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A
Okay,
good
morning
welcome
to
meeting
number
two.
The
house
budget
review
subcommittee
on
Health
and
Family
Services
chairman
Bentley,
is
on
his
way
back
he's
stuck
in
some
traffic,
so
I'll
be
taking
I.
Guess
the
gavel
this
morning
until
he
gets
here.
The
meeting
materials
were
put
online
earlier
this
week
and
made
available
for
downloading.
A
A
Thank
you
minutes
are
approved
all
right
to
start
this
morning's
meeting,
we're
going
to
have
a
couple
of
presentations
regarding
Home
and
community-based
Services
waiver
program.
First
up
are
Pam
Smith
and
Leslie
Hoffman
with
the
department
for
Medicaid
services.
They
will
give
us
an
update
on
the
number
of
waiver
slots
and
waiting
list.
C
C
So
the
first
slide
you'll
see
this
is
busy,
so
I'll
just
go
through,
go
through
it
slowly,
so
we
currently
have
six
1915c
home
and
community-based
waivers,
and
this
is
the
enrollment.
As
you
can
see,
we
have
the
acquired
brain
injury,
acute
waiver,
the
brain
injury,
long-term
care
waiver,
the
home
and
community-based
waiver,
which
was
our
original
and
why
the
name
is
the
same
as
the
overarching.
We
have
the
model
waiver
2,
the
Michelle
P
waiver,
and
then
we
have
the
supports
for
Community
Living
waiver.
C
C
C
C
Does
the
waiver
have
a
waiting
list,
as
you
can
see
both
of
the
acquired
brain
injury
waivers,
do
not
have
waiting
lists
the
home
and
community-based
waiver
as
well
as
model
2
also
do
not
have
a
waiting
list,
our
Michelle
P
waiver
and
our
supports
for
Community
Living
waiver,
however,
do
have
waiting
list.
Please
note
I
wanted
you
to
know
that
a
50
slots
will
be
eligible
or
will
be
allocated
for
the
Michelle
P
waiver
and
for
the
supports
Community
Living
waiver
fiscal
year
23
and
in
fiscal
year
24.
upon
CMS
approval.
C
So
let's
talk
a
little
bit
about
allocation.
The
center
for
Medicare
and
Medicaid
services.
Cms
requires
waiver
slots
to
be
unduplicated,
and
a
lot
of
folks
ask
about
that.
So
I
wanted
to
share
that
with
you.
Today,
CMS
defines
an
unduplicated
waiver
participant
as
a
unique
individual
who
participates
in
the
waiver
during
the
waiver
year,
regardless
of
when
the
individual
entered
the
waiver
and
the
length
of
stay
on
the
waiver,
a
person
who
enters
exits
or
re-enters
the
waiver
during
a
waiver
year
counts
as
one
unduplicated
waiver
member.
C
So
in
essence,
if
a
member
uses
a
slot
one
15-minute
increment
one
15-minute
increment,
then
that
is
their
slot
for
the
entire
waiver
year.
Think
of
the
participant
as
the
owner
of
the
waiver
slot
if
they
leave
the
waiver
for
any
reason
they
still
on
that
slot,
the
waiver
slot
until
the
end
of
the
year
is
over
and
that's
the
way
we're
year.
The
empty
slot
cannot
be
given
to
anyone
else.
C
This
is
unfortunate,
but
this
is
what
CMS
asks
us
to
do
if
the
participant
is
actually
actively
receiving
Services
when
the
waiver
year
ends,
they
become
the
owner
of
that
slot.
So,
unfortunately,
within
the
waiver
year
say,
if
a
waiver
started
year
starts
July
1,
let's
just
say,
July
1
and
on
July
the
5th
they
leave.
We
cannot
reallocate
that
slot
for
over
300
days
to
another
member
until
the
new
waivers
to
the
new
waiver
year.
C
Currently,
the
1915c
HCBS
wait
list
are
for
these
two
Michelle
P
and
scl.
We
have
a
total
of
8021
on
the
Michelle
P
waiting
list
for
your
knowledge
we
have
under
age.
21
is
5547.,
so
that's
just
to
let
you
know
out
of
the
8
000
5547,
our
children,
the
Michelle
P
waiver.
Applicants
are
placed
on
the
waiting
list
in
order
when
the
application
is
received
on
the
scl
waiting
list.
We
have
three
levels
or
categories:
that's
I
think
it's
how
they
we
Define
it.
C
So
we
have
the
emergency,
which
we
have
zero
urgent
and
in
mind
in
mind
process.
That's
about
one
to
three
years,
I'm
going
to
need
services
in
one
to
three
years
and
future
planning,
which
is
five
or
more
SEO.
Applicants
are
placed
on
the
waiting
list
based
on
their
category
of
need.
Once
that
category
is
determined,
applicants
are
placed
with
a
category
on
a
first
come
first
serve
basis.
D
So,
as
Leslie
just
went
over,
you
and
I
can
see
about
70
percent
of
the
children
are
the
individuals
on
the
Michelle.
P
waiting
list
are
children,
so
the
cabinet
Medicaid
has
taken
on
a
children's
waiver
feasibility
study.
So
again,
this
is
just
a
study
at
this
point
to
research
and
consider
what
supports
and
funding
is
necessary
for
children
in
the
Target
Group,
which
I'll
go
over
that
in
just
a
second,
it's
being
led
by
our
Consultant
Group
guide
house.
The
study
has
just
began.
We
are
researching
states
that
serve
children.
D
Looking
at
the
programs,
they
have
that
serve
children,
the
services
they
offer.
We
also
have
a
stakeholder
Advisory
Group
that
is
comprised
of
cabinet
staff
from
Medicaid,
the
Department
of
Behavioral
Health
and
intellectual
disabilities,
the
department
for
aging
and
independent
living
the
department
for
community-based
services,
as
well
as
parents,
Advocates
provider
groups,
the
Kentucky
mental
health
Coalition,
and
we
also
have
a
couple
of
teenage
children
that
their
parents
are
participating,
so
they
also
have
set
in
on
that
first
meeting
and
were
able
to
participate.
D
So
we
know
that
children
with
severe
emotional
disabilities
are
in
hospitals
and
unable
to
be
served
at
home
and
that
there
are
currently
many
children
with
intellectual
disabilities
and
related
conditions,
including
children,
with
autism
spectrum
disorder
on
existing
waivers
or
on
on
a
waiting
list.
The
existing
waivers
today
are
focused
on
an
adult
population,
not
necessarily
the
distinct
needs
of
children
and
program
designs
need
to
reflect
the
needs
of
a
pediatric
population.
D
So
what
what
was
must
we
do?
We
need
to
create
Pathways
to
modernize
by
looking
at
what
are
the
services
they
need.
What
is
necessary
to
have
the
child
remain
in
home
in
the
least
restrictive
setting,
but
still
get
their
clinical
needs
met
by
best
practice
Services.
We
need
to
look
at
our
provider,
Network
determine
what
their
capacity
is
and
their
Readiness
to
serve
children.
What
additional
training
will
they
need?
What
additional
Pride
Riders
are
we
going
to
need?
We
have
to
look
at
that
cost.
D
So
to
talk
about
a
little
bit
about
the
groups
that
we
included
so
severe
emotional
disability,
we're
looking
at
any
clinical,
significant
disorder
of
thought,
mood,
perception,
orientation,
memory
or
behavior.
That
is
listed
in
the
current
edition
of
the
American
Psychiatric
association's
Diagnostic
and
statistical
Manual
of
disorders.
That
is
a
mouthful
we're
also
looking
at
conditions
related
to
intellectual
disabilities.
So
these
are
our
children
who
require
physical
or
Environmental,
Management
or
habilitation.
They
require
planned
program
of
active
treatment,
they
require
protected
environment
and
they
have
substantial
deficits
in
adaptive
functioning
with
ongoing
sport.
D
That
would
limit
them
in
one
or
more
activity
of
daily
living.
So
think
of
this,
a
lot
of
these
are
children
that
have
cerebral
palsy
or
that
may
have
epilepsy
or
another
seizure
disorder
and
then,
lastly,
our
Autism
Spectrum
Disorder,
so
a
developmental
disability
that
can
cause
significant
social
community
education
and
behavioral
challenges,
including
autistic
disorder.
Pervasive
developmental
disorder
not
otherwise
specified,
as
well
as
Asperger's
Syndrome.
D
So,
in
addition
to
CMS
requiring
a
sound
rate
methodology,
its
expectation
is
that
rates
should
have
parity
across
programs
amongst
like
Services.
Currently
we
have
a
rate
disparity
among
our
six
HCBS
waivers.
This
not
only
gives
an
appearance
that
one
population
is
more
important
or
deserves
more
services
than
another,
but
it
also
draws
providers
to
serve
one
population
over
another
from
February
of
2022.
D
The
findings
of
the
completed
rights
study
are
bolstered
by
strong
provider
survey,
satisfaction,
survey,
participation
rate
along
with
sound,
nationally
recognized
external
benchmarks.
We
had
an
over
70
percent
participation
rate
in
the
survey.
The
rate
study
reviewed
and
considered
the
actual
cost
to
provide
services,
as
told
by
our
current
HCBS
waiver
providers.
D
D
So
once
the
impact
has
been
thoroughly
assessed,
we
will
be
sharing
that
information,
but
I
wanted
to
share
what
we've
done
so
far
to
help
providers,
because
I
know
that
sounds
like
a
lot
of
a
lot
of
time.
There's
been
a
lot
of
talk
about
rates
and
rate
changes.
So
what
have
we
done
so
far?
So
as
of
1-1
of
2022,
we
raised
multiple
direct
service
that
individuals
receive
in
the
community,
so
think
attendant
care
or
help
with
their
personal
care.
Those
really
direct
Hands-On
non-clinical
services
that
allow
an
individual
to
remain
in
their
home.
D
This
allows
those
providers
that
attest
to
pass
85
percent
of
the
increase,
which
was
up
to
50
percent
of
their
base
rate
to
the
direct
care
workers
in
the
forms
of
either
wages,
training
bonuses,
so
sign
on
bonuses
retention
bonuses
really
directed
at
trying
to
bolster
the
workforce,
so
those
Services
were
attendant
care.
Community
guide,
Community,
Access,
Community
Living
supports
Homemaker
respite
so
again
those
Services
really
directed
at
providing
that
Hands-On
assistance
to
the
individual.
D
In
addition,
the
scl
level,
one
at
ABI
residential,
have
also
been
able
to
build
the
50
percent
increase
since
January
1st
of
2022,
without
a
limitation
prior
to
that
they
were
able
to
Bill
it.
If
the
individual
was
not
going
to
an
adult
day
training
during
the
day,
we
they
shoot
one
round
of
retainer
payments
to
Adult,
Day,
Health,
Care,
Centers
and
adult
day,
training
providers
in
2020
and
we'll
be
issuing
a
second
round
to
providers
who
applied
and
qualified
in
the
next
two
weeks.
D
Individual
providers
are
going
to
start
being
notified
at
the
end
of
this
week
of
when
they
can
expect
to
see
their
payment
and
us
to
verify
their
address,
for
example,
just
kind
of
the
technicalities
of
of
last
things
we
have
to
do
before.
We
could
issue
that
we
have
received
approval
to
use
the
enhanced
fmap
or
the
arpa
funds.
You
kind
of
hear
those
used
interchangeably,
as
outlined
in
house
bill,
one
for
the
rate
increases
for
the
10
percent
in
fiscal
year,
23
and
10
in
24..
D
We
are
currently
waiting
on
the
final
approval
from
CMS
of
the
appendix
K
Amendment,
which
allows
us
to
go
ahead
and
pass
those
rates
through
to
the
providers
without
having
to
modify
the
regulation
and
modify
the
waivers
until
the
final
rate
study
is
done.
So
it
allows
us
to
get
money
into
the
hands
of
the
providers
sooner.
E
Thank
you,
Mr
chairman
I,
just
want
to
get
some
clarification.
If
you
don't
mind
on
yours,
guess
your
Matrix
I
think
slide
three
that
shows
funded
and
filled
rates
and
so
forth.
You
mentioned
in
your
presentation
that
the
individuals
can
might
be
enrolled,
but
they
might
vacate
it,
for
whatever
reason
is
that
represented
in
your
available
slots.
D
It
is
not,
they
actually
are
included
if,
if
they
vacate
within
that
waiver
year,
because
that
waiver
year
that
slot
will
remain
theres,
they
actually
show
up
in
the
field
slides.
So
you
may
see
individuals
in
that
field,
slot
number
that
are
not
currently
accessing
services,
but
at
any
time,
during
the
waiver
year
they
may
come
back
and
come
right
back
into
that
slot.
E
D
E
Yeah,
if
you
can
just
just
get
up
to
staff
and
just
they'll,
distribute
out
to
folks
just
trying
to
see
exactly
what's
going
on,
I
assume,
that's
that's
more
of
a
federal
requirement.
In
order
to
make
that
do,
then
that's
probably
like
moving
a
battleship
one
degree
and
it
won't
happen,
but
but
I
just
want
to
get
that
clarification
and
also-
and
I,
probably
should
know
this,
but
I
think
I've
seen
numbers
in
the
past.
E
Can
you
assign
our
give
me
some
like
a
cost
allocation
of
each
one
of
these
programs
and
the
costs
that's
associated
with
that,
and
so
I
can
get
a
better
feel?
Yes,.
D
So
I
do
have
the
our
average
cost
per
slot
based
on
our
last
report
to
CMS,
so
they
lag
about
18
months
behind
based
on
claims
coming
in
so
but
these
are
based
on
the
last
accepted
reports
from
CMS
so
for
the
ABI
acute
program
and
I
can
send
this
over.
In
writing.
F
E
D
D
The
model
waiver
2
is
145
233
and
that
that
waiver
is
the
one
that
serves
individuals
that
are
technology
dependent.
So
it
is
100
skilled
services.
So
that's
why
you
see
a
high
cost
for
such
low
member
numbers,
because
the
services
that
are
being
delivered
are
actually
for
up
to
16
hours,
a
day
of
skilled
nursing
care
for
those
individuals
for
Michelle
P,
the
average
cost
per
slot
is
41
732
dollars
and
for
the
supports
for
Community
Living,
it's
ninety
two
thousand
six
hundred
and
ninety
nine
dollars.
E
I'm
sorry
Mr
chairman
I'm
a
little
take
a
little
liberty.
If
you
don't
mind,
I'll
just
be
thank
you
yeah.
If
you
can
send
those
or
actually,
if
you
can
just
take
this
spreadsheet
and
then
assign
the
cost
into
that
as
well.
Okay,
I
appreciate
that,
so
when
you
say
cost
and
I'm
just,
could
you
peel
that
back
a
little
more
there
there's
there's
cost
and
loaded
costs?
What
how
do
you
define
your
costs
and
are
you
be
feeling?
Are
you
fully
covering
your
costs?
E
You
may
say
it's
cost,
but
there's
other
things
that
go
into
a
cost
that
that
I
know
of,
and
is
that
is
that
being
reflected
in
the
numbers
you
provide,
or
is
this
a
sort
of
a
under
the
underestimating
or
under
costs?
Analysis
of
that?
Because,
if
that's
the
case,
then
we're
upside
down
and
we
need
to
figure
out
what
we
need
to
do
in
order
to
cost
us
cost
just
if
I
will
cover
that,
if
it's
a
possibility,
yes,.
D
So
it
actually
is
the
it
is
the
cost
based
on
the
claims.
So
it's
based
on
what
we
are
paying
for
the
services
that
are
provided,
and
so
it
is
an
average
cost.
So
you
do
have
some
vigils
that
are,
you
know
that
are
coming
in
to
hire
some
that
are
coming
in
lower
to
get
that,
but
it
is
based
on
all
the
services
they
receive
in
the
community
to
remain
in
the
community.
So
it
is
their
waiver
slots
as
well
as
if
they
are
getting
other
services.
D
G
Thank
you,
Mr,
chair
and
I
just
have
a
quick
question
and
thank
you
for
the
the
presentation.
It's
a
lot
of
information
on
the
unduplicated
waiver
participant
the
it's
concerning
to
me
that
CMS
is
requiring
that
that
slot
be
filled
no
matter
how
many
days
in
an
individual
uses
it.
G
D
Actually
have
had
the
discussion
and
had
the
question
with
CMS,
particularly
over
if
an
individual
unfortunately
passes
away,
because
obviously
they're
not
going
to
come
back
and
access
that
slot
they
did
commit
to
looking
at
that.
But
again,
that's
and
that's
that's
not
just
Kentucky.
That
has
reflected
that.
It's
been
other
states.
D
The
driving
force
behind
the
unduplicated
slot
is
really
to
keep
individuals
who
you
know
for
no
fault
of
their
own.
They,
you
know,
say
they
fall
and
break
a
leg
and
they're
out
of
services
for
60
days,
which
would
require
them
to
be
discharged
from
the
waiver
them
potentially
having
to
go
back
on
a
wait
list
or
have
Services
delayed.
But
there
is,
there
is,
has
been
discussion
with
CMS
and
I.
G
Well,
if
there's
anything,
we
can
do
to
highlight
that.
Let
me
know.
A
H
We
are
the
trade
Association
representing
providers
of
services
through
Kentucky's
1915
sea
waivers
specifically
focused
on
individuals
with
intellectual
and
developmental
disabilities.
These
services
are
generally
provided
through
the
scl
and
the
Michelle
P
waivers,
but
some
are
supported
through
the
home
and
community-based
waiver.
H
This
allows
individuals
to
live
in
the
least
least
restrictive
setting
in
live
in
their
communities
instead
of
state-run
Institutions.
I
was
asked
to
come
here
today
to
provide
the
committee
with
an
update
on
the
implementation
of
rate
increases
that
were
included
in
the
last
budget
and
for
Kentucky's
1915c
waiver
Services.
Of
course,
I
can
only
provide
the
provider
perspective,
I,
don't
work
for
the
Cabinet
for
Health
and
Family
Services,
but
I'm
here
today
to
provide
that
perspective
first
I
thought.
The
committee
would
like
a
little
background
information
about
how
we
got
here.
H
You
all
saw
a
slide
from
the
cabinet
about
the
Kentucky's
six
waiver,
so
I
won't
go
into
what
they
are,
that
task
force
met
over
the
2021
interim
and
adopted
findings
and
recommendations,
which
recommended
both
short-term
and
long-term
Funding
Solutions
to
address,
among
other
things,
significant
the
significant
Workforce
crisis
experienced
by
providers
in
all
six
waivers
since,
before
the
pandemic,
Kentucky's
waiver
providers
have
faced
tremendous
challenges
to
deliver
care.
The
pandemic
exacerbated
the
ongoing
Workforce
crisis.
H
This
rate
increase
was
intended
to
provide
emergency
relief
to
Providers,
while
the
Cabinet
for
Health
and
Family
Services
conducted
and
finalized
a
rate
study
which
would
indicate
the
true
cost
of
providing
care.
We're
grateful
that
this
increase
remained
in
the
Senate
version
of
the
budget
and
eventually
passed.
H
This
was
our
Lifeline.
This
was
what
would
save
many
of
Kentucky's
waiver
providers
from
closure
and
keep
our
most
vulnerable
out
of
unnecessary
institutional
care.
The
federal
government
must
approve
rate
increases
for
our
waiver
programs
and,
unfortunately,
this
approval
has
taken
much
longer
than
expected.
H
Here
is
the
approval
timeline,
as
we
understand
it,
the
Cabinet
for
Health
and
Family
Services
submitted
the
required
documentation
for
the
approval
of
the
rate
increase
in
May
or
June
of
2022.
During
the
July
2022
meeting
of
the
Medicaid
oversight
committee,
representatives
from
the
cabinet
testified
about
the
implementation
timeline
for
the
waiver
service
rate
increases.
During
that
meeting
cabinet
officials
confirmed
that
they
had
submitted
an
amendment
to
our
approved
arpa
spending
plan
to
request
approval
to
implement
the
rate
increases
in
the
budget.
H
H
H
It's
our
understanding
that
information
was
presented
during
the
January
2023
meeting
of
the
advisory
Council
for
medical
assistance.
The
Mac
indicating
that
the
Cabinet
for
Health
and
Family
Services
may
receive
federal
approval
this
month.
We
also
understand
that
the
Cabinet
for
Health
and
Family
Services
will
backdate
any
rate
increase
to
July
1st
2022
and
will
perform
a
mass
adjustment
on
all
claims.
H
H
Those
other
services
have
received
zero
rate
increase
since
the
beginning
of
the
pandemic,
leaving
them
unable
to
increase
staff,
pay
or
recover
from
other
pandemic
related
expenses.
Further
inflation
has
significantly
increased
the
cost
of
doing
business,
which
has
a
tremendous
impact
on
waiver
providers
who
have
no
ability
to
increase
their
prices.
So
for
this
reason,
Swift
implementation
of
the
rate
increase
included
in
the
budget
is
vitally
important.
H
A
I've
got
one
quick
question:
if,
when
approval
is
granted,
if
it's
granted,
you
says
you
said
it
would
be
retroactive
to.
H
Not
the
authority
on
this,
but
it
is
our
understanding
that
the
Cabinet
for
Health
and
Family
Services
wants
to
make
this
as
easy
as
possible
for
providers,
and
it
is
our
understanding
that
that
mass
adjustment
will
not
be
required.
Providers
to
back
out
claims
and
rebuild
there
were
concerns
raised
during
the
idd
TAC
from
individuals
who
had
experience
other
kinds
of
mass
adjustments
for
state
plan
services,
so
we'll
see
how
that
pans
out.
I
would
hope
that
providers
won't
have
to
back
out
those
claims.
It
would
be
a
pretty
large
undertaking.
A
F
F
Again
good
morning
and
thank
you
for
the
opportunity
to
be
here
today
and
share
about
dcbs.
The
department
for
community-based
services
is
the
largest
Department
within
the
Cabinet
for
Health
and
Family
Services.
We
have
staff
and
at
least
one
office
in
all
120
counties
and,
as
you
see
from
the
map
here,
we
have
the
staff
broken
up
into
nine
service
regions.
Currently,
as
of
as
of
January,
we
had
just
over
4
000
total
full-time
employees
4039,
and
we
also
had
147
interim
employees.
We
have
two
different
types
of
interim
employees.
F
The
majority
of
our
interim
hires
are
the
traditional
nine-month
interims,
but
in
December
of
2021
we
implemented
a
new
hiring
process,
well,
an
interim
hiring
process
that
enables
us
to
onboard
new
employees
quickly
by
hiring
them
as
an
interim
if
they
are
available
for
immediate,
immediate
hire.
So
what
you
of
the
of
the
147
interims
here
listed
as
of
January
56
of
those
were
those
interims
that
were
in
that
hiring
process
and
that
were
that
will
quickly
move
to
full-time
permanent
classified
employees
and
of
that
56
31
were
social
workers.
F
F
We
also
as
well
as
the
10f
block,
grant
the
child
care
assistance
program,
the
LIHEAP
or
the
low
income
home
energy
assistance
program,
as
well
as
child
and
adult
protection
and
foster
care
and
the
other
programs
you
see
listed
there.
In
addition,
we
are
implementing
the
new
employee
child
care
assistance,
partnership
program
that
will
be
in
effect,
beginning
in
April
as
part
of
house
bill.
499.
F
And
here
we
look
at
our
expenditures,
you
on
the
slide.
You
have
a
side
by
side,
comparison
of
expenditures
by
fund
type
for
State
fiscal
year
22
and
the
first
half
a
state
fiscal
year.
23.
F
we,
the
first
half
of
State
fiscal
year,
23,
have
expenditures
totaling,
just
approximately
839
million
dollars,
and
we
are
currently
on
track
to
see
our
expenditures
to
exceed
those
in
state
fiscal
year.
2022.
F
Again,
you
see
the
side-by-side
comparison
of
State
fiscal
year
22
in
the
first
half
of
State
fiscal
year
23.,
as
you
can
see
from
this
Slide,
the
majority
of
our
expenditures
are
in
the
classifications
of
Grant
loans
and
benefits
at
for
the
first
half
of
State
fiscal
year,
23,
that's
totaling
right
at
530,
I'm,
sorry,
yeah,
539
million,
followed
by
Personnel
costs
at
263
million,
and
then
here
we
again
look
at
our
expenditures
by
program
type
again
the
comparison
from
22
to
the
first
half
of
2023.
F
Looking
at
this
slide,
you
can
see
that
in
fiscal
year,
23
hour
say
the
first
half
of
State
fiscal
year
23,
our
largest
expenditure,
has
been
in
the
area
of
alternatives
for
children
at
242
million,
that
is
our
out
of
home
care
cost
followed
by
Child
Care
at
229
million,
which
includes
the
arpa
funding
and
expenditures,
and
next
would
be
our
family-based
services,
that
is,
our
services,
programming
around
in-home
services
prevention,
those
types
of
programs
and
then
our
next
one.
That
we'll
mention
is
our
snap
snap
program
at
93
million.
J
Foreign
just
a
little
bit
about
our
child
welfare
services
and
how
they're
administered
and
where
that
funding
flows
through
so
the
division
of
protection
and
permanency
is
responsible
for
policy
oversight
contracts.
J
Our
stakeholder
engagement,
our
foster
care
contracts,
really
the
programming
and
implementation
pieces
and
how
all
that
funding
flows
through
so
we
implemented
Family
First
back
in
2019,
we
were
one
of
the
first
states
to
implement
that
DPP
is
really
responsible
for
the
expansion
of
those
Prevention
Services,
we're
in
the
process
of
transitioning
prevention
to
the
division
of
prevention
and
Community
well-being.
So
that's
a
new
division
for
the
Department
for
community-based
services,
DPP
overseas
services
for
foster
youth,
former
Foster
youth.
They
actually
oversee
adult
protection
as
well.
J
Next
slide,
so
this
is
a
look
at
our
out
of
Home
Care
numbers
and
for
really
the
past
since
2017
and
those
numbers
really
started
to
Trend
down
in
2019
and
even
since
February
they
continued
to
Trend
down,
you
can
see.
8435
were
in
care
as
of
January.
J
Can
you
go
back
to
that?
Sorry,
just
a
a
look
at.
We
saw
our
highest
numbers
in
July
of
2020,
but
we
implemented
a
relative
service
array
in
2019,
so
prior
to
2019,
relatives
actually
did
not
have
the
option
or
we
didn't
practice
relatives
having
the
option
to
pursue
approval
as
a
foster
home
so
prior
to
that
the
relatives
children
placed
in
the
home
of
a
relative
were
not
shown
in
our
out
of
Home
Care
population.
J
So
if
we
were
practicing
today,
as
we
were
back
Even
in
2016.,
our
numbers
would
actually
be
lower
today
and
than
they
were
six
years
ago.
So
you'd
go
to
the
next
one.
So
this
is
a
look
at
our
number
of
children
placed
in
relative
infective
kin,
so
the
number
I'm
placed
in
non-foster
home
are
951,
and
these
are
children
actually
in
custody.
Custody
of
the
cabinet
but
placed
with
relatives
or
fictive
kin
and
449
are
placed
in
foster
homes.
So
even
that
blue
line,
most
of
those
are
pursuing
approval
as
foster
parents.
J
Next
on,
so
we
as
a
department
have
really
been
committed
to
increasing
our
caregiver
supports,
with
the
support
of
the
legislature
from
Senate
Bill
8.
We
expanded
our
definition
of
fictive
kin
back
in
last
from
the
last
legislative
session
that
allowed
us
to
place
children
from
0
to
12
months
with
effective,
can
caregiver
and
expand
those
supports
to
those
families.
J
I
mentioned
we
expanded
the
relative
support
service
array
back
in
2019
to
allow
relatives
to
approve,
pursue
approval
as
a
foster
home,
and
not
all
relatives
want
to
be
approved
as
a
foster
parent.
So
some
relatives
may
choose
not
to
be
a
foster
parent.
In
those
cases
those
relatives
may
choose
to
receive
ktab,
so
ktab
is
a
cash
benefit
for
those
relatives
and
as
a
department
we
have
filed
administrative
regulations
to
propose
increases
to
k-type,
so
those
regs
are
currently
in
process
and
those
are
for
needy
families
and
relatives
are
eligible
for
those
benefits.
J
We
have
expanded
our
kinship
Navigator
program,
so
that's
a
federal
program
that
states
are
eligible
for
and
those
are
peer
Navigator
programs,
training
for
relatives
that
are
not
foster
parents
and
we've
expanded
those
across
the
state
and
then
we're
in
the
process
of
developing
a
guardianship
assistance
program,
which
is
also
a
federal
program.
Hopefully
we
can
share
some
more
about
that
over
this
next
year
as
we're
implementing
that
program.
J
Currently,
there
are
36
states
with
approved
Guardianship
Assistance
programs
Kentucky
up
until
this
point
has
not
implemented
Gap,
but
with
that
implementation
of
the
relative
service
array
back
in
2019,
it
really
positioned
us
to
be
able
to
move
forward
with
that
and
it's
a
really
a
permanency
option
where
we
can
move
forward
without
having
to
terminate
the
rights
of
parents.
So
we're
really
excited
about
that.
I
I
I'm
sure
this
won't
be
new
to
you,
but
our
staff,
our
social
service
work
staff
especially
have
that
continuous
exposure
to
traumatic
events.
These
positions
can
be
dangerous
at
times
and
and
our
staff
are
in
positions
that
are
high
risk,
similar
to
police
and
EMS.
I
What
that
results
in
oftentimes
is
stress,
vicarious
trauma,
results
in
Burnout
and
compassion
fatigue,
they
oftentimes
experience
secondary
post-traumatic
stress
disorder
and
all
of
that
accumulates
to
result
in
diminished
quality
of
services,
their
work
capacity
and
oftentimes
turnover
and
and
retention
issues.
I
I
What
you'll
see
on
this
slide
is
is
our
turnover
rates
which
are
reflected
over
the
last
three
calendar
years,
so
in
2020
as
we
began
in
the
pandemic,
our
total
turnover
rate
was
right
at
13
and
and
that's
on
a
department
level,
but
more
specifically
for
our
social
service
worker
Frontline
classifications.
We
were
just
under
30
percent
and
our
family
support
front
line
at
28
and
a
half
percent
2021
was
really
our
our
toughest
year.
I
That
I
can
remember
in
a
long
long,
while
of
being
with
this
agency
and
you'll,
see
our
our
overall
Department
turnover
rates
climbed
to
over
20
percent.
Our
social
work
Frontline
classifications
were
over
40
percent,
so
you
can
imagine
how
devastating
that
was
to
our
overall
Workforce
and
our
service
delivery.
I
Family
Support
Frontline
classifications
were
again
high
at
over
29
percent,
but
believe
it
began
to
see
some
improvements
in
2022.
A
lot
of
our
retention
efforts
occurred
during
that
calendar
year
and
and
carry
us
into
2023,
but
in
this
slide
you'll
see
that
we
reduced
our
overall
turnover
rate
by
by
six
percent.
I
I
So
this
reflects
again
specifically
to
our
social
service
worker
classifications,
where
we
find
ourselves
with
caseload
carrying
individuals.
So,
on
your
top
line,
You'll
see
the
numbers
for
CPS
caseload
carrying
workers
in
December
we
had
878
January,
882
and
February
896.,
so
you
can
see
a
a
steady
increase
over
the
last
two
and
a
half
months.
I
Aps
has
been
a
little
more
stagnant,
but
you
can
see
the
numbers
there
on
the
second
line
and
our
totals
have
improved
to
or
look
like
from
965
in
December,
January,
972
and
February
985..
I
The
fourth
line
reflects
our
interim
positions
that
commissioner
Dennis
mentioned
earlier.
We
added
12
in
December
31
in
January,
and
an
additional
35
already
in
February
for
a
total
of
78
in
in
the
last
two
and
a
half
months.
I
will
add
that
we
have
an
additional
32,
more
recommendations
for
Frontline
social
workers
that
aren't
included
in
these
numbers.
I
These
individuals
chose
to
be
processed
through
the
the
normal
Merit
system,
hiring
and
so
they're
slated
to
begin
some
of
those
as
soon
as
tomorrow,
and
then
others
on
the
first
of
March.
So
it's
looking
like,
if
all
of
those
individuals
accept
the
position
or
onboarding
according
to
what
we
expect.
We
should
have
somewhere
around
1052
by
around
the
first
of
March.
I
Next,
we're
going
to
talk
a
little
bit
about
salaries
as
it
relates
to
our
retention
efforts.
So
this
work
really
began
in
Earnest
with
a
December
2021
announcement
from
Governor
beshear,
when
we
were
able
to
increase
entry-level
salaries
for
both
Social
Service
workers
and
family
support
classifications.
I
That
was
also
the
same
time
when
we
implemented
the
new
interim
hiring
process,
so
both
of
those
things
happen
simultaneously
in
May
of
2022,
the
general
assembly
provided
for
pay
increases
again
for
Social
Service
workers
and
family
support
classifications.
So
thank
you
for
that.
I
In
July,
the
general
assembly
granted
the
pay
increases
for
all
state
employees
of
eight
percent.
Again,
a
big
help.
I
July
of
of
last
year
saw
the
Personnel
cabinet
Implement
a
special
entrance
entry
rate
for
many
of
our
positions
and
then
in
January,
May
and
December
of
2022
dcbs
implemented
special
recruitment
rates
for
varying
classifications
across
the
whole
department,
with
the
biggest
coming
in
December
of
2022
that
really
impact
our
social
service,
worker,
job
classifications
and
elevated
the
pay
pretty
substantially,
and
we
feel
like
that.
I
That's
reflected
in
these
most
recent
numbers
and
dcbs
is
currently
in
the
process
of
increasing
all
Department
salaries
to
90
percent
of
the
Personnel
cabinet's
midpoint
for
each
each
job.
Classification.
I
Staff
support
so
one
of
the
things
that
that
we
did
around
November
of
2021,
as
we
were
successfully
at
implementing
a
shift
premium.
So
a
lot
of
our
social
service
worker
staff,
their
job
isn't
Monday
through
Friday
8
to
4
30..
I
These
type
of
events
happen
all
hours
of
the
day
and
night,
seven
days
a
week,
365
days
of
the
year,
and
so
we
were
able
to
implement
a
shift
premium
to
to
help
with
with
paying
these
individuals
an
extra
five
dollars
an
hour
for
those
extra
long
hours
that
they
work
investigating
these
on-call
type,
referrals
on
weekends
and
late
at
night
and
evenings.
We
were
also
successful
in
May
of
last
year
of
acquiring
a
locality
premium
for
the
Jefferson,
County
and
Jefferson
service
region.
I
That
has
traditionally,
for
many
many
years,
I've
been
our
hardest
area
of
the
state
to
retain
staff
and
recruit
staff,
and
so
we
were
successful
in
implementing
a
locality
premium
of
four
dollars
an
hour
for
those
individuals
that
that
provide
these
Direct
Services
in
the
Jefferson
service
region.
We've
continued
with
our
flexible
and
hybrid
work
schedules.
We
have
piloted
shared
caseloads
in
different
areas
across
the
state
which
allow
case
continuity
in
the
event
that
a
staff
member
needs
to
be
out
for
an
extended
period
of
time
or
if
they
leave
the
agency.
I
There's
someone
who's
familiar
with
that
case
and
can
pick
up
and
and
provide
some
continuity
to
that
family.
Moving
forward,
we've
really
started
acting
upon
our
recognition
of
that
secondary
trauma
and
implementing
practices
around.
I
Really,
having
staff
focus
on
their
own
self-care
and
well-being
as
they
do,
this
work
having
a
plan
to
do
those
things
to
revisit
those
things
with
their
supervisors
on
a
regular
basis
to
talk
about
the
impacts
the
work
is
having
on
them
personally
and
how
they
can
mitigate
some
of
that
with
their
own
practices
and
with
the
help
of
the
agency,
we
also
were
successful
in
in
lobbying.
I
Some
regulation
changes
around
critical
incidents
for
our
staff,
so
when
they
are
involved
in
an
incident
that
threatens
their
physical
health
or
well-being,
we
now
have
the
authority
to
Grant
those
individuals,
short-term
leave
to
to
sort
of
take
care
of
themselves
and
process
that
event,
and
then
we
also
have
some
new
initiatives
to
address
caseloads,
specifically
alternative
response
and
Community
response.
I
This
is
basically
accomplished
through
some
Partnerships,
with
with
families
and
Community
Partners
to
to
facilitate
some
sustainable
Pathways
that
has
community
members
respond
to
some
of
those
lower
level
incidents
to
to
sort
of
help.
The
agency
the
department
handle
those
cases
in
a
in
a
upstream
and
preventative
type
approach.
I
I
So
our
recruitment
efforts
again
I'll
mention
the
interim
hiring
process
that
we
began
in
December
of
2021
that
has
been
very
successful
and,
and
you
you've
heard
the
numbers
there.
We
continue
with
our
Public
Child
Welfare
certification
program.
This
has
gone
on
for
many
years
now,
and
and
many
many
graduates
have
have
been
produced
through
that
program
and
have
worked
for
the
agency
through
the
years.
I
We
fully
implemented
a
co-op
and
internship
a
paid
program
for
students,
so
those
students
who
are
in
programs
related
to
the
work
we
do
can
now
come
to
the
agency
work
for
the
agency,
learn
what
we're
all
about,
what
the
work
looks
like
and
and
hopefully
upon
graduation.
They
will
will
be
interested
in
coming
to
work
for
us
right
now.
We
have
22
of
those
individuals
just
since
we
began
this
program
with
this
newest
spring
semester,
we're
constantly
targeting
colleges
and
Career
Centers
to
look
for
those
next
group
of
potential
employees.
I
We
frequent
Career
Fairs
birth,
both
in
person
and
virtually
we
fully
utilize
LinkedIn
and
the
handshake
application
handshake
apps
to
to
sort
of
advertise
our
work
and
get
the
word
out
there
that
that
we're
hiring
on
a
frequent
basis.
For
the
past
several
years,
we've
we've
been
to
the
state
fair,
where
we've
put
forth
some
pretty
concerted
efforts
around
Recruitment,
and
we
currently
have
it's
a
new
day
recruitment
campaign
that
we
began
toward
the
end
of
2022
and
currently
have
daily
ads
running
on
over
100
radio
stations
across
the
Commonwealth.
I
I
We've
really
began
to
look
at
open
concept,
work,
environments
and
and
taking
a
look
at
some
of
our
brick
and
mortar
buildings,
taking
better
care
of
those
and
and
sort
of
upgrading
accommodations.
Where
we
can,
we
can
do
so.
We
want
to
continue
the
flexibility
with
the
the
initiatives
around
work-life
balance.
I
We
continue
to
revise
and
modernize
all
features
and
physical
conditions
again
of
the
dcbs
work
that
we
perform.
We
fully
Incorporated
lived
experience
from
our
trusted
advisors.
We
want
to
know
from
those
who
have
who
have
been
in
situations
where
they
have
come
to
be
in
service
from
our
department
and
learn
from
things
that
we
we
did
well
and
and
areas
that
we
need
to
improve
and
a
living
example
of
who
we
are
as
an
agency
and
what
and
who
we
value.
J
Aware
of
sort
of
a
unique
challenge
that
began
last
year,
we
started
we
started
noticing,
in
May
of
June
of
last
year,
a
trend
in
really
not
being
able
to
find
placements
for
youth
who
have
unmet
sort
of
complex
needs.
J
So
when
I
say
we
were
not
able
to
find
placement,
we-
and
this
is
just
a
snapshot
of
reasons
why
we
we're
not
able
to
find
placements
so
for
December
and
January,
and
this
is
a
snapshot
of
all
referrals
for
children
and
out
of
home
care.
We
may
do
upwards
of
30
000
to
35
000
referrals
for
all
children
and
as
we're
looking
for
a
placement
for
children,
so
we're
making
referrals
to
our
agency
partners
to
be
able
to
search
for
a
placement
for
those
children.
J
J
So
what
the
slide
doesn't
show,
though,
is
you
know,
we've
been
meeting
with
our
providers
and
and
providers
are
struggling
with
Staffing
and
they're
they're
struggling
just
like
we
are
with
you
know,
hiring
quality
staff
and
and
capacity
issues
as
well,
and
our
bed
capacity
is
actually
lower
than
50
percent.
J
But
the
Staffing
is
a
concern
for
our
providers
as
well
and
then
and
when
you
think
about
children
being
referred,
they're
being
referred
on
average
between
65
to
68
times
before
we're
actually
closing
out
those
referrals
and
the
at
the
reason
they're.
The
top
reason
for
denial
is
aggression
or
well.
The
first
reason
is
age.
Most
of
these
kids
are
between
13
and
21,
and
then
the
second
reason
is
aggression.
A
J
We
saw
the
number
of
children
being
referred
out
of
state
double
at
this
point.
Other
states
are
having
the
same
issue.
Most
of
the
kids
are
ended
up,
staying
in
state
with
our
own
providers,
but-
and
we
did
initially
see
the
number
of
children
going
out
of
state
double
number
of
children
around
placement
and
stability
that
has
also
doubled
and
we're
seeing
hospitals,
refusing
access
or
admission
for
dcbs
committed,
Youth
and
then,
of
course,
children,
I'm
sleeping
in
offices
having
to
stay
in
hospital
emergency
rooms.
F
Okay,
so
every
after
we
have
a
excuse
me,
you
have
heard
from
Shannon
and
from
Mary
who
have
described
two.
F
So
sorry,
so
you
have
heard
from
Shannon
and
Mary
as
they
describe
two
of
our
most
significant
challenges
within
the
department,
our
Workforce
capacity
and
our
needs
for
services
for
our
high
Acuity
youth.
As
Mary
stated,
these
are
not
challenges
that
are
unique
to
Kentucky
when
we
talk
with
our
peers
from
Child
Welfare
agencies
across
the
across
the
country,
they
are
experiencing
similar
challenges
that
again
are
similar
to
Kentucky
and
some
are
are
even
are
more
significant.
F
So
in
these
final
two
slides
I'm
going
to
describe
some
of
the
steps
we've
taken
currently
in
further
further
needs
to
tackle
these
issues.
Shannon
has
touched
on
a
lot
of
our
Workforce
initiatives,
so
I'm
going
to
focus
more
on
our
our
steps
taken
around
to
address
our
high
Acuity
youth.
However,
our
these
two
issues,
as
as
Mary
stated,
are
very
connected.
F
Our
lack
of
services
and
resources
to
support
High
Acuity
youth
adds
to
additional
stress
and
drain
on
our
Workforce.
If
you
are
that
front
line
social
worker
with
a
high
Acuity
youth
in
crisis
or
an
imminent
need,
it
becomes
all-consuming
oftentimes
that
you
know
that's,
that's
all
the
worker
can
focus
on
for
a
number
of
days,
and
we
are.
F
F
They
have
done
a
phenomenal
job
of
responding
to
the
needs
of
our
high
Acuity
Youth
and
taking
on
additional
workload
and
and
stress,
and
they
they
do
it
without
without
complaint,
and
they
truly
are
you've
heard
us
say
it
and
describe
them
as
those
everyday
Heroes,
but
I
can't.
We
can't
say
it
enough.
We've
have
a
a
tremendous,
a
tremendous
Workforce
and
appreciate
all
that
they
do
so
to
better
support
youth
in
need
and
our
our
Workforce.
F
Some
of
the
steps
that
we
have
taken
to
address
these
issues
is
when
we,
when
we
first
began
hearing
of
children
placed
in
these
non-traditional
settings.
This
was
new
to
us.
We
hadn't
experienced
this
previously,
so
we
immediately
we
immediately
came
together,
began
discussing
you
know:
where
are
the
gaps?
What
are
the
needs?
How
do
we
support
our
youth
differently?
How
do
we
support
support
our
providers
differently?
What
does
this
look
like
and
a
lot
of
good
work
began
to
happen
really
quickly,
but
what
we
recognize
is
that
it
all
wasn't
coordinated
or
connected.
F
So
we
have
hired
a
high
Acuity
youth
coordinator,
who
sits
in
the
in
the
in
central
office,
and
she
her
responsibility
is
to
be
the
point
of
contact
for
all
all
things
around.
Our
high
Acuity
youth
who
are
in
immediate,
imminent
crisis,
and
we
also
recognize
to
support
our
Workforce
that
this
work
needed
a
similar
approach
and
model
in
our
service
region.
F
So
every
day,
at
8
15
in
the
morning,
staff
from
dcbs,
but
not
only
dcbs,
a
group
of
core
committed
Partners
from
other
agencies
come
together
that
include
again
dcbs
our
regional
staff.
The
Medicaid
is
with
us
Department
of
Behavioral
Health
is
at
the
on
those
calls
with
us,
along
with
Edna
Sky,
our
Mains
Care
Organization,
and
other
providers
as
as
needed.
F
F
We
have
also
began
working
with
our
providers
to
look
at
enhanced
payments,
so
what
additional
therapeutic
services
supports
or
resources
are
needed
to
be
able
to
keep
a
child
in
a
placement
we're
working
very
closely
with
our
Community
Partners,
like
I,
said:
we've
engaged
our
regional
leadership
in
identifying
appropriate
placements
for
youth,
and
we
also
have
a
number
of
work
groups
and
committees
that
are
looking
at
the
short-term
needs,
but
also
looking
at
the
long-term
changes
that
need
to
take
place
to
fill
the
gaps
and
build
out
a
Continuum
of
Care
that
meets
our
children's
needs
and,
of
course,
we're
working
very
closely
with
Aetna
Scott
Aetna
on
Sky,
which
is
our
Managed
Care
Organization
for
all
children
that
are
in
out
of
Home
Care
see.
F
And
finally,
we
talk
about
our
further
needs.
Looking
at
service
challenges
and
gaps,
we
are,
we
are
identifying
ways
to
support
our
providers.
Our
provider
Community,
which
includes
the
review
of
payment
models
and
reimbursement,
supports
we're
also
looking
at
how
we
support
our
work.
Workforce
supports
both
for
dcbs,
as
well
as
for
again
providers
continuing
to
identify
ways
to
move
Upstream,
with
a
focus
on
prevention
and
early
identification.
F
We
can
never
have
enough
community-based,
Services
access
to
which,
which
could
include
increased
access
to
Telehealth
mobile
crisis,
respite
care
and
really
looking
at
building
a
system
of
care
around
the
youth
and
Family's
needs
and
helping
them
to
access
Services
when
they
need
them
and
where
they
need
them.
As
we
look
at
addressing
the
placement
challenges
and
bed
capacity
issues,
we
held
a
a
convening
on
December
9th,
with
the
leadership
from
our
private
child
caring
provider.
Community.
We
shared
data
and
discussed
the
capacity
needs
within
our
Continuum
of
Care.
F
We
asked
providers,
income
providers
shared
again
what
they
were
experiencing
and
what
their
needs
were.
We
asked
them
to
to
submit
proposals
for
how
they
could
support
the
gaps
and
help
us
build
capacity.
So
we
are
beginning
to
receive
some
of
those
responses
and
we
are
reviewing
their
proposals
and
when
we
talk
about
overlapping
and
cross
system
involvement,
we
know
that
many
of
our
high
Acuity
youth
are
cross-system
involved.
F
So
one
example
of
that
is,
you
know
a
high
percentage
of
our
high
Acuity
youth
are
also
involved
with
DJJ,
either
currently
or
past,
or
their
court
involved
and
coming
into
care
related
to
status,
offenses,
but
also,
but
they
also
have
significant
mental
and
Behavioral
Health
needs.
So
looking
at
ways
to
increase
opportunities
for
cross-system
collaboration
is
is
where
we
we
need
to
continue
to
to
work,
and
a
couple
of
good
examples
of
where
that's
already
happening
is
with
ciac
and
the
newly
formed
judicial
commission
on
Mental
Health.
F
So
as
as
as
I
close
I
will
make
one
final
comment:
we
must
continue
our
work
collaboratively
to
better
meet
the
needs
of
our
Workforce
and
our
youth.
Our
systems
should
not
result
in
youth,
presenting
with
complications
or
Consequences
related
to
placement,
availability
or
stability
beyond
what
the
concerns
that
brought
them
to
the
attention
of
the
Child
Welfare
agency,
Youth
and
families
deserve
a
range
of
Pathways
towards
a
resilient
future.
F
We
we
have
the
right
people,
we
have
the
support
and
commitment
from
from
all
levels,
so
the
secretary's
office
secretary
friedlander,
is
very
involved
and
supportive.
The
governor,
the
general
assembly,
has
been
very
involved
in
supporting
our
child
welfare
system
and
we
can't
say
thank
you
enough
for
for
everyone's
commitment
in
helping
us
move
upstream
and
building
a
system
of
care
that
will
better
meet
the
needs
of
our
children.
A
Thank
you
very
much.
I
do
have
a
few
questions
on
the
workforce,
increase
the
case
load
carrying
I,
guess,
workers
you
have
or
employees
you
have
is
that
I
I
see
it's
increasing,
that's
a
good
thing.
Is
that
happening
across
regions
or
are
there
others
that
are
further
ahead
and
some
that
are
falling
behind
it?.
I
Is
happening
across
the
regions
of
course,
recruitment
is
more
difficult
in
some
areas
of
the
state
than
others,
particularly
Jefferson
County
is
is,
is
really
difficult.
Fayette
County
has
been
difficult
at
times
some
areas
of
Northern
Kentucky,
the
competition
for
individuals
that
qualify
for
our
positions
are
are
more
in
those
areas,
and
so
we
have
seen
some
successes
all
across
the
state,
but
but
it
is
a
little
easier
to
recruit
in
some
areas
than
others.
A
I
Really
haven't
experienced
that
okay,
we
thought
we
could
when
we
first
undertook
that
hoe
initiative,
but
it's
really
not
played
out
like
that.
I
A
Right
and
then
I
guess.
Lastly,
I
you
hit
on
it
on
the
end,
the
high
Acuity
youth
problem.
Obviously
that's
a
Workforce
issue.
It
probably
involves
Juvenile
Justice
to
a
degree
and
you
all
working
or
us
figuring
out
fixes
for
that
to
help
you
all
as
well
outside
it
I
know
you
can't
take
that
away,
but
is
that
the
the
largest
remaining
obstacle,
as
far
as
like
Workforce
and
keeping
people
and
keeping
people.
F
F
It
is
additional
stress
for
our
Workforce
I,
don't
know
if
I
would
say
it
was
the
number
one
number.
One
reason
why
we
are
seeing
staff
leave,
but
it
is
definitely
it's
definitely
additional
stress.
It's
additional
worry
for
our
staff
as
well,
and
something
that
we
need
to
address
for
both
our
youth
and
their
well-being,
ensuring
they
have
the
services
that
they
need.
And
Timely,
to
address
what
to
address
their
mental
Behavioral
Health
needs,
but
also
to
help
support
our
Workforce
I.
F
I
I
would
agree,
and-
and
you
know
we
poll
our
our
staff
pretty
regularly-
we
survey
them
and-
and
we
ask
them-
you
know
what
what
are
some
of
the
things
that
you
enjoy
about
working
here
and
then,
where
can
we
improve?
And
if
you
look
back
at
that
data
and
you
look
at
at
the
years
19
through
21
before
the
pandemic?
A
lot
of
the
reasons
we
heard
that
that
staff
leave
was
a
better
job
outside
the
state
government.
I
Higher
pay,
the
retirement
lack
of
promotional
opportunities,
things
like
that,
and
we've
seen
a
shift
a
little
over
the
past
year
to
year
and
a
half
where
the
reasons
we
we
hear
of
our
staff,
primarily
leaving
is
his
workload
not
enough
time
with
family.
It's
not
some
of
the
same
reasons.
Now
they
still
count
some
of
those
pay
a
better
job
and
things
like
that,
but
they're
they're,
not
at
the
top
of
the
list
where
they
once
were.
A
A
Okay-
and
you
mentioned
Community
Partners
work
groups,
everyone
getting
together
different
cabinets
working
together
to
try
to
solve
this
issue.
Were
you
all?
Do
you
plan
to
have
recommendations
at
a
certain
date
like
for
the
legislature
on
that?
As
far
as
the
steps
to
take
to
help
solve
this
issue,.
F
A
Okay
and
as
you
said
today,
I
know
you
always
would
advocate
for
more
resources,
but
I
mean
do
you
all
have
what
you
need
today
to
do
your
jobs.
F
We
are
looking
at
Workforce
supports,
probably
a
little
bit
differently
than
what
we
have
in
the
past.
I
mean
we
thanks
to
General
Assembly.
F
We
we
have
the
the
budget
to
hire
additional
social
workers,
so
it's
a
recruitment
and
retention
pieces
that
are
that
we're
really
focusing
on
and
then
when
we're
talking
about
Workforce
support,
so
the
the
so,
for
example,
the
high
Acuity
use
and
how
we're
putting
services
and
supports
around
the
workforce
with
with
additional
Staffing
positions,
we're
looking
at
that
we're
also
working
on
adding
positions
within
our
service
regions
to
work
alongside
just
don't
they're,
not
there
won't
be
so
they
will
not
be
social
workers
but
they'll.
F
There's
it's
a
job
classification
that
would
work
alongside
that
social
worker
and
help
support
the
worker
and
the
family
in
meeting
and
meeting
the
family's
needs.
It's
think
of
it
similar.
It's
like
a
peer
support
model.
The
the
employee
would
again
be
assigned
to
the
family
and
would
help
them
work
on
identified
needs.
An
easy
example
would
be
truancy
if
so,
helping
the
family
identify
barriers
and
solutions
with
transportation
is,
is
scheduling.
Is
it
what
that
may
be?
F
And
that's
a
very
simple
example,
but
again
someone
a
support
to
the
social
worker
to
have
have
additional
resources
in
that
home,
additional
eyes
on
that
family
and
helping
that
family
very
remain
connected
to
resources.
So
we're
thinking
about
things
like
that
and
then
we're
also
looking
at
the
way
we
made.
Shannon
talked
about
Community
response
and
alternative
response,
so
implementation
of
those
models
where
we're
moving
Upstream.
So
those
referrals,
for
example,
community
of
response,
so
those
referrals
that
did
not
meet
our
statutory
definition
for
allegations
of
abuse
or
neglect.
F
We're
currently
piloting
in
a
handful
of
counties,
Community
response
model
where
they
would
be
referred
to
a
community
partner.
The
community
partner
could
engage
the
family
and
hopefully
provide
them
with
supports
and
resources
so
that
they
this
they
never
come
to
the
attention
of
the
Child
Welfare
agency,
with
a
with
a
concern
that
would
meet
the
definition
of
abuse
or
neglect
an
alternative
response
again.
Looking
at
how
we
work
with
families
differently
engaged
in
them
earlier,
well
engaged
them
in
a
different
approach
of
collaboration
on
some
of
those
lower
risk
referrals.
A
F
J
I
think,
potentially,
especially
with
Community
response,
we
may
be
asking
you
know
we're
currently
doing
a
formal
evaluation
on
that
we
may
be
coming
to
you
asking
for
an
appropriation
for
that.
We
do
hope
to
expand
that
you
know
Statewide.
We
want
to
be
able
to
provide
you
with.
You
know,
outcomes
for
that
before
we
do
that
today
we
have
the
support
for
that
and
the
same
will
be
for
Guardianship
Assistance,
potentially,
okay,
so
I
think
today
we
have
what
we
need
potentially
in
the
future
we
may
be.