment provider, and the TAF customer) is required. Communication should include review/update of the SRCC case plan, any change in activities within the treatment or substance abuse service setting and an explanation of the new process to the customer.

Summary of the SRCC process (once fully implemented) is explained below:

• The new modified SRCC services are only available to TAF recipients, referred by EES staff.
  
  
• SASSI testing will continue to be completed after July 1 and SRCC managers and EES case managers will coordinate this process. Wherever possible, SRCC will deliver the SASSI testing. In rural communities, the process may need to be modified. SRCC managers will score and interpret the SASSI.
  
  
• When TAF customers are referred for SRCC, a copy of the Self Assessment Form or Work Readiness Screening Form is to be attached to the EP-4412 referral form. The EP-4412 should include the number of months TAF assistance has been received and the number of remaining weeks available in job search/job readiness activities.
  
  
• When the TAF customer is referred to SRCC, the SRCC manager and TAF customer will develop an individual SRCC case plan, including treatment services. The SRCC manager will contact the treatment provider and initiate a multi-disciplinary team meeting. The multi-disciplinary team meeting should meet no later than the first day of treatment. The initial meeting should include a review of the SRCC case plan, expectations of its members, how many weeks available the customer has of Job Search/ Job Readiness activities and how many months of TAF assistance have been received. At a minimum the SRCC case manager, treatment provider and customer will be present. Other partners, such as the TAF case manager, will be invited and encouraged to attend as schedules permit. AOD at “0" hours is entered on SESP. Other activity hours are entered as the plan is developed or changed.
  
  
• Treatment providers will be providing documentation of the hours of work verification. This will be provided every two weeks. Information will be entered on the KCPC and also provided to the EES case manager on the ES 4322. EES staff will be notified within 48 hours if the customer does not show for inpatient treatment.
  
  
• Multi-disciplinary team meetings will occur at admission to treatment, pre-discharge, transfers between treatment services and as needed. The purpose of the multi-disciplinary team meeting is to provide regular communication between members, aid in barrier reduction, problem solve and ensure compliance to TAF and other programs. At a minimum, the SRCC manager, treatment provider and customer will be present. Other partners, such as the TAF case manager, will be invited and encouraged to attend as their schedules permit.
  
  
• Federal participation for job search and job readiness activities is limited to 4/6 weeks, within the federal fiscal year (October 1st through September 30th). However, there will be a few times when a TAF customer is in the job search/job readiness activity exceeding this limit. This is appropriate as it is still the expectation that the treatment providers, SRCC and EES staff will continue to do what is best for the individual.

The following examples illustrate these changes:

Ongoing TAF case - Tom is participating in Solutions. His case is currently coded in AOD for “0" hours. In August, Tom’s case is staffed. Tom is currently participating in outpatient treatment. The team determines that Tom should be a Peer Support Coach for 20 hours per week. He is also working on his GED for 10 hours per week. On KsCares, he would be in AOD for “0" hours, WXN for 20 scheduled hours, and SAS for 10 scheduled hours. The treatment provider will be providing reports every two weeks to the EES case manager on Tom’s progress and actual hours of participation in the Peer Support Coach activity. The EES case manager will also obtain verification every two weeks on Tom’s GED progress from the academic or contracted provider.

New TAF case - Mary’s TAF case is approved for July. SRCC explains services to Mary during group orientation. Mary also completes the assessment including SASSI. SRCC scores the SASSI and completes the Turnaround Form (EES Referral for Alcohol and Other Drug Treatment and Assessment), ES-4412, indicating that Mary needs substance abuse treatment. Mary is notified and meets with the SRCC manager. Mary is assigned in-patient treatment. EES case manager codes JSR for 20 hours. The treatment provider will be providing reports every two weeks to the EES case manager on Mary’s progress, changes to the plan and actual hours of participation. If Mary’s case is pulled in the sample her actual activities will be recorded on SESP and actual hours entered on the Actual Hours Window.

Work Program Failure #1 - Mary fails to show for in-patient treatment. A meeting is set for the SRCC and EES case manager to meet with Mary to discuss the situation. Mary does not show. The penalty protocol outlined in KEESM 3500 is followed and a TAF and FS penalty is assessed giving adequate and timely notice.

Work Program Failure #2 - Mary does show for in-patient treatment. However, she is not actively participating in her plan. (She is refusing to leave her room to participate in group sessions.) A meeting is set for the Treatment Provider, SRCC and EES case manager to meet with Mary to discuss the situation. Mary understands the consequences and decides to participate fully in the program and promises to attend the required therapy sessions. SRCC manager follows-up with Mary in a week to support her decision and applaud her progress. A TAF and FS penalty is not assessed and Mary continues to receive full TAF and FS benefits.

SRCC/OARS Participant - Kathy is currently working with both OARS and Solutions. She is currently coded in OAR for “0" hours and AOD for “0" hours. In August, the multi-disciplinary team (including the OARS advocate and the OARS participant) meets to discuss Kathy’s situation. It is agreed that Kathy will start in a Peer Support Coach position for 20 hours per week. The KsCares coding continues as OAR for “0" hours and AOD for “0" hours. In October, the EES case manager receives information that Kathy is not participating in the Peer Support Coach activity. The OARS advocate has an Authorization for the Release of Specified Information Which Affects Eligibility for SRS Benefits to discuss this specific situation with EES and provides information at the multi-disciplinary team meeting that Kathy’s safety plan has changed. It is not safe for Kathy to be involved in the Peer Support activity at this time. No penalty is established.

Note: If the customer does not sign the Authorization for the Release of Specified Information Which Affects Eligibility for SRS Benefits, the OARS advocate can not provide case specific information at the multi-disciplinary team meeting but may still participate and provide generic OARS information. If no case specific information is provided, no penalty is established.

Forms

The EP-4412, Turn-Around Document, is being updated to reflect current terminology and is also being renumbered to the ES-4412. A copy of this form is attached.

The EP-4413, Status Change Form, is now obsolete. Compliance/non compliance information will be required in the provider protocols and EES staff will routinely will be getting this information.