46.56(3)(d)5.
5. Assess how the initiative relates to other service coordination programs operating at the county, tribal, or local level and take steps to work with the other service coordination programs and to avoid duplication of activities, services, and resources.
46.56(3)(d)6.
6. If a county or tribe applies for funding under
sub. (15), assist the administering agency in developing the application required under
sub. (15) (b).
46.56(3)(d)7.
7. Review determinations by the service coordination agency regarding eligibility for assessment, appropriate family resources, or funding of services, at the request of any applicant, recipient, parent of a child who is involved in 2 or more systems of care, or participating county department or tribal agency, school district, cooperative educational service agency, or county children with disabilities education board. The coordinating committee shall adopt written procedures for conducting reviews.
46.56(3)(d)8.
8. Establish operational policies and procedures, such as referral and screening procedures, a conflict management policy, and a flexible funding policy, and ensure that the policies and procedures are monitored and adhered to.
46.56(3)(d)9.
9. Ensure quality, including adherence to core values as adopted by the state advisory committee established under
sub. (14) (a).
46.56(3)(d)10.
10. Develop a plan for orientation of new coordinating committee members and coordinated services team members to the coordinated services team approach to providing services to a child and his or her family.
46.56(3)(d)11.
11. Identify and address gaps in services for children and families who are enrolled in the initiative.
46.56(3)(d)12.
12. Ensure client and partner agency satisfaction through performance of a client and partner agency satisfaction survey.
46.56(3)(d)13.
13. Plan for sustainability of the system change started by the initiative beginning in the first year of any funding received for the initiative and thereafter by acting as a consortium to pursue additional funding for the initiative through grants from the state or federal government or private foundations; maintaining formal collaborative agency relationships; including families in the process by emphasizing rights and advocacy; addressing funding and issues related to providing matching funds required under
sub. (15) (c); and recommending a plan for realized savings from substitute care budgets to be reinvested in community-based care.
46.56(3)(d)14.
14. Establish target groups of children who are involved in 2 or more systems of care and their families to be served by the initiative. For a county or tribe that applies for funding under
sub. (15), severely emotionally disturbed children are required to be a priority target group.
46.56(3)(d)15.
15. Distribute information about the availability and operation of the initiative to the general public and to public or private service providers who might seek to make referrals to the initiative.
46.56(3)(e)
(e) The coordinating committee may direct the initiative coordinator or another person to do any of the following:
46.56(3)(e)1.
1. Maintain data of enrollments in the initiative and results of screening.
46.56(3)(e)2.
2. Establish and report monitoring and evaluation results.
46.56(3)(e)3.
3. Monitor, or ensure proper monitoring by the appropriate entity of, targeted case management and in-home services provided under the Medical Assistance Program, under
subch. IV of ch. 49, including record-keeping and billing processes.
46.56(3)(e)4.
4. Assist in developing and maintaining additional funding sources, including collaborative efforts with system partners.
46.56(3)(e)5.
5. Assist in the development and implementation of advocacy for families.
46.56(4)
(4) Role of administering agency. The administering agency designated under
sub. (2) shall do all of the following:
46.56(4)(a)
(a) Assist the coordinating committee in overseeing the development and implementation of the initiative and designate the staff needed for the initiative.
46.56(4)(b)
(b) Assist the coordinating committee in drafting and executing interagency agreements and any other policies and procedures necessary for the start-up and operation of the initiative.
46.56(4)(c)
(c) Assist the coordinating committee in distributing information about the availability and operation of the initiative to the general public and to public or private service providers who might seek to make referrals to the initiative.
46.56(4)(d)
(d) If the county board of supervisors or tribe decides to seek state funding under
sub. (15), develop the application in cooperation with the coordinating committee.
46.56(4)(e)
(e) Undertake such other activities in compliance with other statutes, rules, department guidelines, interagency agreements, and the directions of the coordinating committee as are necessary to ensure the effective and efficient operation of the initiative.
46.56(5)
(5) Interagency agreement. An interagency agreement shall include all of the following:
46.56(5)(a)
(a) The identity of every county department, tribal agency, agency, school district, cooperative educational service agency, county children with disabilities education board, technical college district, or other organization that will participate in the initiative.
46.56(5)(b)
(b) The identification of services and resources that the participating organizations will commit to the initiative or will seek to obtain, including joint funding of services and resources and funding for the qualified staff needed to support the initiative, such as by cash or contribution of in-kind services and resources as determined by the department under
sub. (15) (c). This identification shall specify the roles and responsibilities of the coordinated services team and the coordinating committee.
46.56(5)(c)
(c) The designation of service coordination agencies.
46.56(5)(d)
(d) The identification of any group of children who will be targeted for services and resources through the initiative.
46.56(5)(e)
(e) The procedures for outreach, referral, intake, assessment, case planning, and service coordination that the initiative will use.
46.56(5)(f)
(f) The specific criteria, based on
sub. (7), that will be used for deciding whether a child and his or her family are eligible for services and resources through the initiative.
46.56(5)(g)
(g) The procedures to be followed to obtain any required authorizations for sharing of confidential information among organizations providing treatment, services, education, and other resources to a child and his or her family.
46.56(5)(h)
(h) The procedures that will be used for managing conflicts among service providers or coordinated services team members or between a child or his or her family and service providers.
46.56(5)(i)
(i) The methods that will be used to measure initiative effectiveness, including satisfaction of a child and his or her family, and for revising the operation of the initiative in light of evaluation results.
46.56(5)(j)
(j) The mission and core values of the initiative.
46.56(5)(k)
(k) Expectations for organizations represented on the coordinating committee under
sub. (3), including provision of the funding match required under
sub. (15) (c).
46.56(6)
(6) Roles of service coordination agency, service coordinator, initiative coordinator, and coordinated services team. 46.56(6)(a)(a) One or more service coordination agencies may participate under the initiative. The organizations and the target groups that are to be served shall be identified in the interagency agreement under
sub. (5). All of the following applies to a service coordination agency:
46.56(6)(a)1.
1. The service coordination agency shall be selected based on its experience in providing services and resources.
46.56(6)(a)2.
2. The service coordination agency shall do all of the following:
46.56(6)(a)2.a.
a. Identify a specific individual to act as service coordinator for each child who is enrolled in the initiative and his or her family to facilitate the implementation of the coordinated services plan of care.
46.56(6)(a)2.b.
b. Provide or arrange for intake, assessment, development of the plan of care, and service coordination under
sub. (8).
46.56(6)(a)2.c.
c. Act as a source for information about other services and resources for children who are involved in 2 or more systems of care and their families who are not eligible for the initiative, if the coordinating committee determines that the service coordination agency can provide the information without interfering with the primary purpose of the initiative.
46.56(6)(cr)
(cr) Every county and tribe that operates any initiative shall develop written policies and procedures specifying the selection process for the initiative coordinator.
46.56(6)(d)
(d) The primary responsibility of the initiative coordinator is to promote collaborative relationships between systems of care. The initiative coordinator shall do all of the following:
46.56(6)(d)1.
1. Bring together parents and relevant staff from various agencies and organizations to comprise the coordinating committee under
sub. (3) (a) and
(b), and support their activities, in order to ensure compliance with established policies and procedures specified in
sub. (3) (d).
46.56(6)(d)2.
2. Work with the coordinating committee to maintain and support agency participation as established in the interagency agreement.
46.56(6)(d)3.
3. Work with the coordinating committee and service coordination agency to receive and review referrals.
46.56(6)(d)4.
4. Work with the coordinating committee and service coordination agency to assure provision of service coordination services for all groups of people working with the child and his or her family.
46.56(6)(d)5.
5. Guide the development of the coordinated service team working with the child and his or her family in order to ensure compliance with basic principles of the initiative core values.
46.56(6)(d)6.
6. Review plans of care, including crisis response plans, for consistency with the coordinated services team approach to providing services to a child and his or her family and core values.
46.56(6)(d)7.
7. Assist the coordinating committee and coordinated services teams in establishing consistent measures for the development, implementation, evaluation, and monitoring of the initiative and its outcomes.
46.56(6)(d)8.
8. Facilitate public education and awareness of issues and programs for children who are involved in 2 or more systems of care and their families.
46.56(6)(d)9.
9. Ensure provision of ongoing support and training that is related to the coordinated services team process for families, service coordinators, and providers and ensure orientation for coordinated services team members.
46.56(6)(d)10.
10. Support service providers in developing strategies to enhance existing programs, to increase resources, and to establish new resources relevant to project goals and objectives.
46.56(6)(d)11.
11. Ensure that local and state agencies submit data and reports in an accurate and timely manner.
46.56(6)(d)12.
12. If directed to do so by the coordinating committee, perform any of the duties set forth in
sub. (3) (e).
46.56(7)
(7) Eligibility of children and families. Children who are involved in 2 of more systems of care and their families shall be eligible for the initiative, except that the coordinating committee may establish specific additional criteria for eligibility for services and may establish certain target groups of children who are involved in 2 or more systems of care to receive services. If target groups are established, only children falling within the target groups may be enrolled in the initiative. Any eligibility criteria shall meet all of the following conditions:
46.56(7)(a)
(a) Be based on a community assessment that identifies areas of greatest need for coordinated services.
46.56(7)(b)
(b) Give priority to children who are at risk of placement outside the home or who are in an institution and are not receiving coordinated services based in the community and other resources, or who would be able to return to community placement or their homes from an institutional placement if the services and other resources were provided.
46.56(7)(c)
(c) Not exclude a child or his or her family from services or other resources because of lack of ability to pay.
46.56(8)
(8) Referral, intake, assessment, plan of care development, and service coordination. 46.56(8)(a)(a) Referrals to the initiative may come from county departments, tribal agencies, agencies, school districts, cooperative educational service agencies, county children with disabilities education boards, technical college districts, courts assigned to exercise jurisdiction under
chs. 48 and
938, tribal courts, or any other organization, or a child who is involved in 2 or more systems of care or his or her family may contact the administering agency or service coordination agency to request services and resources.
46.56(8)(b)
(b) Upon referral, staff from the service coordination agency or individuals designated by the coordinating committee shall screen the referral to determine if the child and his or her family appear to meet the eligibility criteria and any target group requirements established by the coordinating committee. If the child and his or her family appear to be eligible, the staff shall assist the entity that made the referral under
par. (a), and the parent or parents, in gathering information necessary to prepare an application for the initiative.
46.56(8)(c)
(c) Consent for release of information relating to a child shall be obtained from the child's parent, or the child, if appropriate or required by federal statute or regulation or state statute or rule, or by order of a court with appropriate jurisdiction.
46.56(8)(cm)
(cm) Consent for participation of a child and his or her family in the initiative and in the initiative evaluation shall be obtained from the child's parent or, if appropriate, the child.
46.56(8)(d)
(d) The service coordination agency or individuals designated by the coordinating committee shall review the completed application with the family, and, in light of the eligibility criteria in the interagency agreement and
sub. (7), determine whether the child and his or her family are eligible for and appropriate for enrollment in the initiative. The service coordination agency or the individuals designated by the coordinating committee shall approve or disapprove each application within 30 days after the date on which the application was completed.
46.56(8)(e)
(e) If the child who is involved in 2 or more systems of care and his or her family are found to be ineligible, or if it is determined that enrollment in the initiative is not the best method of meeting the needs of the child and his or her family, staff from the service coordination agency or individuals designated by the coordinating committee shall assist the child and family in identifying and accessing needed services or resources from appropriate providers.
46.56(8)(f)
(f) If the child and his or her family are found to be eligible for and are enrolled in the initiative, the agency shall assign a service coordinator who shall assemble a coordinated services team to assess the strengths and needs of the child and his or her family's need for treatment, education, care, and support. The service coordinator shall coordinate the operations of the coordinated services team.
46.56(8)(g)
(g) The service coordinator shall assemble the results of all prior relevant assessments and evaluations documenting the strengths and needs of a child enrolled in the initiative and his or her family, including educational, medical, vocational, and psychosocial evaluations.
46.56(8)(h)
(h) The coordinated services team, the family of the child enrolled in the initiative, and the service coordinator shall, based on a review of a summary of existing assessments of strengths and needs that have been assembled and any additional evaluations and plans that the team, the coordinator, or the family finds to be necessary, prepare a strength-based, gender-competent and culturally competent, family-centered, coordinated services plan of care within 60 days after the date on which the application was approved. The coordinated services plan of care shall include all of the following:
46.56(8)(h)1.
1. The child's present level of functioning expressed in objective terms that will permit ongoing evaluation of the child's progress.
46.56(8)(h)2.
2. The short-term and long-term goals to address the needs of the child and his or her family.
46.56(8)(h)3.
3. The services and resources needed by the child and his or her family, including the identity of each individual and organization that will be responsible for providing the services and other resources. The coordinated services plan of care shall place emphasis on services and resources that are available through community and informal sources.
46.56(8)(h)4.
4. Criteria for measuring the effectiveness and appropriateness of the coordinated services plan of care so that it can be modified as needed to better meet the child's and the child's family's needs. A coordinated services plan of care shall be oriented so as to produce meaningful outcomes and to provide services in the least restrictive setting possible.
46.56(8)(h)5.
5. Identification of any administrative or judicial procedures under
ch. 48,
51,
55,
115,
118, or
938 that may be necessary in order to fully implement the coordinated services plan of care and the identity of the individual or organization that will be responsible for initiating those procedures, if any are required.
46.56(8)(h)6.
6. Identification of available sources of funding to support the services and other resources needed for the child and his or her family and an allocation of funding responsibility among organizations if more than one organization is responsible for the child's and his or her family's treatment, education and support services.
46.56(8)(h)7.
7. Clear statements articulating the specific needs of the child and family that are to be addressed. Needs may not be stated solely in terms of the need for services but may be described in a strength-based manner with a response that is readily achievable.
46.56(8)(h)8.
8. Plans for responding to possible crisis situations that may occur with the child and his or her family.
46.56(8)(i)
(i) If additional evaluations are needed, the coordinated services team shall arrange for them or assist the child's family in obtaining them.
46.56(8)(j)
(j) The proposed coordinated services plan of care shall be submitted to any service providers who are included in the proposed plan of care.
46.56(8)(k)
(k) Upon written approval of the coordinated services plan of care by the proposed service providers, the child's family, and the coordinated services team, the plan of care shall be implemented by the service coordination agency and the individuals and organizations designated to provide services and other resources under the plan of care.
46.56(8)(m)
(m) Each organization or service provider designated to provide services and other resources under the coordinated services plan of care shall identify a specific individual who shall serve as the ongoing contact person to ensure continuity and communication while services are being provided to the child and his or her family under the plan of care.
46.56(8)(n)
(n) The service coordinator shall advocate for the child and his or her family and ensure that they are provided the opportunity to participate in assessment, planning, and ongoing review of services to the fullest extent possible.
46.56(8)(o)
(o) Services and other resources under this section shall be provided in the community, preferably in the child's home or home community, in the least restrictive and least intrusive setting and manner that meets the best interests of the child.
46.56(8)(r)
(r) On a regular basis, and at least every 3 months, the service coordinator shall assemble the coordinated services team, the family of the child, the child if appropriate, and any counsel, guardian ad litem, or other person advocating for the interests of the child or his or her family to review the plan of care and progress toward the goals of the plan of care, establish new goals, request the inclusion of new participating organizations or individuals, or otherwise modify the coordinated services plan of care to better meet the needs of the child and his or her family. Decisions to amend the coordinated services plan of care must be approved by the service coordinator, the coordinated services team, the family and, if the plan of care is being provided under a court order, the court.
46.56(8)(s)
(s) Coordination of services by a coordinated services team may be ended by the agreement of all participants on the coordinated services team that the goals of treatment and support have been met or are being met; by withdrawal of the family of the child; by the service coordination agency upon a recommendation from the service coordinator and the coordinated services team; by the family's refusal to participate in the process; if the child and his or her family no longer meet the eligibility criteria for the coordinated services team; or by court order, if services are being provided under court order.
46.56(9)
(9) Immediate care. Individual county departments, tribal agencies, other agencies, and other service providers shall provide immediate services and other resources as necessary and appropriate to children who are involved in 2 or more systems of care and their families who have been referred for an evaluation of eligibility for and appropriateness of enrollment in the initiative while assessment and planning take place.
