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Revised July 24, 2018 Alpine County Specialized Care Increment Plan Alpine County’s Specialized Care Increment (SCI)/Specialized Care Rate (SCR) Program provides a supplemental payment to the resource family provider caring for a child with additional daily needs and with behavioral, emotional, physical and/or health issues beyond those provided by the Level of Care (LOC) rate. The SCI payment is in addition to the LOC rate. The LOC and SCI may be based on the same conditions when the care and supervision needs of the child are not sufficiently provided by the determined LOC rate. Population Served Children/youth in foster care, including Non-Minor Dependents, will be eligible for SCI consideration, including children receiving foster care benefits in a Non-Relative Legal Guardianship, Kin-GAP, or AAP. The SCI is not available for a child/youth receiving Intensive Services Foster Care (ISFC), placed in Therapeutic Foster Care (TFC), residing in a Supervised Independent Living Program (SILP), residing in a Short Term Residential Therapeutic Program or receiving a Dual Agency Rate as a regional center client. Currently, there are no children in Alpine County who are receiving an SCI, however it is anticipated that there could be 1 child at any time who could receive an SCI. Payment Amounts Alpine County has three established SCI rate levels and will offer SCI rates to resource families meeting criteria for the completion of the SCI assessment. Any of the SCI levels can be applied to any LOC rate with the exception of the ISFC level. As stated above, any child who qualifies for ISFC LOC will not qualify for an additional SCI payment. Alpine County Specialized Care Increment (SCI) Rates SCI Rate Level 1 SCI Rate Level 2 SCI Rate Level 3 LOC Rate plus $100 LOC Rate plus $150 LOC Rate plus $200 Alpine County will apply the same cost of living increases used for the LOC rates to the SCI rates with the same effective dates. Qualifying Criteria Alpine County is adopting the County Welfare Directors Association (CWDA) SCI Matrix (Attachment Each tier can be applied to any LOC rate, except for the ISFC rate. ---PAGE BREAK--- Revised July 24, 2018 County Review Process An SCI assessment will occur after the initial and any subsequent Child and Family Team meeting, and after the completion of the LOC protocol. At triggering events, as defined by ACL 17-11, and within mandated timelines, the social worker completes the LOC determination matrix to determine the foster care rate and the SCI worksheet (attachment In order to determine the appropriate tier for the child, the social worker will gather information from the resource parents, biological parents, behavioral health providers, the Child and Family Team, and other providers as determined. The social worker will give the SCI worksheet to the Deputy Director or Director for review and approval. The effective date of the SCI will be the date the Deputy Director or Director approves the worksheet. A copy will be provided to the integrated case worker and a copy will be maintained in the child welfare case file. The social worker will enter the SCI rate amount in the placement section of CWS/CMS, the child welfare case management system. The integrated case worker will issue the applicable Notice of Action (NOA) (Attachment In instances where an SCI is needed prior to the initial LOC rater determination to immediately stabilize a foster care placement the same procedure will be followed and the SCI rate will be applied to the basic foster care rate. Reassessment The SCI will be reassessed every six months however the SCI may be reevaluated if the social worker determines that the SCI is not meeting the child’s needs (conducted in conjunction with a LOC assessment), there is a change in the child’s needs or a resource family requests a reassessment. The same procedures described above will be followed for reassessments. Implementation Alpine County’s SCI Plan will be implemented once the LOC protocol is fully implemented by California Department of Social Services (CDSS). Currently, there are no children in care receiving an SCI to be transitioned to the new SCI plan. Out of County placement Out of county SCI rates will be determined using the county of residences SCI criteria and methodology. If the county of residence does not have an SCI plan then Alpine County will use our County plan. ---PAGE BREAK--- Revised July 24, 2018 Alpine County SCI Point of Contact Nichole Williamson, Director 75A Diamond Valley Road Markleeville, CA 96120 (530)694-2235 [EMAIL REDACTED] ---PAGE BREAK--- Alpine County SCI Matrix 5/4/2018 SCI Matrix The following table is not intended to include every possible condition or situation, but rather as some basic guidelines. In general, the conditions are suggested to be the minimum for a particular Tier, especially for Tier 3. Area Tier 1 **If three or more of the Tier 1 conditions listed exist, rate will be increased to the next higher level. Tier 2 **If three or more Tier 2 conditions exist, or two Tier 2 conditions and three Tier 1 conditions exist, or one Tier 2 conditions and six Tier 1 conditions exist, rate will be increased to the next higher level. Tier 3 Medical conditions Drug exposed history or positive toxicology screen. Alcohol exposure (FAS, FASD or FAE) Respiratory Difficulties and Diseases Failure to Thrive Diabetes & Heart Disease Hemophilia Seizures Physical Disabilities/Impairments Brain Injury (abuse or accidental) Visually impaired (birth, abuse, or accidental) Hearing impaired (birth, abuse, or accidental) Immune Disorders Surgical intervention Orthopedic abnormalities (birth or abuse) (i.e. scoliosis) Severe burns 1-3 appointments per month not including routine dental or physical examinations. Long-term prescription medications (medication needed on a daily basis for a period of 1 or more months). One-two medications not including prescription vitamins or short-term antibiotics. Mild breathing difficulties requiring prescription medications with close supervision. Sickle Cell SF (Sickle hemoglobin FS, HPFH, respiratory difficulties requiring the use of nebulizer breathing treatments. Diabetes with special diet – no insulin or medication needed. Failure to thrive due to mild feeding difficulties Seizure disorder (Abnormal EEG, medication required for seizure activity) Heart disease requiring close monitoring no intervention special treatments or diet. HIV positive clinically well 4-6 appointments per month not including routine dental or physical examinations. Positive toxicology screen at birth (level should be reduced at 6 month review if baby is not exhibiting any or difficulties) Confirmed by maternal history, drug and/or alcohol exposure prenatal with (level should be reduced at 6 month review if infant is not exhibiting any or difficulties) Apnea or heart monitor required (when discontinued, rate to be reduced to appropriate level) Moderate feeding difficulties requiring therapy or special feeding techniques. Seizures requiring intermittent monitoring, medications and other interventions to control. Severe respiratory difficulties requiring medications, breathing treatments (not including the use of inhalers) and/or CPT (Chest Physical Therapy) on a daily basis. Intermittent oxygen. Diabetes with special diet and oral medications. Stable condition, child compliant with prescribed program. Medical diagnosis of Fetal Alcohol (FAS) or Fetal Alcohol Spectrum Disorder (FASD). Not the same as prenatal alcohol exposure Fetal Alcohol Effect (FAE). Shunt placement-functioning stable More than 6 appointments per month not including routine dental or physical examinations. FAS/FASD with moderate to severe complications (verifiable medical diagnosis) Conditions requiring daily at home Physical Therapy (PT), Occupational Therapy (OT), in addition to weekly or biweekly therapy sessions. Severe feeding problems, excessive crying, sleep disruptions, etc. due to alcohol/drug exposure Continuous oxygen. Diabetes with special diet, close monitoring of daily blood sugars levels, insulin injections, etc., Minor is compliant with program. Hemophiliac requiring close monitoring to prevent injury. Minor requires 4 or more injections per week (i.e. growth hormone, asthma, etc) Sickle Cell SC, Severe Child requires continuous care and supervision on a daily basis in accordance with a prescribed treatment plan that would ---PAGE BREAK--- Alpine County SCI Matrix 5/4/2018 Area Tier 1 **If three or more of the Tier 1 conditions listed exist, rate will be increased to the next higher level. Tier 2 **If three or more Tier 2 conditions exist, or two Tier 2 conditions and three Tier 1 conditions exist, or one Tier 2 conditions and six Tier 1 conditions exist, rate will be increased to the next higher level. Tier 3 Fetal Alcohol Effect or Exposure (FAE) Attention deficits, Memory deficits, Sickle Cell – SB + Thal, Mild Mild/moderate Cerebral Palsy requiring minimal additional assistance with feeding, dressing, bathing, etc. Minimal brain injury requiring minimal additional observations and guidelines. No shunt required or with stable shunt requiring no medical intervention. Visual condition is stable and infrequent intervention is needed eye drops or eye patch). Hearing condition is stable and infrequent intervention is needed or hearing aid is needed. Minimal bracing equipment is needed (i.e. AFO’s) Other: Sickle Cell SB Thal Moderate 11. Minor requires 1-3 injections per week (i.e. growth hormones, asthma, etc). Cleft lip requiring surgical intervention and special feeding assistance. Physical abnormalities requiring medical intervention. Moderate Cerebral Palsy or physical disability requiring assistance with feeding, dressing, etc. 2nd degree burns requiring regular, but not daily dressing changes. This generally applies to children 8 or over who can cooperate with the treatment plan. Visually impaired requiring minimal assistance with daily living (i.e. Mobility, special education, etc.) 17. Hearing-impaired requiring moderate assistance (i.e. specialized communication techniques, speech therapy, and special school program). Scoliosis requiring assisted daily exercise and/or bracing. Other: otherwise require placement in an institutional facility. Visual or hearing impaired requiring constant care provider assistance with daily living activities and/or adaptive home environment. Hearing impaired requiring assistance with daily living including care provider signing abilities for specific child. Combined cleft lip/palate. Other: Developmental delays or disabilities Developmental Delay Developmental Disability Intellectual Disability, Autism Spectrum etc.) Learning Delays or Disabilities Sensory Integration Disorder Moderate developmental delays or disabilities requiring weekly care provider assistance. Other: Moderate to severe developmental delays or disabilities that require daily assistance from the care provider. Regional Center client documentation required from RC SW. Intermittent assistance from a behaviorist or social/health services provider. Regional Center client: 0-3 years of age to be included in Early Intervention Program (EIP) (i.e. Lori Ann Infant Stimulation, Exceptional Parents Unlimited (EPU). Documentation required from either EIP or RC social worker. Severe learning delays or disabilities requiring extensive daily assistance several times a day from the care provider. Regular in-home assistance from a behaviorist or social/health services provider. Multiple impairments, less than 18 months developmentally, nonambulatory. Regional Center ---PAGE BREAK--- Alpine County SCI Matrix 5/4/2018 Area Tier 1 **If three or more of the Tier 1 conditions listed exist, rate will be increased to the next higher level. Tier 2 **If three or more Tier 2 conditions exist, or two Tier 2 conditions and three Tier 1 conditions exist, or one Tier 2 conditions and six Tier 1 conditions exist, rate will be increased to the next higher level. Tier 3 Other: client documentation required from RC SW. Other: Behavioral Issues AWOL Aggressive and Assaultive Animal Cruelty CSEC Substance Use/Abuse Gang Activity Fire Setting Severe mental health issues- including suicidal ideation and/or Self Harm hospitalization(s) Adjudicated violent offenses, significant property damage, and/or sex offenders/perpetrators Habitual Truancy Three or more placements due to the child's behavior Behavior modification required but no medication prescribed. The child presents some risky behaviors sometimes placing self and/or others at risk. Close supervision is sometimes necessary to minimize risk and/or reduce potential for disruption. medication may be required with close supervision by care provider and increased follow up by therapeutic provider. Other: Behavior modification needed in conjunction with prescribed daily medication. The child is at high risk to self and/or others. Behaviors frequently are disruptive to household, school and in other social interactions. Stabilization of disruptive behaviors requires special intervention and discipline strategies. Care provider needs special training and participates in counseling with the minor to accomplish this. 601 behaviors (truant, beyond control of caregiver) exhibited at this level. Chronic resistance to behavior modification strategies. Personal property of others in the home at high risk. Excessive anti-social behaviors which strictly limits unsupervised social interaction. Other: Child at extreme risk to self and/or others. In addition, therapeutic plan is required to address the minor’s disruptive, dangerous, and high-risk behaviors. Behaviors can be stabilized and reduced. Active participation in all areas of counseling and intervention is required by the care provider in order to facilitate therapy and treatment. 601 and 602 frequently exhibited themselves at this level. evaluations are essential at this level to track the progress of the minor and adjust treatment strategies as needed. Minors at this level are at risk of placement if professional treatment or behavior management plans do not modify high risk behaviors and/or emotional disturbances. Other: ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- 75 Diamond Valley Road, Markleeville, CA 96120 (530) 694-2235 / Fax (530) 694-2252 http://www.alpinecountyca.gov COUNTY OF ALPINE Health and Human Services Nichole Williamson, Director SPECIALIZED CARE INCREMENT WORKSHEET Child’s Child’s Assessed Date of LOC Determination:_______________ This child’s needs for a Specialized Care Increment are based on the following: ( ) MEDICAL CONDITIONS ( ) Tier 1 ( ) Tier 2 ( ) Tier 3 ( ) DEVELOPMENTAL DELAYS or DISABILITIES ( ) Tier 1 ( ) Tier 2 ( ) Tier 3 ( ) BEHAVIORAL ISSUES ( ) Tier 1 ( ) Tier 2 ( ) Tier 3 Recommended Attach completed Specialized Care Increment Matrix. Social Worker Director If approved, effective *Provide this form to the foster care eligibility worker. Place copy in CPS file. If approved, enter SCI in CWS/CMS.* Reassessment Due Date (every six Comments: