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A
Okay
good
afternoon
welcome
to
the
interim
joint
committee
meeting
on
health
and
well
health
welfare
and
family
services.
This
is
meeting
two
and
I'd
like
to
go
ahead
and
get
started.
We
have
a
very
busy
agenda
as
always,
and
we
will
go
ahead
and
call
meeting
to
order
and
secretary.
Please
take
the
role.
E
G
A
Chairman
mosher,
I'm
president
in
the
room.
Thank
you
all
right.
Thank
you.
We
have
a
quorum
established
and
are
prepared
to
do
business.
I
would
just
like
to
thank
everyone
for
being
here
thanks
to
our
members
who
are
remote
and
new
to
identify
yourself
and
where
you
were
calling
in
from,
and
I
would
just
like
to
remind
everyone
that
you
should
be
muted
unless
you
are
speaking
and
please
use
the
chat
feature
to
notify
staff.
A
A
Thank
you
and
thank
you
to
everyone
for
your
prayers
to
senator
for
senator
buford
and
representative
bam,
kearney
and
their
families.
They
will
be
sorely
missed.
A
First,
we
would
like
to.
I
would
like
to
approve
the
minutes
from
our
june
16th
meeting.
Did
all
members
have
a
an
opportunity
to
look
at
these?
Thank
you.
We
have
a
motion.
Do
we
have
a
second
a
second
all
in
favor
of
approving
the
minutes,
any
opposed?
Thank
you.
Okay.
First,
we
have
quite
a
few
regulations
that
I
would
like
to
go
ahead
and
talk
about.
If
we,
if
there
are
any
questions,
all
of
these
regs
were
sent
to
members
for
review
and
we've
had
our
staff
review.
A
These
we've
had
conversations
with
various
individuals,
and
I
know
that
we
have
some
folks
here
standing
by
in
case.
There
are
any
questions.
Are
there
any
questions
from
our
committee
members
about
any
of
the
regs.
A
Okay,
see
none.
I
would
just
like
to
say
that
we,
these
regs,
have
been
reviewed,
and
I
thank
everyone
for
paying
close
attention
to
all
of
these
regs
and
thanks
to
the
cabinet
and
all
agencies,
for
your
work
on
on
making
sure
that
these
regs
are
up
to
par.
A
First
on
the
agenda,
we
have
an
overview
of
the
family
first
act,
and
I
would
like
to
thank
jenna
bannon,
the
program
director
for
ncsl
for
being
here
with
us
today.
Thank
you
very
much,
and
I
know
that
this
is
a
big
topic.
I
thought
that,
starting
with
an
overview
of
exactly
what
this
is
and
how
it
affects
all
of
us
would
be
prudent.
So
thank
you
very
much
for
being
here
and
feel
free
to
proceed.
Thank
you.
Thank.
H
H
All
right
again,
thank
you
so
much
for
having
me
I
am
calling
in
from
denver
colorado.
It
normally
would
be
my
office
in
denver
colorado,
but
I'm
actually
in
my
home
office.
So
please
excuse
me
if
you
hear
a
dog
barking
or
children
in
the
background,
but
thank
you
so
much
for
having
me
today.
My
name
is
jenna
bannon.
I
am
a
program
director
for
the
children
and
families
program
at
the
national
conference
of
state
legislatures.
H
I
know
that
you
all
are
very
familiar
with
us.
Ncsl
is
the
country's
most
trusted
bipartisan
organization
serving
legislators
and
staff
for
more
than
40
years.
We
promote
innovation
policy,
innovation,
create
opportunities
for
lawmakers
to
share
their
knowledge
and
ensure
state
legislatures,
have
a
strong,
cohesive
voice
in
the
federal
system.
H
Ncsl
is
the
only
organization
serving
all
7
383
state
legislators
and
more
than
25
000
legislative
staff
across
the
country.
I
think
that
number
is
amazing.
We
track
more
than
1
400
issue
areas
from
criminal
justice
to
education,
healthcare,
transportation
and
children,
families.
We
have
someone
on
our
team
who's
tracking
the
issue
on
your
behalf
and
can
provide
you
with
timely
information.
H
We
also
serve
as
the
connective
tissue
among
all
of
you
around
the
country
we
bring
together
legislators
and
staff
from
both
sides
of
the
aisle
to
tackle
and
discuss
difficult
problems
and
find
solutions.
We
also
specialize
in
professional
development,
specifically
tailored
for
legislators
and
legislative
staff,
and
these
professional
development
opportunities
are
at
no
cost
to
your
state.
H
We're
also
a
state
advocate
in
capitol
hill
fighting
against
preemption
for
the
10th
amendment
and
maintaining
federalism.
We
have
eight
committees
very
similar
to
your
states
and,
as
you
know,
we
also
host
a
series
of
meetings.
We
have
our
big
legislative
summit
happening
in
tampa
florida
in
early
november
and
we
would
love
to
see
you
there.
H
I
realize
that
you
have
a
really
incredibly
full
agenda
today,
so
I
will
be
as
quick
as
possible
for
you.
I
want
to
provide
you
with
a
summary
of
the
prevention
provisions
and
congregate
care
elements
of
the
family.
First
prevention
services
act.
I'm
going
to
provide
you
a
really
quick
summary
of
state
activity
since
2018
and
just
touch
on
some
of
the
major
challenges
states
have
faced
and
some
of
the
creative
solutions
they're
coming
up
with,
and
then
I
hope
to
answer
some
of
your
questions
or
get
back
to
you.
H
So
I'm
going
to
touch
really
quickly
on
our
data
in
the
history
there
are
currently
almost
424
000
children
birth
through
18
in
the
child
welfare
system
in
the
nation,
over
half
of
the
children
in
the
child
welfare
system
nationally
are
under
the
age
of
six,
and
there
are
three
top
reasons:
children
enter
the
child
welfare
system.
The
top
reason
is
for
neglect.
H
The
second
reason
is
around
parental
substance
abuse
and
the
third
reason
is
called
the
caretaker
inability
to
cope.
I
put
in
this
slide
because
it
is
really
very
timely
to
see
how
how
issues
around
physical
abuse
and
sexual
abuse,
which
was
you
know,
historically,
a
very
big
reason
for
moving
children
from
their
homes,
has
declined
over
the
past
30
years,
really
a
significant
decline.
H
We
believe
this
is
because
a
rise
in
the
social
media,
less
stigmatization
of
some
of
these
issues,
but
one
issue
has
remained
consistent
throughout.
It
is
the
issue
of
neglect
over
60
percent
of
our
young
children.
Our
of
our
children,
both
through
18,
are
removed
from
their
homes
because
of
the
issue
of
neglect.
H
So,
as
advocates
were
thinking
about
this
issue
and
as
policy
makers
were
trying
to
identify
what
can
we
do
to
tackle
the
issue
of
neglect
where
conversations
were
beginning
around
upstream
strategies?
More
conversations
with
you
know:
what
could
we
be
doing
to
prevent
the
issue
of
neglect?
What
were
the
evidence-based
prevention
focused
strategies
as
a
way
to
support
families
before
they
were
fully
in
the
system
and
thus
the
development
of
family
first,
so
family
first
was
a
monumental
shift
in
trouble
for
funding
and
structures.
H
It's
a
major
change
to
child
welfare
funding,
allowing
states
to
use
federal
funds
that
were
previously
reserved
for
children
and
families
in
the
child
welfare
system
for
preventing
a
family's
entry
into
child,
the
child
welfare
system.
This
can
include
in-home
par
parents,
skill-based
programs,
mental
health
services,
substance,
abuse
prevention.
H
H
Okay,
eligible
services
must
meet
certain
requirements.
Services
must
be
part
of
a
state's
five-year
prevention
plan
which
kentucky
has
submitted.
It
must
be
approved
by
the
title:
4e
prevention
services
clearinghouse
as
promising
practices,
which
is
creatively
created
from
an
independently
reviewed
study
and
shows
statistically
significant
results
and
supported
practices,
so
reviewing
using
a
rigorous
experimental
design
and
has
sustained
success
for
at
least
six
months
after
the
end
of
treatment.
So
again,
programs
need
to
be
evidence-based.
H
So,
let's
talk
about
congregate
care
congrecare,
which
is
residential
treatment.
Programs
that
have
housed
hard
to
face
youth
states
can
only
receive
federal
funds
for
family-based
placements,
so
foster
care
or
kinship
care
are
qualified
residential
treatment
programs
which,
in
this
presentation,
I'm
going
to
call
qrtps
so
foster
homes
have
only
six
or
fewer
children.
H
Qrtps
have
25
or
fewer
children.
So
in
the
new
legislation
they
must
be
licensed.
They
must
utilize
a
trauma-informed
treatment
model.
They
must
be
staffed
by
our
registered
or
lysing
licensed
nursing
staff.
They
must
be
inclusive
of
family
members
in
the
treatment
process.
If
possible
and
documents
the
extent
of
their
involvement,
they
must
offer
at
least
six
months
of
support
before
discharge,
and
these
placements
must
be
reviewed
and
approved
by
a
state
judge.
H
Eleven
states
dc
and
the
eastern
band
of
cherokee
indians,
indian
tribe
plans
have
been
approved,
kentucky
has
had
theirs
approved.
H
So
state
legislation.
So
it's
been
really
interesting
to
see
over
the
course
of
the
past
few
years
and
since
family
first
was
enacted
in
2018,
we
have
seen
160
bills
from
40
states
and
dc
and
have
introduced
legislation
since
2018
related
to
family.
First,
interestingly,
in
2020
we
saw
one
piece
of
legislation
and
I'm
sure
I
don't
need
to
explain
why
and
in
2020
21
ncsr
has
identified
36
introduced
bills
from
15
states
and
dc
related
to
family.
First.
H
I'm
gonna
just
go
back
one
quick
thing,
so
states
have
focused
a
lot
on
appropriating
funds
and
I'm
happy.
I
think
you
all
have
a
copy
of
the
legislation.
So
the
link
to
all
those
pieces
of
legislation
are
in
my
powerpoint,
so
you
see
how
from
colorado
and
ohio
has
appropriated
funds
states
have
defined
qrtp
and
statute,
they
have
convened
stakeholders
in
massachusetts
and
kansas
examples.
H
So
what
are
the
challenges?
Program
costs
for
states
to
draw
down,
4e
foster
care
maintenance
payments
for
a
child
placed
with
a
parent
in
a
family-based
residential
treatment
facility
for
a
substance
use
disorder,
the
child
must
be
in
state
custody.
This
seems
to
be
counterintuitive
to
prevention
by
requiring
a
child
to
enter
the
system
before
being
placed.
H
So
states
are
also
using
utilizing
multiple
funding
streams
to
braid
funds
for
families,
so
medicaid
can
be
used
to
fund
the
parents
placement,
while
family
first
funds
are
used
to
fund
the
child's
in
also
in
early
2020
states,
expressed
a
problem
with
administrative
costs
when
setting
up
their
prevention
contracts
as
a
solution.
The
family
first
transition
act
was
passed
to
allow
states
to
receive
reimbursement
for
programs
that
haven't
been
assessed
by
the
federal
clearinghouse
but
assessed
by
the
state.
H
Identifying
eligible
programs
has
also
been
a
challenge.
The
title,
4e
family,
clearing
house,
hasn't
released
many
assessments
and
it
has
assessed
programs
differently
than
other
institutions.
So,
as
a
solution,
many
have
turned
to
the
california's,
evidence-based
clearinghouse
for
child
welfare
and
samsa's
evidence-based
practices.
Resource
center
as
a
tool
to
identify
programs,
states
can
also
submit
and
services
for
a
review,
and
then,
last
but
not
least,
a
huge
challenge
has
been
covid19
and
all
of
the
previously
mentioned
problems
have
been
made
worse
by
covet
in-person
assessments,
funding
concerns
setting
up
new
programs,
you
name
it.
H
So
in
closing,
you
are
exercising
one
of
the
most
important
ways
that
legislatures
can
support
the
implementation
of
family
first
by
serving
as
conveners
and
building
the
prevention
infrastructure
necessary
to
to
for
the
success
of
family.
First,
I
would
encourage
you
to
access
our
child
welfare
resources
at
ncsl.
H
We
have
a
family
first
summary
page:
we
have
a
chart
of
state
legislation
going
back
to
2018
and
we
have
experts
on
our
team
who
can
answer
your
questions
also.
We
would
really
encourage
you
to
stay
connected
with
us
via
our
policy.
Newsletters,
our
state
legislature
magazine
just
came
out
this
month.
We
have
a
blog,
we
have
a
terrific
podcast
and
we
have
meetings
and
trainings
practically
every
month
and
you
can
follow
us
on
social
media.
So
again,
thank
you
so
much
for
your
time.
A
Thank
you.
Thank
you,
jenna
great
high
level
presentation.
I
really
appreciate
the
overview
and
in
pointing
our
members
to
some
resources.
A
I
there's
a
lot
of
information
that
I'm
sure
is
available
and
and
we're
going
to
hear
now
about
kentucky's
implementation
of
the
family
first,
and
so
I
think,
having
your
your
background
will
be
helpful
in
moving
forward,
and
you
know
we'll
just
obviously
come
back
to
you.
If
we
have
any
questions
and.
A
That
a
lot
of
our
members
will
see
you
at
the
meeting
in
november
in
tampa.
H
A
A
Implementation
next,
so
I
think
that
that's
probably
the
more
appropriate
spot
to
get
that
question
answered.
So
all
right.
Thank
you.
Anyone
else,
okay,
representative
fleming,
thank.
D
You,
jeremy
moser
just
a
really
quick
question
in
your
first
slide
or
second
slide.
You
decided
three
decades
of
trends,
that's
occurred
nationwide
and
one
was
the
sex
sexual
abuse
and
that
seemed
to
be
going
down
significantly,
but
I've
been
hearing
and
I'm
in
the
mental
health
field
and
I've
been
hearing
and
seeing
a
lot
of
increase
in
sexual
abuse.
H
You
know
I
I
have
not.
I
have
not
looked
at
that
data
point,
so
I'm
not
if
it's
your
question
at
this
moment,
I'd
be
happy
to
take
a
look
at
it
and
get
back
to
you.
I
also
think
that's
a
quick
question
for
your
next
speaker
specifically
to
kentucky,
but
we
will
definitely
take
a
look
at
national
statistics.
Okay,
thank
you,
ma'am.
A
A
C
Good
afternoon
my
name
is
laura
begin
and
I'm
with
the
department
for
community-based
services.
Thank
you
very
much
for
having
us
here
today.
We
are
very
grateful
for
the
opportunity
to
present.
C
C
Dcbs
has
received
a
brief
update
on
child
care
and
a
more
in-depth
look
at
kentucky's
implementation
of
family
first,
something
that
and
again
I
would
submit
to
you
that
they
are
all
very
interrelated,
something
that
we
talk
a
lot
about
dcbs
and
that
you've
heard
a
lot
about
is
the
number
of
kids
in
out
of
home
care,
but
I'd
like
to
explain
what
that
means.
C
C
That
was
less
than
two
years
ago,
but
dcbs
really
grabbed
hold
of
family
first
and
ran
with
it.
We
have
built
many
programs
since
then
look
to
expand
it
and
we
look
at
child
welfare
through
a
family
first
lens
prioritizing
prevention,
rather
than
focusing
on
our
response
after
maltreatment
and
trauma
has
occurred
so
back
to
this
neglect
issue.
Actually,
in
kentucky
sexual
abuse,
physical
abuse
make
up
about
five
percent
of
our
substantiated
findings
so
again
large
focus
on
neglect.
That
means
for
a
large
number
of
these
9
000
children
and
their
families.
C
They
needed
some
form
of
help
before
a
child
was
removed
from
their
care.
Now
neglect
can
look
like
many
issues,
it's
a
complex
issue,
but
maybe
those
families
didn't
have
access
to
safe
and
reliable
child
care,
or
maybe
they
couldn't
afford
it
through
programs
like
the
child
care
assistance
program,
some
of
those
families
might
have
had
issues,
keeping
the
lights
on
keeping
the
heat
on
through
winter
or
purchasing
groceries
for
their
family,
and
they
could
have
received
assistance
through
safety
net
programs
like
lie
heap
and
snap.
B
B
B
The
plan
is
to
utilize
the
supplemental
funding
to
provide
additional
services
and
supports
to
families
across
the
state
by
decreasing
community
collaboration
for
children,
programs
wait
lists
and
then
we
received
1.3
million
from
for
the
child
abuse
prevention
and
treatment
program
grant
those
funds
also
have
to
be
obligated.
By
september.
The
30th
of
2025
planning
is
underway
to
develop
an
alternative
response
model
in
implementing
a
structural
decision-making
model
for
intake
safety
and
risk
assessment
and
child
maltreatment
investigations.
B
We
received
61.6
million
in
lie
heap
funding.
Those
funds
have
to
be
liquidated
by
september
30th
of
2022.
We
will
continue
providing
the
utility
payment
assistance
program
that
we've
done
to
continue
a
year-round
program
for
that.
Using
those
funds
we
received
8.2
million
for
a
low
income
household
water
assistance
program.
B
Those
funds
also
have
to
be
well,
those
have
to
be
liquidated
by
september
30th
of
2023.
The
state
plan
has
been
some
has
not
been
submitted,
but
once
it's
submitted
we'll
have
to
wait
for
approval
from
the
federal
level
to
utilize
those
funds.
The
goal
is
to
mirror
the
way
the
fly,
heap,
assistance
program
works
and
be
administered
through
the
community
action
of
kentucky
in
all
the
states,
and
then
we
receive
17.4
million
for
tanf.
F
F
We
have
been
so
blessed
to
receive
large
amounts
of
funding
for
the
child
care
program
throughout
kentucky
in
order
to
help
rebuild
child
care,
but
also
to
help
create
new
infrastructure
that
the
child
care
system
has
never
had
before,
because
child
care
as
a
business
model
is
not
really
set
up
to
to
support
itself.
It's
a
very
unstable
program,
so
total
we've
been
given
763
million
dollars
in
this
newest
round
of
federal
funding
through
the
american
rescue
plan.
That
funding
is
coming
to
us
from
two
different
sources.
F
The
largest
portion
of
the
funding,
470
million,
is
being
given
to
sustainability
payments
to
child
care
programs
that
were
open
prior
to
march
11
2021.
When
the
bill
was
passed
at
the
federal
level,
we
are
going
to
be
breaking
that
up
into
nine
payments
to
go
to
child
care
programs
that
are
regulated
in
some
way
by
the
state,
whether
that
is
a
licensed
center
or
a
registered
or
certified
family
child
care
home
now.
At
the
same
time,
we
were
also
given
money
from
another
bucket
from
the
child
care
and
development
block
grant
funding.
F
These
are
one-time
funds.
Typically,
we
get
annual
funding
from
the
child
care
and
development
block
grant.
That
really
goes
to
support
families
who
are
at
risk
providing
subsidy
for
child
care
programs,
as
well
as
our
monitoring
programs
through
the
state.
Our
national
background
check,
program
and
quality
initiatives.
F
This
one-time
funding
has
a
slightly
different
purpose
because
it
is
going
to
all
child
care
programs
in
some
way.
It's
open
to
not
just
families
who
are
at
financial
risk.
There
have
been
a
lot
of
rules
and
regulations
placed
on
this
money,
as
there
should
be
for
being
accountable
for
this
large
of
a
sum.
L
So
this
slide
depicts
that
family
first,
although
we
normally
talk
mostly
about
the
impacts
to
our
prevention
services,
it
depicts
that
it
really
did
have
impacts
across
our
entire
child
welfare
continuum,
from
prevention
and
family
preservation
to
kinship
care.
It
provided
requirements
and
funding
for
kinship
navigator
programs
for
the
states.
It
also
impacted
foster
care
by
establishing
the
requirement
for
model
foster
home
licensing
standards.
L
It
impacted
congregate
care,
as
ms
bannon
shared
by
implementing
the
requirements
for
the
qualified
residential
treatment
programs
or
congregate
care
residential
treatment
providers
by
establishing
that
states
must
ensure
that
their
congregate
care
providers
meet
those
qualified
residential
treatment
program
requirements
in
order
to
request
reimbursement
from
the
federal
level,
and
it
also
made
provisions
that
impacted
and
established
greater
benefits
for
our
youth
aging
out
of
foster
care.
So
it
extended
the
age
to
age
23
for
which
youth
could
take
advantage
of
chafee
aftercare
services.
L
L
So,
as
ms
bannon
said,
the
family
first
prevention
services
act
was
enacted
in
february
of
2018..
It
was
a
significant
shift
in
the
way
that
federal
funding
works
for
child
welfare
services.
It
allowed
states
for
the
first
time
to
use
federal
title
e
funds
for
evidence-based
practices
delivered
to
candidates
for
foster
care,
so
in
other
words,
to
provide
services
to
families
to
prevent
entry
into
care
when,
historically
those
title,
four
e-funds
were
reserved
for
services
to
fund
services
for
out-of-home
care
and
adoption.
L
So
state
funds
also
have
to
be
available
to
support
prevention
services
under
family
first,
it
is
a
50
federal
reimbursement.
So
there
have
to
be
state
funds
available
to
cover
that
other
50
percent.
That
is
not
reimbursed
by
federal
title
e
f
title.
4
e
funds
states
could
implement
as
early
as
october,
1st
2019,
but
all
states
have
to
comply
by
october.
1St
of
21.
L
kentucky
really
wanted
to
be
a
leader.
We
knew
that
our
prevention
services
were
effective
in
our
state
and
they
were
really
helpful
to
families
and
children,
and
so
we
wanted
to
take
advantage
of
the
opportunities
offered
by
family
first
to
expand
those
services.
And
so
we
chose
to
be
a
leader
and
implemented
october.
1St
of
2019.
L
This
next
slide
is
really
similar
to
one
of
the
slides
that
ms
bannon
presented.
This
is
a
map
that
was
created
by
casey
family
programs.
That
shows
the
states
that
have
approved
4e
five-year
prevention
plans,
and
so
kentucky
was
one
of
the
first
handful
of
states
that
implemented
in
2019
and
still
today.
As
of
the
end
of
may,
one
of
only
12
jurisdictions
that
have
an
inclu
an
approved
plan
that
includes
11
states
and
the
district
of
columbia
and
the
eastern
band
of
cherokee
indians.
L
So
it
includes
impacts
on
equity,
so
looking
at
racial
disparities,
certainly
an
impact
in
terms
of
addressing
poverty.
By
providing
economic
support,
it
impacts
on
trauma
and
resilience.
Families
certainly
and
children,
avoid
the
trauma
of
removal
from
the
home
and
entry
into
the
child
welfare
system,
with
the
prevention
or
with
the
provision
of
these
prevention
services,
and
mostly,
it
impacts
families,
children
and
youth.
We
know
that
children
grow
up
healthier
when
they
have
the
opportunity
to
stay
safely
in
a
healthy
environment
with
their
families
and
in
their
own
communities.
L
L
The
kentucky
strengthening
ties
and
empowering
parents
or
k-step
program
is
probably
a
program
that
you've
heard
of
it
was
developed
and
expanded
here
in
kentucky
it
is
included
under
our
family
first
prevention
services,
so
it
is
not
included
by
name,
but
on
that
previous
slide,
you
will
see
motivational
interviewing
and
parent-child
interaction
therapy.
These
are
two
evidence-based
practices
that
are
used
in
the
k-step
program
and
model
k-step
began
in
kentucky
in
2017
and
only
four
counties
in
our
northeastern
service
region.
It
was
part
of
our
title,
4e
waiver
demonstration
effort.
L
in
state
fiscal
year,
21
we
expanded
to
three
counties
in
the
salt
river
trail
service
region
in
state
fiscal
year,
2020
k-step
served
202
families,
including
380
children,
and
at
the
time
of
closure,
93
of
those
children
remained
safely
at
home
with
their
families.
So
that's
356
children
that
avoided
entry
into
care
because
of
the
services
provided
under
k-step.
L
Our
family
preservation
program
is
also
equally
successful
and
that
represents
the
in
terms
of
numbers,
the
majority
of
the
services
that
we
are
providing
under
family
first,
our
family
preservation
program
includes
all
of
the
evidence-based
practices
that
you
saw
under
the
previous
slide,
with
the
exception
of
our
start
program.
That
is
a
separate
program
altogether
and
with
the
exception
of
multi-systemic
therapy,
which
I'm
going
to
talk
about
in
just
a
few
minutes,
but
also
there's
a
presentation
later
on
the
agenda
today.
L
So
in
state
fiscal
year,
2020
fpp
served
2762
families,
including
4999
children
of
these
93,
remained
in
the
home
at
the
time
of
closure
of
those
services
and
92
of
those
children
were
still
in
the
home
six
months
after
closure.
So
overwhelmingly,
we
are
demonstrating
that
those
results
and
the
impact
of
that
intervention
is
sustainable
in
terms
of
children
remaining
sleepy
safely
with
their
families.
So,
if
not
for
the
availability
of
these
fpp
services,
4665
children
potentially
could
have
entered
our
out-of-home
care
system.
L
If
those
services
had
not
been
available,
an
expansion
of
25
percent
of
our
fpp
program
was
planned
for
state
fiscal
year
2021..
L
We
are
still
waiting
for
the
final
reports
from
our
contracted
service
providers,
so
I
don't
have
the
data
about
the
number
of
children
served
in
state
fiscal
year
2021,
but
we
should
be
able
to
provide
that
very
soon.
The
goal
of
our
fpp
program
and
our
expansion
family
first
services
is
to
ensure
that
there
is
no
waiting
list
for
fpp
services
anywhere
in
our
state.
L
So
the
total
impact
of
our
prevention
services
under
family
first,
including
our
start
program
in
state
fiscal
year,
2020,
was
3367
family
served.
That
includes
six
thousand
one
hundred
and
thirty,
two
children,
five
thousand
seven
hundred
and
six
of
those
children
remained
in
the
home
at
the
time
of
closure
of
those
services
and
the
percentage,
so
the
percentage
of
effectiveness
across
all
of
our
family.
First
prevention
services
is
93
percent.
L
One
of
the
ways
that
we
want
to
look
at
the
success
of
our
intentional
effort
to
expand
prevention
services
is
in
our
out
of
home
care
numbers.
We
would
expect
to
see
that
if
our
prevention
efforts
are
successful,
that
our
out
of
home
care
numbers
are
going
to
go
down,
so
obviously
we
are
never
going
to
be
able
to
tease
out
any
potential
impacts
of
the
pandemic
during
our
first
year
of
provision
of
family
first
prevention
services,
but
I
did
want
to
mention
one
other
thing.
L
L
This
number
that
you
see
on
the
end
of
this
trend
line
the
9120
in
june
of
2021
1408
children
were
placed
with
relatives
that
is
included
in
that
number,
so
that's
15.4
percent
of
our
out-of-home
care
population.
As
of
june
2021.,
if
you
subtract
that
from
our
total
population,
that
would
mean
that
would
leave
7714
children
in
foster
care.
L
If
you
exclude
those
placed
with
relatives,
so
you
can
see
that
that
almost
identically
matches
our
lowest
point
over
the
last
six
years,
which
was
september
of
2015,
there
were
seven
thousand
seven
hundred
and
eleven
children
out
of
home
care.
At
that
time,
only
275
of
those
were
placed
with
relatives
or
3.6.
L
So
this
is
the
right
thing
to
do,
obviously,
for
relative
caregivers,
for
fictive
convictive
kin,
caregivers
and
for
families
and
for
support
of
those
children,
and
we
want
those
children
in
our
out
of
home
care
population.
If
those
children
and
families
need
those
supports.
But
I
think
it's
an
important
consideration
when
we
look
at
the
look
at
the
impact
of
our
prevention
services
that
we're
taking
into
account
that
we
had
a
significant
shift
in
practice
whereby
we
have
more
children
in
care
placed
with
relatives.
L
L
So
our
total
out
of
home
care
costs
in
state
fiscal
year.
2020
was
395
million,
998
000.,
and
so
remember
that
we
did
not
implement
family
first
until
october
1st
of
2019,
and
that
first
quarter
rollout
was
a
little
slow.
So
we
didn't
have
the
full
impact
of
a
full
year
of
services
during
state
fiscal
year
2020.
L
we
have
just.
It
was
too
late
to
update
this
presentation,
but
we
have
just
gotten
our
rough
totals
from
state
fiscal
year
21
in
state
fiscal
year
21
we
spent
368
million
328
114
dollars
on
out
of
home
care.
That
represents
a
27
670
thousand
dollar
deduction
a
reduction
over
the
previous
year.
So
more
than
27
million
dollars
less
less
spent
on
out
of
home
care
cost.
L
One
of
the
things
that
I
will
mention
related
to
those
out
of
home
care
costs
is
that
it's
impossible
to
to
draw
a
straight
cause
and
effect.
There
are
a
number
of
factors
that
go
into
those
costs.
So
one
of
the
things
that
I
want
to
mention
is
that
in
this
past
state
fiscal
year
we
did
also
implement
the
qualified
residential
treatment
program
requirements
and
we
have
seen
a
significant
reduction
in
the
number
of
children
in
congregate
care
settings.
So
we
are
seeing
more
children
remain
in
family-based
and
community-based
settings
as
of
this
month.
L
Just
a
year
ago,
we
had
800.
In
july
of
last
year,
we
had
861
children
in
residential,
so
we've
seen
a
16
reduction
over
the
past
year,
and
if
you
go
back
to
july
of
2019,
we
had
955
children
in
residential,
which
is
a
24
in
decrease
over
the
past
two
years,
so
these
obviously
are
most
costly
out
of
home
care
services.
L
L
L
So
we
divide
our
prevention
efforts
into
three
categories.
The
first
is
primary
prevention,
and
these
are
activities
that
are
directed
at
the
general
population
they're
available
to
everyone,
and
so
all
members
of
the
community
have
access
to
these
services,
so
you
can
think
about
some
of
the
activities
of
prevent
child
abuse
kentucky.
So
some
of
those
awareness
activities
about
child
child
abuse
and
child
maltreatment.
L
L
L
A
home
visiting
program
like
that
that
most
people
are
familiar
with
it
also
could
be
high
school
programs
for
teen
parents
that
provide
basic
parenting
skills
and
supports
for
those
parents
who
may
have
a
higher
risk
for
future
child
mild
treatment
or
also
think
about
respite
programs
for
parents
of
children
with
special
needs.
Those
are
all
secondary
prevention
activities
and
then
we
have
tertiary
prevention,
so
tertiary
prevention
is
when
something
has
already
occurred.
L
The
cabinet
has
gone
out
and
done
some
type
of
assessment
and
perhaps
there's
a
substantiation,
but
the
assessment
doesn't
indicate
that
that
child
that
there's
an
immediate
safety
concern
or
that
child
needs
to
be
removed
from
the
home.
So
services
are
provided
to
ensure
that
there's
not
future
maltreatment
and
to
ensure
that
that
child
can
stay
stay
safely
in
the
home.
L
So
that
is
a
tertiary
prevention
and
that's
really
what
most
of
our
family
first
prevention
service
activities
are,
is
tertiary
prevention,
and
so
I
think
this
is
a
really
nice
depiction
of
how
we
can
conceptualize
primary
and
secondary
and
tertiary
prevention,
so
that
bridge
that
you
see
upstream,
is
primary
prevention.
If
everyone
had
access
to
that
bridge
and
could
get
across
that
stream,
no
families
or
children
would
ever
be
in
danger
of
going
over
that
waterfall
that
picket
fence
that
you
see
across
the
stream.
It's
intended
to
stop.
L
So
I
want
to
talk
a
little
bit
about
our
expansion
of
investment
and
prevention
services,
so
with
the
additional
20
million
dollars
that
was
appropriated
and
out
of
this
most
recent
legislative
session,
for
which
we
are
greatly
appreciative.
It
will
have
a
significant
impact
on
the
types
of
services
and
the
quality
of
services
that
we
can
provide
for
families.
L
It
will
be
used
in
these
major
ways.
We
are
going
to
expand
our
family
preservation
program
services
by
an
additional
25
percent
in
state
fiscal
year.
2022..
We
also
have
a
planned
expansion
of
k-step.
K-Step
is
a
program
that,
in
some
ways,
is
similar
to
the
start
program
with
which
many
people
may
be
familiar,
but
k-step
has
proven
very
effective
in
the
rural
areas
of
our
state,
and
so
that
is
a
majority
of
the
families
that
we
serve.
L
L
We
also
are
going
to
increase
our
flex
funds
for
families,
so
research
shows
that,
with
some
minimal
economic
supports,
it
results
in
less
incidents
of
neglect,
less
referrals
to
the
child
welfare
agency
in
those
family.
First
prevention
services,
there's
a
very
small
amount
of
flex
funds
available
for
families
right
now,
the
maximum
is
five
hundred
dollars.
We
want
to
increase
those
flex
funds
to
a
thousand
dollars
now
that
doesn't
mean
that
every
family
gets
a
thousand
dollars.
L
The
contracted
providers
who
assess
those
families
and
work
with
those
families
to
provide
services
in
their
home
make
a
determination
as
to
whether
that
family
has
some
type
of
barrier,
whether
it's
a
needed
car
repair,
whether
it's
you
know,
assistance
with
that
month's
rent.
If
there's
some
significant
barrier,
those
funds
are
available.
Most
families
actually
do
not
utilize
those
funds,
but
for
the
families
that
that
do
the
difference
between
five
hundred
dollars
and
a
thousand
dollars
can
be
really
significant,
especially
if
you're
talking
about
something
like
a
car
repair.
L
And
then,
finally,
we
talked
a
little
bit
about
primary
and
secondary
prevention.
We
also
are
making
some
additional
investments
in
that
area.
In
addition
to
the
additional
state
appropriation,
we
also
have
additional
funding
under
the
community-based
child
abuse
prevention,
federal
funds
or
cbcap
that
cb
cap
money,
it's
a
very
small
pot
of
money,
and
it
is
limited
to
use
for
primary
and
secondary
prevention.
L
It
cannot
be
used
to
serve
families
who
are
already
have
children
in
the
child
welfare
system,
but
we
do
want
to
use
a
small
portion
of
that
money
and
combine
it
with
cbcap
funding
to
start
some
community
response
pilot.
So
you
may
be
aware
that
less
than
50
of
the
calls
that
come
into
our
agency
receive
any
type
of
action
or
intervention
from
our
agency,
they
don't
meet
the
statutory
criteria
for
us
to
do
anything
and
nothing
really
happens
with
those
families.
L
L
They
are
very
successful
in
keeping
those
families
from
becoming
child
welfare
involved,
and
we
also
want
to
increase
our
in-home
service
provision
under
community
collaborations.
For
children.
Ccc
is
available
in
all
parts
of
our
state.
It
is
community
based
and
it
is
also
its
secondary
prevention.
So
it
is
aimed
at
those
families
where
there's
some
type
of
risk
factor,
but
maltreatment
has
not
occurred
and
it
prevents
those
families
from
becoming
child
welfare
involved
at
a
later
date.
L
We
also
want
to
increase
the
client
assistance
funds
under
ccc,
for
the
same
reasons
that
I
just
mentioned
about
the
flex
funds.
There
is
a
lot
of
research
that
indicates
that
the
provision
of
a
small
amount
of
concrete
support
can
really
prevent
families
from
becoming
child
welfare
involved,
and
then,
finally,
we
have
created
a
prevention
collaborative.
A
Okay,
wow,
what
a
what
a
presentation?
Thank
you
I
I
know
that
we've
combined
a
lot
of
these
topics
into
into
one
talk,
and
so
we
do
have
some
questions
from
members.
I
I
have
a
question
about
slide
back
on
slide.
15..
A
You
talk
about
the
the
cost
of
the
prevention
versus
the
out
of
home
care,
expenditures
and
boy.
Those
are
drastic
increases,
and
so
I'm,
my
first
question
about
this
is:
are
those
first
numbers,
the
15
million
and
21
million
are
those
inclusive
of
both
out
of
care
expenditures
previously
and
residential
treatment.
And
then
you
know,
how
is
this?
Sustainable
is
the
second
part,
but
if
you
just
expound
upon
that
sure
so.
L
The
the
expenditures
that
are
included
in
the
blue
columns
and
the
prevention
services,
those
are
only
our
prevention
services
that
now
fall
under
family
first.
So
those
are
our
start
program,
our
k-step
program
and
our
family
preservation
program.
So
it's
all
of
those
programs
that
fall
under
family
first,
it
does
not
include
cb
cap.
That's
just
for
primary
and
secondary
prevention.
L
The
red
expenditures
are
all
of
our
out-of-home
care
costs,
so
those
are
payments
per
diems
to
our
dcbs
foster
homes,
our
private
agency
foster
homes
and
our
residential
facilities.
So
it's
all
of
our
actual.
It's
cost
for
care.
It's
not
including
our
the
cost
for
our
for
our
dcbs
staff.
It's
actual
expenditures
for
care
of
children
who
are
in
the
out
of
home
care
population.
L
A
And
so
are
these
it
says
2019
2020,
so
these
are
not
exclusive
to
family.
First
provisions,
no.
L
But
what
we
did
for
the
2019,
we
included
only
those
programs,
because
a
lot
of
those
programs
were
existing,
so
we
already
had
a
family
preservation
program.
We
already
had
a
start
program.
We
already
had
k-step
they
just
some
of
those
programs
were
not
utilizing
the
evidence-based
practices
that
are
now
included
under
our
five-year
prevention
plan,
but
we
only
compared
like
programs,
so
the
programs
that
now
fall
under
family
first
that
you
see
in
state
fiscal
year
2020.
A
Okay,
I
think
I
understand.
Okay,
I'm
gonna
go
ahead
and
move
on
to
some
of
our
members
who
have
questions
as
well.
Representative
raymond.
J
Thank
you.
I
think
this
is
from
misspell.
I
wanted
to
dig
into
neglect
a
little
bit.
I
really
was
hoping
that
you
would
tell
us
what
it
looks
like
in
a
lot
of
these
families.
We
hear
very
often
that
kentucky's
number
one
for
child
abuse,
and
some
of
us
may
even
use
that
statistic,
but
it's
my
understanding
that
neglect
is
built
in
there,
and
so
you
know
when
we're
comparing
states
is
it?
Is
it
apples
to
apples?
J
L
Sure
so
that
is
really
a
great
question,
and
the
answer
is
definitely
that
it's
not
apples
to
apples.
There
is
actually
no
way
to
compare
one
state
to
another
that
child
maltreatment
report
that
comes
out
at
the
federal
level
attempts
to
aggregate
data,
and
it
does
come
down
to
a
rate
of
substantiation
per
capita.
So
looking
at
you
know
the
relative
size
of
a
state
to
the
number
of
substantiations,
but
each
state
establishes
their
own
statutory
definitions
of
neglect,
their
own
acceptance
criteria.
L
So
what
meets
criteria
for
acceptance
for
investigation
or
acceptance
or
assessment
in
kentucky
and
what
then
results
in
a
substantiation
kentucky
is
entirely
different
from
every
other
state.
Each
state
is
unique,
so
there's
really
no
way
from
an
empirical
or
research
perspective
to
compare
states
and
rank
them
like
that.
Kentucky
does
have
the
highest
rate
of
substantiation
per
capita,
but
we
also
a
lot
of
national
consultants,
describe
us
as
having
very
wide
open
front
doors,
and
I'm
not
saying
that's
necessarily
a
bad
thing.
L
I
think
what
it
says
is
that
we
care
a
lot
about
how
children
are
treated
in
our
state,
and
so
the
things
like
educational
neglect
is
accepted
for
investigation
in
our
state
is
not
accepted.
In
many
other
states.
We
also
have
very
broad
mandatory
reporting
laws,
so,
for
example,
in
kentucky
it's
universal
mandatory
reporting,
everyone
is
a
mandated
reporter.
That
is
not
true
in
other
states
and
other
states.
It's
true
in
some
other
states,
it's
not
true
in
all
other
states
and
some
other
states.
L
Only
professionals
who
work
with
children
and
families
are
mandated
reporters,
and
so
it's
definitely
not
an
apples
to
apples
comparison.
The
other
part
of
your
question,
yes,
overwhelmingly
of
the
calls
that
do
meet
acceptance
criteria
for
us
and
that
result
in
a
substantiation
overwhelmingly
those
fall
into
the
neglect
category.
L
There
are
many
different
types
of
neglect,
so
we
have
neglect.
You
know
as
a
result
of
inadequate
supervision.
We
have
medical
neglect,
there's
environmental
neglect
if
the
child's
home
environment
is,
is
not
appropriate
or
doesn't
meet
their
needs,
but
the
very
the
smallest
categories
in
terms
of
substantiation
are
physical
abuse,
even
less
sexual
abuse,
and
then
the
last
category
that
we
don't
talk
about.
A
lot
is
emotional
injury.
So
in
that
order,
but
neglect
is
overwhelmingly
the
largest
category
of
substantiations.
B
Thank
you,
madam
chair,
and
thank
you
for
your
presentation,
mine's,
a
historical
question,
I'm
on
page
on
slide,
14
page
seven,
you
talked
about
the
new
category
of
in-home
care
being
with
relatives,
and
some
of
what
you
presented
seems
like
and
kind
of
common
sense
things
that
would
would
make
a
difference
which
are
making
a
difference.
B
L
I'm
not
I'm
not
sure,
I'm
not
sure
that
I
can
answer.
It
goes
back.
You
know
a
number
of
years
in
terms
of
our
practices,
but
it
was
certainly
a
practice
both
by
the
child
welfare
agency
and
by
the
courts,
that
it
was
very
commonplace
for
relatives
to
be
given
custody
of
those
children
directly,
and
many
relatives
still
choose
that
today.
I
think
the
difference
today
between
what
was
happening
prior
to
april
1st
of
2019
is
that
we
have
a
written
array
of
services
or
written
array
of
options
that
relatives
can
choose
from
that.
L
They
can
hold
in
their
hand
and
they
can
see
and
have
a
very
good
understanding
of
what
all
their
options
are
from
taking
temporary
custody
of
the
child
directly
to
becoming
approved
as
a
child,
specific
foster
home
becoming
approved
as
a
basic
foster
home,
and
they
understand
the
expectations
and
also
the
benefits
of
every
one
of
those
choices.
And
so
we
were
not
doing
that
well
prior
to
april
1st
of
2019.
E
Thank
you,
madam
chair,
and
two
questions.
If
I
may,
first
nice
presentation
did
a
great
job
kind
of
like
drinking
from
a
fire
hose,
but
I
appreciate
the
information
I
was
going
to
ask
you,
and
you
may
have
kind
of
answered
this
already
about
the
incident
rate
per
capita.
But
you've
already
said
that
we
can't
compare
ourselves
to
other
states,
because
the
reporting
requirements
are
entirely.
L
Yes-
and
that
is
a
great
that
I'm
glad
that
you
asked
that
question-
that
is
a
great
use
of
that
report
that
comes
out
from
the
federal
level
is
so
that
a
state,
assuming
that
there
aren't
haven't
been
significant
changes
in
statutory
definitions
of
abuse
and
neglect.
It
is
a
great
use
of
that
report
is
for
a
state
to
measure
itself
against
a
previous
year's
performance.
E
Another
reason
I
was
going
to
ask
that
question
is:
I
heard
the
number
9
300,
roughly
kids,
just
ain't
generally,
that
seemed
like
a
a
small
number,
so
I
was
wondering
about
our
capabilities
to
actually
identify
these
cases.
That's
not
a
question
just
just
an
observation.
I
just
thought
it
seemed
low
compared
to
kentucky's
historical
position
of
having
a
lot
of
poverty
and
that's
obviously
consistent
with
this
type
of
situation.
So
that's
something
that
may
we
need
some
further
information
on
the
future.
E
But
last
thing
I
have
is
on
slide
number
three:
the
child
care
funding
and
the
update
we've
got
293
million
designated
through
one-time
ccdf
funds
for
increasing
provider
payments,
improving
payment
policies,
increasing
wages,
building
supply
of
child
care,
which
I
think
is
all
great
and
certainly
needed,
but
I
am
curious.
Have
you
given
any
thought
to
what
happens
after
these
funds
are
no
longer
available?
How
are
we
going
to
sustain
that.
F
Yes,
that
was
one
of
the
first
questions
that
was
asked
by
many
of
us
at
the
state
level
whenever
the
funds
were
awarded,
so
there
are
going
to
be
some
projects
that
are
created.
That
will
sustain,
like
one
of
the
things
that
the
federal
government
is
wanting,
is
us
to
change
our
technology
and
data
collection
system
so
that
we
will
know
exactly
where
enrollment
is
across
the
state
things
like
that,
so
those
funds
will
be
developed
one.
F
You
know
they'll
be
used
for
a
one-time
project
and
then
be
sustainable
for
a
long
term,
and
there
are
several
projects
like
that:
start-up
grants
for
new
programs
and
child
care,
deserts
or
family
child
care
homes,
and-
and
we
won't
need
the
startup
funding
again
now
when
it
comes
to
subsidy
and
employee
wages.
Those
are
things
that
we
have
to
think
about
what
what
happens
long
term.
F
So,
as
some
subsidy
rates
go
up,
we
do
have
some
match
money,
that's
increasing.
Also.
We
were
very
grateful
that
we
received
additional
funds
from
the
state
government
this
year
for
an
increase
in
c-cap.
So
a
lot
of
these
projects
are
working
together.
Now
will
we
be
able
to
match
the
exact
same
rates
after
the
this
two
and
a
half
years
is
over?
I
doubt
that
we
will
have
an
influx
of
money.
That's
this
large.
E
I
appreciate
that
and
just
to
kind
of
summarize,
what
I
think
you
told
me
is
that
by
improving
for
one
of
a
better
term,
the
environment
of
kentucky
and
getting
more
families
back
to
where
they
need
to
be
children
back
in
the
homes
that
the
real
life
savings
of
that
can
be
used
to
sustain
these
increased
payments
for
services.
Is
that
fair.
F
That's
fair
and
then
some
of
those
projects
will
have
a
long-term
difference
that
don't
need
continued
funding
too,
and
you
know
with
our
data
with
new
startup
programs
and
areas
where
there
hasn't
been
access
to
child
care.
That
will
make
a
huge
difference
as
well.
B
Thank
you,
ladies
for
a
very
detailed
and
interesting
presentation.
I
don't
know
if
we
have
these
numbers
and
if
not
I'm
going
to
ask
you
if
you
can
perhaps
estimate,
but
when
we
talk
about
neglect
as
being
our
biggest
number
in
the
state,
do
you
all
have
a
sensor?
Do
we
have
the
data?
What
percentage
of
that
is
poverty
driven?
What
percent
of
that
is
substance,
abuse
driven
and
what
percentage
of
that
is
mental
health
care
in
the
in
the
caretakers
driven.
L
Yeah,
I
think
that
we
can
provide
some
data
around
the
categories
of
neglect.
L
It
is
hard
for
us
to
provide
hard
data
around
poverty
because
we
do
not
routinely
collect
household
income
information
when
we
do
a
child
welfare
assessment,
but
I
think
that
there
are
categories
of
neglect
that
you
can
certainly
see
the
link
to
poverty,
a
lot
of
times
with
a
supervisory
neglect
it
maybe
the
family
does
not
have
access
to
reliable
quality
child
care.
There
are
areas
of
our
state
where
there
are
child
care
deserts
that
we
still
do
not
have
licensed
and
certified
child
care
providers.
So
that's
a
real
challenge
for
families.
L
Environmental
neglect
very
often
is
because
of
poverty.
The
families
are
living
in
structurally
unsafe
dwellings,
for
example,
and
so
I
think
that
you
know
we
do
capture
information
in
the
narrative
of
our
assessments.
That
certainly
speaks
to
poverty
at
times,
but
that
is
again.
We
don't
capture
that
household
income
information
on
every
family,
for
which
we
provide
an
assessment.
So
it's
hard
to
provide
that
hard
data,
but
poverty
alone
is
not
neglect
and
that's
one
of
the
things
that
we
really
want
to
address.
L
We
do
so
substance.
Abuse
in
and
of
itself
is
not
a
category,
but
we
do
collect
information
about
whether
substance
abuse
was
a
case
characteristic.
So
we
are
noting
when
we
do
those
assessments,
whether
substance
abuse
was
present,
whether
it
was
a
factor
that
led
to
removal
of
the
child.
So
we
can
provide
data
on
that.
I
don't
know
the
data
off
the
top
of
my
head,
but
yes,
we
can
definitely
provide
that.
K
Thank
you,
ma'am
sharon.
Thank
you
all
for
your
presentation
just
really
quickly.
One
thing
of
interest
to
me
is
these:
high
fidelity
wrap
around
services
programs,
which
you
know
are
very
effective,
got
a
group
in
mount
sterling
gateway.
Children's
services
which
wants
to
get
into
this
field.
I'm
curious
about
the
costs
per
child.
On
that
I
know
they're
very
expensive,
but
I
know
that
it's
evidence-based
data
that
actually
works
once
you
implement
it.
So
I'm
curious.
If
you
could
comment
on
that
of
it.
K
You
know
if
I'm
looking
at
how
much
money
we're
receiving
if
we
have
roughly
9
300
kids,
that's
a
lot
of
money
per
child
and
if
we've
got
evidence-based
practices
that
work
if
we
applied
it
per
child,
that
would
be
enough
potentially
to
really
make
huge
impacts
in
those
children.
So
I'm
curious.
If
you
could
comment
on
you
know
what
that
entails,
how
much
money
that
would
be
roughly
per
child
when
you
get
those
programs,
if
it's
an
annual
cost,
it's
a
one-time,
cost,
etc.
L
K
And
again
it's
if
even
if
you
could
just
educate
the
committee
a
bit
on
what
those
kinds
of
things
entail,
I
mean
because
it's
I
mean
our
group
in
my
district-
are
talking
about
forty
thousand
dollars
or
something
per
per
child.
So
it's
not
cheap
either.
But
but
if
we've
got
about
by
my
calculations
about
ninety
two
thousand,
seven
hundred
and
thirty
one
dollars
we're
getting
we're
getting
assigned
here
for
those
ninety
three
hundred
for
each
child.
K
Ninety
three
hundred
kids,
we're
spreading
it
out
in
lots
of
different
methods,
but
you've
got
systems
that
are
proven.
That
can
work.
I
mean
you
could
really
put
a
lot
of
that
emphasis
in
there,
and
so
that's
why.
But
if
you
could
expound
as
to
what
that
would
cover
what
those
high
fidelity
services
are.
L
Sure,
and
so
the
high
fidelity
wrap
around
services.
It
really
very
often
works
in
conjunction
with
other
other
evidence-based
practices.
So
what
happens
a
lot
of
times
when
families
are
in
need
of
services
they
get
referred
to?
You
know
one
provider
for
one
type
of
service
to
another
provider
for
another
type
of
service.
What
high
fidelity
wraparound
does
is
it
puts
one
case
manager
in
charge
of
ensuring
that
a
family
has
access
to
every
service
that
they
need
and
ensures
that
those
services
are
occurring.
L
So
it's
really
it's
largely
based
on
case
management
services,
not
the
provision
of
a
specific
type
of
therapy,
as
some
of
our
other
evidence-based
practices
are
so
most
of
the
costs
for
a
high
fidelity
wrap
around
our
ins
are
in
staffing,
but
the
the
staff
who
are
qualified
to
provide
that
service
are
from
a
personnel
cost,
may
not
cost
as
much
as
some
of
the
staffing
that
is
required
to
provide
other
evidence-based
practices.
K
The
other
thing,
if
I
could
madam
chair
kinship
care,
which
obviously
has
always
been
a
topic
that
we've
seen
here
at
least
since
I've
been
in
the
general
assembly
many
of
us-
I
know-
support
that
idea.
That
concept
there's
always
a
huge
price
tag
on
it.
K
Have
any
funds
been
considered
to
at
least
to
expand
the
number
of
people
that
could
get
that
or
do
we
still
have
to
have
any
kind
of
renewed
price
tag
on
what
that
would
cost
for
us
as
a
general
assembly
per
year,
because
we
have
several
families
who
have
said?
Listen,
I've
already
done
I've
already
raised
my
kids,
I'm
your
grandparent.
K
You
know
I'd
love
to
raise
my
grand.
I
don't
have
any
funds
with
which
to
do
it.
If
you're
going
to
put
those
kids
into
a
foster
care
home,
you're
spending
the
money
there
anyway,
even
if
we
give
them
a
percentage
of
that,
they
could
probably
afford
to
do
that
and
keep
it
within
their
own
family.
So
I'm
curious
if
we
have
any
updated
numbers
and
what
that
would
cost
on
a
program
to
cover
a
lot
of
these
kids
within
that
that
setting.
L
So,
with
the
with
the
implementation
of
the
new
relative
service
array,
that
is
actually
one
of
the
things
that
the
information
that's
provided
to
relatives
in
the
very
beginning
in
terms
of
their
options
and
what
the
benefits
are
associated
with
those
options.
L
I
know
that
there
are
relatives
prior
to
the
implementation
of
that
new
relative
service
array
prior
to
2019,
that
fall
in
that
gap
between
the
old
kinship
care
and
when
the
new
relative
service
array
rolled
out-
and
I
I
don't
know
what
the
cost
would
be
to
provide
long-term
supports
to
those.
But
that
may
be
the
the
population
that
you're
asking
about.
K
It'd
be
helpful
to
have,
if
you
guys
could
provide
that
I
mean
ultimately,
we've
got
a
budget
cycle
coming
up,
there's
always
discussions,
always
priorities
and
that's
you
know.
Budget
ultimately
comes
about
priorities,
but
we're
planning
to
focus
on
kids.
That
might
be
something
that
we
might
have
an
opportunity
to
do
moving
forward,
so
I'd
be,
if
you
all
could
provide
us
updated
numbers
would
be
great.
Thank
you.
A
Yes,
sir,
and
and
in
that
line
of
thinking
before
I
forget
just
if
we
could
really
identify
what
sorts
of
barriers
there
are
to
getting
kids
into
relative
care
versus
into
foster
care,
I
think
that
would
be
helpful
as
well.
You
know
are
there
are
some?
Are
there
some
things
that
we
can
do
to
incentivize
relative
care
versus
out
of
home
placement
in
in
foster
care?
So
we
do
have
a
few
more
questions.
Representative
fleming.
D
Thank
you,
ma'am
terry
appreciate
it.
First
of
all,
ladies,
unlike
some
department
who's
come
before
committees,
I
have
most
comfort
in
your
handling
of
the
data
servicing
these
children
and
coming
up
with
some
answers
that
are
very
well
thought
out
and
the
way
you
handle
things
are
very
good.
So
I
want
to
compliment
you
on
on
your
job.
Well
done
and
getting
us
educated,
I'm
still
getting
myself
acclimated
to
all
this,
so
I
do
appreciate
all
the
information
to
provide
so
kudos
to
to
all
three
of
y'all.
Thank
you.
D
I
wanted
to
make
sure
the
numbers
that
you
threw
at
us
are
there
like,
like
I
think,
on
on
number
13
13
slide
13.
I
should
say
you
said
all
ffps
services
and
he
gave
some
stats.
Are
there
any
duplication
of
kids
and
families
being
being
served?
I
mean
no,
would
you
they
had
a
couple
programs?
Are
they
being
counted?
No.
These
are
all
unique
individuals.
Okay,.
L
Yes,
so
those
ffpsa
services
that
are
all
compiled
together
on
slide
13,
the
three
major
program
under
program
areas
under
ffpsa,
our
start
k-step
and
our
family
preservation
programs,
and
so
there
is
not
duplication.
So
if
a
family
is
being
served
under
k-step,
they
would
not
also
be
served
under
family
preservation.
They're
going
to
be
under
one
of
those
three
program
areas.
D
Okay,
the
other
question
I
have
when
it
comes
to
neglect
of
children.
Can
you
give
me
a
geographical
distribution
of
of
children
and
families
in
the
state?
L
That's
certainly
data
that
we
have.
I
can't
tell
you
sitting
here
today
that
I'm
aware
of
significant
differences
between
regions
in
terms
of
how
that
breaks
out
when
you
think
about
neglect
physical
abuse,
sexual
abuse
and
emotional
injury.
I'm
not
aware
sitting
here
today
of
significant
differences
by
region,
but
that
certainly
is
information
that
we
can
gather
together,
and
I
would.
C
D
Okay,
well,
thank
you
one.
Hopefully
one
last
quick
question,
madam
chair,
and
that
is,
you
gave
a,
I
guess,
a
sort
of
two
or
three
points.
One
of
the
points
you
made
was
you
don't
keep
track
of
or
have
a
good
handle
on
emotional
impact?
L
So
what
I
believe,
what
I
said
was
the
emotional
injury
is
one
yeah
emotional
injury
is
one
category
under
which
we
can
substantiate.
So
the
large
category
categories
are
neglect
which
is
broken
down
into
different
types
of
neglect:
physical
abuse,
sexual
abuse
and
emotional
injury.
So
emotional
injury
requires
the
statement
of
a
qualified
mental
health
professional
that
emotional
injury
has
occurred
to
a
child,
so
our
one
of
our
child
welfare
workers
on
their
own
could
not
draw
that
conclusion
and
substantiate
emotional
injury.
It
does
have
to
be
assessed
by
a
qualified
mental
health
professional.
L
B
Your
time
here
today,
out
of
your
schedules,
I'm
on
slide
14
talk
about
the
commitments
to
the
cabinet
and
there's
lies.
Damn
lies
and
statistics
all
across
everything,
but
we
seem
to
see
this
uptake
somewhere
around
february
of
2018
of
a
significant
increase
in
commitments.
L
L
Certainly
there
has
been
attention
to
the
opioid
epidemic
for
a
number
of
years
as
contributing
to
the
number
of
families
coming
to
the
attention
of
the
cabinet,
and
certainly
the
number
of
substantiations,
and
so
I
think
that
that
could
be
a
contributing
factor,
but
I
I'm
not
sure
that
there
is
one
or
two
things
that
would
that
we
would
be
able
to
say
is
a
clear
or
direct
cause
and
effect
on
that.
L
A
Okay,
thank
you
and
then
representative
weber,
for
you.
A
No
you're,
okay,
you're
good,
okay.
Well,
I
I
just
want
to
thank
you
for
this
excellent
presentation
and
for
all
of
your
work
on
implementing
family
first,
I
know
it's
no
small
undertaking
and
I
I
just
want
to
applaud
you
for
for
the
good
work.
You
know,
I'm
sure
that
questions
will
continue
to
arise
and-
and
we
appreciate
your
partnership
in
in
working
on
any
barriers
that
we
might
have,
okay
and
and
also
thanks
to
jenna
once
again
from
ncsl.
I
do
have
a
very
quick
question.
A
I
brought
this
up
in
a
previous
presentation,
but
we
have
residential
agencies
who
are
kind
of
waiting
in
the
wings
now,
with
family,
first
being
implemented,
they're,
not
exactly
sure
what
their
role
is
now
are.
A
There
has
any
thought
been
given
to
creating
partnerships
in
in
really
you
know
rolling
these
professionals
into
helping
implement
some
of
the
family
first,
because
you
know
it's
it's
not
as
though
they're
going
away,
nor
should
they
I
mean
we
may
need
them
again,
and-
and
I
just
I
want
to
make-
make
sure
that
we're
cognizant
of
of
that
issue.
L
Yes,
absolutely
and-
and
these
are
our
valued
partners
and
they're
very
important
to
the
services
that
we're
providing
to
not
just
our
children
and
our
out
of
home
care
population,
but
many
of
them
currently
have
also
a
continuum
of
services
under
their
umbrella
that
they're
also
providing
services
to
families
in
their
homes
and
you're,
going
to
hear
from
a
couple
of
those
later
on
the
agenda,
but
we
are
having
intentional
conversation
with
those
providers.
L
L
There
is
also
right
now
a
request
for
proposals
that
has
it
is
currently
posted
and
providers
have
been
made
aware
of
that
opportunity
to
provide
prevention
services
under
family
first
perfect.
A
A
D
Good
afternoon
everyone
chair,
moser
and
alvarado,
my
name
is
steve
vino.
I'm,
commissioner
of
the
department
of
income
support
cabinet
for
health
and
family
services,.
D
Fortunately,
chairman
ed
massey
sponsored
our
legislation
and
got
it
through
the
process,
and
we
have
the
new
law
now,
with
more
updated
numbers,
statistically
valid
and
I'll
just
go
through
some
of
the
updates.
Literally
we'll
talk
about
the
regulatory
implications,
so,
first
of
all
krs-403
to
11
9,
we
increased
the
extraordinary
medical
expenses.
D
You
know
it's
been
in
place
for
a
number
of
years,
so
that
made
sense
to
do
it.
Wasn't
a
federal
requirement,
just
common
sense
thing:
403
to
12,
2d
self-support
reserve
was
added
to
the
statute
and
it
was
considered
a
substance
census
needs
of
the
pay
or
parent
with
a
limited
ability
to
pay.
In
other
words,
you
know
when
you
order
child
support,
you
make
sure
that
the
individual
that's
paying.
The
support
has
the
ability
to
live
basically,
so
that
is
factored
into
the
guidelines.
D
403
212
updated
language,
defining
a
non-residential
custodian.
Basically,
as
a
parent
and
403
212
7
updated
the
guidelines
tables
the
table.
That
was
the
major
thing
we
did
in
the
legislation.
D
D
We
did
extend
the
gross
income
to
30
000
to
the
uppermost
reaches
of
the
chart
for
parents
that
have
a
combined
monthly
income
of
thirty
thousand
dollars
a
month.
Also,
there
was
a
a
new
section
created
under
403
shared
parenting
and
how
to
determine
obligation
of
each
parent
in
each
situation.
D
Chairman
massey
and
chairman
petry
and
a
number
of
judges
and
private
bar
had
interest
in
so
that
was
included
in
this
bill.
It's
a
delayed
implementation
chairman
massey
is
in
the
process
actually
of
gathering
stakeholder
feedback
and
plans
to
submit
changes
to
our
input
received
from
the
stakeholders
in
the
next
session
of
the
legislature.
D
So
very
I'm
sure
he'll
have
recommendations.
In
the
next
session.
406
31
retroactively,
applying
child
support
obligation
two
years
from
the
date
of
the
birth
originally
was
four
years
thinking
there
again.
This
wasn't
a
federal
requirement,
but
thinking
there
was
when
someone
is
found
is
found
to
be
the
father
of
the
child.
D
And
that
was
tempora
ordering
child
support
in
temporary
removal
situations.
In
other
words,
when
someone
is
removed,
child
is
removed
and
placed
with
a
caretaker.
D
The
court
is
required
to
order
temporary
child
support
in
those
situations
and
we'll
move
on
with
lilly.
J
J
J
D
And
our
last
slide
regarding
the
new
section
of
krs-403
regarding
the
shared
parenting
credit
again,
I
mentioned
we're
we'll
be
collaborating
with
chairman
massey.
We
have
some
input,
of
course,
he's
driving
the
meetings
and
we'll
seek
out
comment
from
the
stakeholders.
D
The
I
mentioned
the
delayed
start
date
regarding
the
month
of
applying
credit
due
to
each
parent,
so
he
wanted
to
hear
from
a
lot
of
the
stakeholders
regarding
that,
you
know,
there's
different
opinions
in
that
area,
depending
on
what
what
practice
you're
in
and
the
child
support
enforcement
program
is
actively
engaged
with
key
stakeholders.
We
lily
has
worked
with
a
number
of
the
county
attorneys
on
their
issues.
A
Okay,
thank
you
so
much.
This
was
helpful.
I
appreciate
the
update
and
we
have
a
question
from
senator
alvarado.
K
I
do
thank
you,
madam
chair,
can
you
guys
give
me
an
idea
about
how
much
money
is
currently
in
child
arrearages
right
now?
As
far
as
throughout
the
state
I
mean,
I
I've
been
told,
it's
a
huge
amount
of
money.
I've
been
told
jefferson
counties,
80
million
dollars
alone.
So
I'm
curious
what
we
are
looking
at
as
far
as
statewide
and
our
rear
edges
on
child
support.
D
We
don't
we,
I
don't
have
that
information
available,
but
I
can
get
it
for
you,
but
let
me
kind
of
clarify
what
encompasses
that
amount.
So
we
don't
handle
the
child
support
case
from
birth
onward.
So
a
lot
of
times
when
people
apply
for
our
services,
there
is
alway
already
a
substantial
or
rare
edge
due.
D
So
when
that
person
comes
to
us
and
becomes
one
of
our
child
support
cases,
they
could
have
a
twenty
five
thousand
dollar
arrearage
and
then
that
incorporates
into
our
total
marriages
uncollected,
but
it
doesn't
necessarily
mean
we
weren't
able
to
collect
it.
It
is.
It
is
a
substantial
problem,
though,
and
of
uncollected
or
marriage
across
the
commonwealth,
but
we'll
be
happy
to
get
you
some
detailed
information.
K
I
mean,
I
would
think
if
you
know
that's
kind
of
that's
your
role
right
to
find
out
how
much
money
there
is.
I'm
surprised
you
don't
have
that
data
at
the
top
of
your
head
is
how
much
money
is
being
owed
in
that,
but
if
it's
80
million
dollars
for
one
county,
I
don't
know
jefferson's
large
that
it's
going
to
be
hundreds
of
millions
of
dollars
and
that's
that's.
What
happens
is
when
that
doesn't
get
paid.
K
Then
those
children
have
to
come
to
the
state
for
support
and
it
adds
all
those
issues
and
we've
got
an
administration,
that's
been
pushing
to
say,
let's
get
people
who
aren't
paying
that
those
funds,
let's
give
them
snap
benefits
and
give
them
other
kind
of
public
assistance,
and
they
have
a
responsibility
to
pay
for
those
things.
So
we,
I
think
you
need
to
know
those
numbers
at
the
top
of
your
head
as
a
commissioner
to
find
out
how
much
money
is
being
owed
in
that.
K
If
it's
80
million
for
one
county,
I
can
imagine
what
it's
like
and
that
just
puts
more
of
a
burden
on
the
system
for
others
who
may
need
those
supports,
because
then
those
kids
don't
have
any
any
way
of
having
any
help
and
they
come
to
the
state
for
that.
So
I
would
encourage
you
to
get
those
numbers
have
it
off
the
top
of
your
head.
K
If
you
come
before
our
committee
to
kind
of
know
what
those
numbers
are,
because
I
know
it's
astonishing,
but
that's
what
I've
been
told
is
80
million
for
one
county.
That's
got
to
mean
the
rest
of
the
state's
going
to
be
over
200
million
dollars,
and
I
think
we
need
to
know
that
because
it
puts
quite
a
burden
on
other
support
services
for
us
in
the
state.
D
And
keep
in
mind
the
the
arrearage
that
we
capture
is
from
from
whenever
the
case
comes
into
our
system
to
when
it
leaves
ours,
it
continues
to
accrue
when,
even
though
they're
they
turn
18,
we
still
keep
those
arrearages
in
our
system
even
after
they
emancipate.
A
Okay,
see
no
further
questions.
Thank
you
for
your
presentation.
I
do
hope
that
the
a
rear
edge
issue
is
is
part
of
the
conversation
with
chairman
massey.
I
know
that
he's
he's
very
in
tune
to
these
issues
and
is
pretty
creative.
Maybe
we
can
look
at
ways
to
to
give
more
support
to
our
county
attorneys,
who
are
tasked
with
collecting
this.
The
the
child
support,
so
look
forward
to
hearing
more,
but
thank
you
very
much
for
your
update.
A
Next,
we
have
some
folks
here
to
talk
about
the
most
multi-systemic
therapy
pilot
programs,
and
I
see
my
friends
from
the
children's
home
of
northern
kentucky
and
I
think
we
have
some
folks
here
also
from
home
of
the
innocent.
So
if
everyone
wants
to
make
your
way
to
the
table-
and
you
can
figure
out
how
you
want
to
sit
and
introduce
yourselves
for
the
record-
and
I
look
forward
to
hearing
your
your.
A
I
Good
afternoon
I'm
paul
robinson,
I'm
the
president
and
ceo
at
home
of
the
innocence.
Thank
you
very
much
for
the
opportunity
to
speak
to
you
this
afternoon
about
multi-systemic
therapy,
we'll
just
refer
to
it
as
mst.
To
keep
this
even
more
brief
for
those
of
you
that
are
not
familiar
with
home
of
the
innocence.
We
are
141
year
old
organization
that
is
committed
to
taking
care
of
the
children
and
families
of
our
commonwealth.
I
We
operate
the
state's
only
skilled
nursing
facility
for
medically
complex
children,
and
we
are
one
of
the
largest
providers
of
congregate
residential
treatment
care
in
the
state.
As
you've
heard
in
the
previous
presentations,
we
are
certified
as
a
qrtp
and
beyond
the
those
two
items
I
just
mentioned.
We
also
operate
a
large
array
of
mental
health,
behavioral
health
services
that
are
rendered
in
homes
in
the
community
and
really
are
beginning
to
expand
to
provide
more
and
more
preventative
services.
I
This
came
really
at
a
wonderful
time
because
in
2018,
as
you
heard
at
the
federal
level,
family
first
prevention
services
act
was
passed
and
at
that
exact
same
time,
our
board
of
directors
was
very
interested
in
getting
into
preventative
services
because
we
really
aspire
one
day
to
not
exist.
We
would
love
to
be
at
a
point
where
no
child
comes
into
congregaire
and
there's
no
need
for
our
services.
I
That
may
sound
odd,
but
we
really
truly
want
to
help
keep
children
with
their
families.
So
in
2018
we
began
working
with
the
department
of
community-based
services
and
with
mst
to
begin
having
discussions
about
how
could
we
bring
mst
to
the
state
and
how
could
that
fit
into
the
state's
plan
to
expand
preventative
services?
I
At
that
time,
no
one
in
the
state
was
licensed
to
provide
mst.
So
we
were
really
the
first
that
were
really
working
to
champion
that
and
the
reason
that
we
selected
mst
is
because
it
had
incredible
outcomes
also
because
it
was
well
supported
on
the
california.
Clearinghouse
you've
heard
a
little
bit
about
that
in
the
previous
presentations.
I
I
recognize
that
because
we
knew
when
we
made
the
decision
to
get
into
mst,
there
was
a
500
000
price
tag
associated
with
that
that
most
non-profits
are
not
in
a
position
to
be
able
to
weather.
We
are
very
fortunate
that
we
had
large
grant
funding
from
several
private
grant.
Funders
that
really
provided
us
an
incredible
opportunity
to
jump
into
the
service
array,
to
pilot
this
for
the
state
and
to
help
find
a
way
to
bring
this
to
kentucky.
G
My
name
is
lydia
bell,
I'm
the
chief
strategy
officer
at
home
of
the
innocence,
and
I
want
to
talk
to
you
today
a
little
bit
about
our
experience,
starting
the
implementation
of
mst.
We
were
able
to
well.
First
of
all,
let
me
let
me
start
talking
about
what
the
model
is.
The
model
empowers
families
and
youth
by
working
intensively
to
teach
them
skills
and
change
behaviors.
G
G
Theoretically,
365
days
a
year,
though,
the
treatment
doesn't
last
that
long
where
our
therapists
are
actually
working
with
the
families
and
the
children
in
the
very
ecologies
they
need
to
be
worked
within
because
of
the
intensity
of
the
program.
Mst
can
reduce
delinquent
behaviors,
it
can
change
anti-social
behaviors
and
it
does
so
by
viewing
clients
as
parts
of
a
larger
system,
families
and
children.
Don't
act
in
a
vacuum.
Kids
go
to
school
parents
do
or
do
not
go
to
work.
G
There's
churches,
there's
community,
there's
peer
groups,
so
all
of
those
things
are
factored
into
the
way.
The
mst
model
is
worked,
caseloads
are
kept
very
small
due
to
the
intensity
of
the
cases,
so
each
therapist
will
work
with
somewhere
between,
say
three
and
six
families.
The
typical
caseload
is
about
five
families.
You'll,
usually
only
see
the
sixth
coming
on
as
a
family
is
being
discharged
out
of
the
program
and
they're
ready
to
bring
a
new
one
in
oversight.
Well,
the
ideal
case
length
by
the
way
is
three
to
five
months.
G
G
G
G
They
may
also
be
transitioning
back
home
from
either
a
djj
placement
or
dcbs
placement,
so
a
child
coming
out
of
congregate
care
who's
going
back
home
to
a
parent.
This
may
be
a
perfect
way
to
get
them
back
into
the
home
and
have
them
stay
there
again,
because
it
works
with
the
entire
ecology
of
the
child,
including
the
parents.
G
There
is
the
model
does
allow
for
children
in
foster
care
where
the
foster
parents
are
are
interested
in
doing
multi-systemic
therapy
to
have
that
happen,
while
the
child
is
in
placement.
However,
currently
due
to
ffpsa
and
dcbs,
we
cannot
put
children
who
are
in
paid
placements
into
mst
at
this
time.
G
Another
exclusion
or
another
criteria
for
being
a
part
of
the
program
is
that
less
intensive
treatments
have
been
ineffective
for
children
who
cannot
be
served
by.
We
do
have
exclusion
criteria.
There
are
some
children
for
whom
mst
will
not
work.
Kids
cannot
be
served
by
mst
if
homicidal,
suicidal
or
psychotic
events
are
the
major
thing.
Unless
those
crises
have
been
averted
and
abated,
youth
who
live
independently
cannot
be
served.
They
must
be
living
at
home
with
a
family.
G
Sexually
reactive
youth,
where
the
sexual,
the
in
the
absence
of
other
delinquent
behavior,
so
if
sexual
reactive
is
the
only
thing
going
on,
they
would
be
excluded
from
the
program
youth,
whose
issues
stem
from
disorders,
like
developmental
disorders
like
moderate,
to
severe
autism
spectrum
disorder
or
youth
for
whom
intellectual
disabilities
are
the
primary
causes
of
problems.
There
is
an
ability
to
learn
and
engage
in
the
material
that
has
to
happen.
G
G
Our
therapists
are
the
experts
in
behaviors,
so
we
don't
give
up
on
families
that
is
not
an
option
in
mst
and
part
of
what
becomes
really
crucial
for
the
mst
teams
is
that
they
are
creative
and
they
are
working
on
how
to
engage
those
families
throughout
the
entire
process.
And
if
you
can
think
about
an
intensive
three
to
six
month
process
of
having
to
reach
out
to
your
therapist
multiple
times
a
week,
it
becomes
crucial
that
the
therapist
be
really
good
at
keeping
the
families
engaged.
G
So
our
therapists
become
really
good
at
doing
that
really
quickly
and
I'll
show
you
a
slide
in
just
a
moment
that
can
show
that
we
know
that
parents
want
what's
best
for
their
children,
regardless
of
the
situation.
We
also
believe
that
families
and
communities
need
to
be
seen
as
partners
and
trying
to
keep
these
families
together.
We
always
joke
about.
It
takes
a
village
we
joke
about
that
at
the
home,
because
we
built
a
village.
If
you've
ever
visited
our
campus,
you
would
you
could
see
that,
but
it
is
true
that
you
cannot
ask.
G
You
cannot
take
a
child
out
of
a
situation,
work
on
the
child
and
put
them
back
in
that
situation
and
expect
that
things
are
going
to
change
so
mst
again.
Multi-Systemic
therapy
really
looks
at
those
large
system
changes
that
incorporate
the
family,
the
community,
the
child,
so
we
might
be,
our
therapist
might
be
with
the
football
coach
teaching
the
football
coach
how
to
have
a
more
positive
influence
over
the
kids
that
he's
coaching.
They
might
be
with
teachers
talking
about
how
to
engage
the
parents
in
this
family
to
ensure
that
the
child
is
inspired.
G
G
Changes
can
occur
quickly
when
you
engage
the
family
in
these
in
multi-systemic
therapy
and
they
engage
in
the
work
and
they
do
the
work.
Four
months
is
really
doable
to
make
these
changes
happen
and
to
make
them
stick
in
the
previous
slide.
We
showed
a
lot
of
the
outcomes
that
come
from
mst.
They
can
show
over
a
period
of
months
or
years
post-discharge
from
the
program.
G
We
also
believe
that
science
and
research
can
provide
valuable
guidance
on
how
to
move
forward
evidence-based
practices.
These
practices
work,
and
so
we
continue
to
stick
with
things
that
do
work.
The
nice
thing
about
multi-systemic
therapy.
If
trauma-focused
cognitive-based
therapy
isn't
working,
maybe
we
can
try
motivational
interviewing.
Those
are
both
two
evidence-based
practices
that
can
be
incorporated
into
the
mst
model.
G
G
G
G
Lack
of
engagement,
no
matter
what
our
therapist
tried.
They
could
not
keep
the
family
engaged
or
because
of
an
early
placement
which
made
them
no
longer
eligible
for
the
program.
I
will
tell
you
out
of
those
37
kids.
We
only
had
two
kids
who
ended
up
going
on
to
a
placement,
so
you
should
look
at
these
37
kids,
as
37
potential
could
have
been
in
out
of
home
placement
in
a
congregate
care
setting
through
the
state,
but
instead
have
been
in
mst.
G
You
can
see
in
that
first
quarter.
We
had
in
the
first
quarter
of
data.
It
takes
a
while
to
get
the
team
going.
You
have
to
hire
the
team.
You've
got
to
train
the
team,
so
we
were
really
only
able
to
onboard
one
client
in
that
first
quarter.
We
hit
some
pretty
good
targets
there,
our
average
length
of
stay.
We
try
to
keep
that
average
length
of
stay
between
100
and
120..
G
We
did
have
to
discharge
this
child
for
lack
of
engagement.
Those
two
outcomes
are
red
because
we
did
not
meet
the
targets
on
those.
You
can
see
that
in
the
second
and
third
quarters,
the
second
quarter,
we're
kind
of
wobbly
there
we're
starting
to
see
more
yellow
in
the
third
quarter,
but
by
the
fourth
quarter,
we're
really
starting
to
hit
a
stride.
There
are
a
couple
things
that
that
reflects
one.
It
starts
to
reflect.
G
You
will
also
see
that
every
one
of
those
targets
that
we
look
for
for
the
clients
were
hit
in
that
fourth
quarter.
It
takes
a
long
time
to
get
that
momentum
going
in
mst.
It
is
an
extremely
difficult
model.
It's
very
team
based
again,
the
team
has
to
be
available
to
the
client
24
hours
a
day,
seven
days
a
week,
so
some
of
the
lessons
that
we've
learned
number
one.
It
takes
a
long
time
for
the
team
to
hit
that
stride.
Staffing
is
an
issue.
G
It
is
not
the
kind
of
model
that
every
therapist
in
the
world
wants
to
go
out
there
and
do
because
it's
the
24
7
intensity.
It
takes
a
special
type
of
person
who
really
wants
to
do
that
work.
It
takes
someone
willing
to
engage
and
do
whatever
it
takes
to
get
the
family
to
stay.
Successful
in
the
model
turnover
can
be
a
huge
issue.
What
you
see
in
these
numbers
reflects
two
team
members
that
we
had
that
we
lost
in
the
middle
of
our
first
year.
G
We
are
very
stabilized
right
now,
but
at
that
time
we
had
a
lot
of
turnover
happening.
We
had
to
let
go
of
a
supervisor,
and
then
we
also
had
another
therapist
who
left
we
have
since
replaced
the
supervisor
and
have
an
amazing
supervisor.
Another
interesting
thing
about
mst
when
you
do
hiring
for
mst.
It's
not
just
your
own
hr
department.
You
have
to
work
with
the
mst
institute
to
hire
people.
They
put
them
through
role,
play,
there's
a
four
interview
process
that
has
to
be
done
with
mst.
G
It
can
take
two
months
from
the
time
the
application
is
is
placed
until
you
hire
someone
and
then
there's
a
lot
of
intensive
training
that
comes
on
after
that.
As
an
example,
we
hired
a
new
therapist
in
june
of
this
year.
She
will
be
ready
to
see
clients
at
the
first
week
of
august.
It's
taken
her
that
long
to
get
ready
and
get
on
boarded,
then
let
the
other
lesson
we've
learned
is
that
our
therapists
really
need
to
be
creative
to
keep
these
families
engaged.
G
I
So
as
we
wrap
up
our
portion
of
this,
it's
also
important
to
note
that,
because
of
the
intensive
nature
of
the
care
that
is
being
provided,
msd
does
limit
us
to
a
90-mile
driving
radius
around
where
we
are
operating
so
for
us.
We
are
domiciled
in
louisville,
so
beyond
jefferson
county
on
the
slide.
Here
you
see
the
18
counties
that
we
are
currently
equipped
to
be
able
to
serve.
I
This
does
not
preclude
other
providers
from
getting
in
and
being
able
to
provide
mst.
It
is
actually
the
hope
that
more
providers
will
come
on
board
and
more
people
inside
of
these
counties
will
be
served.
We
do
hope
to
expand
from
our
current
first
team
to
a
second
team
this
year
on
our
way
to
a
third
team.
The
third
team
is
slated
to
hopefully
be
out
of
our
hardin
county
office
that
is
located
in
elizabethtown,
which
further
expands
our
ability
to
reach
additional
counties
as
well.
M
Thank
you
so
much.
I'm
crystal
lawyers,
I'm
chief
programming
officer
at
children's
home
of
northern
kentucky,
I'm
so
grateful
for
the
presentation
it
was
so
incredibly
informative
and,
as
mentioned,
chnk
is
going
to
be
relatively
new
to
multi-systemic
therapy,
but
what
we're
not
new
to
is
prevention
services.
So
in
2019
we
initiated
a
contract
for
the
provision
of
family
preservation
program
through
that
we
were
able
to
provide
a
number
of
evidence-based
practices,
one
of
which
is
functional.
Family
therapy
we've
served
141
families.
M
So
a
number
of
clients
who
have
been
served
through
that
functional
family
therapy
is
a
slightly
less
intensive
model
than
multi-systemic
therapy,
and
so,
as
we
were
evaluating
the
needs
of
the
region,
we
felt
like
it
was
really
important
in
our
desire
to
have
a
full
continuum
of
care
to
have
a
slightly
more
intensive
model
than
functional
family
therapy,
but
to
prevent
out
of
home
care
and
also
juvenile
justice.
Involvement
for
the
families
that
we're
serving
so
functional
family
therapy
is
specifically
targeting
families
with
children
with
slightly
lesser
crimes.
M
As
mentioned
by
home,
of
the
innocence
multi-systemic
therapy
there
might
be
a
number
of
more
serious
offenses.
Also,
when
we're
looking
at
a
family
or
a
child
who's,
particularly
oppositional,
there's
a
lot
of
defiance
and
resistance
in
the
system,
sometimes
that
child
ends
up
in
residential
care
because
of
engagement
concerns.
But
multi-systemic
therapy
is
a
really
great
antidote
to
that
in
the
prevention
of
residential
or
juvenile
justice
involvement.
M
So
we've
submitted
a
request
for
a
pilot
program.
We've
actually
just
started
meeting
with
our
mst
expert,
which
has
really
been
a
great
learning
opportunity.
We're
currently
recruiting
for
that,
but
feel
like
it's
really
going
to
be
a
nice
natural
extension
of
our
existing
continuum
of
care
like
home,
of
the
innocence,
we're
also
qrtp
certified.
So
mst
is
going
to
be
one
step
down
from
our
qrtp
and
one
step
up
from
our
family
preservation
program
and
really
important.
A
Okay,
well,
rick
did
you
want
to
say
anything
or
introduce
yourself
for
the
record,
maybe
since
you're
sitting
at
the
table,
it's
great
to
see
you
thank
you
for
coming
down.
E
I
think
you,
you
see
the
theme
here
right
since
the
1800s
children's
home
of
northern
kentucky
has
been
serving
some
of
kentucky's
most
vulnerable
youth
and
families,
and
we
have
to
do
that
in
different
ways
in
the
1800s
kentucky
needed
us
to
be
an
orphanage,
and
we
did
that
work
and
in
the
1980s
we
switched
gears
and
we
started
taking
care
of
kids
who
were
in
out
of
home
care
who
were
in
custody
of
the
state
and
over
the
last
few
years,
similar
to
what
paul
has
been
describing.
E
It's
the
the
whole
secret
to
success.
If
we're
really
going
to
be
serious
about
ending
child
abuse
and
child
neglect
in
kentucky,
we
have
to
move
these
services
upstream
and
so
starting
around
2014
2015.
We
really
spent
a
lot
of
time
and
energy
and
money
investing
in
these
outpatient
services
and
in
fact,
our
outpatient
services
at
children's
home
of
northern
kentucky
had
actually
outpaced
our
residential
services.
E
But
one
of
the
major
obstacles
I
see
that
one
of
your
agenda
items
was
to
talk
about
the
impact
of
covet
19
when
our
school
partners,
which
constitute
our
largest
referral
partners
in
northern
kentucky,
when
in-person
instruction
ceased
the
number
of
kids
that
we
were
seeing
dried
up.
It
really
presented
some
major
opportunities
to
be
creative
and
to
be
relevant.
E
Fortunately,
we
had
a
donor
who
provided
around
five
hundred
thousand
dollars
for
us
to
grow
our
computer
hardware,
our
computer
software
platforms,
and
we
have
been
able
to
offer
over
six
thousand
unique
telehealth
services
in
our
outpatient
arena.
So
I
think
the
theme
here
is
how
do
we
continue
to
be
relevant
as
children's
homes
and
that
relevancy
right
now
is
causing
us
to
pay
attention
to
expansion
of
family
preservation,
programming
and
now
the
launch
of
multi-systemic
therapy.
A
A
Excuse
me
what
great
work
you
both
do
and
it
is
important
that
we
continue
to
hear
about
how
you
are
working
to
remain
relevant
and
really
reach
those
families
and
reach
the
kids
where
they
are
and
and
really
address
what
they
need.
So
thank
you
for
what
you're
doing.
Thank
you
for
being
involved
in
the
pilots.
It's
great
to
it's
always
great,
to
hear
an
update
on
on
some
of
the
newer
programming,
and
this
makes
complete
sense.
I
I
really
applaud
your
work.
A
I
don't
know
that
we
have
any
questions
from
the
committee.
I
know
that
we've
got
a
couple
of
other
committees
going
on
simultaneously
so,
but
I
sure
appreciate
your
being
here
and
all
of
your
great
work
and
I
look
forward
to
continuing
the
conversation.
Thank
you.
A
All
right
having
no
further
business,
I
will
thank
you.
We
have
a
motion
to
adjourn.
Oh
the
next
meeting,
I
guess
I
should
say,
is
at
the
kentucky
state
fair
in
louisville
on
thursday
august
29th
or
26th.
Excuse
me
it
is
at
8
30
in
the
morning.
A
I
know
that's
super
early,
but
we
we
want
everyone
to
be
able
to
take
advantage
of
the
country,
hand
breakfast.
I
guess
that
morning
and
and
then
come
over
and
talk
about
health
and
welfare.
So
thanks
very
much
everyone
for
being
here
being
here
and
we
will
see
you
august.
A
C
B
B
B
B
B
I
mean
I
was,
I
was
the
only
family
member
who
was
allowed
to
supervise
hesitation.
Are
you
saying,
oh
my
god?
First
of
all,
I
drive
past
it
on
my
way
home
from
hospital
every
day.
Second
of
all,
I've
been
there
a
million
times.
Third
of
all,
I
give
you
all
money,
but
I
just
want
you
all
to
know
you
saved
my.