Resource Connection
Bridging Families with Community Services
At Saint Francis Ministries, our mission is to provide healing and hope to children and families. For the Clinical Utilization team at Saint Francis Community Services in Texas (SFCS), that often means connecting children and families with the right experts and community resources to stabilize a child’s behavioral, medical, or mental health. The Resource Connection is a new way to connect children and their caregivers with the needed resources within their home community, resources that often go under-utilized simply because they aren’t known.
Resource Connection engages community resource providers by inviting them to the table when SFCS meets about a child and what services they need. Wrapping services around a child and his or her caregiver can often make the difference between being able to keep the child here in their home community as opposed to sending them across the state or even outside of Texas to access the same services elsewhere.
SFCS, the Single Source Continuum Contractor (SSCC) for the Texas Department of Family and Protective Services (DFPS) in Region 1, began coordinating paid placements for children in foster care and residential capacity building for the 41 counties in the region in January 2020. Since that time, many factors have contributed to a decline in therapeutic capacity across the State of Texas. The COVID‐19 pandemic has contributed to a significant staffing shortage and created other challenges in the realm of Behavioral Health, the extent of which we do not truly yet know. Additionally, greater penalties for an increase in licensing investigations that come with serving complex‐needs children has been a leading factor for remaining residential providers across the state to be wary of serving children with more complex needs.
SFCS has found that the combination of these and other factors have contributed to a rise in placement disruptions and the need to place children in out‐of‐state facilities or short‐term emergency placements, diminishing or prolonging the child’s chances for positive permanency.
In response, the Clinical Utilization Team at SFCS began building a database of resources within the community to wrap around a child, family, or placement to stabilize the child using a multi‐disciplined approach. Building on that, we have adopted a process piloted by the Wisconsin Association of Family & Children’s Agencies (WAFCA) to bring providers to the table to plan how the community as a whole can serve a complex‐needs child and contribute to their stabilization in each provider’s respective area of expertise.
SFCS envisions a process that:
- Focuses on youth with complex needs.
- Provides a universal format for submission of child information.
- Engages system consultant expertise and representation from providers across the continuum of care.
The purpose of the Resource Connection is to locate treatment and services for children with complex behavioral health needs to support placement stability. To be successful, we need to partner efficiently and effectively, think creatively, and act with urgency. We value the expertise and experience of the professionals coming to the table and have established the following set of commitments as a framework for our joint efforts.
The centralized resource connection process will be streamlined, with a singular contact for requesting a resource connection session, and a virtual platform for presenting the child’s case so all providers receive the same information at the same time. This will allow placement and service providers to ask questions in real time.
Information shared electronically should not include identifying information. Presentations conducted virtually will not be performed on HIPAA compliant platforms; therefore, placing agencies are encouraged to refrain from utilizing the child’s name and/or other personally identifiable information during the session.
To be successful, we will need to draw on the full continuum of providers – from community service providers, to those licensing foster homes, to those operating GROs, shelters, and/or residential treatment centers. Multiple members from SFCS, such as the child’s Permanency Specialist, Permanency Supervisor, and the placement coordinator, will be needed as well, to ensure options explored can continue to be discussed amongst decision‐makers following the session.
The goal of each session will be to have all possible treatment options identified for the child, and to equip SFCS Permanency Staff and current or potential placement providers with contact information for the identified options so they can follow‐up with those agencies specifically to coordinate the child’s care.
Resource Connection sessions will be held on Wednesdays from 12:00‐1:00 p.m. CT via Microsoft Teams. One child will be presented each session. Placing agencies and provider agencies wishing to participate in the resource connection process must review and agree to the terms outlined in the Memorandum of Understanding (MOU).
- Providers should email this form along with agency contacts (those who will attend the connection sessions) to txreg1clinicalutilization@st‐francis.org to be added to the provider list.
- Agencies or SFCS staff requesting a connection session must submit the MOU to txreg1clinicalutilization@st‐ francis.org and complete the Request Form for the session to be scheduled.
Following receipt of the information from a provider, SFCS staff will add the agency’s contact(s) to the provider list and begin including the contacts in connection session announcements. Following receipt of the information from a session request, SFCS Clinical Utilization staff will review the information for completeness.
- If complete, SFCS will schedule the child for the next available session (unless the placing agency notes a specific day will not work for them), notify all placing agency staff of the day/time identified, and provide the Teams link and Presentation Outline.
- If incomplete, SFCS will request the missing information from the sender.
Announcements and reminders regarding upcoming sessions will be sent via email to the provider list. Announcements will contain the information provided in the session request so that individual providers can make an informed decision regarding their participation in the session.
During the session:
SFCS Clinical Utilization staff will review the ground rules for the session. SFCS Permanency Staff and/or Current Placement Staff/Caregivers will then utilize the Presentation Outline to share information about the child.
- Provider agencies will be allowed to ask questions and share how they may be able to support the child and/or family.
- ALL POTENTIAL SERVICE OPTIONS SHOULD BE PROVIDED PRIOR TO THE END OF THE SESSION. A combination of services is better than no in‐state option. For example, if the child wants to stay with a relative and there is a resource but a lack of supports, agencies may share how they could support this placement.
- Agency A – “Our agency could provide mentoring.”
- Agency B – “Our agency can offer respite in a foster home.”
- Agency C – “Our agency can provide weekly in‐home family counseling.”
- Contact information for all options identified will be provided in the chat so that placing agencies can follow up.
- If a provider is unsure if they have options available, they may request the Permanency Specialist’s contact information for follow‐up.
Following the session:
SFCS will take the option(s) and contact information from the meeting, discuss next steps, and strategize funding solutions (if needed).
- If SFCS or the Placement Provider decides to refer the child for services to one or more agencies who stepped forward as a resource, they will need to reach out to that agency directly to begin the process.
- SFCS must be notified of the outcome of the session (the child was/was not successfully served by an agency as a result of the connection session). This information can also be sent to txreg1clinicalutilization@st‐francis.org.
- If services are tried and do not work out, an additional connection session can be requested.
First 5 minutes:
Participants sign on. Facilitators introduce themselves, review the schedule, and briefly highlight the agreements made through signing of the Memorandum of Understanding.
Up to 35 Minutes:
The primary representatives (those who will be sharing information) from SFCS introduce themselves and share information utilizing the Presentation Outline as a guide. [Note: If the child and/or parent(s)/legal guardian(s) are present and are comfortable doing so, they may introduce themselves before the information sharing occurs.]
Presentation Outline
- The reason treatment is needed (i.e., behavioral challenges; initial placement; lower level of care needed; higher level of care needed; placement disruption; something else).
- What it looks like when the child is successful.
- What are the child’s strengths?
- Are there things in the environment that contribute to the child’s success?
- Are there characteristics of caregivers/others that align better with the child’s needs/personality?
- Is there a certain level of activity or a certain type of activity (area of interest) the child benefits from?
- Is there a certain level of attention the child benefits from?
- The primary presenting challenges for the child’s caregivers.
- What kinds of behaviors, attitudes, or concerns have contributed to the child needing treatment?
- What interferes with the child being successful at home or elsewhere?
- What have others said about why they struggle to work/live with the child?
- What trauma history contributes to the current presenting issues?
- The child’s triggers, behavior when triggered, and supports/interventions that promote regulation.
- The child’s level of cognitive/developmental functioning.
- The child’s physical health needs.
- The child’s ability to reside with others(including pets).
- Additional information regarding the child’s support system/connections, including who the child is closest to.
- Other treatment, services, or activities the child is connected to and/or has been successful in.
- Anything else a person working with the child and/or family should know.
- The level of urgency as it pertains to treatment (low – 30 days; medium – 2 weeks; high – 1 week).
- Where the child would like to be served and/or placed and the viability of those options.
Facilitators and providers ask questions to gain clarity about child strengths, needs, and wants. Brainstorming occurs to outline the best‐case scenario for care and treatment, with a focus on what would be needed to help the young person stabilize and heal. Providers ask additional clarifying questions that help them determine whether they have ability to serve the child.
Last 5 Minutes:
Based on the list of things determined to help stabilize the child, providers identify which service they would be able to provide and enter the following into the chat:
- Agency name, service type, approximate date when service would be available, contact person, email and/or phone.
Providers who may have ability to serve the child but need to connect further with their team can note that in the chat box and follow up with
txreg1clinicalutilization@st‐francis.org after the team consult occurs. The link to the session survey is posted in the chat, and the session adjourns.
SFCS, the Single Source Continuum Contractor (SSCC) for the Texas Department of Family and Protective Services (DFPS) in Region 1, began coordinating paid placements for children in foster care and residential capacity building for the 41 counties in the region in January 2020. Since that time, many factors have contributed to a decline in therapeutic capacity across the State of Texas. The COVID‐19 pandemic has contributed to a significant staffing shortage and created other challenges in the realm of Behavioral Health, the extent of which we do not truly yet know. Additionally, greater penalties for an increase in licensing investigations that come with serving complex‐needs children has been a leading factor for remaining residential providers across the state to be wary of serving children with more complex needs.
SFCS has found that the combination of these and other factors have contributed to a rise in placement disruptions and the need to place children in out‐of‐state facilities or short‐term emergency placements, diminishing or prolonging the child’s chances for positive permanency.
In response, the Clinical Utilization Team at SFCS began building a database of resources within the community to wrap around a child, family, or placement to stabilize the child using a multi‐disciplined approach. Building on that, we have adopted a process piloted by the Wisconsin Association of Family & Children’s Agencies (WAFCA) to bring providers to the table to plan how the community as a whole can serve a complex‐needs child and contribute to their stabilization in each provider’s respective area of expertise.
SFCS envisions a process that:
- Focuses on youth with complex needs.
- Provides a universal format for submission of child information.
- Engages system consultant expertise and representation from providers across the continuum of care.
The purpose of the Resource Connection is to locate treatment and services for children with complex behavioral health needs to support placement stability. To be successful, we need to partner efficiently and effectively, think creatively, and act with urgency. We value the expertise and experience of the professionals coming to the table and have established the following set of commitments as a framework for our joint efforts.
The centralized resource connection process will be streamlined, with a singular contact for requesting a resource connection session, and a virtual platform for presenting the child’s case so all providers receive the same information at the same time. This will allow placement and service providers to ask questions in real time.
Information shared electronically should not include identifying information. Presentations conducted virtually will not be performed on HIPAA compliant platforms; therefore, placing agencies are encouraged to refrain from utilizing the child’s name and/or other personally identifiable information during the session.
To be successful, we will need to draw on the full continuum of providers – from community service providers, to those licensing foster homes, to those operating GROs, shelters, and/or residential treatment centers. Multiple members from SFCS, such as the child’s Permanency Specialist, Permanency Supervisor, and the placement coordinator, will be needed as well, to ensure options explored can continue to be discussed amongst decision‐makers following the session.
The goal of each session will be to have all possible treatment options identified for the child, and to equip SFCS Permanency Staff and current or potential placement providers with contact information for the identified options so they can follow‐up with those agencies specifically to coordinate the child’s care.
Resource Connection sessions will be held on Wednesdays from 12:00‐1:00 p.m. CT via Microsoft Teams. One child will be presented each session. Placing agencies and provider agencies wishing to participate in the resource connection process must review and agree to the terms outlined in the Memorandum of Understanding (MOU).
- Providers should email this form along with agency contacts (those who will attend the connection sessions) to txreg1clinicalutilization@st‐francis.org to be added to the provider list.
- Agencies or SFCS staff requesting a connection session must submit the MOU to txreg1clinicalutilization@st‐ francis.org and complete the Request Form for the session to be scheduled.
Following receipt of the information from a provider, SFCS staff will add the agency’s contact(s) to the provider list and begin including the contacts in connection session announcements. Following receipt of the information from a session request, SFCS Clinical Utilization staff will review the information for completeness.
- If complete, SFCS will schedule the child for the next available session (unless the placing agency notes a specific day will not work for them), notify all placing agency staff of the day/time identified, and provide the Teams link and Presentation Outline.
- If incomplete, SFCS will request the missing information from the sender.
Announcements and reminders regarding upcoming sessions will be sent via email to the provider list. Announcements will contain the information provided in the session request so that individual providers can make an informed decision regarding their participation in the session.
During the session:
SFCS Clinical Utilization staff will review the ground rules for the session. SFCS Permanency Staff and/or Current Placement Staff/Caregivers will then utilize the Presentation Outline to share information about the child.
- Provider agencies will be allowed to ask questions and share how they may be able to support the child and/or family.
- ALL POTENTIAL SERVICE OPTIONS SHOULD BE PROVIDED PRIOR TO THE END OF THE SESSION. A combination of services is better than no in‐state option. For example, if the child wants to stay with a relative and there is a resource but a lack of supports, agencies may share how they could support this placement.
- Agency A – “Our agency could provide mentoring.”
- Agency B – “Our agency can offer respite in a foster home.”
- Agency C – “Our agency can provide weekly in‐home family counseling.”
- Contact information for all options identified will be provided in the chat so that placing agencies can follow up.
- If a provider is unsure if they have options available, they may request the Permanency Specialist’s contact information for follow‐up.
Following the session:
SFCS will take the option(s) and contact information from the meeting, discuss next steps, and strategize funding solutions (if needed).
- If SFCS or the Placement Provider decides to refer the child for services to one or more agencies who stepped forward as a resource, they will need to reach out to that agency directly to begin the process.
- SFCS must be notified of the outcome of the session (the child was/was not successfully served by an agency as a result of the connection session). This information can also be sent to txreg1clinicalutilization@st‐francis.org.
- If services are tried and do not work out, an additional connection session can be requested.
First 5 minutes:
Participants sign on. Facilitators introduce themselves, review the schedule, and briefly highlight the agreements made through signing of the Memorandum of Understanding.
Up to 35 Minutes:
The primary representatives (those who will be sharing information) from SFCS introduce themselves and share information utilizing the Presentation Outline as a guide. [Note: If the child and/or parent(s)/legal guardian(s) are present and are comfortable doing so, they may introduce themselves before the information sharing occurs.]
Presentation Outline
- The reason treatment is needed (i.e., behavioral challenges; initial placement; lower level of care needed; higher level of care needed; placement disruption; something else).
- What it looks like when the child is successful.
- What are the child’s strengths?
- Are there things in the environment that contribute to the child’s success?
- Are there characteristics of caregivers/others that align better with the child’s needs/personality?
- Is there a certain level of activity or a certain type of activity (area of interest) the child benefits from?
- Is there a certain level of attention the child benefits from?
- The primary presenting challenges for the child’s caregivers.
- What kinds of behaviors, attitudes, or concerns have contributed to the child needing treatment?
- What interferes with the child being successful at home or elsewhere?
- What have others said about why they struggle to work/live with the child?
- What trauma history contributes to the current presenting issues?
- The child’s triggers, behavior when triggered, and supports/interventions that promote regulation.
- The child’s level of cognitive/developmental functioning.
- The child’s physical health needs.
- The child’s ability to reside with others(including pets).
- Additional information regarding the child’s support system/connections, including who the child is closest to.
- Other treatment, services, or activities the child is connected to and/or has been successful in.
- Anything else a person working with the child and/or family should know.
- The level of urgency as it pertains to treatment (low – 30 days; medium – 2 weeks; high – 1 week).
- Where the child would like to be served and/or placed and the viability of those options.
Facilitators and providers ask questions to gain clarity about child strengths, needs, and wants. Brainstorming occurs to outline the best‐case scenario for care and treatment, with a focus on what would be needed to help the young person stabilize and heal. Providers ask additional clarifying questions that help them determine whether they have ability to serve the child.
Last 5 Minutes:
Based on the list of things determined to help stabilize the child, providers identify which service they would be able to provide and enter the following into the chat:
- Agency name, service type, approximate date when service would be available, contact person, email and/or phone.
Providers who may have ability to serve the child but need to connect further with their team can note that in the chat box and follow up with
txreg1clinicalutilization@st‐francis.org after the team consult occurs. The link to the session survey is posted in the chat, and the session adjourns.